A Decline in Generalism for Family Medicine? First-Practice Profile Ideals cf. Realities.

The authors compare the ideal composition of medical practice, as seen by graduating family medicine residents, with the characteristics of practice these residents were about to enter. This exploration of practice ideals finds somewhat anemic interest in several of the more technical aspects of practice. A substantially higher percentage of graduates was expecting to do obstetrics on graduation then would do so by choice, suggesting the possibility of a further decline in obstetrical activity should opportunity occur. A similar pattern emerges for family counselling, nursing-home activity and house calls, producing a composite picture of potential evolution toward more exclusive office practice. Substantial variations are shown to exist, however, among the five programs studied, both in relation to the ideals expressed by the graduates and also in relation to their first-practice profiles. Possible implications for residency programs and the profession are discussed.