Retraining physicians for primary care. A study of physician perspectives and program development.
OBJECTIVE: To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining. DESIGN: A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups. Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. RESULTS: The majority of institutions contacted perceived a need for retraining, but few programs had been established. Programs being "considered" varied widely in duration, class size, target audience, accreditation, and projected training settings. Although unenthusiastic about retraining, physicians preferred programs that would expand their patient base, maintain the practice population, be inexpensive and close to home, and provide hands-on training in the eventual practice environment. Physicians also preferred a goal-oriented, part-time retraining program in a large group practice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorporate many of these features. The most likely candidates for retraining are subspecialty physicians who currently provide some primary care and are employed by a medical plan. CONCLUSIONS: Despite efforts by those who perceive that a need for more generalist physicians is stimulating interest in retraining specialists and subspecialists to provide primary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining. This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist physician workforce since the beginning of this study have diminished the call for retraining.