Family practice career attrition, 1969 to 1993: A comparison of 336 civilian and military graduates of one medical school

Military Medicine, Aug 2000 by Jacques, Louis B

Instability of specialty choice and career after initial residency entry will affect health personnel projections. Military physicians may differ from civilian physicians in their specialty choice behaviors during their careers. A cohort of 336 graduates who chose family medicine residency paining was identified from the graduating classes of 1969 through 1993 at a large private medical school. Current specialty identification was determined, and attrition from family medicine was computed. As of 1997, 275 graduates (82%) were still in family medicine careers, defined by American Academy of Family Physicians membership or current American Board of Family Practice certification. Of graduates who entered military programs, 22 of 77 (28%) had left family medicine careers; 39 of 259 (15%) of the graduates who entered civilian programs had left. This difference was statistically significant (p = 0.007). Family medicine career retention is lower for males in military programs compared with males in civilian programs or females in military programs.

Introduction

National data suggest that most graduates of family practice residency programs remain in family practice careers. A previous study reviewed data from 1969 through 1993 for all family practice graduates and found that 91% of 36,088 graduates of family practice programs continued to identify themselves as family physicians.' Resident attrition from family practice programs has been found to be similarly low (7.8%) for graduates of U.S. medical schools but higher (18.5%) for international graduates.2 Career choice regret among family physicians in early practice has been explored, and 70% would choose family medicine careers again.3

Limited data are available comparing career regret and retention among graduates of U.S. civilian and military family practice residencies. The analysis presented in this study explores the differing career attrition rates and raises several questions pertinent to both civilian and military family practice educators.

Methods

The records of the classes of 1969 through 1993 graduating from a large, private, East Coast medical school were examined. All students who entered family medicine residency training were identified from National Resident Matching Program reports and cross-referenced with other resources such as yearbooks and alumni rosters. Data collection was performed in 1997, and all determinations of a graduate's active or inactive status in the practice of family medicine were made as of that year. Students who graduated later than 1993 were excluded, because they might not have completed residency and earned board certification status in time to be included in the professional reference sources used in this study. Students who graduated before 1969 but who entered family practice residencies later were excluded because family practice training was not available at the time of their graduation. Students who undertook family medicine residency training after initial postgraduate training in another specialty were included with those whose initial match was in family medicine.

Family practice career activity was identified as current membership in the American Academy of Family Physicians or current board certification by the American Board of Family Practice. Graduates listed in the rolls of either of these organizations were placed in the "active" category. Graduates unaccounted for were surveyed by mail about their current practice status. Results were compared with other specialty listings for confirmation of career change. Any graduates who were initially misclassified were moved into the appropriate category. Statistical analysis was performed using Minitab for Windows, version 11.21 (1996).

Results

Results are summarized in Figure 1 and Table I. From the graduating classes of 1969 through 1993, we identified 336 medical school graduates who had entered family medicine residency training: 77 (23%) entered military family medicine residency programs, and 259 (77%) entered civilian family medicine training programs. Women constituted 21% of the military group and 28% of the civilian group.

Eighty-two percent (275 of 336) of the graduates who entered family medicine training were still active in the practice of family medicine. Two graduates were deceased, one civilian and one military. They were retained in the database and classified according to their last known status. Of the 275 total active graduates, 220 (80%) had entered civilian residencies, and 55 (20%) had entered military residencies.

Eighteen percent (61 of 336) of the graduates who entered family medicine training were no longer in the practice of family medicine in 1997. Subsequently, we discovered that one female military graduate who had left family medicine for obstetrics/ gynecology training had decided to return to complete family medicine residency, and one male civilian 1992 graduate had entered family medicine residency in 1997. They remained in the inactive category because they had not yet completed family medicine training and were not in practice. Of the 61 inactive graduates, 22 had entered military residencies and 39 had entered civilian residencies.