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Yale D. Podnos, MD, MPH; Brian Campbell, MD; Samuel E. Wilson, MD; Russell A. Williams, MD

Arch Surg. 1999;134:876-881.

Hypothesis  Despite successful efforts in California to increase the number of graduating medical students entering primary care residencies, general surgery remains a popular career choice.

Design  Retrospective survey of annual graduating medical student residency selections from allopathic medical schools in California between 1993 and 1998.

Methods  Each medical school in California was sent a survey of its graduates' specialty choices from 1993 to 1998. Once quantified, comparisons using t tests, ² analyses, and analyses of variance were performed to assess differences in graduating medical student career choices.

Results  Surveys were received from 7 of 8 allopathic medical schools in California representing 5154 students (3645 from University of California medical schools). In the study period, the number entering primary care residencies rose from 45.5% in 1993 to 54.3% in 1998. Despite this overall trend, statistically significant increases were seen only for pediatrics between 1993 and 1994. The number of students entering general surgery did not change significantly. Significant decreases were seen in emergency medicine and obstetrics and gynecology between 1997 and 1998 and in anesthesiology between 1994 and 1995 and again between 1995 and 1996. When considering only University of California graduates, the number choosing primary care residencies rose from 46.6% in 1993 to 54.2% in 1998. As before, the number entering general surgery did not change (6.1% in 1993 and 6.3% in 1998).

Conclusion  Owing to institutional, legislative, and market pressures, more graduates of California medical schools (both public and private institutions) are choosing to become primary care practitioners. A corresponding decrease in medical students entering general surgery has not resulted, which points to an optimistic future and continuting demand for surgeons.

From the Department of Surgery, University of California, Irvine Medical Center, Orange, Calif.

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