Preparing for health care reform and an LCME site visit: addressing the generalist-non-generalist imbalance.

PURPOSE: The purpose of the present study was to evaluate primary care outcomes for the Loma Linda University School of Medicine (LLUSM), using Association of American Medical Colleges (AAMC) data files. The two principal objectives were to estimate the percentages of LLUSM graduates who are practicing or will practice primary care medicine and to determine what information available on application to LLUSM is useful in predicting graduates' specialty choices (i.e., primary versus non-primary care).

METHOD: In 1993-94 data were taken from several AAMC data files (available to all medical schools), including the Graduate Medical Education (GME) Tracking Census and the American Medical College Application Service (AMCAS) Applicant Master File. The second and fourth years after graduation were used as points of evaluation. Primary care (generalist) was defined as taking or having completed a residency in family practice, internal medicine, or pediatrics, and not having taken any fellowship training.

RESULTS: Fourth year after graduation: 42.4% of the 1,064 LLUSM graduates (1983 to 1990) were training in or had completed residencies in family practice (19.8%), internal medicine (16.2%), or pediatrics (6.4%). Second year of GME: of the 1,365 LLUSM graduates (1983 to 1992), 49.3% were in the primary care pipeline (19.8% in family practice, 21.9% in internal medicine, and 7.6% in pediatrics). Two variables available on admission to medical school were associated with being in the primary care pipeline (second-year GME generalist): being a woman and being a member of a non-underrepresented minority. One variable was associated with being in the non-primary care pipeline: having a rural county code. Undergraduate grades and Medical College Admission Test scores were not good predictors.

CONCLUSION: The AAMC data files, available to all medical schools, are useful for estimating and evaluating primary care outcomes.