Declining interest in family medicine: perspectives of department heads and faculty.

BACKGROUND AND OBJECTIVES In 2003, US seniors filled 42% of family practice residency positions, the lowest percentage in the specialty's recent history. We hypothesized that institutional support, contact with family medicine faculty, and faculty satisfaction would be positively related to choice of family practice and that faculty satisfaction would be negatively affected by increasing pressure for clinical productivity. METHODS We surveyed department heads and faculty at 24 US allopathic medical schools, selected by their rate of family medicine graduates from 1997 to 1999 and the size of the school. Twelve of these schools had an increase in rates of graduates selecting family practice, and 12 showed decreases. RESULTS Department heads and faculty from schools with an increase in student entry into family practice residencies were significantly more likely to report financial and philosophical support from their state legislature or medical school administration. Faculty ranked patient care as most valued at their institutions, followed by teaching, research, and service. A common theme emerging from both the faculty and department head surveys was an inverse relationship between research activity and graduates choosing family practice. CONCLUSIONS This study demonstrates the importance of upper-level institutional support on family practice specialty choice. It also highlights a need for further examination of the specialty's relationship to research.