The Relationship of Specialty and Training Site on Residents' Attitudes Toward a Changing Health Care System

Published in: Research in the Sociology of Health Care, v. 15, 1998, p. 129-144

Posted on RAND.org on December 31, 1997

by Michael Wilkes, Ian D. Coulter, Eric Hurwitz

The authors' stated goal was to study attitudes to changes taking place in the practice of medicine of primary care residents (pediatrics, internal medicine, family medicine) at three different training sites. Using a self-administered questionnaire, all primary care residents at three training sites were asked about their attitudes toward managed care, primary care, rationing and cost controls, and government involvement in health care. The results show that residents' attitudes toward the above changes differ by both training site and specialty. Those training in a public hospital were more likely to be positive about primary care and those training in an HMO were more likely to be positive about managed care. Residents in internal medicine were less positive about both primary care and managed care. Females were less positive about the prospects of rationing care. Those residents who were positive about primary care were also more likely to be positive about a government role in health policy and about rationing and cost controls. Residents who valued the prestige of the specialty were less likely to value primary care. However, their attitudes did not change between first and third year of residency. The results suggest that the attitudes held by residents toward changes occurring in health care may develop prior to entering postgraduate training rather than as a result of that training.

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