PT  - JOURNAL ARTICLE
AU  - Joanna Veazey Brooks
TI  - Hostility During Training: Historical Roots of Primary Care Disparagement
AID  - 10.1370/afm.1971
DP  - 2016 Sep 01
TA  - The Annals of Family Medicine
PG  - 446--452
VI  - 14
IP  - 5
4099  - http://www.annfammed.org/content/14/5/446.short
4100  - http://www.annfammed.org/content/14/5/446.full
SO  - Ann Fam Med2016 Sep 01; 14
AB  - PURPOSE The environment during medical school has been shown to dissuade students from choosing primary care careers. The purpose of this study was (1) to explore how long-standing this hostility toward primary care is historically and (2) to understand the mechanisms through which the environment conveys disparagement of primary care to students.METHODS The study is based on a qualitative analysis of 52 primary care physician oral histories. The data are from the Primary Care Oral History Collection, created by Fitzhugh Mullan and deposited in the National Library of Medicine. Transcripts were analyzed using qualitative data analysis and the constant comparative method.RESULTS Respondents (63.5%) reported experiencing discouragement or disparagement about primary care, and this proportion remained fairly high through 5 decades. Findings indicate that hostility toward primary care operates through the culture and the structure of medical training, creating barriers to the portrayal of primary care as appealing and important. Support for primary care choice was uncommon but was reported by some respondents.CONCLUSION The primary care shortage and primary care’s unfavorable representation during medical training is a multifaceted problem. The evidence reported here shows that cultural and structural factors are critical components of the problem, and have existed for decades. For policy responses to be most effective in meeting the primary care workforce problem, they must address the presence and power of persistent hostility against primary care during training.