The Relative Importance of Undergraduate and Postgraduate Education to the Practice Decisions and Attitudes of Young Family Physicians Practising in Ontario

Objectives - To examine the influence of medical education and residency education on decisions regarding type of practice, practice activities and attitudes of family physicians. Design - Secondary analysis of data from a mailed survey of a cohort of family physicians that had a 70% response rate. Setting - Ontario Participants - All physicians certified by the College of Family Physicians of Canada between 1989-1991 after completing a family medicine residency who resided in Ontario and had either graduated from an Ontario medical school or a residency program in family medicine offered by an Ontario medical school. Outcome measures - Selected questionnaire items regarding whether they extended their residency, practice location, primary source of remuneration, practice organization, services included in practice, satisfaction with their education and patient care attitudes. Results - Systematic differences were observed in professional decisions, behaviours and attitudes of the physicians studied that were associated with the medical or residency programs that they attended when other factors such as gender of the physician were taken into account. For example, provisions of shared obstetrical care was less frequently observed among those who extended their residency or took a residency in family medicine at the University of Toronto. Both these variables were associated with higher probability of providing intrapartum care. Solo practitioners were twice as likely as other practitioners to do shared obstetrical care. Rural practice was also associated with providing intrapartum care. Physicians involved in research were less likely to have a predominantly fee-for-service practice, but more likely to have attended McMaster medical school or extended their residency. Conclusions - The differences observed are likely to reflect both self and program selection effects and the socialization/education provided by these educational programs. It is surprising that the differences by educational program were as striking as those we observed by gender, urban or rural location and type of practice despite the fact that all medical schools and family medicine residency programs exist in the same province.