Factors associated with choosing a primary care career.

The factors influencing the career choices of medical students need to be understood so that the proportion of physicians entering primary care-defined as family practice, general internal medicine, general pediatrics, and general obstetrics and gynecology-can be increased. We sent a questionnaire to 474 University of California, San Diego (UCSD), School of Medicine alumni (classes of 1974, 1978, 1982, 1986, and 1990) inquiring about demographics, personal and medical school factors, and level of debt. A total of 351 alumni responded (74% response rate), and 327 of them were engaged in direct patient care (38% in primary care). Respondents who were older, female, an underrepresented minority, from a rural background, and who chose their specialty before medical school were significantly more likely to enter primary care. The primary care group was influenced by factors unrelated to the medical school environment, such as personal social values, whereas the top 3 factors rated by the non-primary care group were directly related to school environment. Many of the respondents in primary care reported that the environment at UCSD was antagonistic toward primary care. From 1974 to 1990, more students had debt and their total debt increased, although debt had little or no influence on specialty choice.

Health care needs for children of the recently homeless.

Thirty families were surveyed at a shelter for the homeless in San Diego, California concerning the health care status and needs of their children. 56.7% of the families had no regular source of health care and 46.6% were not covered by any form of health coverage. Children whose families had a regular source of health care were more likely to have reported better health and more frequent checkups. Also, increased duration of homelessness was predictably correlated with poorer reported health of the children. Though the families sampled were representative of those recently made homeless i.e. less than six months, needs were identified that would be applicable to all homeless families. The most frequent needs the families expressed for their children were: general nonemergency clinics (76.7%), emergency services (66.7%), and dental services (66.7%). Nutritional and dietary counseling were chosen by 43.3% and only 6.7% of the parents rated social and psychological services as needed.

Health care usage by Hispanic outpatients as function of primary language.

Three groups of Hispanic patients at five outpatient clinics in San Diego County, California, participated in a survey questionnaire concerning health care usage according to whether they were Spanish-speaking only, bilingual with Spanish as a primary language or primarily English speaking. Although the three groups were similar in age and income distribution, the use of health services (regular source of health care, health insurance, admission to hospital and frequency of general physical, eye and dental examinations) was positively correlated with increased use of English. Likewise, respondents whose primary language was English were more likely to describe their health care as more than adequate and their own health as excellent than were those whose primary language was Spanish.