Overview

For the greater part of the first half of the 20th century, graduates of U.S. medical schools would automatically complete one of several types of internships. Most of these doctors would then directly enter practice. This was possible because there was a limited amount of medical knowledge available, and physicians could therefore treat patients with a wide variety of illnesses. Specialization was an uncommon path for the bulk of medical school graduates. If undertaken, it frequently involved overseas postgraduate training. This obviously had limited appeal for most graduates.

The situation changed dramatically in the second half of the century. The internship period was transformed into postgraduate year one (PGY-1). Major and remarkable advances in medical knowledge and technology mandated that graduating physicians secure postgraduate training to acquire the background and skills needed to serve as generalists or specialists. This situation usually requires medical students to make challenging and decisive career choices at some point during their undergraduate medical education. The choice that has to be made is among three fundamental options. Each choice will have its own advantages and liabilities. Furthermore, each path will require subsequent difficult decisions as you narrow your focus. Your basic options are selecting a

• Generalist track or

• Specialist track or

• Transitional year.

Each of these will be discussed separately.

Choosing a generalist track

Over the past several decades, with the onset of radical changes in health care management, the position of the generalist physician has assumed much greater significance in the provision of patient services.