Effect of changes in the health care system on the career outlook of University of Washington, Seattle, medical students.

We describe how market-oriented and governmental reforms were shaping students' career choice and outlook toward future clinical practice during the 1993-1994 academic year. A random sample of a third of University of Washington, Seattle, medical students (n = 212) was surveyed regarding attitudes toward health care reform, specialty choice, and future clinical practice; 171 responded (81%). Most students (90%) thought that the health care system required fundamental change. An equal proportion favored managed competition and single-payer proposals (40% and 39%, respectively). Most (72%) were confident that they would be able to practice medicine in a professionally satisfying environment. More than half the students interested in specialty careers thought that they might not be able to practice in their chosen field, but only 21% of these were more likely to choose a career in primary care in light of anticipated reforms. Most students were optimistic about their future medical careers. Knowledge of market-oriented reforms exerted little influence on the career decisions of students interested in nonprimary care fields. Medical schools should play a more active role at the undergraduate level so that those students who apply to medical school have a better understanding of the changing nature of health care delivery in this country.