This study is designed to predict the impact of characteristics, attitudes, and experiences of house staff on their AIDS-related, post- residency, career behavior. It builds on the investigators' prior research, relying upon a longitudinal design and interviewing physicians during their sixth post-graduate year, when they are entering practice. The goal of the proposed project is to generate an empirical basis for undertaking effective interventions to increase the numbers of physicians who are committed to treating HIV+ and AIDS patients in their practices. Hypotheses to be tested have been informed by the researchers' previous work and focus on identification of predictors that are susceptible to change i.e., elements of residency training and individual attitudes whose effects can be mediated through intervention. Such predictors include supportiveness of the residency program (as measured by such dimensions as tolerance of diversity of opinions, democratic decision-making, and collegial support), perceptions of faculty outlook on AIDS treatment, cynicism concerning patient care, homophobia, and revulsion toward drug addicts. Based upon two prior waves of data collected at critical junctures in the training of physicians --upon graduation from medical school and during the third year of residency -- the investigators' prior research has established that attitudes toward AIDS fluctuate significantly between the fourth year of medical school (time l) and completion of the third year of residency training (time 2), and residents' attitudes are significantly related to their practice plans with regard to AIDS treatment. From this work, it is clear that residency, not medical school, is the formative period determining AIDS-related career plans. The impact on willingness to treat AIDS of even seemingly intractable attitudes, such as homophobia, was muted and exacerbated by factors which are changeable during training. The current project addresses the linkage between residency training and AIDS-related career behavior. As such, it addresses a significant gap in knowledge of factors affecting physicians' career choices, it promises to yield concrete strategies for enhancing the supply of providers who care for PWAs, and it relies upon a powerful design for achieving these ends.
