Resident workforce in a time of U.S. health-care system transition.

Abstract

(Reves) Professor and Chairman, Department of Anesthesiology; Director of the Duke Heart Center, Duke University Medical Center.(Rogers) Professor of Anesthesiology; Vice Chancellor for Health Affairs; Executive Director and CEO, Duke University Hospital and Health Network.(Smith) Assistant Professor, Division of Biometry, Community and Family Medicine; Assistant Professor, Experimental Surgery, Department of Surgery, Duke University Medical Center.Received from the Duke University Medical Center and Duke University Hospital and Health Network, Durham, North Carolina. Submitted for publication May 30 1995. Accepted for publication December 18, 1995.Address reprint requests to Dr. Reves: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710.Make up your mind how many doctors the community needs to keep it well. Do not register more or less than this number.G. B. ShawPreface to The Doctor's DilemmaHealth-care delivery in the United States is changing from a fee-for-service system, which required large numbers of specialists, to a system acutely sensitive to competitive market forces and in which financial incentives are created to reduce the provision of specialty care and, therefore, the need for medical subspecialists. In addition, there is a societal perception that this country has far too many specialists and too few primary-care physicians. These forces are transforming the focus of resident education from one of hospital-based specialty care toward more ambulatory and primary-care education. [1]The pending legislative changes in Congress as part of restructuring Medicare will exacerbate this trend. This change in health-care delivery has major ramifications in all aspects of health care, none more than academic medical centers, [2]where much anesthesiology graduate medical education (GME) resides.The United States, unlike any other country, has never had a national physician workforce plan nor a health-care reimbursement and medical education financing strategy to address physician workforce needs. [3,4]In the United States, the education of physicians is conducted in 141 schools of allopathic and osteopathic medicine and more than 1,500 teaching hospitals [4]overseen by a