The Evolution of the Physician's Role

Abstract

CONTROVERSY CONTINUES OVER HOW PHYSICIANS SHOULD BE employed in the United States. Some workforce experts believe there is a physician oversupply, arguing that allopathic, osteopathic, and international medical graduates are all competing for limited practice opportunities in the managed care setting. Other experts have advocated the expansion of US medical school positions, claiming that physician demand has not lessened despite a perceived oversupply. Yet others continue to hold that a “maldistribution” of physicians into urban and suburban areas, rather than rural and inner-city regions, is the root of the problem. Recent data suggest that this practice disparity, the target of primary care initiatives in many medical schools, has not closed, and may even have widened. Whatever the outcome of the physician workforce debate, physicians will face a changing landscape of clinical practice roles as well as increased availability of alternate career options. Some medical graduates are choosing to reject traditional clinical roles altogether. In this issue, we explore the continuing evolution of physicians’ clinical and nonclinical roles, including additional career possibilities. The Association of American Medical Colleges has monitored medical students’ future practice patterns since 1978, polling medical students each year prior to graduation to ask them about their career plans. In this issue, Dr Richard and colleagues examine 10 years of data from the questionnaire relevant to medical student career decisions, especially those outside traditional clinical medicine. Physicians seeking an alternative path have frequently sought additional graduate or professional degrees to expand their career options. Many medical schools have responded to the demand by offering combined degree programs, traditionally in public health and health policy, and, more recently, in business and law. The juris doctor degree is one possibility that has grown in popularity in the past decade: in this issue, Matthew Howard, MD, JD, outlines the development of legal medicine and the roles that physicians with legal training can play. In this era of managed care, training in business may be an asset. Not only are some physicians seeking business knowledge to increase their proficiency in the financial affairs of medicine, but businesses are also seeking persons with MD and combined MD/PhD degrees to bring new knowledge to the workplace. Michael Ennen examines why firms are hiring physicians as consultants. What possible choices exist for medical students who decide to contribute, outside of traditional research, to the advancement of medical science? For those with patience, medical editing is a possibility. The effort that brings you JAMA and MSJAMA—long hours of editing, reediting, and copyediting—is explored by Jerome Kassirer, MD, a former editor-in-chief of the New England Journal of Medicine.