American Medical School Graduates Research Articles

Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment.

Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

The impact of gendered experiences on female medical students’ specialty choice: A systematic review

BackgroundWomen make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students’ specialty choice. HypothesisGendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties. MethodsStudies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students’ specialty choice. Results34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models. ConclusionThis systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.

Abstract No. 97 Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds, and scholarly activities

To analyze the demographics, academic background, and scholarly activity of pediatric interventional radiologists (PIRs) across the United States (US) and Canada A list of all members of the Society for Pediatric Interventional Radiology was obtained, and PIRs at academic and private practice institutions in the US and Canada were included. Publicly available online sources were used to gather demographic and educational information, including online curriculum vitae, HealthGrades.com and Doximity.com websites, and Elsevier’s Scopus database. Demographic and educational data such as age, gender, education, academic rank, prior leadership positions, and metrics of scholarly activity were recorded. Fellowships in diagnostic pediatric radiology, adult interventional radiology, and/or pediatric interventional radiology were recorded. Mann-Whitney U and Kruskal-Wallis tests were used to compare the differences between groups. A total of 125 pediatric interventionalists were included, of which 24 (19.2%) were female. The mean age was 48.59 years (SD 10.58, median 45, range 36-82). There was no statistical difference between median age for male versus female PIRs (44.5 vs 45, P = 0.89). A majority of PIRs were American medical school graduates (AMG) (96, 76.8%), while 29 (23.2%) were international medical graduates (IMGs). Eighty-three percent (104) of PIRs completed diagnostic radiology residency in the US, most commonly at the University of Cincinnati (6.4%) and University of Washington at St. Louis (5.6%). Amongst fellowship training, pediatric interventionalists had completed a pediatric radiology fellowship (61.6%), adult interventional radiology fellowship (40%) and/or a dedicated PIR fellowship (57.6%). The mean (and median) publication, citations and h-index for pediatric interventionalists was 31.63 ± 44.84 (12), 668.2 ± 1316.57 (120) and 9.18 ± 10.07 (5), respectively. There was a statistically higher number of publications, citations and h-index with increasing academic rank at assistant, associate and professor levels (P< 0.001 for all groups). IMG PIRs had a higher, but not statistically significant median publication count (26 vs 11, P = 0.25), citation count (236 vs 93, P = 0.35) and h-index (9.0 vs 4.5, P = 0.24), compared to AMG PIRs. Pediatric interventionalists in North America are predominantly male, with about a quarter having graduated from international medical schools. Pediatric radiology fellowship followed by PIR fellowship was the most frequently pursued training pathway.

Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds and scholarly activities.

Pediatric interventional radiology has grown as an advanced subspecialty with increased demand, number and complexity of cases, and number of pediatric institutions offering a pediatric interventional radiology service. Despite the overall increase in the number of pediatric interventionalists over the past two decades, there is a heterogeneity in their academic backgrounds and a lack of uniform training pathways. To analyze the demographics, academic backgrounds and scholarly activities of pediatric interventionalists across the United States (U.S.) and Canada. A list of all members of the Society for Pediatric Interventional Radiology was obtained and pediatric interventionalists at academic and private practice institutions in the U.S. and Canada were included. Publicly available online sources were used to gather demographic and educational information about each pediatric interventionalist, which included the online curriculum vitae, the HealthGrades.com and Doximity.com websites, and Elsevier's Scopus database. Demographic and educational data including age, gender, educational background, additional degrees, academic rank, previous leadership positions, and metrics of scholarly activities were recorded. Fellowships in diagnostic pediatric radiology, adult interventional radiology and/or pediatric interventional radiology were recorded. Mann-Whitney U tests and Kruskal-Wallis tests were used to compare differences between groups. One hundred and twenty-five pediatric interventionalists were included, of whom 24 (19.2%) were female. The mean age was 48.6years (standard deviation [SD]: 10.6, median: 45years, range: 36-82years). There was no statistical difference between median age for male versus female pediatric interventionalists (44.5years vs. 45years, P=0.89). A majority of pediatric interventionalists were American medical school graduates (96, 76.8%), while 29 (23.2%) were international medical graduates. Eighty-three percent (104) of the pediatric interventionalists completed diagnostic radiology residency training in the U.S., most commonly at the University of Cincinnati in Ohio (6.4%) and Washington University in St. Louis, MO (5.6%). Among fellowship training, pediatric interventionalists completed a pediatric radiology fellowship (61.6%), adult interventional radiology fellowship (40%) and/or a dedicated pediatric interventional radiology fellowship (57.6%). The mean±SD (median) publications, citations and Hirsch index (h-index) for pediatric interventionalists were 32±45 (12), 68±1,317 (120) and 9±10 (5), respectively. There was a statistically higher number of publications, citations and h-index with increasing academic rank at the assistant, associate and professor levels (P<0.001 for all groups). International medical graduate pediatric interventionalists had a higher, but not statistically significant, median publication count (26 vs. 11, P=0.0.25), citation count (236 vs. 93, P=0.36) and h-index (9.0 vs. 5, P=0.24) compared to pediatric interventional radiologists from American medical schools. Pediatric interventionalists in North America are predominantly male, with about a quarter having graduated from international medical schools. Pediatric radiology fellowship, followed by pediatric interventional radiology fellowship, was the most frequently pursued training pathway.

Descriptive analysis of interventional radiology residency program directors in the United States

PurposeTo analyze the academic background, demographics and scholarly metrics of Interventional Radiology (IR) residency program directors (PDs) in the United States. MethodsOnline search of publicly available resources was performed from April 6–10, 2020. PDs and associate PDs of ACGME accredited integrated and independent IR residency programs were included in the study. The variables collected from publicly available sources included age, sex, academic background (including medical school, residency and fellowship), and scholarly activity (publications, citations and h-index). Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. ResultsA total of 174 PDs and associate PDs from 110 unique integrated and independent IR residency programs were included in the study. One hundred fifty three (87.9%) were male and twenty one (12.1%) were female. The average age of PDs was 47.39 years (SD 8.99, median 45, range 34–74). Eighty six percent of the PDs were American medical school graduates, 97% received a MD degree or foreign equivalent, and 3% received a DO degree. There was no statistical difference between male and female PDs with regards to number of publications, average number of citations or mean h-index. Fellow of the Society of Interventional Radiology (FSIR) qualification was held by 21.3% and PDs with FSIR designation had significantly higher scholarly metrics. ConclusionIR Residency PDs are predominantly male and graduates of American medical schools. Women represent only 12% of the IR PD workforce with no significant difference in scholarly metrics of female PDs compared to male PDs. PDs with FSIR designation had significantly higher scholarly metrics.

Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools

There continue to be low numbers of underrepresented minorities, including African Americans, in academic medicine. Historically Black medical colleges and universities are major sources of training for medical school graduates who are African American or who belong to other underrepresented minority groups. Several historically Black medical schools were closed during the period surrounding the 1910 Flexner report. The implications of these school closures with regard to the number of African American medical school graduates have not been fully examined. To examine the consequences associated with the closure of historically Black medical schools for the number of African American medical school graduates. This observational economic evaluation used steady expansion and rapid expansion models to estimate the consequences associated with the closure of historically Black medical schools for the number of African American medical school graduates. The numbers of graduates from 13 historically Black medical schools that are now closed were obtained through historical records. Data on historically Black medical schools that are currently open were obtained from school-specific reports and reports published by the Association of American Medical Colleges. The study focused on projected estimates of outcomes from the hypothetical continued operation and expansion of 5 closed historically Black medical schools that were included in the Flexner report: Flint Medical College of New Orleans University, Knoxville Medical College, Leonard Medical School of Shaw University, Louisville National Medical College, and the University of West Tennessee College of Medicine and Surgery-Memphis. The main outcome was the estimate of the number of African American students who would have graduated from historically Black medical schools that were closed during the period surrounding the 1910 Flexner report. Among the 5 historically Black medical schools that were closed, the estimated mean number of graduates per year was 5.27 students at Flint Medical College, 2.60 students at Knoxville Medical College, 11.06 students at Leonard Medical School, 4.17 students at Louisville National Medical College, and 6.74 students at the University of West Tennessee. If the 5 closed historically Black medical schools had remained open, the steady expansion and rapid expansion models indicated that these schools might have collectively provided training to an additional 27 773 graduates and 35 315 graduates, respectively, between their year of closure and 2019. In the analysis of Leonard Medical School and the University of West Tennessee only, the steady expansion and rapid expansion models indicated that these 2 schools would have provided training to an additional 10 587 graduates and 13 403 graduates, respectively, between their year of closure and 2019. An extrapolation based on the racial and ethnic self-identification of current graduates of historically Black medical schools indicated that if these closed schools had remained open, the number of graduating African American physicians might have increased by 355 individuals (29%) in 2019 alone. To increase the number of African American medical school graduates, consideration should be given to creating medical education programs at historically Black colleges and universities. Such programs may start with small enrollment but could have positive consequences for the diversity of the physician workforce.

Bridging the Gap: Identifying Global Trends in Gender Disparity Among the Radiology Physician Workforce

Women make up half of American medical school graduates, but remain underrepresented among radiologists. This study sought to determine whether workforce gender disparities exist in other countries, and to identify any country-specific indices associated with increased female representation. In this cross-sectional study, 95 professional radiology organizations in 75 countries were contacted via email to provide membership statistics, including proportion of female members, female members aged 35 or under, and women in society leadership positions. Country-specific metrics collected included gross domestic product, Gini index, percent female medical school enrollment, and Gender Development Index for the purposes of univariate multiple regression analysis. Twenty-nine organizations provided data on 184,888 radiologists, representing 26 countries from Europe (n = 12), North America (n = 2), Central/South America (n = 6), Oceania (n = 2), Asia (n = 3), and Africa (n = 1) for a response rate of 34.7% (26/75). Globally, 33.5% of radiologists are female. Women constitute a higher proportion of younger radiologists, with 48.5% of radiologists aged 35 or under being female. Female representation in radiology is lowest in the United States (27.2%), highest in Thailand (85.0%), and most variable in Europe (mean 40.1%, range 28.8%-68.9%). The proportion of female radiologists was positively associated with a country's Gender Development Index (P = .006), percent female medical student enrollment (P = .001), and Gini index (P = .002), and negatively associated with gross domestic product (P = .03). Women are underrepresented in radiology globally, most notably in the United States. Countries with greater representation of women had higher gender equality and percent female medical school enrollment, suggesting these factors may play a role in the gender gap.

Sexual Harassment in Radiology

PurposeTo gauge the prevalence of sexual harassment (SH) and to understand the issues regarding its disclosure among radiologists. MethodsA questionnaire on ethics and SH was sent by e-mail to 1,569 radiologists and radiology trainees in an institutional database maintained for continuing medical education purposes on three separate occasions between September 17 and October 31, 2016. The link to the survey was also posted on social media sites via the authors’ divisional and institutional accounts on Facebook, Twitter, Instagram, and Aunt Minnie, as well as on ACR and RSNA web blogs. ResultsOverall, 9.75% (39 of 400) respondents stated they had suffered SH, with more female (22 of 90 = 24.4%) than male victims (11 of 249 = 4.4%) (P < .001). Only 29.4% of SH victims said they would likely report SH (P < .001). Women (46 of 90 = 51.1%) said they were less likely to report SH than men (150 of 242 = 62.0%) (P = .03), and American medical school graduates (119 of 220 = 54.1%) were less likely than graduates from outside the United States (37 of 48 = 77.1%). Of 401 respondents to questions on SH, 28.7% (n = 115), including more women (38 of 91 = 41.8%) than men (61 of 249 = 24.5%) (P = .002), said they had witnessed SH. ConclusionsBy percentage responding, female radiologists are more frequently victims and witnesses of sexual harassment but are less likely to report such cases. Steps need to be taken to eliminate a culture that leads radiologists to tolerate SH without addressing it.

The Ethics of Physician Migration and Their Implications for the United States

Currently, the United States trains only three quarters of the physicians it requires to fill its entrylevel residency positions. The other quarter of residents employed by its hospitals is composed of immigrants who have been trained in other countries. This reliance of our healthcare system on foreign physicians puts a tremendous strain on the healthcare systems of developing nations. At the same time, by replacing American medical school graduates with graduates of foreign schools, the policy prevents a significant number of Americans who desire to practice medicine from doing so. An alarming shortage of physicians by the year 2020 has been forecasted. Discussion of how this shortage will be addressed is long overdue. The options are clear: either the United States can increase its dependence on foreign medical training programs or it can expand its own. It should choose the latter. 1 Daniel Bohl is a Biological Sciences major, Global Health Studies minor at Northwestern University in Evanston, IL. He will graduate in June of 2008 and subsequently begin a master’s program in International Health Policy at the London School of Economics. He can be contacted at dbohl@northwestern.edu.

An ERAS-Based Survey Evaluating Demographics, United States Medical Licensing Examination Performance, and Research Experience Between American Medical Graduates and United States Citizen International Medical Graduates: Is the Bar Higher on the Continent?

To provide an assessment and comparison of the demographics, medical school academic performance, United States Medical Licensing Examination (USMLE) performance, and research experience between American Medical Graduate (AMG) and United States International Medical Graduate (USIMG) candidates who applied for and successfully matched into categorical general surgery residency programs. Data were obtained through the Electronic Residency Application Service (ERAS) and a post-match survey distributed to all applicants. The study was conducted at a community-based, university-affiliated hospital. All United States citizen graduates of allopathic American medical schools or international medical schools, who were applying for a general surgery residency position at our institution. A total of 854 candidates applied, including 143 AMGs and 223 USIMGs. Seventy-two AMGs (50.3%) and 41 USIMGs (18.4%) were invited to interview (p < 0.0001). Mean USMLE step 1 scores were higher among USIMG applicants overall (USIMG: 212.1 ± 14.9 vs AMG: 206.9 ± 15.5; p < 0.0005) and among those invited to interview (USIMG: 227.8 ± 16.2 vs AMG: 215.5 ± 16.2; p < 0.0001). Seventy percent of AMGs matched into a categorical surgery residency compared with 31.6% of USIMGs (p < 0.001). Compared with AMGs, USIMGs applied to more programs (USIMG: 90.3 ± 42.8 vs AMG: 52.1 ± 26.4; p < 0.002), were offered fewer interviews (USIMG: 9.0 ± 6.9 vs AMG: 20.9 ± 13.7; p < 0.0001), and subsequently ranked fewer programs (USIMG: 7.5 ± 4.5 vs AMG: 12.5 ± 6.1; p < 0.0008). USIMGs require higher USMLE scores than their AMG counterparts to be considered for categorical general surgery residency positions. However, excellence on the USMLE neither ensures an invitation to interview nor categorical match success. A well-rounded application in conjunction with a practical application strategy is critical for USIMGs to achieve success in attaining a general surgery residency position.

Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

Pediatric Workforce: A Look at Adolescent Medicine Data from the American Board of Pediatrics

Pediatric Workforce: A Look at Adolescent Medicine Data from the American Board of Pediatrics

Pediatric workforce: A look at pediatric gastroenterology data from the American Board of Pediatrics

his report, which is part of a series discussing workforce trends for general pediatrics and related subspecialty areas, highlights the American Board of Pediatrics’ (ABP) workforce data for pediatric gastroenterology. Readers are encouraged to read the initial report in the series, because it provides information about general pediatrics and summary nformation about other ABP subspecialties. In 1990, pediatric gastroenterology became the eighth ABP subboard to offer a ertification examination, with the first examination yielding 275 board-certified pediatric gastroenterologists. Today, almost 900 ediatricians have been certified by the ABP as pediatric gastroenterologists. The focus of this report is to provide a snapshot f the current ABP workforce data for this subspecialty. The full ABP workforce data are available on the ABP Web site at ww.abp.org.

Pediatric workforce: A look at pediatric critical care medicine data from the American Board of Pediatrics

his report, which is part of a series discussing workforce trends for general pediatrics and related subspecialty areas, highlights the American Board of Pediatrics’ (ABP) workforce data for pediatric critical care medicine. Readers are encouraged to read the initial report in the series, because it provides information about general pediatrics and summary nformation about other ABP subspecialties. In 1987, pediatric critical care medicine became the seventh ABP subboard to offer certification examination, with the first examination yielding 182 board-certified pediatric critical care physicians. Today, lmost 1300 pediatricians have been certified by the ABP as pediatric critical care physicians. This report provides a snapshot f the current ABP workforce data for this subspecialty. The full ABP workforce data are available on the ABP Web site at ww.abp.org.

Report of the 2005 STS Congenital Heart Surgery Practice and Manpower Survey

Limited information is available concerning the congenital heart surgery workforce in North America. To obtain reliable data, The Society of Thoracic Surgeons (STS) Workforce on Congenital Heart Surgery undertook a subspecialty focused survey. Preliminary research of websites and databases revealed a potential target group of 263 congenital heart surgeons, including 248 surgeons at 121 US centers and 15 at eight Canadian sites. Surveys were sent to these, plus any additional individuals who listed an interest in congenital or pediatric heart surgery on CTSNet or STS websites. Responders include active congenital heart surgeons, inactive, or retired surgeons, adult cardiac surgeons, and surgeons in training. Analysis is based exclusively on the responses of 217 active congenital heart surgeons (>80% of target). Average age was 48.3 +/- 8.3 years (range, 33 to 78). Ten were female (5%), 207 male (95%). American Medical School graduates were 170 (79%), with 9.2 +/- 1.6 years of postgraduate training. Eighty-five percent are Thoracic Board certified. Congenital heart surgery training outside the United States or Canada was obtained by 29 (14%). One hundred twenty-eight (59%) do exclusively congenital heart surgery. One third perform fewer than 100 congenital cases per year, one third perform 100 to 199, and one third perform 200 or more. Congenital heart surgeons have been in their current positions for 9.5 +/- 8.2 years. Eleven are in their first year of practice. Mean anticipated years to retirement is 15.7 +/- 7.5 (range, 1 to 34). Three anticipate retirement within 1 year. At the same time, 39 fellows will complete postgraduate training at 28 centers this year, and 19 will seek positions in North America. These data should help to facilitate rational plans to meet manpower needs, including evolving policies concerning training and certification.

The Geriatric Psychiatry Workforce in 2002: Analysis From the 2002 National Survey of Psychiatric Practice

Using the 2002 National Survey of Psychiatric Practice (NSPP), authors update demographic and professional work activities of a nationally representative sample of the psychiatric workforce who treat geriatric patients. The sampling frame for the 2002 NSPP used the American Medical Association's Masterfile of Physicians. Professional, demographic, and patient data are compared between general and self-reported geriatric psychiatrists. Authors also present detailed analyses comparing high geriatric providers (HGPs; geriatric caseloads >20%), and board-certified geriatric psychiatrists (BCGPs). The proportion of HGPs in the 2002 NSPP was 26.0% of all respondents and was 28.1% among American Psychiatric Association (APA)-member respondents. Among the APA-member psychiatrists, this reflected a 55% increase from the 1996 NSPP. Of HGPs, 31.0% were certified in geriatric psychiatry. As compared with general psychiatrists, proportionally fewer men and American medical-school graduates were self-reported geriatric psychiatrists. Geriatric psychiatrists saw nearly three times as many geriatric patients and five times as many dementia patients as did their generalist counterparts. Mood-disorder patients were the largest treatment group, however. Investigators observed no significant differences in professional and practice characteristics between HGPs and BCGPs. About 1 in 4 psychiatrists in the 2002 survey are HGPs. Geriatric psychiatrists treat proportionally more geriatric patients than do generalists, but they do not have exclusively geriatric practices. The similarities between HGPs and BCGPs raise issues about the incentives for geriatric psychiatry certification, but not the need to train subspecialists to serve as faculty and community resources.

The Geriatric Psychiatry Workforce in 2002: Analysis From the 2002 National Survey of Psychiatric Practice

Using the 2002 National Survey of Psychiatric Practice (NSPP), authors update demographic and professional work activities of a nationally representative sample of the psychiatric workforce who treat geriatric patients.The sampling frame for the 2002 NSPP used the American Medical Association's Masterfile of Physicians. Professional, demographic, and patient data are compared between general and self-reported geriatric psychiatrists. Authors also present detailed analyses comparing high geriatric providers (HGPs; geriatric caseloads >20%), and board-certified geriatric psychiatrists (BCGPs).The proportion of HGPs in the 2002 NSPP was 26.0% of all respondents and was 28.1% among American Psychiatric Association (APA)-member respondents. Among the APA-member psychiatrists, this reflected a 55% increase from the 1996 NSPP. Of HGPs, 31.0% were certified in geriatric psychiatry. As compared with general psychiatrists, proportionally fewer men and American medical-school graduates were self-reported geriatric psychiatrists. Geriatric psychiatrists saw nearly three times as many geriatric patients and five times as many dementia patients as did their generalist counterparts. Mood-disorder patients were the largest treatment group, however. Investigators observed no significant differences in professional and practice characteristics between HGPs and BCGPs.About 1 in 4 psychiatrists in the 2002 survey are HGPs. Geriatric psychiatrists treat proportionally more geriatric patients than do generalists, but they do not have exclusively geriatric practices. The similarities between HGPs and BCGPs raise issues about the incentives for geriatric psychiatry certification, but not the need to train subspecialists to serve as faculty and community resources.

The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.

Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups. All 122 medical schools in the United States were surveyed in 2001 to determine whether they required dedicated course work in musculoskeletal medicine, defined as a preclinical module or clinical clerkship in orthopaedic surgery, rheumatology, or physiatry. Data from the Electronic Residency Application Service were obtained for the class of 2002. From these two sources, the rate of applications from students to orthopaedic surgery residency programs was calculated as a function of exposure to a required course in musculoskeletal medicine. Subgroup analysis was further carried out for women and for African Americans, Latinos, and Native Americans. In 2002, there were 16,294 graduates of American medical schools, of whom approximately 55% had mandatory instruction in musculoskeletal medicine. The rate of application to orthopaedic surgery residency programs was 5.7% among the students with required instruction compared with a rate of 5.1% for students without such required instruction. The rate of application for female students was 2.0% for those who had required courses and 1.1% for the female students who had not had the required courses. The rate of application for minority students in schools with required courses was 8.2% compared with a rate of 6.1% for those students without such exposure. Required instruction in musculoskeletal medicine was associated with a 12% higher rate of application to orthopaedic surgery residency programs among all students (5.7% of those who received required instruction compared with 5.1% of those who did not). The relative difference was more pronounced among women (a 75% difference in the rate of application) and minorities (a 35% difference in the rate of application). This study suggests that required instruction in musculoskeletal medicine can help to promote diversity in orthopaedic surgery residency programs.

THE HOSPITALIST MOVEMENT: Is There a Place for Anesthesiologists?

The growth of managed care continues to impact American health care in a variety of ways. Two significant changes that have resulted from managed care strategies include a dramatic emphasis on primary care, and reorganization of inpatient care, which is provided by hospital-based clinicians. These hospital-based models are being adopted by an increasing number of both teaching and nonteaching institutions from New England to California. What role will the anesthesiologist play in this new era? Will our practice be limited to that of intraoperative providers of anesthesia or will we assume greater responsibility and take a leadership role in directing the evolution of a system striving for efficient, cost-effective delivery of medical, surgical, and perioperative care? The trend toward generalism has already had an impact on anesthesiology—visible by its effect on the preference of American medical school graduates, with a significant falloff in the number of students choosing specialty (especially anesthesiology) residencies. This chapter will explore the hospitalist movement and discuss the possible role of anesthesiologists as they expand their practice as perioperative specialists.

Downsizing Psychiatric Residency Programs

Under the varied pressures of decreasing recruitment of American medical school graduates into psychiatry, the thrust of health care policymakers to decrease the production of specialist physicians, and financial cutbacks for training by hospitals, universities, and governments at all levels, many psychiatric training programs are considering downsizing or have already implemented plans to do so. The authors describe the motivations, early experiences, anticipated concerns, and thoughts regarding downsizing obtained from interviews or questionnaires provided by 17 programs in 1993. On the basis of the authors' experiences, some recommendations are offered for the many programs likely to deal with this issue in the future.