Medical School Output Research Articles

The Allopathic Program Director's Dilemma.

The Allopathic Program Director's Dilemma.

The Potential Impact of Reduction in Federal GME Funding in the United States: A Study of the Estimates of Designated Institutional Officials

As a result of the decisions made in the Summer of 2011 to increase the federal debt limit of the United States,1 the Joint Select Committee on Deficit Reduction (the “Super Committee”) was formed to recommend to the Congress by 12 2011 reductions in federal spending to be accomplished over the next 10 years. Among the entitlement program elements being examined by the Super Committee, Medicare reimbursement for Graduate Medical Education (GME), the primary source of GME funding in the United States, has been identified as an opportunity for spending reductions. Specifically, the Medicare Payment Advisory Commission (MedPAC) has indicated that approximately 50% of the Indirect GME Reimbursement is not “empirically justified” on the basis of current costs of teaching hospitals intended to be covered by that reimbursement.2 This is seen by many as an opportunity for reduction. Furthermore, the Simpson Bowles Commission recommended a reduction in total GME funding in excess of 50% ($60 billion over 10 years) as a component of a comprehensive strategy to reduce federal deficit spending.3 This discussion occurs in the context of a predicted physician shortage, a mounting surge in the number of domestic graduates of schools of allopathic and osteopathic medicine designed to remedy that anticipated physician shortage,4 and slow growth in GME output over the past decade.5 However, this increase in medical school output must be accompanied by an increase in Graduate Medical Education, which is the required final pathway to entry into the unsupervised practice of medicine in the United States. As the body charged by the public and the profession with accreditation oversight of the vast majority of the GME programs in the United States, and to measure the quality of educational opportunities for physicians as they seek to prepare to meet the needs of the American public, the Accreditation Council for Graduate Medical Education (ACGME) attempted to estimate the impact of reductions in GME funding of the magnitude under discussion in our nation's capital on the educational pipeline for physicians.

The Social Mission of Medical Education: Ranking the Schools

The basic purpose of medical schools is to educate physicians to care for the national population. Fulfilling this goal requires an adequate number of primary care physicians, adequate distribution of physicians to underserved areas, and a sufficient number of minority physicians in the workforce. To develop a metric called the social mission score to evaluate medical school output in these 3 dimensions. Secondary analysis of data from the American Medical Association (AMA) Physician Masterfile and of data on race and ethnicity in medical schools from the Association of American Medical Colleges and the Association of American Colleges of Osteopathic Medicine. U.S. medical schools. 60 043 physicians in active practice who graduated from medical school between 1999 and 2001. The percentage of graduates who practice primary care, work in health professional shortage areas, and are underrepresented minorities, combined into a composite social mission score. The contribution of medical schools to the social mission of medical education varied substantially. Three historically black colleges had the highest social mission rankings. Public and community-based medical schools had higher social mission scores than private and non-community-based schools. National Institutes of Health funding was inversely associated with social mission scores. Medical schools in the northeastern United States and in more urban areas were less likely to produce primary care physicians and physicians who practice in underserved areas. The AMA Physician Masterfile has limitations, including specialty self-designation by physicians, inconsistencies in reporting work addresses, and delays in information updates. The public good provided by medical schools may include contributions not reflected in the social mission score. The study was not designed to evaluate quality of care provided by medical school graduates. Medical schools vary substantially in their contribution to the social mission of medical education. School rankings based on the social mission score differ from those that use research funding and subjective assessments of school reputation. These findings suggest that initiatives at the medical school level could increase the proportion of physicians who practice primary care, work in underserved areas, and are underrepresented minorities.

International medical graduates in the National Health Service

The UK's National Health Service (NHS) has benefited from the skills of foreign qualified doctors for many years. International medical graduates (IMGs) - that is, those doctors with primary medical qualifications outside the European Economic Area (EEA) - have come to the UK despite the significant personal and financial costs, alongside the burden of taking the Professional and Linguistic Assessment Board (PLAB) examination. Despite the costs and increasing indications that the UK job market was becoming saturated with the increased indigenous medical school output and expansion of the EEA, doctors still migrate to the UK in their thousands (McGinn, 2005). The government's active international recruitment policy, which continued until very recently despite the significant increase in places in UK medical schools, was partially responsible for this trend. Until last year, once registered to practise in the UK, access to specialty training was facilitated by the permit-free training visa (PFTV) system, which allowed IMGs to work and train simultaneously, without the need for a work permit. This meant that they could compete on an equal footing with UK graduates for training opportunities in the UK. The implementation and potential impact of some of the recent policy changes in the NHS specifically with regard to IMGs is discussed here briefly.

The solution to chaos is not chaos

The solution to chaos is not chaos

The solution to chaos is not chaos

The solution to chaos is not chaos

Female physicians in Mexico: Migration and mobility in the lifecourse

To date there have been few studies of professional women in health care in the developing world. With the increased feminization of the Mexican health work force, an estimated 30 per cent of all physicians are female, there is an urgent need to study this group of workers in terms of their impact on the health service. In particular, the potential for female physicians to migrate could have a dramatic impact on the health service. Indeed, it has long been recognised by the Mexican health authorities that there is an uneven spatial distribution of physicians and yet little is known about the distribution and mobility of female physicians. To this end this paper will analyse the migration and mobility of female physicians through the lifecourse in provincial Mexico. The paper examines the factors that control and structure female physician migration in childhood, during their training and career development. Data for this study were obtained during a period of ten months fieldwork in Mexico. Primary data were obtained from interviews with a sample of physicians in five study states. The interviewees also completed a diary for three months to outline their daily, weekly and monthly routine activities. Secondary data sources were various health employment records, medical school output statistics and the Atlas of Professionals produced by the Mexican census service. Material presented in this paper demonstrates that female physicians in provincial Mexico are not highly mobile. A lack of mobility is due to the constraining factors of education, gender, institutional structures and family and household imperatives.

What Is Balance in the Physician Workforce?

To the Editor. —A number of organizations, public and private, have called for an increase in the production of primary care physicians to of medical school output. 1-4 Others have cast doubt on this goal. Dr Cooper 5 claims that production of one-third generalists would be more appropriate. That would essentially maintain the current specialist-generalist distribution. Cooper uses selected data to make several arguments against the 50% solution. First, he states that the size of each specialty should depend on technological advances within the specialty rather than on the population to be served. Actually, there is no direct relationship between specialist numbers and expanding technology; the equation is multifactorial, with income potential, training center needs, and academic value systems among the independent variables. Fully developed, rather than halfway, technologies frequently reduce workforce needs. 6 Elsewhere, Cooper states a preference for market-driven solutions over regulation and legislation. Isn't the market

The special study module: a novel approach to undergraduate teaching in occupational medicine.

Difficulties in teaching occupational medicine to undergraduates stem from the reduced availability of teaching time and the perception of the specialty. Recent changes in the General Medical Council curricular framework have permitted the development of a special study module (options course) in occupational medicine, in which a small number of motivated undergraduates elected to participate and which was adequately resourced. This course laid particular emphasis on changing students' attitudes towards the specialty, self-learning techniques, problem-solving and other skills such as workplace assessment. The objectives, content and teaching methods of the course are described, as is a preliminary evaluation. It is suggested that other medical schools should adopt and refine this approach in order to improve the quality of undergraduate training in at least a proportion of the output of medical schools.

The AMA, Accreditation, and the Number of Physicians

Too many people, including some journalists, seem willing to believe that the American Medical Association limits the output of medical schools. They observe a shortage of physicians, extreme competition to enter US medical schools, US citizens in foreign medical schools, and the immigration of foreign medical graduates, and then declare that the AMA uses accreditation to restrict the output of US medical schools. Granting that we have problems with the number and especially the distribution of physicians, and that not all qualified students can enter medical schools, the facts are otherwise. The AMA Council on Medical Education published its first classification of medical schools in 1907, and since 1942 has been an equal partner with the Association of American Medical Colleges in the Liaison Committee on Medical Education, which is recognized by numerous groups, including the US Office of Education, for its accreditation of medical schools. The Liaison Committee membership

Overseas-born doctor migration 1962-66.

Overseas-born doctor migration 1962-66.

Attributes of Lifelong Competence in Medical Practice

Consideration of the characteristics associated with lifelong competence raises an ancient dispute about the relative influences of nature and nurture—of inheritance and environment. The process of selecting students for admission to medical school is concerned with nature. The medical curriculum and hospital training programs represent an extreme form of nurture or environment influence. What do we know about the relative contribution of these two factors to competence? Although the production of competent physicians is a major goal of the medical educational process, surprisingly few attempts have been made to determine how well this goal is achieved. The large volume of research on selection of medical students almost suggests that picking students who can complete the four-year curriculum is a goal in itself. The medical students are accessible and easily studied whereas the competence of the physicians —the medical-school output—is difficult or occasionally impossible to measure. We do, however, have a