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Biomedical subjects

M E Whitcomb

Publications and source records attributed to M E Whitcomb.

At least 37 records · Page 2Linked to original sources
PubMed1995

A cross-national comparison of generalist physician workforce data. Evidence for US supply adequacy.

OBJECTIVE: To assess the adequacy of the US generalist physician workforce using population-based, cross-national physician workforce data. DESIGN: A comparative analysis of physician workforce data obtained from primary sources in Canada in 1991 and from England and Germany in 1993. METHODS: Generalist physician-to-population ratios were calculated for each country and the results compared in the context of how primary care services are delivered. The findings were used to create a framework for analyzing the adequacy of the generalist physician workforce of the United States. MAIN OUTCOME MEASURE: The comparability of the number of primary care providers per 100 000 population in the US physician workforce with the number in Canada, England, and Germany. RESULTS: On a population basis, the size of the full-time US generalist physician workforce is larger than that of England, similar to that of Germany, and smaller than that of Canada. These size differences are largely reconciled when one takes into account differences in the way primary care services are delivered, the degree to which nurse practitioners are employed in each country, and the degree to which nongeneralist physicians provide primary care services. CONCLUSIONS: The size of the US generalist physician workforce is currently adequate to meet the needs of the population. Policies designed to greatly expand the size of the US generalist physician workforce are ill-conceived.

Canada↗
PubMed1995

Participation of international medical graduates in graduate medical education and hospital care for the poor.

OBJECTIVE: To determine the impact of limiting international medical graduate (IMG) participation in US graduate medical education (GME) on the delivery of hospital care to the poor. METHODS: To ascertain the pattern of IMG participation in GME and the degree to which the principal teaching hospitals with programs with large IMG enrollments provide care to the poor, we used data from the American Medical Association 1993 Annual Survey of Graduate Medical Education Programs and Teaching Institutions to analyze the pattern of IMG participation in GME in the six core specialties of internal medicine, family practice, obstetrics and gynecology, surgery, pediatrics, and psychiatry. MAIN OUTCOME MEASURES: Programs were identified as IMG dependent if at least 50% of the resident physicians enrolled in the first year of the program were IMGs. All programs were linked to their principal teaching hospitals, and hospitals were assessed according to the number of programs based at each institution, the number of IMG-dependent programs at the institution, and whether no-pay patients and/or Medicaid/public assistance beneficiaries constituted more than 20% of the patients served. RESULTS: Of the 20,170 first-year resident physicians in the six core specialties, 31.8% were IMGs. The proportion of programs dependent on IMG enrollment was 27.7%, ranging from 5.2% in obstetrics and gynecology programs to 49.5% in psychiatry programs. About 72% of all first-year IMGs were in IMG-dependent programs. Of the 688 hospitals serving as principal teaching sites for programs in at least one of the six core specialties, 106 were categorized as dependent on IMG programs, but only 77 of those provided a disproportionate amount of care to the poor. Finally, 40% of the IMG-dependent GME programs and 36% of first-year IMG residents were based in hospitals that did not provide a disproportionate amount of care to the poor. CONCLUSIONS: Based on this analysis, 77 hospitals can arguably be considered dependent on IMG resident physicians to provide care to the poor. Moreover, a large number of IMG residents and IMG-dependent programs are in hospitals that do not provide a disproportionate amount of care to the poor. These findings show the scale of the problem policymakers must address if they choose to limit IMG access to GME while maintaining access of the poor to needed hospital care.

Education, Medical↗
PubMed1994

Recovery of function in survivors of the acute respiratory distress syndrome.

We performed a prospective cohort analysis to determine the rate and extent of improvement in pulmonary function abnormalities and self-perceived health for 1 yr after surviving an episode of the acute respiratory distress syndrome (ARDS). We also examined the effect of ARDS severity and etiology, age, and sex on functional recovery. Patients were recruited from the intensive care units of one hospital and followed at regular time intervals from extubation to 1 yr. Fifty-two of 82 eligible adult survivors (63%) consented to participate; 37 of 82 (45%) had at least two examinations, and 20 (24%) had complete follow-up. Risk factors for ARDS included sepsis (n = 12), trauma (n = 15), and other (n = 10). Pulmonary function and self-perceived health scores improved considerably in the first 3 mo after extubation, with only slight additional improvement at 6 mo. No further changes were evident at 1 yr. Patients with more severe ARDS had significantly lower pulmonary function tests than did other survivors throughout follow-up. These observations should be useful for clinical follow-up of ARDS survivors and provide specific information concerning the expected rate of functional recovery in these patients.

Adult↗
PubMed1993

Financial performance of academic medical center hospitals.

In its 1990 report to the U.S. Congress and to the Secretary of Health and Human Services, the Council on Graduate Medical Education noted that the financial status of teaching hospitals, as measured by trends in profit margins, had deteriorated during the years 1985-1988, and that major teaching hospitals had the lowest margins in the hospital industry. To gain insight into the financial viability of major teaching hospitals, the authors updated the analysis of the financial status of these hospitals and further analyzed their financial performance. They identified academic medical center hospitals using criteria established by the Association of American Medical Colleges' Council on Teaching Hospitals; accessed financial performance data on these institutions from the Health Care Financing Administration's prospective payment system minimum-data sets for the years 1987-1991; evaluated the financial performance of these institutions for the five-year period by calculating their total margin, return on equity, and financial leverage; and determined the percentage of Medicaid discharges for each year. The analyses show that academic medical center hospitals had stabilized their short-term financial performance in recent years. Nevertheless, their financial position is not strong. Their return on equity and debt financing percentages suggest that they will be forced to reduce their future rate of investment in new plant and equipment. Further, their overall financial performance is threatened by the growing percentage of Medicaid discharges. These observations raise serious concerns about the financial viability of these institutions in the face of continued changes in the financing of hospital services.

Academic Medical Centers↗
PubMed1993

Safety of bronchoalveolar lavage in patients with adult respiratory distress syndrome.

Although shown to be safe in many other lung disorders, the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in critically ill patients with adult respiratory distress syndrome (ARDS) remains unproven. We conducted a prospective study to evaluate the safety of BAL in patients with ARDS. There were 438 patients with ARDS at our institution during the study period. Of these, 110 underwent FOB and BAL for either research or clinical purposes. Data were collected at baseline, at 5-min intervals during the procedure, and 1 h after the procedure. We did not detect any statistically or clinically significant changes in PaO2/FlO2, mean arterial pressure, heart rate, peak inspiratory pressure, or static thoracic compliance after the procedure. A small decrease in SaO2 occurred after BAL. Although this change was statistically significant, the magnitude was not of clinical importance. Five patients (4.5%) had transient arterial oxygen desaturation to < 90% during FOB and one patient (0.9%) experienced desaturation to < 80%. There were no prolonged episodes of severe hypoxemia. No serious bleeding occurred. One pneumothorax developed during the procedure. No deaths occurred that were related to the procedure. We conclude that FOB and BAL can be performed safely and are reasonably well-tolerated in patients with ARDS.

Adolescent↗
PubMed1993

The effect of federal grants on medical schools' production of primary care physicians.

OBJECTIVES: Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS: The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. RESULTS: The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. CONCLUSIONS: The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes.

Career Choice↗
PubMed1992

Comparing the characteristics of schools that produce high percentages and low percentages of primary care physicians.

To examine whether the medical school environment is important in influencing students to choose careers in primary care, the authors in 1991 compared certain characteristics of the environments of schools that produced high percentages of primary care physicians with those of schools that produced low percentages over a five-year period. The authors used the American Medical Association Physician Masterfile to identify the percentage of graduates of each of 121 medical schools for the period 1981-1985 who entered primary care specialties. They then compared the 25 schools that produced low percentages (22-29%) with the 25 schools that produced high percentages (39-56%). The results demonstrate important differences between the two groups of schools in their commitments to primary care education, their research programs, and their clinical environments supporting required clerkships. The authors conclude that a school's educational environment is an important factor in influencing some students to pursue careers in primary care medicine.

Career Choice↗
PubMed1990

Physician manpower for rural America: summary of a WAMI region conference.

Although legislators have intermittently focused their attention on physician manpower issues, the needs of rural America for physicians remain unmet. These needs will not be met unless there is an adequate supply of physicians receptive to and appropriately trained for the challenges and opportunities of practice in a rural community. A declining interest by matriculating and graduating medical students in primary care practice makes it problematic that the needs of rural America can be met in the near future unless medical schools attempt to reverse the trends in medical students' specialty choices. In October 1989, the University of Washington School of Medicine conducted a working conference on physician manpower issues facing rural communities in Washington, Alaska, Montana, and Idaho. The discussions and conclusions of this conference about increasing the percentage of graduates entering rural practice apply to other regions of the country, and this paper summarizes the conference's recommendations.

Delivery of Health Care↗
PubMed1988

Financing graduate medical education: a federal health policy perspective.

Since 1984, the federal government has incrementally linked funding of Medicare to considerations of medical manpower supply, training, and specialization. To beneficially implement such policy, the government should: reaffirm that general medical education costs are an integral part of care costs in teaching hospitals; discontinue federal support of medical education in foreign schools with unacceptable standards; create programs to allow fully trained physicians to replace trainees in the provision of services to inner city poor; and require teaching hospitals to affiliate with medical schools.

Education, Medical, Graduate↗