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Biomedical subjects

M R Dunn

Publications and source records attributed to M R Dunn.

At least 19 recordsLinked to original sources
PubMed1999

Graduate medical education, 1998-1999: a closer look.

Despite the ever-present risk of a critical imbalance in the physician workforce total numbers and specialty distribution, no systematic planning mechanism is in place. Furthermore, the length of training for graduate medical education (GME) precludes timely rectification of imbalances. We report GME activities collected in the American Medical Association Annual Survey of Graduate Medical Education Programs for 1998-1999, along with trends during the last 3 to 6 years. These data initially suggest that little has changed during the past several years; however, on closer examination, small but significant changes during the past 2 years may have serious consequences if continued. The total number of resident physicians, which has been constant during the last several years, decreased in 1998 by 760 from the previous year, while the number of programs continues to increase (6.1% since 1993). The number of US medical graduates entering GME programs remained stable during the last 6 years, the number of osteopathic graduates entering GME increased by 55.7%, and the number of international medical graduates (IMGs) entering GME continued to drop (down 13.2% since 1993). More IMGs tend to pursue additional training than do US graduates (in 1997, 32.9% vs 23.6%). Because IMGs are remaining in GME programs for longer periods, the total number of IMGs has not yet reflected significant change. About 62% of IMGs now entering GME training are either US citizens or permanent residents; ethnic minority residents are not decreasing in numbers as some predicted; and for the first time in the past 5 years, the primary care specialties have ceased their persistent growth. Toward the end of GME, the number of residents leaving programs before completion increased by 5.7% during the last 3 years. While some of these changes may be ascribed to reduced GME funding through the Balanced Budget Act of 1997, other factors clearly are at play. To anticipate future changes in the physician workforce, these factors should be identified to permit them to be monitored and modified as needed.

Education, Medical, Graduate↗
PubMed1998

Employment-seeking experiences of resident physicians completing training during 1996.

CONTEXT: Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment. OBJECTIVE: To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices. DESIGN: Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year. SETTING: A total of 25 067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties. MAIN OUTCOME MEASURE: Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors. RESULTS: After 6 months of data collection, 12135 (48.4%) of 25 067 resident physicians responded to the survey. Of the respondents, 11 200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%),those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%). CONCLUSIONS: Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.

Career Choice↗
PubMed1998

Graduate medical education, 1997-1998.

In response to growing concerns that continued unlimited governmental funding of graduate medical education (GME) would lead to a physician surplus, Congress enacted provisions in the Balanced Budget Act (BBA) of 1997 to limit further growth, as well as to encourage reductions in GME. The measures incorporated in this section of the BBA reflect recommendations made by a number of major professional associations. The question now is how effective these efforts will be and whether they will produce unintended or deleterious consequences. We report the changes occurring in GME from 1993 to 1997, focusing on changes prior to and since the enactment of the BBA. The total number of residents in GME programs has remained relatively constant from 1993 to 1997. The number of residents entering GME programs without prior GME experience has also remained constant; however, over the same period, the number entering a new program with some prior GME experience has fallen by 5.8%. The number of international medical graduates in all GME programs has increased 12.4% during this same period, while the number of US allopathic medical school graduates has decreased 4.4%. As federal and state initiatives are introduced to change the number and distribution of GME positions, it is critical that the American Medical Association and other professional organizations monitor GME tracking data more systematically and accurately than ever before.

Data Collection↗
PubMed1997

US graduate medical education, 1996-1997.

Workforce planners continue to be concerned that unlimited growth in graduate medical education (GME)-principally fueled by unrestrained federal support-will lead to a physician surplus. Because of this concern, in 1996 six major professional organizations called for a reduction in Medicare support of GME to bring residency training programs into more rational alignment with population needs. As of July 1, 1997, no final action had been taken by Congress to limit GME funding, although extensive discussions are under way. Even without governmental restrictions, the American Medical Association's annual survey of GME programs showed a reduction in the numbers of first-year residents in most major specialties and subspecialties. Minor reductions were initially noticed last year; now, the decreases are significant. Nearly all the specialties that had difficulty placing their graduates for 2 consecutive years also reported at least 10% fewer first-year residents than in 1994. More importantly, disciplines without employment difficulties also reported downsizing. The overall effect of these first-year reductions is easily masked by the addition of programs in new disciplines and some residents staying in the GME system longer. Entry-level reductions appear to be broader and more extensive than can be explained by market forces alone.

Education, Medical, Graduate↗
PubMed1997

Initial employment status of resident physicians completing training in 1995.

OBJECTIVE: To assess the degree and type of difficulty encountered by resident physicians attempting to enter the workforce in 1995. DESIGN: Employment information derived from a 1-page descriptive survey completed by residency program directors from January 1, 1996, to June 15,1996, is described and compared with the results of a similar survey completed 1 year earlier. SETTING: Directors of 4568 residency programs in 31 specialties and subspecialties accredited by the Accreditation Council for Graduate Medical Education. MAIN OUTCOME MEASURE: The number of 1995 program graduates, their current professional status, and program directors' characterization of the experience of graduates who entered clinical practice, including the number who experienced major difficulties securing an acceptable practice position. Program directors reported actual and anticipated decreases in the number of residency positions and the likely availability of future professional opportunities. RESULTS: The 3819 program directors (83.6%) who completed the survey reported that 20065 resident physicians completed a residency program during 1995. Of those seeking employment (n = 13215), most entered clinical practice (80.1%) or took an academic position (15.6%); 2.2% were unemployed or had taken a position in a specialty or subspecialty different from the one in which they were last trained. A portion (6.3%) of graduates who entered clinical practice in their specialty or subspecialty experienced difficulty finding a suitable position; the percentage was lowest among graduates of general surgery, psychiatry, and primary care specialties. CONCLUSIONS: Survey results regarding the 1995 graduates are consistent with those obtained regarding the 1994 graduates and suggest that the market for physician services in some disciplines continues to be restrictive. We found that graduates of the specialties of anesthesiology and plastic surgery, whom we reported had the greatest difficulty finding acceptable positions in 1994, had less difficulty in 1995, suggesting a possible improvement in the market, less competition, a change in the respondents' perception of "acceptable," or a change in the resident physicians' willingness to pursue different opportunities. The general consistency of our results and their congruence with other published data suggest that this method is useful to identify and monitor trends in the physician market.

Employment↗
PubMed1996

The shifting sands of graduate medical education.

Each year the American Medical Association (AMA) surveys all programs in graduate medical education (GME) accredited by the Accreditation Council for Graduate Medical Education. Because of the importance of GME in the national workforce policy debate, this year's survey report has been expanded to provide more detailed GME data. The authors describe the historical basis of the current GME workforce dilemma and the multiple forces that now tend to neutralize efforts to adapt to a changing marketplace. For example, as resident physicians find it increasingly difficult to locate suitable employment, one would expect a reduction in hospital-based programs and in the number of their resident physician appointments. Yet, while US medical graduates (USMGs) did not pursue certain programs in this year's National Resident Matching Program, AMA data show that during the past 2 years the reduced number of residents in hospital-based programs was almost exactly offset by the increased number in new and expanded programs. Also, more USMGs are leaving residency training to enter practice after 3 years of basic training in primary care (internal medicine, pediatrics, and family practice). At the same time, an increasing number of international medical graduates are remaining in subspecialty programs. Other examples are cited to show the ebb and flow of GME activities that behave like "shifting sands."

Education, Medical, Graduate↗
PubMed1968

Effect of blood flow reversal in liver autotransplants upon the site of hepatocyte regeneration.

We studied the role of the direction of intrahepatic blood flow upon the location of hepatocyte formation in regenerating liver. Single liver lobes in the dog were autotransplanted to the region of the neck with the blood supply reestablished in a manner to perfuse the hepatic lobule from portal tract to central vein or, in a reverse direction, from central vein to portal tract. Partial resection of the nontransplanted liver was later performed to induce regeneration in the grafts by humoral means. Tritiated thymidine was administered, and radioautographs were prepared from excised graft and nontransplanted liver. In the "straight" blood flow grafts, as well as in all nontransplanted livers, labeled hepatocytes indicating DNA synthesis were found predominantly in the vicinity of the portal tracts. In the "reverse" blood flow grafts, labeled hepatocytes were more prevalent about the central veins. Thus, the localization of hepatocyte formation in the lobule during active liver regeneration cannot be attributed to an inherently greater capacity of periportal liver cells to divide but is probably related to their preferential exposure to blood constituent changes (humoral mechanisms). Hepatocyte regeneration in the presence of abnormal directional circulation might lead to lobular disorganization resulting in consequent biochemical aberrations despite the formation of new cells.

Animals↗