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Biomedical subjects

R M Politzer

Publications and source records attributed to R M Politzer.

At least 19 recordsLinked to original sources
PubMed1999

Eliminating primary care health professional shortage areas: the impact of Title VII generalist physician education.

Most policy-makers and researchers agree that although the United States is headed for a significant physician surplus, problems of equity in access to care still remain. To help meet this challenge, Title VII of the Public Health Service Act focuses on producing generalist physicians to serve in medically underserved areas (MUAs). This study estimates the impact Title VII support for generalist training has on reducing and eliminating health professional shortage areas (HPSAs) under multiple scenarios that vary either the Title VII funding level or the percentage of Title VII-funded program graduates who practice in MUAs. For each scenario, the number of Title VII-funded residency graduates who initially practice in MUAs and the time it would take to eliminate HPSAs are estimated. Using 1996 rates, the analysis predicts that 1,214 generalist physicians will enter practice in HPSAs annually, leading to elimination of HPSAs in 24 years. In 1997, Title VII-funded programs increased the rate of graduates entering HPSAs, resulting in 1,357 providers and reducing the time for HPSA elimination to 15 years. Doubling the funding for these programs would increase the number of Title VII-funded generalist physicians entering MUAs and could decrease the time for HPSA elimination to as little as 6 years. The study concludes that eliminating HPSAs requires broader Title VII influence and continuous improvement in rates of production of graduates who practice in MUAs. Without Title VII graduates and continuous improvement of Title VII program, MUA rates, the number of HPSAs and the number of Americans with reduced access to essential health care will continue to expand.

Forecasting↗
PubMed1996

Matching physician supply and requirements: testing policy recommendations.

Managed care has been growing and likely will increase market share. This movement will require fundamental alterations in the number and specialty distribution of physicians. Under current production, future supply does not appear well-matched with requirements. Although the adequacy of generalist supply is of concern, the oversupply of specialists is the overriding problem. Neither reducing the number of first-year residents nor increasing the generalist output alone would bring both generalist and specialist supply within requirement ranges. Combining an increase in generalist production to 50% with a reduction in first-year residents to 110% of the number of U.S. medical graduates would minimize the projected specialty surplus while maintaining generalist supply within the requirement range.

Education, Medical, Graduate↗
PubMed1995

Medical migration and the physician workforce. International medical graduates and American medicine.

OBJECTIVE: Because of the size and growth of the international medical graduate (IMG) contribution to graduate medical education (GME) in the United States, and subsequently to the US physician workforce, it is essential to understand the demographics and patterns of IMG training and practice as well as the routes of entry into the United States. DATA SOURCES: Published data from the American Medical Association, the American Osteopathic Association, and the Association of American Medical Colleges; tabular runs of county-level data contained on the Bureau of Health Professions' Area Resource File. RESULTS: The majority of IMGs who participate in GME in the United States ultimately enter US practices. A significant proportion of exchange visitors eventually enter into permanent practice in the United States, contrary to the intent of the J-1 visa-based GME training as an international educational exchange program. International medical graduates gravitate toward initial residency programs in internal medicine and pediatrics, many of which have unfilled positions; however, IMGs subspecialize at a disproportionately high rate, reducing their net contribution to the generalist pool. Patterns of ultimate practice location of IMGs parallel the patterns of US medical graduates (USMGs). CONCLUSIONS: In recent years, participation of IMGs in GME and practice has increased significantly. Most IMGs in GME are not exchange visitors, but are either permanent residents or US citizens. Patterns of specialization and location of IMGs ultimately mirror those of USMGs. National IMG policy must be examined in light of the projected surplus of physicians in the United States. The best option for long-term control of the number of physicians in practice, USMG or IMG, is a system of specifying the number of GME positions nationally.

Education, Medical, Graduate↗
PubMed1995

Managed care on the march: will physicians meet the challenge?

The health care delivery system in the United States is in transition. Increasingly managed care plans are gaining in predominance. The proliferation of managed care systems will have an impact on the demand and requirements for physicians. This paper attempts to project and estimate requirements for physicians in 2000 and 2020, assuming that the health care system will continue to be dominated by managed care. The projections are then compared to forecasts of physician supply under two separate physician production scenarios. The authors discuss the adequacy of the future physician workforce to provide services required by a health care system dominated by managed care.

Forecasting↗
PubMed1994

Balance and limits: modeling graduate medical education reform based on recommendations of the Council on Graduate Medical Education.

National commissions, medical philanthropies, scholars, and policy analysts agree that the key to improved health care access and cost containment is a physician workforce built on a generalist foundation. They propose a national system to allocate a specific and limited number of graduate medical education (GME) positions. The Council on Graduate Medical Education recommended that training positions be limited to 110 percent of the graduates of U.S. allopathic and osteopathic medical schools and that the system graduate 50 percent into primary care practice (50/50-110 proposal). The 50/50-110 option would significantly modify GME training: surgical and support specialty positions would be reduced, and increased numbers of medical and pediatric residents would enter general practice. This workforce composition would facilitate provision of universal health care access and help control costs--the basic tenets of reform.

Education, Medical, Graduate↗
PubMed1993

Doctors, dollars, and determination: making physician work-force policy.

Because managed care is likely to feature prominently in a reformed health care system, policymakers need to examine the impact managed care will have on medical practice, physician supply, and access to primary care providers. Goals for work-force reform should focus on five areas: (1) training physicians in the generalist disciplines of family practice, general internal medicine, and general pediatrics; (2) shaping the physician work force to reflect the nation's ethnic diversity; (3) distributing physicians in a geographically equitable way; (4) maintaining the current physician-to-population ratio rather than letting it continue to grow; and (5) establishing supply needs for nurse practitioners, primary care physician assistants, and certified nurse midwives.

Competitive Medical Plans↗
PubMed1989

The hidden future supply of foreign medical graduates.

The number of foreign medical graduates (FMGs) as reported by the American Medical Association (AMA) has registered increases in recent years far exceeding the Department of Health and Human Services' (DHHS) published forecasts. The DHHS projections of new entrants have been derived from the number of postgraduate year-one positions filled by FMGs. Apparently, the FMG supply is augmented by physicians who enter by other paths. By using AMA data, this study takes the first step in attempting to shed light on the characteristics of these recent FMG additions. It then uses the DHHS model to forecast FMG supply based on a short-run continuation of the AMA-reported changes. The paper also forecasts FMG supply assuming that no new foreign national FMGs (FNFMGs) will enter the pool. The analysis suggests that some FNFMGs may be entering this country with visas granted to family members of United States citizens or permanent immigrants and then establishing practices without exiting directly from graduate medical education (GME). Further restrictions on GME participation for FMGs likely are not going to severely curtail FMG entrance into the medical care delivery system. Rather, they will likely restrict their entrance by way of the most traditional route.

Education, Medical, Graduate↗
PubMed1978

Foreign-trained physicians in American medicine: a case study.

The understanding of reliance upon foreign medical graduates (FMGs) in the United States is vague and general. Little is known about the specific roles of FMGs or the populations they serve in relation to United States medical graduates (USMGs). The recent passage of the Health Professions Educational Assistance Act calls for significant reductions in the future influx of FMGs. Hence, there is an immediate need for detailed information upon which to base predictions of legislative outcomes. The American Medical Association's 1974 physician data tape for Maryland was used as the study population. These data were analyzed, using th Gini Index of Concentration and other test stastistics, for FMG/USMG distributional differences for 1) office-based practice and hospital-based practice, 2) catchment areas aggregated by income, 3) primary, secondary, and tertiary case specialty groupings, 4) level of development of country of medical education, and 5) all of the above in relation to population. Office-based and hospital-based catchment areas were developed in order to create a valid consumer-provider relationship between the numerator and denominator of physician/population ratios. The major finding is that regardless of practice setting, FMGs are more evenly distributed relative to population than USMGs. This conclusion is in contrast with the notion that FMGs tend to locate where USMGs locate. A useful methodology has been presented for 1) development of catchment areas, and 2) examination of distributional differences in relation to population which can easily be duplicated.

Catchment Area, Health↗