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Biomedical subjects

R M Politzer

Publications and source records attributed to R M Politzer.

30 records · Page 2Linked to original sources
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↗
PubMed1977

A comparison of primary care educational experiences in two urban pediatric settings.

The purpose of this study was to initiate the evaluation of the ambulatory care training programs of the Johns Hopkins Medical Institutions and affiliated programs as resources for primary care education, and to provide input into the development of a primary care educational curriculum. It was determined that these settings fell short of fulfilling an a priori set of educational objectives designed to emphasize primary as opposed to secondary care. Foresight must be exercised in the selection of sites and the design of the clinical practice of an acceptable training program in primary care is desired.

Ambulatory Care↗
PubMedDate not supplied

The impact of Title VII departmental and predoctoral support on the production of generalist physicians in private medical schools.

Although federal support for medical education comes from several sources, only 1 targets generalist education--Title VII of the Public Health Service Act. With governmental streamlining and downsizing, the federal investment in medical education should be evaluated. We tested the relationship between 2 Title VII authorities and presence of a medical school generalist training infrastructure, and the relationship between this infrastructure and generalist production. Based on our definitions for receipt of Title VII support, generalist infrastructure, and generalist production, we found that, for private schools, sustained receipt of Title VII funds directed for undergraduate medical education is positively associated with presence of family medicine departments, which is positively associated with higher rates of generalist production. Establishment and maintenance of family medicine departments in private schools and their generalist production are positively associated with Title VII support. Title VII support in public schools, the major generalist producers, has less of a unique measurable impact on generalist production.

Education, Medical, Graduate↗
PubMedDate not supplied

Availability of primary care providers and pharmacists in the United States.

OBJECTIVE: To determine the rural distribution of primary care providers (primary care physicians, physician assistants, nurse practitioners, and nurse midwives) and pharmacists. DESIGN: Five-digit ZIP code mapping to study the availability of primary care providers and pharmacists, alone and in combinations, in rural areas and ZIP code-based health professional shortage areas (HPSAs). National averages for annual physician visits for hypertension, asthma, and diabetes were used to estimate the sufficiency of the rural physician supply. SETTING: Rural areas of the United States. RESULTS: In rural areas, all providers were present in lower densities than national averages, particularly in HPSAs. The primary care physician supply was insufficient to meet national averages for office visits for hypertension, asthma, and diabetes. Among available providers, the most prevalent co-presence was primary care physician with pharmacist. HPSAs showed very low physician density (1 per 22,122), and the most prevalent providers were pharmacists. States varied widely in provider density. CONCLUSION: Despite longstanding efforts and the expansion of managed care, primary care providers remain in short supply in rural areas, especially ZIP code-based HPSAs. Making the best use of available providers should be encouraged. The continued shortfall of primary care providers in rural areas, particularly HPSAs, makes it logical to use other available providers and combinations to increase health care access. Pharmacists could increase care for patients with conditions treated with medications. Other available providers, based on skills and work site, could also offset shortages.

Asthma↗
PubMedDate not supplied

The National Practitioner Data Bank: the first 18 months.

In response to a need for information on the quality of professional practice and a perceived threat to the preservation of the peer review process, as well as to concern about the cost to society of incompetent physicians, Congress passed the Health Care Quality Improvement Act of 1986. The Act established a legal basis for protecting peer review and quality assurance activities. It also established a national reporting system, the National Practitioner Data Bank (NPDB), which is intended to ensure that appropriate information is available to be used in the peer review process.

Licensure, Medical↗
PubMedDate not supplied

Implications of pregnancy for residents and their training programs.

This study investigated the implications of pregnancy on residents and their training programs and how programs have planned for pregnancy disruptions compared to other employers. We received questionnaires from 236 male and female residents and their families who had experienced at least one pregnancy during their training. Results for female residents were compared with working spouses of male residents. Approximately half of the female residents reported that their programs had formal leave policies compared to 70% of the working spouses. The average amount of leave taken by residents was considerably less than that taken by the spouse group. For both groups, 35% of all pregnancies were unplanned; 19% of these without benefit of birth control. Approximately 30% of both groups said they should have timed their pregnancies differently. Female residents were more likely to perceive their pregnancies as a stressful time. Despite this greater stress, female residents were equally as unlikely as spouses of male residents to miss work for pregnancy-related causes. This study supports the need for better planning for pregnancy during residency training.

Adult↗
PubMedDate not supplied

Downsizing the physician workforce.

OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A managed care dominated-system would call for greater downsizing in most of the non-primary care specialties. CONCLUSION: These data support the need for downsizing the nation's physician supply, especially in the internal medicine subspecialties and hospital support specialties and to a lesser extent among surgeons and primary care physicians.

Health Services Needs and Demand↗