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Biomedical subjects

Fitzhugh Mullan

Publications and source records attributed to Fitzhugh Mullan.

17 recordsLinked to original sources
PubMed2006

International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes.

BACKGROUND: The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to personal and professional characteristics and attitudes that may have implications for the health care system resulting from the increasing numbers of IMGs in family medicine in the United States. METHODS: This is a secondary data analysis of the 1996-1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week. RESULTS: Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs. CONCLUSION: There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.

Journal Article↗
PubMed2005

The metrics of the physician brain drain.

BACKGROUND: There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. METHODS: Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. RESULTS: International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean. CONCLUSIONS: Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries.

Africa↗
PubMed2004

Geographic retrofitting: a method of community definition in community-oriented primary care practices.

Community definition is an important aspect of community health work in general and community-oriented primary care (COPC) in particular. Yet, community definitions are often nonspecific, relying on geopolitical boundaries or local presumptions about patient populations. Such definitions are an impediment to the precise application of sociodemographic or health status data to community health problems or to targeted community organizing. This paper describes a technique called "geographic retrofitting" that has proved useful in establishing a rigorous definition of a practice's community based on current patterns of health care by the community. It also demonstrates how this approach, used in conjunction with geographic information systems software, facilitates more-powerful capabilities in community characterization and intervention.

Catchment Area, Health↗
PubMed2002

Community-oriented primary care: new relevance in a changing world.

Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa. We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility. COPC has important values and methods to offer disparate but powerful movements in public health worldwide.

Community Health Centers↗
PubMedDate not supplied

Time-capsule thinking: the health care workforce, past and future.

The size and shape of the U.S. health care workforce are in constant evolution. Using the metaphorical device of a time capsule, this essay examines the past and future of the workforce. It traces the growth, specialization, and diversification of health care workers during the twentieth century, emphasizing the particular expansion of the nonmedical aspects of the workforce. Looking ahead, the paper examines technology, informatics, nursing, provider distribution, and the global migration of health care workers as pivotal issues for the future of the workforce.

Clinical Medicine↗
PubMedDate not supplied

The future of medical education: a call for action.

The challenge of building new medical schools or expanding the class size of current ones is a lengthy and costly enterprise. That reality argues for the creation of a national vision about how to proceed and what to prioritize, a vision that could serve as a map for public and private officials considering further investment in medical education. A national commission funded by one or several health philanthropies is suggested as an expeditious vehicle to focus this discussion and move the debate forward. Instructive educational innovations in osteopathic and nursing education are suggested as germane to the deliberations of a national commission, as are creative means of student funding.

Education, Medical↗
PubMedDate not supplied

Immigration pediatrics.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMedDate not supplied

Doctors for the world: Indian physician emigration.

Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.

Australia↗
PubMedDate not supplied

My dad was not a prepaid group practice patient.

The author's father was a psychiatrist, a concerned citizen, and a Medicare patient. He died recently after a prolonged illness during which a panoply of physicians cared for him in ways that were sometimes redundant, inefficient, and poorly coordinated. He was definitively not a prepaid group practice patient. The author reviews the growing body of evidence that suggests that physician density is associated with greater costs but not improved outcomes. He reflects on his father's concerns with equity in health care and how prepaid managed care might have provided more efficient and less expensive medical coverage for his father's final sickness.

Aged↗