PubMed Health⌕ Search

Biomedical subjects

M L Rivo

Publications and source records attributed to M L Rivo.

At least 19 recordsLinked to original sources
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

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↗
PubMed1995

State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992.

State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measureable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts.

Education, Medical↗
PubMed1995

Cancer prevention behaviors among African-American adults: a survey of wards 7 and 8 in Washington, DC.

A telephone survey of knowledge, attitude, and health practices regarding cancer was undertaken in wards 7 and 8, Washington, DC in 1988. These wards have the highest cancer rates in the city and are predominantly African American. Of the 670 randomly selected persons over 18 years of age, 243 were males and 427 were females. Among females, 84% believed cigarette smoking causes cancer, and 48% thought alcohol causes cancer; 31% smoked cigarettes and 38% consumed alcoholic beverages. Among males, 91% and 52% thought cigarettes and alcohol causes cancer respectively; 41% smoked and 54% consumed alcoholic beverages. Only 6% of the males over age 40 practiced all eight recommended cancer prevention behaviors, while 2% of the females over age 40 practiced all preventive health behaviors. Cancer preventive behavior was examined in relation to socioeconomic status. This study indicates that preventive health behaviors were not associated with socioeconomic status. Data suggest that cancer prevention and control programs and services targeted to this Washington, DC population should be increased and intensified.

Adolescent↗
PubMed1994

Defining the generalist physician's training.

OBJECTIVE: To determine the extent to which various specialties prepare residents in the broad competencies required for primary care practice and to propose guidelines for improving generalist physician training. DATA SOURCES: Leading causes of morbidity and mortality, 1991 National Ambulatory Medical Care Survey data, expert reports, and the special requirements for residency training. DESIGN: From the data sources we identified the common presenting conditions and diagnoses that broadly trained generalist physicians could be expected to manage in primary care practice. We then compiled a list of 60 requisite residency training components grouped according to seven practice criteria for generalist physicians. Using the special requirements for residency training for family practice, internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine, we determined the extent to which the requirements addressed the 60 components and continuity-of-care training. RESULTS: Almost all of the 60 generalist training components were required by family practice (95%), internal medicine (91%), and pediatrics (91%), compared with emergency medicine (42%) and obstetrics and gynecology (47%). Family practice, internal medicine, and pediatric residencies also require lengthy, well-defined continuity-of-care experiences. CONCLUSION: Family practice, internal medicine, and pediatric programs prepare residents in the broad competencies necessary for primary care practice. To train competent generalist physicians, we recommend that residency programs require training in 90% or more of the 60 components, 50% or more of the components in each of the seven categories, and a continuity-of-care experience for a panel of patients during at least 10% of the entire residency training period.

Clinical Competence↗
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

Internal medicine and the journey to medical generalism.

The overspecialized U.S. physician workforce and mix of graduating residents undermine strategies to provide quality and affordable health care to all Americans. Several respected advisory bodies have recently proposed fundamental changes in federal policy to better match physician supply and specialty mix with health care needs. They recommend that Congress limit the total number of filled first-year resident positions to 110% of the number of U.S. medical school graduates, a 20% reduction from current levels. They have proposed that positions and funding be allocated to medical schools, teaching hospitals, residency programs, or consortia of such entities to ensure that at least 50% of each graduating residency class enters generalist practice. An all-payer, graduate medical education pool and financing system have been suggested as ways to uncouple the physician workforce from hospital service needs and to eliminate disincentives toward ambulatory and primary care training. Increases in generalist production must be accompanied by decreases in nonprimary care specialty and subspecialty positions. In addition, generalist physicians must be better prepared in managed care competencies. Given today's subspecialist surplus, managed care organizations are considering how to retrain subspecialists as generalists. The Federated Council of Internal Medicine's goal that 50% of its graduates become general internists is an important step because internists compose one sixth of all physicians and one third of all first-year residents. This article identifies the challenges that lay ahead on the road to medical generalism and what it may take to get there.

Health Policy↗
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↗