Biomedical subjects

Sarah E Brotherton

Publications and source records attributed to Sarah E Brotherton.

9 recordsLinked to original sources

PubMed2005

US graduate medical education, 2004-2005: trends in primary care specialties.

CONTEXT: Over the last decade, the primary care specialties have experienced an ebb and flow in popularity. A description of the future primary care workforce may inform planning for the health care needs of our population. OBJECTIVES: To describe characteristics of physicians training in primary care specialties over the past 9 years and to monitor trends in the characteristics of the entire residency population. DESIGN, SETTING, AND PARTICIPANTS: Descriptive survey study of the National GME Census, conducted by the American Medical Association and Association of American Medical Colleges, which jointly surveyed 8246 allopathic graduate medical education (GME) programs during the academic year 2004-2005 about active, transferred, and graduated residents, as well as about program characteristics. Program directors confirmed the status of 97.3% of active residents. The accompanying program survey was completed by 7163 (87%) of the program directors. MAIN OUTCOME MEASURES: General trends in the numbers and characteristics of all residents, fellows, and training programs, with specific trends for residents and fellows training in the primary care specialties and subspecialties over the past 9 years. RESULTS: The census counted 101 291 physicians-in-training during the 2004-2005 academic year, the largest number ever recorded by this survey. The number of osteopathic medical school graduates (DOs) in allopathic GME decreased from 5838 in 2003-2004 to 5675, following many years of annual increases. The number of residents in primary care specialties reached a peak in the mid 1990s. The number of family medicine residents who are graduates of US allopathic medical schools (USMDs) has fallen from 8232 (77.6%) in 1998-1999 to 4848 (51.7%) in 2004-2005. The number of primary care residents who are graduates of foreign medical schools and US citizens (USIMGs) nearly doubled between 1995-1996 (n = 1768) and 2004-2005 (n = 3304). The number of USIMGs training in internal medicine or pediatrics subspecialties increased by 45.7% between 1995-1996 (n = 622) and 2004-2005 (n = 906). The number of pediatric subspecialty fellows grew 55.7%, mostly because of the near doubling of USMDs, from 813 to 1617. More than half of primary care residents are women (52.5%). All primary care specialties and subspecialties experienced gains in the proportion of female residents, with the greatest in obstetrics/gynecology, which increased by 28.7% (57.9% in 1995-1996 vs 74.5% in 2004-2005). CONCLUSIONS: An increasing proportion of physicians are pursuing subspecialty training, while the number in primary care specialties has leveled off. Trends in GME suggest that the primary care medical workforce of the future will include more women, more IMGs, and more DOs.

Databases as Topic↗

PubMed2004

US graduate medical education, 2003-2004.

CONTEXT: Information about recent graduates of medical schools and the characteristics of physicians training in graduate medical education (GME) portends the size and composition of the US physician workforce of the near future. OBJECTIVES: To examine trends in training programs and career choices of graduating male and female residents and to monitor trends in the size of the entire residency population. DESIGN, SETTING, AND PARTICIPANTS: The American Medical Association and Association of American Medical Colleges jointly surveyed residency programs during the academic year 2003-2004 about active, transferred, and graduated residents, as well as about program characteristics. The 8192 programs confirmed the status of 94.6% of residents. Nearly 86% of program directors (n = 7040) completed the accompanying program survey. MAIN OUTCOME MEASURES: Overall trends during the last 6 years in the number and characteristics of residents and programs, as well as the specialty of male and female graduating residents. RESULTS: There were 99,964 active residents during the 2003-2004 academic year, the highest ever recorded by the National GME Census. The number of residents (n = 22,444) entering US graduate medical education programs for the first time is also the highest on record. In 1999, 28,773 physicians completed training, 10,546 (36.7%) of whom were women. In 2003, there were 29,745 graduates, 11,681 (39.3%) of whom were women, representing a 10.8% increase. The number of obstetrics/gynecology male graduates decreased 31.3%, while female graduates increased 18.2%. Other specialties that lost men and gained women were dermatology, family medicine, internal medicine, ophthalmology, pathology, psychiatry, and general surgery. The proportion of graduates who pursued additional training increased; percentages were 27.2% in 1999, 29.6% in 2001, and 32.1% in 2003. In 2000, 35.7% of programs provided opportunities to develop cultural competence; the percentage in 2003 was 50.7%. The percentage of programs with complementary/alternative medicine curriculum has held steady at 24%. CONCLUSIONS: The number of physicians in GME is at its highest, and nearly one third of physicians completing training in one program continue on in another. The choices of female residents parallel those of male residents in many respects, but there are important differences.

Adult↗

PubMed2003

US graduate medical education, 2002-2003.

CONTEXT: By selecting a specialty to train in, physicians entering graduate medical education (GME) training provide advance information about the future physician workforce. OBJECTIVE: To determine trends in the residency choices of medical school graduates entering GME training. DESIGN, SETTING, AND PARTICIPANTS: The American Medical Association and Association of American Medical Colleges jointly surveyed active programs as well as combined programs in academic year 2002-2003 about active, transferred, and graduated residents. In 2002 the survey was sent to 8064 program directors; 84.2% of them confirmed the status of all active residents and 82.6% completed the program survey. MAIN OUTCOME MEASURES: In addition to overall trends, the specialty choices of graduates of osteopathic schools (DOs) and international medical graduates (IMGs). Also, where native US citizen resident physicians attended medical school if not in the United States, with a focus on Hispanic ethnicity and Spanish-language facility. RESULTS: The census counted 98 258 resident physicians in GME programs in academic year 2002-2003, similar to 5 years ago and reversing a decline over the past few years. There were 23 443 residents in graduate year 1 (GY1) positions, for which prior GME training is not required, a slight increase from 2001-2002. The proportion of GY1 residents without prior GME increased slightly compared with 2001-2002 (92.3% to 93.3%). In 1996-1997, 624 DOs were GY1 residents without prior GME (2.9%); their numbers increased to 1312 (6.0%) in 2002-2003. The number of IMGs in GY1 positions without prior GME also increased over this period, from 5033 (23.5%) to 5623 (25.7%). Over the past 6 years the number of IMG and DO GY1 residents without prior GME in specialties such as general surgery, obstetrics and gynecology, and emergency medicine has increased disproportionately faster than the overall rate. Hispanic native US citizens are more likely to be IMGs than non-Hispanic native US citizens (9.6% vs 5.0%). One third of Hispanic native US citizen IMGs received their medical education in Spanish vs less than 3% of non-Hispanic native US citizen IMGs. CONCLUSIONS: Nearly 25% of physicians in US allopathic training programs in 2002-2003 were IMGs, and the percentage of DOs continues to increase. The number of residents conversant in Spanish could serve a need for a large US minority population.

Career Choice↗

PubMed2003

Developmental and behavioral pediatric practice patterns and implications for the workforce: results of the Future of Pediatric Education II Survey of Sections Project.

A survey of developmental-behavioral pediatricians was conducted to obtain data and insights on their current practice. As part of the Future of Pediatric Education (FOPE) II Survey of Sections Project, questionnaires were sent to individuals who were most likely to represent those pediatricians engaged in the subspecialty of developmental-behavioral pediatrics. Four groups of physicians were compared within the survey: developmental-behavioral fellowship group (n = 272), developmental disabilities fellowship group (n = 139), general academic pediatrics or other fellowship group (n = 57), and a nonfellowship group (n = 224). A majority of respondents indicated a need for an increased number of subspecialists in developmental-behavioral pediatrics in their community during the next 3 to 5 years. There were significant differences in the survey results of a variety of practice issues between those who had and had not received formal fellowship training. The survey data illustrate a developmental-behavioral pediatrician workforce that is becoming increasingly fellowship trained, receiving more referrals, and encountering constraints to seeing more patients in an era of declining reimbursement for services. To overcome these obstacles, stakeholders in child health, including health care payers, will need to be educated about the unique skills and clinical expertise of physicians in developmental-behavioral pediatrics and neurodevelopmental disabilities.

Child↗

PubMed2002

US graduate medical education, 2001-2002: changing dynamics.

The National Graduate Medical Education (GME) Census, jointly administered by the American Medical Association and the Association of American Medical Colleges, completed its second year as an online survey of all GME programs accredited by the Accreditation Council for Graduate Medical Education as well as combined specialty programs approved by their corresponding medical specialty boards. Continuing trends include the growing number of subspecialty programs, which increased by 65 since last year to 3822, and a smaller number of specialty programs, which decreased by 25 to 4203. There were corresponding shifts in the number of residents training in them. The number of graduates from osteopathic medical schools in allopathic GME has increased from 3288 in 1996-1997 to 4658 in 2001-2002, an increase of 42%. Overall, the total number of residents in GME has declined slightly, to an estimated 96 410 this year. The number of residents in graduate year 1 (GY1) positions (entry positions in GME, for which prior training is not required) has also decreased, although the proportion of residents in GY1 positions who have not had prior GME has increased. The number of international medical graduates (IMGs) in GY1 positions has decreased from a high of 6727 in 1999-2000 to 5898 in 2001-2002, a decrease of 12.3%. However, the number who have entered GME immediately on graduation has grown from 310 in 1996-1997 to 936 in 2001-2002. Most of these IMGs were citizens or permanent residents of the United States and attended medical schools in the Caribbean. New race and ethnicity questions, which parallel those of the US Census, continue to reveal disparities in the racial/ethnic distribution of the training physician population relative to the US population. Despite continued interest in resident work hours, there was no decrease in reported hours worked between 2000-2001 and 2001-2002. Physicians training in surgical specialties are reported to work the most hours per week, while internal medicine and pediatrics allow for the most consecutive time on duty, at 30 hours or more. Specialties and subspecialties with limited on-call schedules, such as forensic psychiatry and pediatric pathology, have, on average, the lowest number of duty hours.

Curriculum↗

PubMed2002

Practice of pediatric otolaryngology: results of the future of pediatric education II project.

OBJECTIVES: To define the practice of pediatric otolaryngology compared with general otolaryngology and to estimate pediatric otolaryngology workforce utilization and needs. METHODS: Survey of members of the American Academy of Pediatrics Section on Otolaryngology and Bronchoesophagology and the American Society of Pediatric Otolaryngology and of a random sample of the membership of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS: Pediatric otolaryngologists were more likely to practice in urban and/or academic settings than were general otolaryngologists. Children (age <18 years) comprised over 88% of the patients of pediatric otolaryngologists and 30% to 35% of the patients of general otolaryngologists. Pediatric otolaryngologists were more likely to see children with complicated diseases such as airway disorders or congenital anomalies than were general otolaryngologists. Pediatric otolaryngologists, unlike general otolaryngologists, reported an increasing volume of pediatric referrals, as well as increased complexity in the patients referred. The surveyed physicians estimated the present number of pediatric otolaryngologists in their communities as approximately 0.2 to 0.3 per 100 000 people. CONCLUSIONS: Most children receiving otolaryngologic care in the United States receive such care from general otolaryngologists. The patient profile and practice setting of the subspecialty of pediatric otolaryngology differ from those of general otolaryngology. The demand for pediatric otolaryngologists appears to be increasing, but many general otolaryngologists do not believe there is an increased need.

Education, Medical↗

PubMed2002

A comparison of pediatric emergency medicine and general emergency medicine physicians' practice patterns: results from the Future of Pediatric Education II Survey of Sections Project.

BACKGROUND: This survey was conducted to obtain information about career and practice issues facing pediatric emergency medicine (PEM) physicians and general emergency medicine (GEM) physicians. We hypothesized that PEM physicians work fewer clinical hours and perform more teaching and research in their positions than GEM physicians. METHODS: Two surveys sponsored by the Future of Pediatric Education II Project were sent to 1545 emergency physicians identified by the American Board of Pediatrics, the American Academy of Pediatrics, and the American College of Emergency Physicians between October 1997 and February 1998. Data on demographics, job description, recent job changes, and career expectations were obtained and analyzed using Student t test or Welch analysis of variance for continuous variables and chi2 for categorical data. P values less than 0.05 were considered significant. Comparisons between PEM and GEM physicians were adjusted using analysis of covariance to control for the effect of medical school affiliation. RESULTS: Effective response rate was 934 (64%) of 1451. A total of 705 (75%) respondents identified themselves as a PEM physician, and 229 (25%) identified as a GEM physician. PEM physicians were younger (41.0 y vs 45.1 y) and more likely to be women (44% vs 15%, P < 0.0001 for both). Children younger than 18 years made up 80.9% and 28.6% of patients seen by PEM and GEM physicians, respectively (P < 0.001). Seventy-nine percent of PEM physicians and 42% of GEM physicians held an academic appointment (P < 0.0001). No differences were found for full-time equivalents per physician group (9.7 vs 9.1) or clinical hours spent in the emergency department (ED) (31.5 vs 32.7) when means were adjusted for academic appointment. During ED clinical activities, PEM physicians reported more time spent supervising trainees (34% vs 16%, P < 0.0001), and GEM physicians reported more time spent in direct patient care (77% vs 57%, P < 0.0001). Total clinical hours worked per week were greater for GEM physicians (37.9 vs 35.3, P < 0.05). PEM physicians spent more time than GEM physicians teaching (12% vs 8%, P < 0.005) and conducting clinical research (5% vs 2%, P < 0.0003). Of PEM and GEM physicians combined, 26% reported a job change in the past 3 years. Extended reduction of ED clinical duties occurred most commonly because of child care issues and was reported more commonly by women than men (53% vs 6%, P < 0.0001) irrespective of PEM or GEM practice. The likelihood of leaving emergency medicine practice within 5 years increased with age for both groups: 10% of PEM and GEM physicians under 40 years old anticipated leaving practice versus 30% of those older than 50 years (P < 0.0001). PEM physicians were more likely than GEM physicians to predict an increased need for additional pediatric subspecialists in general (60% vs 26%, P < 0.001) and for pediatric subspecialists in their discipline (54% vs 17%, P < 0.001). PEM subspecialists were twice as likely as GEM specialists to perceive competition in their subspecialty (60% vs 31%, P < 0.001). CONCLUSIONS: According to our sample, GEM and PEM physicians worked the same number of clinical hours in the ED but reported significant differences in how those hours are spent. Job changes and extended leaves were common in both groups. These results suggest that PEM and GEM physicians face similar vocational challenges, especially in the areas of balancing of family time, clinical hours, and academic productivity. These data also have important implications for workforce projection for the PEM physician supply, given the current estimated attrition rate, frequency of leave from clinical duties, and projection for increased need for PEM physicians in the future.

Adult↗

PubMed2002

Pediatric residents' career intentions: data from the leading edge of the pediatrician workforce.

OBJECTIVE: To determine factors influencing career choices by pediatric residents and how they may change the future pediatric physician workforce. BACKGROUND: Societal norms and policy decisions can influence the demographics of residents entering pediatric practice and resident career choices. Although predictors of physician career choice have been identified retrospectively by examining the characteristics of physicians in practice, little work has focused on the job selection factors important to pediatric residents when they make their postresidency career decisions. DESIGN/METHODS: For 3 consecutive years (1997-1999), the American Academy of Pediatrics surveyed a national sample of 500 third-year residents, totaling 1500 residents. Data on resident characteristics, job selection attitudes, and career decisions were obtained, and trends for the past 3 years were examined. RESULTS: The percentage of residents intending to practice primary care remained constant at around 69% from 1997 through 1999. Female residents, US medical graduates, and residents married to nonphysicians were more likely to report primary care practice as their future clinical goal. These relationships were mediated by higher rates of a primary care practice goal among those who felt geographic location and future colleagues were very important and by lower rates among those who felt acceptable income, teaching opportunities, and research opportunities were very important. Six percent of residents entering general pediatrics were heading to rural locations. CONCLUSIONS: With a projected increase in the number of female pediatricians and a decline in international medical graduates, our study suggests that pediatrics may continue to shift toward an increased proportion of general pediatricians. Lifestyle issues are a major factor influencing job choice and must be addressed.

Adult↗

PubMedDate not supplied

The practice of clinical genetics: a survey of practitioners.

PURPOSE: A survey of clinical geneticists was undertaken to learn more about current practice. METHODS: An attempt was made to survey all geneticists practicing in the United States to elicit information on a variety of issues. RESULTS: A total of 69% of geneticists responded. Most practice at a medical school, most receive a portion of their income from salary, and many receive personal financial support from research grants. CONCLUSION: The specialty of medical genetics is primarily housed in tertiary care settings. Although a substantial amount of time is required to see patients, reimbursement for these services does not cover the costs to maintain such practices.

Data Collection↗