PubMed · 8531550
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K J Rothman. 1996-01-06. Lessons from John Graunt.. https://doi.org/10.1016/s0140-6736(96)91562-7
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OBJECTIVE: To determine alternate combinations for reductions in US medical school graduates (USMGs), international medical graduate (IMG) immigration, and graduate medical education (GME) residencies, based on future physician supply targets. DESIGN: A demographic projection model of the physician supply was constructed and calibrated to fit observed American Medical Association Physician Masterfile data and current supply forecasts. Total annual input to GME was backcast from given future supply targets, adjusting for the portion of IMGs in GME who do not enter the US workforce. MAIN OUTCOME MEASURES: The annual number of new physicians added to supply from domestic or international sources needed to reach future physician-to-population ratio targets. RESULTS: Because of the low rate of attrition from the physician supply, it takes up to 50 years for workforce policy to effectively stabilize the physician-to-population ratio at a target level. All target ratios considered here would require immediate reductions in the total number of GME positions. These reductions must be followed by gradual annual increases to account for population growth. The size of USMG and IMG reductions are interrelated and depend critically on the percentage of IMG trainees who remain to practice in the United States. CONCLUSIONS: Reductions in future physician supply can come from either the IMG or USMG component of physician production, or both. The model developed here allows the estimation of multiple combinations of both GME components.
OBJECTIVE: To examine the current supply and distribution of gastroenterologists and project future supply under various scenarios to provide a paradigm for workforce reform. DESIGN: An analysis of current practices and distribution of gastroenterologists and a demographic model, using the 1992 gastroenterology workforce as a baseline. MAIN OUTCOME MEASURE: Comparison of current supply, distribution, and practice profiles with past data and future projections, using analyses of data from the 1993 Area Resource File, 1992 Medicare Part B file, age- and sex-specific death and retirement rates from the Bureau of Health Professions, managed care staffing patterns, the National Survey of Internal Medicine Manpower, and the Bureau of the Census. RESULTS: Rapid growth in the number of US gastroenterologists has resulted in a gastroenterologist-to-population ratio double that used on average by health maintenance organizations. In addition, the work profile of gastroenterologists is shared significantly by primary care physicians and other specialists, with the exception of a few specific and uncommon procedures. CONCLUSIONS: Empirical evidence suggests that, even in the absence of detailed models to describe the desired supply/need balance for gastroenterology, the US health care system and clinicians may benefit from a reduction in gastroenterology training programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in trainee numbers over 5 years, and recent National Resident Matching Program data indicate that a voluntary downsizing process is in full force. This study illustrates a paradigm for workforce planning that could be useful for other medical specialties.
This historical review introduces a series of papers abstracting, reanalyzing and commenting upon family studies of schizophrenia conducted by Ernst Rüdin and his geneologic-demographic department in Munich. These studies, which pioneered many of the methods still critical to psychiatric genetics, are little known in the anglophonic world. Starting with a study of schizophrenia in siblings, members of the Rüdin school expanded to study a wide range of relationships (including grandchildren and nieces/nephews) and disorders (including affective illness, obsessive-compulsive disorder, epilepsy and personality disorders). They examined many methodologic issues in psychiatric genetics including i) ascertainment correction, ii) anticipation, iii) age correction, iv) assortative mating, v) reduced fertility, vi) spectrum disorders, and vii) familial transmission of age at onset. After the rise of Hitler in Germany, Rüdin and his institute became involved in the eugenic policies of the Nazis, raising important questions about possible political abuse of scientific findings in general and those from the field of psychiatric genetics in particular.