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Al-Sowygh ZH, Sukotjo C. Foreign-Trained Dentists in Advanced Education in Prosthodontics Programs in the United States: Demographics, Perspectives on Current Training, and Future Goals. J Prosthodont 2010; 20:161-5. [DOI: 10.1111/j.1532-849x.2010.00658.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Leon LR, Ojeda H, Mills JI, Leon CR, Psalms SB, Villar HV. The Journey of a Foreign-Trained Physician to a United States Residency: Controversies Surrounding the Impact of This Migration to the United States. J Am Coll Surg 2008; 206:171-6. [DOI: 10.1016/j.jamcollsurg.2007.06.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 06/25/2007] [Indexed: 10/22/2022]
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Healy G, Oikelome F. A global link between national diversity policies? The case of the migration of Nigerian physicians to the UK and USA. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2007. [DOI: 10.1080/09585190701638135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leon LR, Villar H, Leon CR, Psalms SB, Aranha G. The Journey of a Foreign-Trained Physician to a United States Residency. J Am Coll Surg 2007; 204:486-94. [PMID: 17324786 DOI: 10.1016/j.jamcollsurg.2006.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 11/29/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Luis R Leon
- Southern Arizona Veteran Affairs Healthcare System, Tucson, AZ 85723, USA
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Howard DL, Bunch CD, Mundia WO, Konrad TR, Edwards LJ, Ahinee Amamoo M, Jallah Y. Comparing United States versus international medical school graduate physicians who serve African- American and White elderly. Health Serv Res 2006; 41:2155-81. [PMID: 17116114 PMCID: PMC1955313 DOI: 10.1111/j.1475-6773.2006.00587.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. DATA SOURCES Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. STUDY DESIGN Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. DATA COLLECTION/EXTRACTION METHODS Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. PRINCIPAL FINDINGS Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. CONCLUSION IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.
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Affiliation(s)
- Daniel L Howard
- The Institute for Health, Social, and Community Research at Shaw University, Raleigh, NC 27601, USA
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Abstract
OBJECTIVES To characterize the composition of the pediatric subspecialty workforce in terms of the distribution of women and international medical graduates (IMGs) across pediatric medical subspecialties and to determine whether the proportions of board-certified pediatric subspecialists who are women or IMGs differ between graduation cohorts. STUDY DESIGN We used board certification data from the American Board of Pediatrics. Within each pediatric subspecialty, we classified physicians into 2 groups, ie, recent graduates, defined as those who completed medical school after January 1, 1987, and nonrecent graduates, who completed medical school before that date. We calculated the percentage of female physicians for each subspecialty and computed 95% confidence intervals around those estimates to identify male-dominated subspecialties. Using Pearson chi2 tests, we compared the percentages of women between the 2 graduation cohorts for each subspecialty. Similar calculations were performed for the percentage of IMGs in each subspecialty. Sensitivity analyses were performed with data from the 2002 American Medical Association Physician Masterfile. RESULTS For 9 of 16 pediatric medical subspecialties studied, the percentages of board-certified women were significantly greater in the recent cohort than in the nonrecent cohort. Subspecialties that remain predominantly male in the recent graduation cohort include cardiology, critical care medicine, gastroenterology, pulmonology, and sports medicine. In contrast, the percentages of board-certified IMGs were significantly lower for 6 of the 16 specialties studied; endocrinology and gastroenterology remain relatively reliant on IMGs. CONCLUSIONS For the majority of pediatric medical subspecialties, concerns that the predominance of women in pediatric training may negatively affect the supply of subspecialists are likely unfounded; however, a small number of procedure-based specialties, as well as sports medicine, continue to rely disproportionately on men. There do not seem to be consistent differences in the role of IMGs across the pediatric medical subspecialties between recent and nonrecent graduates, which may reflect differing tendencies to become certified.
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Affiliation(s)
- Michelle L Mayer
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590, USA.
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Abstract
The effective and efficient delivery of children's health care depends on the pediatrician workforce. The number, composition, and distribution of pediatricians necessary to deliver this care have been the subject of long-standing policy and professional debate. This technical report reviews current characteristics and recent trends in the pediatric workforce and couples the workforce to a conceptual model of improvement in children's health and well-being. Important recent changes in the workforce include (1) the growth in the number of pediatricians in relation to the child population, (2) increased numbers of female pediatricians and their attainment of majority gender status in the specialty, (3) the persistence of a large number of international medical graduates entering training programs, (4) a lack of ethnic and racial diversity in pediatricians compared with children, and (5) the persistence of marked regional variation in pediatrician supply. Supply models projecting the pediatric workforce are reviewed and generally indicate that the number of pediatricians per child will increase by 50% over the next 20 years. The differing methods of assessing workforce requirements are presented and critiqued. The report finds that the pediatric workforce is undergoing fundamental changes that will have important effects on the professional lives of pediatricians and children's health care delivery.
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Hagopian A, Thompson MJ, Fordyce M, Johnson KE, Hart LG. The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. HUMAN RESOURCES FOR HEALTH 2004; 2:17. [PMID: 15598344 PMCID: PMC544595 DOI: 10.1186/1478-4491-2-17] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Accepted: 12/14/2004] [Indexed: 05/02/2023]
Abstract
BACKGROUND: The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa. METHODS: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA. RESULTS: More than 23% of America's 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools. CONCLUSIONS: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
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Affiliation(s)
- Amy Hagopian
- WWAMI Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Meredith Fordyce
- WWAMI Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karin E Johnson
- WWAMI Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - L Gary Hart
- WWAMI Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Kuczkowski KM. International medical school graduates in American medicine: is there the “dark side of the moon”? Acta Obstet Gynecol Scand 2004; 83:1228-9. [PMID: 15548165 DOI: 10.1111/j.0001-6349.2004.0452a.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shipman SA, Lurie JD, Goodman DC. The general pediatrician: projecting future workforce supply and requirements. Pediatrics 2004; 113:435-42. [PMID: 14993531 DOI: 10.1542/peds.113.3.435] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Trends affecting both the supply and requirements of child health physicians call into question earlier assessments about the adequacy of the general pediatric workforce. To understand the effects of these trends over time, we developed a model that projects the national supply of practicing general pediatricians over a 20-year period (2000-2020). DESIGN The model incorporates current data on the practicing pediatrician workforce in the United States, pediatric residency graduates entering general pediatrics, and gender- and age-specific measures of productivity and of retirement or death. In addition, it accounts for projected changes in the size and ethnicity of the child population and the proportion of children currently receiving outpatient care from family practitioners. MAIN OUTCOME MEASURES Time trend of the supply of general pediatricians and the number of children in the population per practicing pediatrician. RESULTS The baseline model projects that the number of general pediatricians will expand by nearly 25 000 by the year 2020, a 64% increase from the year 2000, whereas the child population is projected to expand by only 9%. The increase was robust to sensitivity analyses measuring the impact of each of the model's variables on the future supply of pediatricians. In all probable scenarios, the general pediatrician workforce will expand significantly more rapidly than the child population. In addition, the trend in pediatrics is in marked contrast to the other primary care specialties. CONCLUSIONS Despite a number of factors that might attenuate the growth of the general pediatrician workforce, none seems sufficient to slow its expansion in relation to the pediatric population. To maintain practice volumes comparable to today, pediatricians of the future may need to provide expanded services to the children currently under their care, expand their patient population to include young adults, and/or compete for a greater share of children currently cared for by nonpediatricians.
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Affiliation(s)
- Scott A Shipman
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon 97201, USA.
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Kuczkowski KM. Pursuing your American (medical) dream: a "stairway to heaven?" or not? Acta Anaesthesiol Scand 2004; 48:257. [PMID: 14995953 DOI: 10.1111/j.0001-5172.2004.00295c.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hagopian A, Thompson MJ, Kaltenbach E, Hart LG. The Role of International Medical Graduates in America's Small Rural Critical Access Hospitals. J Rural Health 2004; 20:52-8. [PMID: 14974436 DOI: 10.1111/j.1748-0361.2004.tb00007.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. PURPOSE This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. METHODS Chief executive officers (CEOs) of CAH facilities answered a telephone survey on their use of IMGs and the characteristics of those IMGs in winter 2002 (388 responded, for a 96% response rate). This descriptive report presents roles and characteristics of IMGs in CAH facilities and the opinions of the CEOs about these practitioners. FINDINGS Overall, 1 (24%) in 4 admitting physicians in CAHs are graduates of non-US medical schools (compared with 23% of physicians nationally), although the rates are higher for CAHs in persistent poverty counties, CAHs that report recruitment problems, and CAHs with smaller medical staffs. Hospitals east of the Mississippi River are more heavily reliant on IMGs than hospitals in the west. Most IMGs are internists (59%) and most (61%) come from India, the Philippines, or Pakistan. Hospital administrators rate the clinical skills of their IMGs highly and their interpersonal skills only slightly lower. Almost half of CAH administrators said their communities recruited their first IMGs during or after 1994, the year of pro-IMG legislative changes. CONCLUSION IMG physicians play a significant and possibly growing role in staffing CAHs.
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Affiliation(s)
- Amy Hagopian
- Department of Family Medicine, University of Washington's WWAMI, Rural Health Research Center, University of Washington School of Public Health and Community Medicine, Seattle, Wash., USA.
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Abstract
Despite suggestive evidence, there has been no adequately powered systematic study of the ways in which marital status influences health care consumption. Using a novel data set of 609016 newly diagnosed, seriously ill elderly individuals in the USA, and employing hierarchical linear models, we look at differences in the experience of hospitalization as a function of marital status. We find that the married consistently use higher quality hospitals and have shorter lengths of stay. On the other hand, the married and the widowed appear to receive similar quality care once they are in the hospital. Marital status thus has a substantial impact on the health care obtained by the elderly. We suggest that these patterns are most consistent with spouses exerting their benefits by functioning as higher-order decision-makers than as home health assistants.
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Affiliation(s)
- Theodore J Iwashyna
- Department of Medicine, Hospital of the University of Pennsylvania, Pennsylvania, PA, USA.
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Abstract
There has been sentiment against international medical graduates (IMGs) that could lead to a reduction in their future supply within the US. In this study, an analytical framework is proposed to illustrate the many issues that need to be considered in replacing IMGs in rural, needy areas. To learn about possible approaches to IMG replacement, interviews with 15 recruiters and planners at the local, regional and state levels in four states with strong IMG concentrations were conducted. Through analysis of participants' comments, this study shows that every posited solution to replacing IMGs has serious flaws.
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Affiliation(s)
- Leonard D Baer
- Department of Geography, Lancaster University, Lancaster LA1 4YB, UK.
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Jackson J, Shannon CK, Pathman DE, Mason E, Nemitz JW. A comparative assessment of West Virginia's financial incentive programs for rural physicians. J Rural Health 2003; 19 Suppl:329-39. [PMID: 14526516 DOI: 10.1111/j.1748-0361.2003.tb01052.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Financial incentive programs are increasingly being used as a strategy to recruit physicians to underserved rural areas. Critical evaluation of state-supported programs is often lacking but is necessary to determine their efficacy and to improve outcomes. PURPOSE The purpose of this study was to assess 4 service-contingent programs in West Virginia, a state with critical physician shortages. METHODS Survey instruments were developed to evaluate the effectiveness of these programs and to document the practice environments and career paths of obligated allopathic and osteopathic physicians compared with a control group of nonobligated rural practitioners. Data were also collected from physicians who were recipients of multiple incentive programs and from obligated physicians who had defaulted. FINDINGS Responses from more than 60% of surveyed physicians indicated that the typical respondent was a married white male who was a midcareer family practice physician. Obligated physicians were more likely than nonobligated physicians to have graduated from a West Virginia medical school and residency program, to be influenced by financial factors in their career decisions, to provide care to uninsured patients, and to work in offices that offered sliding fee scales. Both groups of physicians demonstrated similar retention patterns, reported a high degree of job satisfaction, and expressed a need for more practice management training. CONCLUSIONS Although these financial incentive programs were found to be effective in recruiting primary care physicians to medically underserved areas of the state, the financial support of these programs was found to be too modest, and improved marketing of the programs was indicated.
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Affiliation(s)
- Jodie Jackson
- West Virginia University Office of Rural Health, PO Box 9003, Morgantown, WV 26506-9003, USA.
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Fink KS, Phillips RL, Fryer GE, Koehn N. International medical graduates and the primary care workforce for rural underserved areas. Health Aff (Millwood) 2003; 22:255-62. [PMID: 12674429 DOI: 10.1377/hlthaff.22.2.255] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The proportion of international medical graduates (IMGs) serving as primary care physicians in rural underserved areas (RUAs) has important policy implications. We analyzed the 2000 American Medical Association Masterfile and Area Resource File to calculate the percentage of primary care IMGs, relative to U.S. medical graduates (USMGs), working in RUAs. We found that 2.1 percent of both primary care USMGs and IMGs were in RUAs, where USMGs were more likely to be family physicians but less likely to be internists or pediatricians. IMGs appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs.
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Affiliation(s)
- Kenneth S Fink
- Department of Family Medicine, University of North Carolina at Chapel Hill, USA
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Christakis NA, Iwashyna TJ, Zhang JX. Care after the onset of serious illness: a novel claims-based dataset exploiting substantial cross-set linkages to study end-of-life care. J Palliat Med 2003; 5:515-29. [PMID: 12243676 DOI: 10.1089/109662102760269751] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To date, there has not been a study using a large, nationally representative group of patients with serious illness who are at risk for hospice use and who are followed forward in time to understand the determinants of hospice use. In this paper, we outline the development of a large new cohort of 1,221,153 Medicare beneficiaries newly diagnosed with 1 of 13 serious conditions in 1993, a cohort that can be used to study end-of-life care in the United States. In describing our methods, we illustrate the possible utility of Medicare claims for end-of-life research. The members of our cohort are followed forward for hospice and other health care use through December 1997, and for mortality through June 1999. Medicare claims data on their inpatient and outpatient hospital use is also collected. Based on the ZIP Codes and counties in which cohort members lived, we were also able to characterize the health care markets of cohort members, as well as obtain other socioeconomic information about them. Information about cohort member's health care providers is also available. Detailed health information about cohort members' spouses was also collected. We conclude by highlighting the types of analyses that can be conducted in this data set.
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Affiliation(s)
- Nicholas A Christakis
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Iwashyna TJ, Chang VW, Zhang JX, Christakis NA. The lack of effect of market structure on hospice use. Health Serv Res 2002; 37:1531-51. [PMID: 12546285 PMCID: PMC1464044 DOI: 10.1111/1475-6773.10562] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the relative importance of health care market structure and county-level demographics in determining rates of hospice use. DATA SOURCES Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data. STUDY DESIGN Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared. DATA COLLECTION METHODS The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims. PRINCIPAL FINDINGS There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists. CONCLUSIONS Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts.
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Shemin RJ, Dziuban SW, Kaiser LR, Lowe JE, Nugent WC, Oz MC, Turney DA, Wallace JK. Thoracic surgery workforce: snapshot at the end of the twentieth century and implications for the new millennium. Ann Thorac Surg 2002; 73:2014-32. [PMID: 12078824 DOI: 10.1016/s0003-4975(02)03585-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND An appropriately sized physician workforce is an essential component for healthcare planning. Contemporary economic forces and the impact of managed care have stimulated renewed interest in understanding and monitoring workforce issues. METHODS Between August and December of 1999, the Workforce Committee of the American Association for Thoracic Surgery and The Society of Thoracic Surgeons conducted a survey detailing demographic, geographic, and socioeconomic practice characteristics of the membership. RESULTS The 2,515 returned surveys represented a 62.6% return rate (+/- 1.6% margin of error), providing a highly statistically valid sample. Active thoracic surgeons are a mean of 50 years old, 98% men, with a high level of career satisfaction. Length of training and educational debt has been escalating. Adult cardiac surgical case volumes have increased (mean, 225 cases) and 52% of adult cardiac surgeons perform general thoracic procedures. Surgeons work 67 hours/week and 47 weeks/year. Most are organized in single specialty groups (50%) in urban areas (59%) as for-profit corporations (77%). Half of the respondents will be retired a mean of 13 years from now corresponding to a median calendar year of 2011. CONCLUSIONS This survey highlights significant workforce retirement during the next 10 to 15 years. Currently, the workforce in thoracic surgery appears "right sized." These valuable data provide a profile of the specialty. The information enhances our ability to strategically plan.
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Affiliation(s)
- Richard J Shemin
- Department of Cardiothoracic Surgery, Boston Medical Center, Massachusetts 02118, USA.
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Pan RJ, Cull WL, Brotherton SE. Pediatric residents' career intentions: data from the leading edge of the pediatrician workforce. Pediatrics 2002; 109:182-8. [PMID: 11826193 DOI: 10.1542/peds.109.2.182] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Richard J Pan
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California 95817, USA.
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Abstract
BACKGROUND The professional standards of international medical graduates have been the subject of controversy, but empirical research on this topic has been limited. OBJECTIVES This report considers whether international medical graduates are at greater risk than US medical graduates for exclusion by the federal government from federally funded programs, such as Medicare and Medicaid. RESEARCH DESIGN The list of excluded physicians was merged with data regarding 87,729 family and general practice physicians from the American Medical Association Physician Masterfile, 555 of whom were currently excluded. Logistic regression was used to estimate the effect of international medical graduate status on the probability of exclusion, controlling for board-certification status and other physician characteristics. International medical graduates from high-income Organization for Economic Cooperation and Development (OECD) countries are distinguished from other international medical graduates. RESULTS The adjusted exclusion rates of international medical graduates from OECD countries were similar to that of US medical graduates. Among board-certified physicians, the relative risk of exclusion of non-OECD international medical graduates was 2.19 (P <0.001) compared with US medical graduates. Board certification had an even stronger association: US medical graduates who had never been board certified had a relative risk of 4.12 (P <0.001) compared with board-certified US medical graduates. The never board-certified relative risk was 1.72 (P <0.001) among non-OECD international medical graduates compared with board-certified graduates. Among physicians who had never been board certified, rates of US and international medical graduates did not differ substantially. CONCLUSIONS Further investigation is needed regarding the causal determinants of exclusion disparities. It is unclear to what extent these disparities may reflect differences in ethical conduct, quality of care, or prejudicial enforcement practices, and the extent to which board certification can causally reduce actions leading to exclusion.
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Affiliation(s)
- William H Dow
- Department of Health Policy and Administration, University of North Carolina, Chapel Hill, North Carolina 27599, USA
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Mick SS, Lee SY, Wodchis WP. Variations in geographical distribution of foreign and domestically trained physicians in the United States: 'safety nets' or 'surplus exacerbation'? Soc Sci Med 2000; 50:185-202. [PMID: 10619689 DOI: 10.1016/s0277-9536(99)00183-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the United States, a debate has existed for decades about whether foreign-trained physicians (known in the US as 'international medical graduates' or 'IMGs') and US medical graduates (USMGs) have been differentially distributed such that IMGs were more likely to be found in locales characterized as high in need or medical underservice. This 'safety net' hypothesis has been countered by the IMG 'surplus exacerbation' argument that IMGs have simply swelled an already abundant supply of physicians without any disproportionate service to areas in need. Through an analysis of the American Medical Association Physician Masterfile and the Area Resource File, we classified post-resident IMGs and USMGs into low and high need counties in each of the US states, compared the percentage distributions, and determined whether IMGs were found disproportionately in high need or underserved counties. Using four measures (infant mortality rate, socio-economic status, proportion non-white population, and rural county designation), we show that there were consistently more states having IMG disproportions than USMG disproportions. The magnitude of the differences was greater for IMGs than for USMGs, and there was a correlation between IMG disproportions and low doctor/100,000 population ratios. These findings are shown to exist simultaneously with two empirical facts: first, not all IMGs were located in high new or underserved counties; second, IMGs were more likely than USMGs to be located in states with a large number of physicians. The juxtaposition of an IMG presence in 'safety net' locales and of IMGs' contribution to a physician abundance is discussed within the context of the current debate about a US physician 'surplus' and initiatives to reduce the number of IMGs in residency training.
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Affiliation(s)
- S S Mick
- Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond 23298, USA.
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Cromwell J. Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 1999; 24:1331-1361. [PMID: 10626695 DOI: 10.1215/03616878-24-6-1331] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.
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Mick SS, Lee SY. Are there need-based geographical differences between international medical graduates and U.S. medical graduates in rural U.S. counties? J Rural Health 1999; 15:26-43. [PMID: 10437329 DOI: 10.1111/j.1748-0361.1999.tb00596.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objectives of this study are to compare the rural location of international medical graduates (IMGs) and U.S. medical graduates (USMGs) by specialty (primary care vs. specialty care) according to geographical measures of need. This study utilized a cross-sectional survey using the 1997 American Medical Association Physician Masterfile for all active post-resident allopathic physicians and the Area Resource File (ARF) (Bureau of Health Professions, 1996) for all active post-resident osteopathic physicians in 1995 in the rural U.S. physician work force (N = 69,065). Allopathic physician ZIP code location was matched to county data using the ARF. The key measure was the difference in proportions between USMGs and IMGs in each state's rural counties characterized by need: high infant mortality, low socioeconomic status, high proportion of nonwhite population, high proportion of population 65 years and older, and low physician-to-population ratio. Primary care and specialty care rural physicians were studied separately. A disproportion of IMGs were located in needy rural counties of more states than were USMGs. Further, IMG disproportions were generally larger than USMG disproportions when they existed. Disproportions of IMGs tended to be located more often in the central and south census regions. Disproportions of specialty care IMGs were more frequent and of greater magnitude than those of primary care IMGs. Variations in the relative and absolute numbers of IMGs and USMGs among the states was wide. Services delivered by active post-resident primary care and specialty care IMGs appeared to be disproportionate to their overall number compared with USMGs in numerous needy rural counties. The extent of the IMG "safety net" presence differed, however, by the criteria used. Still, proposed limits on IMG entry into U.S. residency training may create long-term problems of access to rural physician services absent policies to induce USMGs or midlevel practitioners to locate in such areas. State-by-state assessments of the potential impact of IMG restrictions are called for because of the wide state-level variation that existed in comparative IMG-USMG distributions.
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Affiliation(s)
- S S Mick
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA
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Mick SS, Sutnick AI. International medical graduates in rural America: the 1987 distribution of physicians who entered the U.S. medical system between 1969 and 1982. J Rural Health 1999; 12:423-31. [PMID: 10166138 DOI: 10.1111/j.1748-0361.1996.tb00809.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines the differential location on Dec. 31, 1987, in nonmetropolitan U.S. counties of a cohort of international medical graduates (IMGs) (n = 246,754) certified by the Educational Commission for Foreign Medical Graduates between 1969 and 1982, and a matched group of U.S. medical graduates (USMGs). Analysis of counties grouped into categories of population size revealed disparities across certain U.S. census divisions. IMGs were distributed disproportionately in the West North Central and East South Central census divisions. The implications of the IMG presence in numerous rural counties is discussed from the perspective of recent policy proposals to reduce the number of IMGs in the United States.
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Affiliation(s)
- S S Mick
- School of Public Health, University of Michigan, Ann Arbor 48109, USA
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Affiliation(s)
- M L Rivo
- PCA Health Plans of Florida, Miami 33126, USA
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Smith JJ. Legal implications of specialty board certification. THE JOURNAL OF LEGAL MEDICINE 1996; 17:73-111. [PMID: 8882798 DOI: 10.1080/01947649609511000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J J Smith
- Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA
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Whitcomb ME. Correcting the oversupply of specialists by limiting residencies for graduates of foreign medical schools. N Engl J Med 1995; 333:454-6. [PMID: 7616998 DOI: 10.1056/nejm199508173330712] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M E Whitcomb
- Association of American Medical Colleges, Washington, DC 20037, USA
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