Barbara Barzansky, Ph.D., and Sylvia I. Etzel, of the American Medical Association, Chicago, examined the status of a number of variables related to medical education that represent areas that recently have been in flux or have potential impact on health care delivery. The study compared selected results of the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire between 2004-2005 and 1994-1995. The questionnaire was sent to the deans of all 125 LCME-accredited medical schools. The response rate was 100 percent in both years.
The authors found that the number of medical students in 1994-1995 and in 2004-2005 remained constant, at about 67,000. The number of full-time faculty members increased from 90,016 in 1994-1995 to 119,025 in 2004-2005 (a 32 percent increase). In 2004-2005, 68 percent of all first-year medical students were residents of the state in which the medical school is located and an average of 43 percent of 2005 graduates remained in the same state as the medical school for graduate medical education; results were similar in 1995. In 2004-2005, night call was less common in the family medicine, internal medicine, pediatrics, and psychiatry clerkships compared with 1994-1995.
"A number of factors may have contributed to this increase [in faculty size]. Some disciplines, such as genetics and emergency medicine, increased well beyond the average, perhaps indicating a newly-defined need for this expertise for patient care or research. In addition, during 2002-2003 medical schools derived 35.9 percent of their total revenue from faculty practice and 32.6 percent from grants and contracts (including direct and facilities/administrative costs). Maintaining these revenue streams requires considerable faculty effort and has provided some of the impetus to increase the size of the faculty," the authors write.
"Many of the variables that we have examined, including faculty size and the geographic pipeline into medical school and residency training, may be affected by factors external to the medical school. Understanding these interrelationships will be critical in addressing important issues in medical education and health care today and in the future," the authors conclude.
(JAMA. 2005; 294:1068 - 1074. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This research was funded solely by the American Medical Association, which employs Dr. Barzansky and Ms. Etzel.
Record Number of Residents and Fellows in Training Programs
There are more than 100,000 physicians-in-training in the U.S., the highest recorded amount, according to an article in this issue of JAMA.
Over the last decade, the primary care specialties have experienced an ebb and flow in popularity, according to background information in the article. A description of the future primary care workforce could help plan for the health care needs of the population.
Sarah E. Brotherton, Ph.D., of the American Medical Association, Chicago, and colleagues examined graduate medical education data from the past 9 years to determine the major trends among residents in family medicine, internal medicine, pediatrics, combined internal medicine/pediatrics programs, and obstetrics/gynecology. They also examined trends in fellows training in Accreditation Council for Graduate Medical Education (ACGME)-accredited subspecialties of internal medicine and pediatrics.
The study of the National GME Census, conducted by the American Medical Association and Association of American Medical Colleges, included survey data from 8,246 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 percent of active residents. The accompanying program survey was completed by 7,163 (87 percent) of the program directors.
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 5,838 in 2003-2004 to 5,675, 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 U.S. allopathic medical schools (USMDs) has fallen from 8,232 (77.6 percent) in 1998-1999 to 4,848 (51.7 percent) in 2004-2005. The number of primary care residents who are graduates of foreign medical schools and U.S. citizens (USIMGs) nearly doubled between 1995-1996 (n = 1,768) and 2004-2005 (n = 3,304).
The number of USIMGs training in internal medicine or pediatrics subspecialties increased by 45.7 percent between 1995-1996 (n = 622) and 2004-2005 (n = 906). The number of pediatric subspecialty fellows grew 55.7 percent, mostly because of the near doubling of USMDs, from 813 to 1,617. More than half of primary care residents are women (52.5 percent). 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 percent (57.9 percent in 1995-1996 vs. 74.5 percent in 2004-2005).
"There are now more than 100,000 physicians training in ACGME-accredited programs. An increasing proportion of these physicians are pursuing subspecialty training, while the number in primary care specialties has leveled off after a period of popularity in the mid 1990s. The trends we describe suggest that the primary care medical workforce of the future will include more women, more IMGs, and more DOs, information which may inform the current discussions about physician workforce needs," the authors conclude.
(JAMA. 2005; 294:1075–1082. Available pre-embargo to the media at www.jamamedia.org.)
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JAMA