Related Topics: Research

Medicare, Graduate Medical Education, and New Policy Directions
John Iglehart, New England Journal of Medicine, August 2008
"It has been more than a decade since Congress enacted legislation that significiantly altered the policies under which Medicare supports graduate medical education (GME). Now, the political ground under this relationship is beginning to gradually shift again, and if this development gathers momentum, it could lead to greateer support for the training of primary care physicians." Read more... (Read the Medicare Payment Advisory Committee (MedPAC) response to this article here.)

Efforts to Expand Physician Supply Deserve Scrutiny
Laurence Baker, PhD, Health Services Research, August 2008
"Efforts to expand physician supply reflect a variety of factors including
concerns about potential doctor shortages as the population grows and ages, the hope that more physicians will help address concerns about quality of care, and the view that adding to the pool of physicians could help address the fact that physicians are currently not well distributed around the country. While these efforts may be well intentioned, they deserve considerable scrutiny, as there are many reasons to be concerned that expansions of supply that are not
carefully considered may not meet their stated goals." Read More...

Humanism or Professionalism? The White Coat Ceremony and Medical Education
Judah L. Goldberg, MD, MA, Academic Medicine, August 2008
Distinguishing professionalism from humanism is crucial to understanding the divergent attitudes of providers and lay persons with regard to health care delivery and physician behavior. Moreover, it highlights the tension that medical students experience as they are
tacitly asked to leave behind their lay, humanistic values and embrace a new professional identity, a transition that the common blurring of humanism and professionalism fails to recognize. Read More...

Medical Students' Perceptions of the Poor: What Impact Can Medical Education Have?
Delese Wear, PhD and Mark G. Kuczewski, PhD, Academic Medicine, July 2008
"There is currently little knowledge or understanding of medical students' knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students' greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor." Read More...

Confronting the Complexity of the Workforce Equation
Darrell G. Kirch, MD and David J. Vernon, BA, Journal of the American Medical Association, June 2008
"The United States is a nation in which 47 million citizens have no health insurance, more than 16% of the country's gross domestic product is spent on rapidly increasing health costs, and stark disparities exist in health care access, exemplified by 20% of the population currently residing in federally designated health professional shortage areas. These formidable challenges have led to renewed interest in reforming the health care system while engendering intense debate among policy makers and politicians." Read More...

Grassroots Activism and the Pursuit of an Expanded Physician Supply
John K. Iglehart, New England Journal of Medicine, April 2008
"Heeding reports from an array of interests that a shortage of physicians looms nationally and already exists in some locales and in many specialties, allopathic and osteopathic schools of medicine have begun to increase the size of their first-year classes, and new schools are being developed to educate more students. As an early result, the total number of students entering U.S. medical and osteopathic schools last September was the largest in their history." Read More...

Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription
David C. Goodman, MD and Elliot S. Fisher, MD, MPH, New England Journal of Medicine, April 2008
"Despite the fact that there are now more physicians per capita in the United States than there have been for at least 50 years, the Council on Graduate Medical Education (COGME) recently predicted a 10% shortfall of physicians by 2020. Public concern about access to care, reports of difficulties in recruiting physicians in many specialties, and discussion of the looming collapse of primary care all contribute to the sense of crisis. " Read More...

The Health Workforce: A Position Statement
Jay L. Grosfeld, MD et al., Annals of Surgery, October 2007
"The Symposium on workforce April 27, 2007, during the 127th annual meeting of the American Surgical Association (ASA) is published in this issue of the Annals of Surgery. The Council of the American Surgical Association believes this adds considerable support to the growing evidence of a substantial health workforce shortage." Read More...

Surgical Workforce Since the 1975 Study of Surgical Services in the United States
George F. Sheldon, MD, Annals of Surgery, October 2007
"The Flexner Report in 1910 was the first workforce study of the modern era. In 1900 there were 160 medical schools graduating 5214 students. They were the survivors of 457 schools that dotted the landscape with medical schools in the 19th century, especially in the midwestern region of the United States. In the late 19th century, the United States was producing nearly half of the world's medical graduates." Read More...

Medicine Cut off From Its Roots: Context Matters in Medical Education
Richard J. Baron, Health Affairs, September/October 2008
"The values and rewards that animate community practice are not clearly visible to those in traditional medical training programs. Flexnerian education explicitly chose to exclude practitioners in favor of full-time faculties." Read More...

US Residency Training Before and After the 1997 Balanced Budget Act
Edward Salsberg, MPA et al., Journal of the American Medical Association, September 10, 2008
"In 1997, the Balanced Budget Act (BBA) capped the number of residents and fellows that the federal Medicare program—the single largest source of funding for GME—would support. Prior to the BBA, the number of physicians training in residency programs had been increasing for many years. Given the central role of Medicare funding in supporting GME, many observers presumed that the Medicare freeze in funded positions would limit growth in the number of residents and fellows." Read More...

Assessing Students for Medical School Admissions: Is It Time for a New Approach?
Robert J. Sternberg, PhD, Academic Medicine, October Supplement, 2008
"Our methods for admitting students, whether to medical school or even to undergraduate and graduate school, are rather archaic. We use tests that we know are only modestly to moderately predictive of success in medical school and that measure content that covers only a small fraction of the skills necessary for success as a medical professional. Might there be more effective ways of devising devices to help us make decisions in admissions situations?" Read More...

The Educational Realities of Increasing Medical School Class Size
Giulia Bonaminio et al., Academic Medicine, October Supplement 2008
"Increasing the U.S. medical student pool by 30% has been discussed as a solution to the physician shortage. Currently, many schools are increasing class size or adding new campuses, and 12 new medical schools are under construction. These changes represent a large commitment of resources, both in terms of initial outlays and ongoing obligations. However, little discussion has ensued about how quality standards will be assessed and maintained or how the medical educational infrastructure will accommodate the increases, either initially or as the students progress through the pipeline." Read More...

Medical Education in the Caribbean: Variability in Medical School Programs and Performance of Students
Marta van Zanten and John R. Boulet, Academic Medicine, October Supplement 2008
"Often, Caribbean medical schools are viewed as a single entity, ignoring the variability in training programs and performance of students. The purpose of this study is to follow up on previous research by describing the variability of educational experiences, structure and oversight of medical schools, and performance of students who attended medical schools in the region." Read More...

Health Care Reform and the Presidential Candidates
New England Journal of Medicine, October 9, 2008
"The editors asked Senator John McCain, the Republican presidential nominee, and Senator Barack Obama, the Democratic presidential nominee, to describe their plans for reforming the U.S. health care system." Read More...

Perspective Roundtable: Election 2008 - Health Care in the Next Administration
New England Journal of Medicine, October 9, 2008

States With More Physicians Have Better Quality Health Care
Richard Cooper, Health Affairs Web Exclusive, December 4, 2008
"As efforts begin to expand the physician workforce in response to deepening shortages of physicians, attention has focused on the value of what physicians do. There is a widely held belief that states with more specialists have poorer-quality health care, while quality is better in states with more family physicians. This is myth." Read More...

States with More Health Care Spending Have Better Quality Health Care: Lessons about Medicare
Richard Cooper, Health Affairs Web Exclusive, December 4, 2008
"Based on broad measures of health system quality and performance, states with more total health spending per capita have better-quality care. This fact contrasts with a previous finding that states with higher Medicare spending per enrollee have poorer-quality care." Read More...

Cooper's Analysis is Incorrect
Katherine Baicker and Amitabh Chandra, Health Affairs Web Exclusive, December 4, 2008
"In his papers, Richard Cooper finds positive associations between health care quality and both specialist and generalist physicians, but he misinterprets his results. Instead of undermining the findings of our study, which found higher quality in areas with more generalists relative to specialists, his results bolster ours: they suggest that the effect of generalists on quality is ten times larger than that of specialists." Read More...

The Elusive Connection Between Health Care Spending and Quality
Jonathan Skinner et al., Health Affairs Web Exclusive, December 4, 2008
"Richard Cooper has shown a positive association between health care quality and "total spending" at the state level, but he does not appear to understand the limitations of this total spending measure; simply adjusting for median age causes the significant positive correlation to disappear. Cooper also finds that some third factor--we think that it is "social capital"--is the key to explaining health care quality." Read More...

More is More and Less is Less: The Case of Mississippi
Richard Cooper, Health Affairs Web Exclusive, December 4, 2008
"One can't help but admire the vigor with which some members of the Dartmouth group defend their core belief that "more is less." But polemics aside, some questions still linger." Read More...

Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education
John Iglehart, New England Journal of Medicine, December 3, 2008
"On December 2, about 5 years after the Accreditation Council for Graduate Medical Education (ACGME) imposed national limits on the duty hours of medical residents, the Institute of Medicine (IOM) issued a report recommending that further measures be taken to ensure that hospitals provide safer conditions for patients and trainees while maintaining rigorous teaching programs." Read More...

Perspective: Competency-Based Medical Education: A Defense Against the Four Horsemen of the Medical Education Apocalypse
Mark Albanese et al., Academic Medicine, December 2008
"Medical education is facing a convergence of challenges that the authors characterize as the four horsemen of the medical education apocalypse: teaching patient shortages, teacher shortages, conflicting systems, and financial problems." Read More...

The Schism Between Medical and Public Health Education: A Historical Perspective
A.R. Ruis and Robert Golden, Academic Medicine, December 2008
"The separation of "medicine" and "public health" in academic institutions limits the potential synergies that an integrated educational model could offer. The roots of this separation are deeply imbedded in history. During the past two centuries, there have been repeated efforts to integrate public health education into the core training of physicians, usually in response to a perceived short-term crisis, and without widespread, lasting success." Read More…

Doctors, Dollars and Quality
Health Affairs Web Exclusive, December 4, 2008
"Does the United States have enough doctors, given the enormous demand for health care and forecasts about a future filled with aging and chronically ill baby boomers? And do we have the right mix of doctors--since specialists "cost" more to produce than general practitioners, are paid more under current reimbursement systems, and prescribe more health care to boot?" Read More...

Medical School Enrollment Is Up But Still Falls Short Of Meeting Need
Journal of the American Medical Association, December 17, 2008
"Steady increases in enrollment have pushed the number of first-year students in US allopathic medical schools past 18 000 for the first time, according to new figures from the Association of American Medical Colleges (AAMC). Although the growth includes a substantial increase in Latino medical students, experts caution that growing enrollment is not the only answer to meeting future patient care needs, in terms of the number and diversity of physicians." Read More…

The Physician as Public Health Professional in the 21st Century
Journal of the American Medical Association, December 24/31, 2008
"For their part, medical schools need to accept students who are best oriented to address the health problems facing the population. With few exceptions, requirements for medical school matriculation have not changed for decades. The need also exists to establish a viable and steady stream of medical school applicants from underserved communities." Read More…

Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration
The Dartmouth Institute for Health Policy and Clinical Practice, December 17, 2008
"This paper discusses opportunities for Congress and the Obama Administration to address key shortcomings in our health care system that result in unwarranted geographic variation and uncontrolled growth in health care spending. Success in this effort will not only improve the quality of care, it will make it possible to extend coverage to America's uninsured without inducing a major increase in health care spending." Read More...

Great Expectations – The Obama Administration and Health Care Reform
New England Journal of Medicine, January 22, 2009
"Health care reform is back. For the first time since 1993, momentum is building for policies that would move the United States toward universal health insurance. President Barack Obama has made health care a central part of his domestic agenda, and key members of Congress have promised to introduce ambitious health care reform legislation in 2009. Groups long opposed to reform, including the insurance industry, are reportedly prepared to make a deal. There is thus growing sentiment that "the prospects for meaningful health care reform have never looked better." Read More…

Health Care and the American Recovery and Reinvestment Act
Robert Steinbrook, M.D., New England Journal of Medicine, February 17, 2009
"On February 17, 2009, four weeks after his inauguration, President Barack Obama signed into law a $787 billion economic stimulus package. The act also provides $650 million to support prevention and wellness activities…including $300 million to revitalize the National Health Service Corps (NHSC). The NHSC provides loan repayment, salary support, and scholarships for physicians and other providers who practice in underserved areas." Read More…

Report: Growth of Medical Schools Brings Opportunity to Redefine Their Mission
March 18, 2009 – Journal of the American Medical Association
Medical schools in the United States are not doing enough to find the right students to train for careers in medicine and are not adequately addressing the needs of a diversifying patient population. However, the current environment of expansion of US medical school slots provides an opportune moment to address these issues. So said medical education experts in a report, Revisiting the Medical School Educational Mission at a Time of Expansion, released January 29 by the Josiah Macy, Jr. Foundation." Read More…

A Single Mission for Academic Medicine: Improving Health
Paul G. Ramsey, MD and Edward D. Miller, MD Journal of the American Medical Association, April 8, 2009
"It is time for academic medicine to return to its historic roots by focusing on the long-established mission of improving the health of the public. Academic medicine can do this by uniting and integrating its unique strengths—excellence in education, research, and clinical care—within an administrative structure that encourages and facilitates the use of all resources to support the mission of improving health. The administrative structure that best accomplishes this goal is an integrated health system in which the school of medicine, hospital(s), and research enterprise are within a single integrated structure with strategic planning occurring in all 3 activities and with the ultimate goal of improving the health of the public." Read More…

The Ethical Foundations of American Medicine
Darrell G. Kirch, MD and David J. Vernon, MD, Journal of the American Medical Association, April 8, 2009
"Following a historic electoral transition accompanied by an economic downturn unprecedented in the lives of most US residents, attention has once again turned to improving the cost and effectiveness of health care in the United States. While many have described the dysfunctional aspects of the US health care system, the focus has prioritized issues of payment systems2 and delivery models3 over a fundamental underlying ethical conflict. Within an ethical context, it is important to discuss how the commercialization of medicine has fostered a distortion of emphasis among the basic tenets of medical ethics, and how this unbalanced emphasis has created serious barriers to improving the health care system." Read More…

The Struggle for Reform – Challenges and Hopes for Comprehensive Health Care Legislation
April 23, 2009 – New England Journal of Medicine
"Undaunted by a soaring federal deficit, competing legislative priorities, and skeptical Republicans, leading Democrats are relentlessly pursuing health care reform, as they hold hearings, engage key stakeholders, plot strategy, and draft legislation. Five congressional committees — two in the Senate and three in the House — are at work on major reform legislation. While underscoring his administration's strong support for reform, President Barack Obama has emphasized his preference that Congress lead in crafting a measure aimed at expanding coverage, improving care delivery, and constraining the growth of health care spending." Read More...

Commentary: Aging in America: Meeting the Needs of Older Americans and the Crisis in Geriatrics
Academic Medicine - May 2009
"The aging of the United States population will offer unprecedented challenges and opportunities for the health care system at large, and particularly medical education. In this issue of Academic Medicine, three articles provide opportunities for medical educators and others to ponder anew how we can address this so-called age wave as the baby boomers become senior boomers."
Click here to read more of this letter.
Click here to see other articles on geriatrics in this issue of Academic Medicine.

An Open Letter to All Graduating Medical Students
Academic Medicine - May 2009
"The months of May and June are exciting times at many medical schools around the world as faculty prepare to anoint the next generation of physicians with a formal medical degree, and students prepare to make the transition to doctor. I wish to celebrate this juncture with the following letter." Read More…

The Separate Osteopathic Medical Education Pathway: Uniquely Addressing National Needs
Candice Chen, MD MPH and Fitzhugh Mullan, MD, Academic Medicine, June 2009
"As we reconsider the U.S. health care system, the osteopathic educational tradition should be recognized for the contribution it has made and continues to make to the physician workforce in primary care and underserved areas. The structure of today's osteopathic medical schools may be hard to distinguish from that of their allopathic counterparts, but the output of osteopathic schools remains clearly distinctive, and the nation's health care system benefits as a result." Read More…

The Separate Osteopathic Medical Education Pathway: Isn't It Time We Got Our Acts Together?
Jordan Cohen, MD, Academic Medicine, June 2009
"Those who wish to sustain the historic dichotomy between these two increasingly convergent medical professions point to the osteopathic profession's avowed commitment to primary care and to patient-centered, holistic care. To my mind, this is a distinction without a difference. After all, the calls for more attention to primary care and to patient-centeredness are as loud in the halls of allopathic medicine as anywhere." Read More…

Factors Affecting Specialty Choice Among Osteopathic Medical Students
Howard Teitelbaum, DO PhD MPH, Nat Ehrlich, MD, and Lisa Davis, MS, Academic Medicine, June 2009
"Worldwide, there has been a trend away from primary care by both allopathic and osteopathic medical school graduates in recent years. This is a cause for concern, because the availability of primary care directly and favorably affects the health status of local communities, socioeconomic regions, and countries. We carried out the research reported below to identify reliable predictors of students' choosing primary care as their specialty of choice." Read More…

Implementing Health Care Reform in Massachusetts: Strategic Lessons Learned
Jon Kingsdale, Health Affairs, May 28, 2009
"Massachusetts has been in continuous campaign mode on health reform since 2004, when then Gov. Mitt Romney (R) and advocacy groups from both parties began to promote universal coverage. The state has already enacted two sets of reforms (in 2006 and 2008), and it may soon consider an all-payer proposal aimed at containing costs. Much remains to be done, but the political strategy of enacting reform in stages has already produced big gains and momentum to do more." Read More…

Building Momentum as Democrats Forge Health Care Reform
John Iglehart, New England Journal of Medicine, May 14, 2009
"In the midst of dealing with countless challenges, both foreign and domestic, and a deep ideological divide in Congress, the Obama administration and its Democratic allies have nevertheless made important strides in their aggressive pursuit of health care reform legislation. In what President Barack Obama characterized as "a historic day, a watershed event in the long and elusive quest for health care reform," major organizations representing the nation's physicians, hospitals, health plans, and medical suppliers pledged to do their part to achieve the administration's goal of reducing by 1.5% annually the growth of health care spending over the next decade — saving an estimated $2 trillion." Read More…

Commitment to Care for the Community
Catherine DeAngelis MD, Journal of the American Medical Association, May 13, 2009
"With the variety of proposed solutions to the problem of so many Americans not having access to care, in this case primary care, the common theme is commitment to care for the community. This includes commitment by physicians and other clinicians to provide the kind of care they know is best for patients, commitment by all payers—private or public—to provide the resources needed for this care, and commitment by patients to pay for what they can and not to misuse the system that provides care for them. Some individuals might believe this effort to be a pipe dream, but without the commitments by all those involved, there will never be a health system in the United States to care for all who truly need it." Read More…

Commentary: Grow the National Health Service Corps
Jonathan Saxton MD and Micheal Johns MD, Journal of the American Medical Association, May 13, 2009
"President Barack Obama has called for the renewal and expansion of volunteerism and national service so that citizens everywhere can help address serious national challenges. This call has been embraced across the country and even across party lines. Both the US House of Representatives and the US Senate have responded with bipartisan legislation designed to encourage such service. This broad initiative presents the health professions with an extraordinary opportunity to renew health professions' basis in charity while modeling service, wellness, and chronic care programs essential to health care reform. The National Health Service Corps (NHSC) could be the best place to start." Read More…

Building Momentum as Democrats Forge Health Care Reform
John Iglehart, New England Journal of Medicine, June 4, 2009
"In the midst of dealing with countless challenges, both foreign and domestic, and a deep ideological divide in Congress, the Obama administration and its Democratic allies have nevertheless made important strides in their aggressive pursuit of health care reform legislation." Read More…

Congressional Action on Health Care Reform: An Update
John Iglehart, New England Journal of Medicine, June 18, 2009
"The pursuit of health care reform continues to gather steam, as Democrats, with a nudge from President Barack Obama, set an ambitious target for action — House and Senate passage of measures by July 31. At the same time, legislators intensified their discussions about how far the government should extend its regulatory reach into the health care system, and two new reports underscored the necessity of embedding cost-cutting policies in any reform proposal." Read More…

Sill Closing the Gap
July/August 2009 – Health Affairs
"In spite of the accomplishments of the safety net, we still have not closed the gap for many Americans. Equality in health remains an unfulfilled promise and is, in fact, much more complicated now than it was in 1965. Inequity in health care continues to plague not only blacks but numerous other people and communities around the country." Read More…

Efforts Under Way to Prepare Physicians to Care For Growing Elderly Population
Bridget Kuehn, Journal of the American Medical Association, August 19, 2009
"In 2008, the Institute of Medicine (IOM) recommended that all physicians develop competency in geriatrics to help them provide good care for the growing population of older individuals in the United States. Now leaders from a variety of medical specialties have drafted a roadmap for providing such training." Read More…
To read the white paper referenced in this article, click here.

Medical Student Perception of Education in Health Care Systems

Mitesh S. Patel, MD MBA et al., Academic Medicine, September 2009

"Undergraduate medical education has been criticized for not keeping pace with the increasing complexity of the U.S. health care system. The authors assessed medical students' perceptions of training in clinical decision making, clinical care, and the practice of medicine, and the degree to which the intensity of education in health care systems can affect perceptions." Read More…

The End of Fee-For-Service Medicine? Proposals for Payment Reform in Massachusetts
New England Journal of Medicine, September 10, 2009
"Health care reform has multiple goals, including expanding insurance coverage, improving quality and access to care, and controlling costs. Since Massachusetts enacted reforms in 2006, the proportion of residents lacking health insurance has decreased to an estimated 2.6% — the lowest of any state. However, there are continuing concerns about quality and access, and health care costs per capita remain among the highest in the United States. A special commission has therefore proposed that Massachusetts effectively end fee-for-service medicine, the predominant form of payment for health care services, and replace it with a system of global payments that combines the approaches of risk-adjusted capitation and pay for performance with a strong focus on primary care." Read More…

Regional Variation and the Affluence-Poverty Index
Journal of the American Medical Association, September 9, 2009
"As the nation embarks on health care reform, concerns have been raised that the United States is training too few physicians for the future. However, progress in responding has been stalemated by a broadly accepted view that there is unexplained geographic variation in both physician supply and health care spending and that correcting it could obviate the need for more physicians—indeed, that less care is a value that should be rewarded." Read More…

Medical Schools in the United States, 2008-2009
September 23/30, 2009 – Journal of the American Medical Association
"The following tables contain data derived mainly from the 2008-2009 Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire. The questionnaire was sent in February 2009 to the deans of all 126 LCME-accredited medical schools with enrolled students and had a 100% response rate. Each questionnaire was reviewed and attempts were made to verify information and obtain missing data. Data for years other than 2008-2009 were obtained from previous LCME Annual Medical School Questionnaires and other sources, as indicated." Read More…

Graduate Medical Education, 2008-2009
September 23/30, 2009 – Journal of the American Medical Association
"The American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) maintain a database of information on graduate medical education (GME) training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and of the residents and fellows in them. Every spring this database of residents is updated by adding to it the approximately 19 000 new residents who match into programs through the National Resident Matching Program (NRMP) as well as from information collected through the AAMC's follow-up report of medical schools." Read More…

Doctors as the Key to Health Care Reform
September 24, 2009 – New England Journal of Medicine
"Primary care is rapidly becoming an endangered specialty; an important, but not the only, reason is its relatively low economic rewards. A system like ours, which is grossly deficient in primary care physicians and dominated by specialists who are trained to use expensive tests and procedures, is inevitably costly, particularly when most specialists practice as independent small businesses, competing for patient referrals and for income." Read More…

Physicians' Beliefs and U.S. Health Care Reform – A National Survey
September 17, 2009 – New England Journal of Medicine
"Previous research suggests that physicians endorse a public role for the profession and believe they have an obligation to care for people with limited resources. But it remains unclear whether physicians in 2009 see participation in the formation of health policy as part of their professional responsibility or accept the potential consequences of reform." Read More…

Disruption and Innovation in Health Care
Robert Brook, PhD, Journal of the American Medical Association, October 7, 2009
Successful health care reform may provide virtually all individuals in the United States an adequate health insurance package. However, the need to increase value for health care dollars will extend far beyond the current policy window. Achieving that goal will require disruptive innovation in the health care system." Read More…

Baucus's Bill and the Long Road to Reform
John Iglehart, New England Journal of Medicine, October 8, 2009
"Although Baucus's proposed increase in physicians' fees is meager, primary care clinicians would receive 10% bonuses for certain evaluation and management services if more than 60% of their practice consists of these services. The bonuses would be targeted at physicians practicing family, geriatric, internal, and pediatric medicine, as well as advanced practice nurses and physician assistants. The bill would also extend a 10% bonus to general surgeons who practice for 5 years in a medically underserved area." Read More…

Service Learning Helps Sustain the Status Quo
Arch G. Mainous III, PhD and Richard Baker, MD, Family Medicine, October 2009
"The strategy of selective ad¬mission and creation of socially responsible physicians to provide uncompensated care for the un¬insured assumes that we will not fix the problem of having a large segment of the population without health insurance. Volunteering and providing free care to uninsured patients is a societal good and should be applauded." Read More…

Physician Assistants and Nurse Practitioners as a Usual Source of Care
Chrisinte M. Everett, MPH PA-C et al., Journal of Rural Health, September 23, 2009
"The United States (US) is faced with an aging population, projected physician shortages, and an increase in the prevalence of chronic disease, health care costs, and the number of uninsured Americans, making access to health care a leading policy issue. Since 1967, non-physician providers such as Physician Assistants (PAs) and Nurse Practitioners (NPs) have been utilized to improve access and reduce health care costs. Approximately 110,000 PAs and NPs currently practice in the United States. Fifty percent of PAs and 85% of NPs practice in primary care and are more likely than doctors to practice in rural areas and with underserved populations." Read More…

Commentary: Flexner Redux 2010: Graduate Medical Education in the United States
November 2009 – Academic Medicine
"In 1910, the Carnegie Foundation for the Advancement of Teaching issued what is popularly known as the Flexner Report, clearly one of the most influential reports ever published by the foundation. But if Flexner could be brought back to rewrite his report today, I do not think he would focus on the state of medical students' education, assuming that his mandate was consistent with the one the Carnegie Foundation gave him long ago. In that case, he would spend no time examining how medical students are being educated; he would concern himself instead with how the country's graduate medical education (GME) system is preparing resident physicians for entry into clinical practice." Read More…

How Many Physicians? How Much Does It Matter?
October 21, 2009 – Journal of the American Medical Association
"The analysis of current estimates of the number of physicians practicing in the United States by Staiger and colleagues in this issue of JAMA touches on a topic that is both arcane and central to policy debates. The arcane part is how physicians are counted; the policy part is how their contributions to the economy and to social needs are estimated." Read More…

Comparison of Physician Workforce Estimates and Supply Projections
October 21, 2009 – Journal of the American Medical Association
"Recent projections indicate that the supply of US physicians may soon decrease below requirements, with some projecting a shortfall as high as 200 000 by 2020. Although debate over potential shortages has focused largely on the number and type of physicians needed in the future, concerns have also been raised about data used in physician supply estimates and projections." Read More…

The Baucus Bill and the Hope for Reform
October 14, 2009 – New England Journal of Medicine
"After months of wrangling with Republicans over the appropriate role of government in health care, the Senate Finance Committee's 13 Democrats were joined by a lone Republican, Senator Olympia Snowe of Maine, on October 13 in approving a reform bill that would establish a mandate for most individuals to obtain health insurance. The 14-to-9 vote by the panel, chaired by Senator Max Baucus (D-MT), moved the reform process to the next step: blending the Finance Committee bill with a more liberal one previously approved by the Senate Health, Education, Labor, and Pensions Committee." Read More…

Reform and the Health Care Workforce - Current Capacity, Future Demand
November 5, 2009 – New England Journal of Medicine
As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers, if not also creating a competing public insurance option. But among the major questions that their policy prescription leaves unanswered is, How would a health care workforce that many (though not all) observers agree is already inadequate in some regions and specialties provide medical care to an additional 30 million newly insured people?" Read More…

Compromises and Controversies – Moving Forward on Reform
November 4, 2009 – New England Journal of Medicine
"Accelerating progress toward the Democrats' goal of enacting health care reform legislation, House Speaker Nancy Pelosi unveiled a bill on October 29 that would establish a mandate for most legal U.S. residents to obtain health insurance. The bill would extend coverage to some 36 million people, and according to the Congressional Budget Office (CBO), its net costs would be fully paid for — largely through an income-tax surcharge on high-income persons and a reduction in the growth of Medicare's payment rates for most services, except those provided by physicians. Meanwhile, Senate Majority Leader Harry Reid was preparing to introduce the Democrats' reform bill in the Senate, awaiting only a CBO estimate of its cost." Read More…

Forestalling a Filibuster – Senate Reform Bill Cleared for Floor Debate
November 25, 2009 – New England Journal of Medicine
"Faced with unanimous Republican opposition, Senate Democrats, joined by two independents, closed ranks in a rare Saturday session on November 21 to advance consideration of a vast health care reform bill. Without a vote to spare on a motion to clear the way for floor consideration of the contentious bill, Democrats prevailed 60 to 39. Having defeated Republican efforts to derail the measure, Senate Majority Leader Harry Reid of Nevada can now open floor debate in early December." Read More…

Are There Enough Doctors to Make Reform Work?
November 21, 2009 – National Journal
"Under the best of circumstances, it takes a few months for Allan Nichols, the executive director of Mainline Health Systems in rural Arkansas, to fill a primary-care position in one of his community health centers. But the worsening shortage of primary-care doctors means that the job search could last more than a year. The shortage of primary-care doctors has been a well-reported, chronic problem in medicine. The American Academy of Family Physicians estimates that by 2020, the patient load will require 40,000 more doctors than will be practicing. Many worry that expanding coverage under health care reform will exacerbate the problem." Read More…

Doctoral-Level Programs Prepare Nurses for Expanded Role in Care and Research
November 18, 2009 – Journal of the American Medical Association
'The DrNP programs are typically 2 years long, including a 1-year residency, and accept individuals who have already earned a master's degree in nursing and have been licensed as a nurse practitioner. Eventually, programs will accept students with a baccalaureate nursing degree, but according to recommendations from AACN, these programs would take 3 to 4 years to complete. The programs emphasize evidence-based practice, quality improvement, and systems-level thinking, said Raines. 'We think people with the DrNP preparation will be particularly skilled at translating research into practice,' she said." Read More…

Narrowly Clearing the Next Hurdle – Passage of the Health Reform Bill
November 11, 2009 – New England Journal of Medicine
"With Democrats wielding their sizable majority to fend off strong Republican opposition and survive the defection of 39 members of their own party, the U.S. House of Representatives voted 220 to 215 to approve health care reform legislation after a day of contentious debate. On November 7, as midnight drew near, 219 House Democrats and 1 Republican approved a measure that would extend insurance coverage to virtually all Americans by 2013. The 1990-page bill would also restructure private insurance, bolster primary care, and make countless other policy changes — but would not eliminate the scheduled 21.2% reduction in Medicare's physician fees, a problem that Democrats plan to tackle in separate legislation before the cuts take effect January 1, 2010." Read More…

What Attracts Students to Interprofessional Education and Other Health Care Reform Initiatives?
Fall 2009 – Journal of Allied Health
"An international consensus has emerged that interprofessional education (IPE) and other health care reforms are necessary to address the increasing complexity of patients' health needs. Despite overwhelming barriers to its system-wide implementation, health professional students worldwide have organized themselves to promote IPE and have achieved considerable attention. This study seeks to offer insights into what attracts students to IPE and other health care reform initiatives and how advocates of change can stimulate this interest." Read More…

Physician Assistants: Policy and Practice, 3rd Edition, 2010
Roderick D. Hooker, PhD, James F. Cawley, MPH PA-C, and David P. Asprey, PhD PA-C

Settling in for a Long Debate
December 2, 2009 – New England Journal of Medicine
With virtually all Republicans in opposition and public opinion sharply divided, the Senate opened debate on a Democratic health care reform bill that would greatly expand insurance coverage and, its leadership hopes, reverse the erosion of the party's standing in the electorate's eyes. Prospects seem dim that the Democrats will be able to enact their proposal without scaling down its scope to accommodate the more conservative Democratic senators and two independents. Nevertheless, Majority Leader Harry Reid (D-NV) opened floor debate on December 1 by saying that 'the next weekends, plural, we will be working' on the reform bill, because there is 'not an issue more important than finishing this legislation.'" Read More…

The Doctor Can't See You Now: New York's Physician Shortage Grows
December 2009 – Healthcare Association of New York State
"Physician shortages threaten many New York residents' access to health care. While steps have been taken to begin to address this recognized problem, more state and federal action is needed to increase the number of primary care physicians, as well as physicians in other specialties that are in demand. Further, New York State must explore alternative ways to deliver care to underserved populations." Read More...

Patient Centered Medical Homes in Ontario
January 7, 2010 – New England Journal of Medicine
"As the United States debates health care reform, the concept of "patient-centered medical homes" is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives for providing comprehensive care will lead to improvements in health, increase efficiency, and reduce costs of care while making practice more attractive for primary care physicians. Lessons regarding the implementation of medical homes and their ability to accomplish these goals can be gleaned from Ontario's experience with Family Health Teams (FHTs)." Read More…

Accreditation Standards of DO- and MD- Granting Medical Schools: An Incomplete Comparison
January 2010 – Academic Medicine
"In their June 2009 Academic Medicine article, Wood and Hahn reported "perceptions that the quality of osteopathic education, and therefore the graduates of DO medical schools, are of a lower quality than is the case with MD schools." They then sought to dispel these perceptions by analyzing certain aspects of accreditation across the two professions. There are fundamental problems with this approach. Simply assessing the similarities and differences between the accreditation standards for the educational programs that grant MD and DO degrees does not begin to provide an answer to this complex question, as we will presently explain." Read More…

Accreditation Standards of DO- and MD- Granting Medical Schools: An Incomplete Comparison (Reply)
January 2010 – Academic Medicine
"We appreciate the comments offered by Drs. Hunt, Barzansky, and Sabalis. However, they imply that our objective in the article was to 'dispel these perceptions by analyzing certain aspects of accreditation across the two professions.' Instead, we aimed our article at the broader topics of accreditation rather than at this one issue and attempted, in a limited way, to determine whether the standards "and other issues could help account for real or perceived quality differences between the two types of medical schools." Read More…

Senate's Reform Package Wrapped Up in Time for Christmas
December 28, 2009 – New England Journal of Medicine
"With no votes to spare — because every Republican stood in opposition — the normally fractious Senate Democrats cast aside their differences to pass a landmark health care reform bill by a vote of 60 to 39 on Christmas Eve, the 25th straight day of debate over the measure. The Congressional Budget Office (CBO) estimated the bill's cost at $871 billion over 10 years — divided among public subsidies to help lower-income people pay for private insurance, expansions of Medicaid and the Children's Health Insurance Program, and tax credits for small businesses." Read More…

Acceptance of Physician Assistants and Nurse Practitioners in Trauma Centers
January 2010 – Journal of the American Academy of Physician Assistants
"The physician assistant (PA) and nurse practitioner (NP) professions began in the 1960s as part of a strategy to cope with a lack of primary care medical providers in rural and underserved areas. PAs and NPs fi lled gaps in primary care services that were created as more physicians moved into specialty and subspecialty areas of medicine. However, recent employment trends in the PA and NP professions indicate movement away from primary care and into specialty fields." Read More…

Flexner Centenary Collection
February 2010 – Academic Medicine

American Board of Family Medicine (ABFM) Maintenance of Certification: Variations in Self-Assessment Modules uptake within the 2006 Cohort
January 2010 – Journal of the American Board of Family Medicine
"In its recent shift to a Maintenance of Certification for Family Physicians (MC-FP) paradigm, the American Board of Family Medicine provides diplomates completing 3 self assessment modules (SAMs) in the first 3 years (or first stage of MC-FP) a pathway to extend their recertification cycle to 10 years provided additional requirements are met, versus a 7-year cycle for "non-completers." We use geographic information systems to report on variations in SAM participation and completion in a single cohort of diplomates followed during their first stage of MC-FP to better understand the communities impacted, barriers to uptake, and urban-rural differences." Read More…

Trends in the Work Hours of Physicians in the United States
February 24, 2010 – Journal of the American Medical Association
"The potential expansion of health insurance coverage and associated reform of the delivery system, combined with recent forecasts of physician shortages (particularly in primary care), have catapulted issues related to the adequacy of the physician workforce high up on the health policy agenda. Whether the workforce is equipped to handle the demand for physician services depends on both the quantity and specialty distribution of physicians and the number of hours worked per physician." Read More…

Abraham Flexner and his Remarkable Report on Medical Education: A Century Later
March 3, 2010 – Journal of the American Medical Association
"For 16 months, from January 1909 through April 1910, Abraham Flexner crisscrossed North America via train, horse and buggy, and the occasional Ford flivver. The result, his Herculean Report on Medical Education in the United States and Canada, was released to the public in June 1910. The opening chapters of this powerful text discussed the historical underpinnings and basic necessities of US medical education. The second section featured a school-by-school analysis and included allopathic, osteopathic, proprietary, and sectarian institutions." Read More…

The Democrats' Last Ditch: Reconciliation or Bust
March 3, 2010 – New England Journal of Medicine
"The endgame has begun: with Republicans staunch in their opposition, the Obama administration and its congressional allies are poised to go it alone on a tortuous path toward enactment of ambitious health care reforms." Read More…

Medical Education Futures Study

George Washington University School of Public Health and Health Services

Josiah Macy Jr. Foundation

Related Topics: Research