"The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured."
"The authors report on the status of osteopathic graduate medical education training for the 2010-2011 academic year. Data are presented on approved programs and trainee positions, including distribution by state and by specialty. The authors also examine other trends in postdoctoral training including programs dually accredited by the American Osteopathic Association and the Accreditation Council for Graduate Medical Education."
"Development of new osteopathic graduate medical education (OGME) programs has emerged as a priority for the osteopathic medical profession. As colleges of osteopathic medicine (COMs) expand class sizes and branch campuses, and as new COMs are launched, availability of sufficient internship, residency, and fellowship positions for future COM graduates will become a challenge. "
"In 1999, the Accreditation Council for Graduate Medical Education (ACGME) introduced the six domains of clinical competency to the profession,1 and in 2009, it began a multiyear process of restructuring its accreditation system to be based on educational outcomes in these competencies. The result of this effort is the Next Accreditation System (NAS), scheduled for phased implementation beginning in July 2013. The aims of the NAS are threefold: to enhance the ability of the peer-review system to prepare physicians for practice in the 21st century, to accelerate the ACGME's movement toward accreditation on the basis of educational outcomes, and to reduce the burden associated with the current structure and process-based approach."
"Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans."
"As part of the Readiness for Reform initiative, the AAMC presents a case studies series to share member strategies for implementing key elements of health reform. These 10 cases showcase a series of competencies required for success from AAMC member teaching hospitals and medical schools in an era of reform. The institutions profiled are implementing diverse programs and initiatives to transform their care delivery models."
"Two key data points in the discussion of medical student education debt are the percentage of graduates with debt (86% in 2010) and the average education debt of an indebted graduate (nearly $158,000 in 2010)."
Documenting trends in the number of physicians and the changing composition of the U.S. physician workforce is important for understanding whether there will be an adequate supply of physicians to meet future health care needs. Although physician supply is projected to increase over the coming decade, it is unlikely to keep pace with demand for physicians, particularly in certain specialties and states.
"The author reviews the history of calls for reform of graduate medical education (GME), beginning with the Rappleye report of 1940, the first report on GME."
"With the 100th anniversary of Flexner's seminal report on medical education, The Lancet published guidelines by a global independent Commission that aimed to establish a 21st-century vision for the education of health professionals. As young doctors, we applaud the Commission for moving beyond professional silos to new models of interprofessional collaboration. But there should be more emphasis on service and social mission in health professionals' training."
"Many observers have been concerned about a mismatch between the knowledge, skills, and professional values of newly trained physicians and the requirements of current and future medical practice. We surveyed and interviewed Kaiser Permanente’s clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology to ascertain their views of the perceived gaps in the readiness of newly trained physicians."
"Shortages of 100,000 physicians and up to one million nurses are projected in the next 10 years. If these statistics are close to true, medical schools would need a 100% increase in graduates over the next 4 years, and nursing schools a 100% increase over the next 13 years. These calculations are instructive in that they demonstrate the absurdity of expecting schools to provide these sorts of increases in that time frame."
"In this issue of the journal, you will find 15 essays responding to my 2011 Question of the Year, What improvements in medical education will lead to better health for individuals and populations? These essays, selected from over 120 submissions, represent a set of important ideas, programs, and plans aimed at understanding and strengthening the link between medical education and the health of individuals and populations."
"With the current focus on reducing the federal budget deficit, funding for graduate medical education (GME) has come under scrutiny, particularly those monies labeled as indirect medical education payments; these are intended to cover ill-defined costs inherent to training programs, such as increased lengths of stay, additional testing, and patients with more complex conditions."
"Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure."
"The trend for choosing to work part-time (PT) in medicine is increasing. We hypothesize that strategies to employ PT surgeons and prolong the duration of practice might reduce the surgeon shortage considerably. We calculated the effects of PT employment on the surgical workforce."
"There is a growing demand for educating future physicians to be socially responsible. It is not clear, however, how social responsibility is understood and acted on in medical education and practice, particularly within the context of a growing desire to improve health care through an equitable and sustainable delivery system. The authors conduct a concept analysis, exploring the practical philosophical understanding of social responsibility and its implications for medical education and practice."
"A Black man on the south side of Chicago will live 8 years less than the average white man in the US. Much of this life expectancy gap is due to excess heart disease and cancer among Black men compared to whites. This gap could be reduced with prevention, early detection and access to primary care. The failures of the health care system in Chicago and in particular the gaping holes in the public health safety-net are partly to blame."
"We found that specialists caring for more acutely ill patients or those requiring intensive monitoring (usually in hospital settings) work longer hours than physicians focused on more stable, chronically ill patients (mostly in ambulatory settings).The exceptions were physicians practicing emergency medicine or hospital medicine. Both of these specialties are characterized by fixed, hourly shifts; although patient acuity may be high,the number of work hours per day and days per month are limited."
"Between 1998 and 2008, the number of hospital-based emergency departments (EDs) in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures. Federal law requiring EDs to treat all in need regardless of a patient's ability to pay may make EDs more vulnerable to the market forces that govern US health care."
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