The manpower crisis facing radiation oncology.

Data from several sources document that the number of radiation oncologists being trained is substantially above the number projected as recently as 1983. This paper addresses the manpower crisis facing radiation oncology and includes information on the supply of and need for specialists, as well as possible courses of action given current circumstances.

Entry of U.S. medical school graduates into family practice residencies: 1987-1988.

This study continues a series of reports from the American Academy of Family Physicians on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 12.0% of the 15,872 graduates of United States medical schools between July 1986 and June 1987 were first-year residents in family practice in December 1987. The West North Central region reports the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1987; the New England and Middle Atlantic regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1987 as were graduates from privately funded medical schools.

Controlling physician oversupply through certificate of need.

By 1990 the aggregate supply of physicians in the United States is likely to exceed the population's requirements by 10 percent or more. State and regional aggregate and specialty-specific surpluses may be more extreme. Since the demand for physician services appears to be determined to a significant degree by the supply of physicians, the number of physicians who can maintain financially viable practices in a region is not likely to be limited effectively by the normal market interaction of supply and demand. Excessive physician supplies may, however, have a number of deleterious effects, including rapid escalation of health care costs, fragmentation of patient care, and a decrease in the quality of patient care. In this Article, the authors review the potential effectiveness of a number of policy interventions that might be employed to optimize physician supplies in areas of excess. They evaluate the following alternatives: (1) a limit on the number of medical school graduates; (2) control of physician residencies by number and by specialty; (3) creation or implementation of incentive policies; (4) control by hospitals--indirectly by limiting the number of beds, or directly by denying staff privileges; (5) widespread development of HMOs; (6) direct employment by the federal government of the majority of practicing physicians; and (7) creation of certificate of need for physician licensure is the alternative that shows the greatest promise of enabling the number and specialties of physicians providing patient care in areas facing a physician surplus to be managed in such a way that the populations of such areas can obtain adequate medical care at a reasonable cost.

Characteristics of graduating medical students who were matched and unmatched to hospital training posts.

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.

First-year graduate medical education positions obtained by U.S. graduates in 1977.

When the 2,308 residencies obtained by U.S. medical school graduates outisde of th National Intern and Resident Matching Program were added to those of the 11,172 students who matched, the distribution of all 1977 graduates among specialties was found to be essentially the same as for those who matched, but regional differences were marked. A regional comparison of the location of the residencies obtained by the graduates with the location of the schools attended by students suggested that recruitment of graduates from other regions was as important in determining the number of first-year residents as was retention of graduates in a given region.

The allocation of house officer posts: a UK survey.

The methods of allocation of house officer posts at British medical schools were investigated by postal questionnaire. Three categories were found: a free market, a matching process between student and consultant preferences, and the use of in-course assessments, the matching process being the most popular. Many medical schools had changed their method of house officer allocation since 1969, but often with unsatisfactory results.

Estimating the number of residents needed in community teaching hospitals.

Hospitals are concerned with the performance of their graduate medical education programs because of increasing costs and reduced reimbursements, residency review committees' decisions about the number and size of programs, and pressures that derive from the increasing supply of physicians. In any effort by hospitals to evaluate the need for residency programs and the costs and benefits of having them, it is essential to forecast accurately the number of residents needed for specific activities. Refined methods to do this have not been developed. In this article, the author reports on an evaluation of a methodology developed by Chan and Bernstein to estimate the number of residents required and presents (a) the changes in the methodology that were necessary to estimate needs for both service care and assisting attending physicians with their private cases; (b) the data collection process; (c) some representative findings; (d) an evaluation of the method that employs as criteria the cost, the ease of use, understandability, communicability, and validity; and (e) the limitations found.

A reply to the comments on The Condition of Surgery.

Any system of allocation of services works more efficiently in the consumer's interest when there is competition among suppliers of the service. But this same competition reduces income and options of sellers. Professionals-as-sellers are likely to resist competition by restricting entry into their ranks and the range of qualities to be offered. An informed consumer should be allowed to exercise discretion in choosing among qualities and substitutions. Future policy might well incorporate less reliance on regulation and more on removing barriers to free market factors.

The condition of surgery: an analysis of the American College of Surgeons' and the American Surgical Association's report on the status of surgery.

The supply of surgical services--a function of both the number of surgeons and the amount of surgery each performs--was extensively studied as a basis for new public policies in medical practice. The Report concludes that there is a surplus of physicians performing surgery and recommends restricting their number through more rigorous board certification and reducing the number of new entrants to specialized training. But the technological criteria advanced to assure "quality" are not based on adequate empirical evidence; and control by surgeons over their own numbers is likely to have uneven--and unfavorable--consequences for the public. The causes of surplus surgical capacity must be explained, and impediments to self-correction through competition in the "medical market" addressed in future policy.

Residency positions. Are there enough?

This article presents data on postgraduate year 1 positions in US residency programs. It points out the distinctions between data published annually in the Directory of Residency Training Programs and the data reported by the National Resident Matching Program on the subject of positions. On the basis of data reported from all accredited programs there were 1.3 positions for each US medical school graduate in 1983. The number of US graduates is expected to decrease in future years. The number of foreign medical graduates in residency programs is not increasing; however, the proportion of foreign graduates who are US citizens is increasing.