Results of the 2001 National Resident Matching Program: family practice.

The results of the 2001 National Resident Matching Program (NRMP) reflect a persistent decline of student interest in family practice residency training in the United States. Compared with the 2000 Match, 240 fewer positions (317 fewer US seniors) were filled in family practice residency programs through the NRMP in 2001, as well as 76 fewer (47 fewer US seniors) in primary care internal medicine, 5 fewer in pediatrics-primary care (7 fewer US seniors), and 7 fewer (1 fewer US senior) in internal medicine-pediatric programs. In contrast, 40 more positions (64 more US seniors) were filled in anesthesiology and 11 more (10 more US seniors) in diagnostic radiology, two "marker" disciplines that have shown increases over the past 3 years. Ninety-one fewer positions (2 fewer US seniors) were also filled in categorical internal medicine, while 49 more positions (67 more US seniors) were filled in categorical pediatrics programs, where trainees perceive options for either practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer a market for family physicians, family practice experienced a fourth year of decline though the 2001 NRMP. Current forces, including student perspectives of specialty prestige, the turbulence of the health care environment, media hype, market factors, lifestyle choices, and student debt, all appear to be influencing many students to choose subspecialty rather than primary care careers.

A descriptive study of managed-care hassles in 26 practices.

OBJECTIVES: To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem. METHODS: 16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship. RESULTS: Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both. CONCLUSIONS: The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.

Results of the 2000 National Resident Matching Program: family practice.

The results of the 2000 National Resident Matching Program (NRMP) reflect substantial volatility in the perceptions and career choices of physicians entering graduate medical education in the United States. Ninety-four fewer positions (191 fewer US seniors) were filled in family practice residency programs through the NRMP in 2000, compared with 1999, as well as 60 fewer (66 fewer US seniors) in primary care internal medicine, 12 fewer in pediatrics-primary care (6 fewer US seniors), and 10 fewer (9 fewer US seniors) in internal medicine-pediatric programs. In contrast, 37 more positions (36 more US seniors) were filled in anesthesiology and 4 more (13 more US seniors) in diagnostic radiology, two "marker" disciplines that have recently been market sensitive. Twelve fewer positions (63 fewer US seniors) were also filled in categorical internal medicine, while 35 fewer positions (104 fewer US seniors) were filled in categorical pediatrics programs, where trainees perceive options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer a market for family physicians, family practice experienced a third year of decline through the 2000 NRMP. Current forces, including media hype, market factors, lifestyle choices, debt, and the turbulence of the health care environment, appear to be influencing many students to choose subspecialty rather than primary care careers.

Genital findings in prepubertal girls evaluated for sexual abuse. A different perspective on hymenal measurements.

OBJECTIVE: To evaluate the usefulness of the horizontal transhymenal diameter as a screening parameter to differentiate between prepubertal girls with and without other definitive signs of sexual abuse. DESIGN: Case comparison study using transhymenal measurements as a diagnostic screening test referenced against prior publications of criterion standards. SETTING: A primary care (family practice) clinic in association with an academic program in northern California. PATIENTS: A consecutive, referred sample of 1058 prepubertal girls aged 6 months to 10 years who were examined as allegedly having been sexually molested between 1987 and 1994. RESULTS: Girls with no definitive signs of genital trauma exhibited a mean transhymenal diameter of 2.3 mm and in general showed an increase of approximately 1 mm per year of age. Girls with definitive signs of genital trauma exhibited a mean transhymenal diameter of 9.0 mm and no significant variance with age. Correcting for age differences, the transhymenal diameter was highly significant as a differentiating factor (F = 1079, P < .001). When compared against the criterion standard, the transhymenal measurement is 99% specific and 79% sensitive as a screening tool. CONCLUSION: Although not independently diagnostic of sexual molestation, the transhymenal diameter, when compared against the criterion standard for age, is a useful screening parameter for primary care physicians evaluating children of potential sexual abuse.

Transferring hospital sponsorship of a family practice residency: financial implications.

Family practice residency programs close each year, many in which there is a perception by the sponsoring institution that the program was too costly. Upon the imminent closure of a program's sponsoring hospital, we analyzed and projected the residency's budget and revenues to convince another community hospital to accept transfer of the sponsorship of the program. Revenues directly attributable to the residency (family practice center, grants, Medicare graduate medical education reimbursement) were identified. In addition, we identified that portion of new inpatient revenues necessary to offset the balance of the residency budget. We found that the program could account for reimbursement of 51.8% of its budget through patient care services, requiring 5.2% to be subsidized through state grants and 43.1% through federal graduate medical education reimbursement. Consistent with studies by several authors, family practice residency programs continue to require financial subsidy to balance their budgets. The nation's need for family physicians can only be ensured if state and federal priorities for needed primary health manpower are translated into continued and enhanced financial support.

The "one-and-two" family practice residency revisited.

First brought to the attention of the medical education community in 1977, the "one-and-two" program was designed to improve the relevance of residency training by using both a university teaching hospital and a smaller community hospital as training centers. This paper reviews the progress of implementing this format over the past ten years, and cites some of the advantages and disadvantages encountered from doing so.

Sterilization of infant formula: current practices and recommendations.

Home sterilization of infant formula became a standard of well-baby care in the 1940s. Its purpose was to eliminate bacterial pathogens that could contaminate water and bottles. Public water supplies are now rarely contaminated, and studies have confirmed that sterilization is no longer necessary. Connecticut family physicians and Connecticut mothers were polled and it was found that 48 percent of physicians recommend sterilization and that 54 percent of mothers (using public water supplies) sterilize formula. Formula sterilization recommendations by physicians and sterilization practices by mothers need to be updated.

Hospital privileges for family physicians: rights, rationale, and resources.

This review discusses the factors responsible for problems incurred by family physicians in the process of applying for hospital privileges. They include issues such as local unfamiliarity with family practice as a specialty, regional needs for primary care providers, reluctance to "make waves," and the breadth of privileges sought. Major areas of contention center on the utilization of obstetrical, surgical, and critical care facilities. If a request for privileges is denied, the applicant does, however, possess the right of due process. This right is substantiated in law and includes appeal procedures consisting of an enumeration of specific justifications for denial, adequate notice of a hearing, and the opportunity to be present, rebut the evidence, and present a defense. When dealing with such conflicts, the family physician will recognize the importance of training-content documentation, a willingness to demonstrate competence, and resources for professional assistance through both local and regional offices of the American Academy of Family Physicians.