Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest.

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. Any threat to the integrity of PMAs must be thoroughly and effectively resolved. Current PMA policies, however, are not uniform and often lack stringency. To address this situation, the authors first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs. The authors then went on to formulate guidelines, both short-term and long-term, to prevent the appearance or reality of undue industry influence. The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.

Achieving board certification in psychiatry: a cohort study.

OBJECTIVE: The purpose of this study was to track the progress of a cohort of graduates of psychiatry residency training programs in achieving certification by the American Board of Psychiatry and Neurology (ABPN). These data provide a detailed picture of how recent graduates perform on the ABPN's examinations. METHOD: The subjects for this study were the 739 new candidates who sat for the part I examination in fall 1994. The cohort's performance on the part I and part II examinations was analyzed, as was the relationship between performance on the two examinations. RESULTS: Approximately 8 years after their first attempt at the part I examination, 85% of the cohort were certified, and 15% were not. The majority passed both the part I and part II examinations on the first attempt. Those who passed part I on the first attempt were more likely than those who failed to pass part II on the first attempt. Of the 627 who were certified at follow-up, 199 (32%) were also certified in one subspecialty, and 29 (5%) were certified in two, for a total of 257 subspecialty certificates. CONCLUSIONS: The results of this study suggest that most recent graduates of residency training programs who attempt the ABPN process are likely to become board certified, and the majority will do so by passing both components on the first attempt.

Selected characteristics and data of psychiatrists in the United States, 2001-2002.

OBJECTIVE: To provide basic data about the physician workforce as a whole and the relative place of psychiatrists in the total workforce. To provide data on characteristics of psychiatrists' work activities in routine psychiatric practice. METHOD: Data were obtained from the American Medical Association's (AMA) Physician Characteristics and Distribution in the United States, 2002-2003 and the 2002 National Survey of Psychiatric Practice, a nationally representative survey of 2,000 randomly selected psychiatrists in the United States. RESULTS: Psychiatry is the fourth largest specialty in the United States. Since 1970, psychiatry has grown 86.7%, while child psychiatry has grown 194.6%. However, psychiatrists are distributed unequally across the country, are working fewer hours than in the past, and less of their time is spent in direct patient care activities. CONCLUSIONS: Psychiatry is a growing and significant part of the U.S. physician workforce. However, if trends that show the psychiatric workforce is aging and working fewer hours continue, it is unclear if its current rate of growth will be able to keep pace with the demand for psychiatric services.