The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America

[Excerpt] This book is a case study of one profession that plays a key role in the health care sector, which now represents about one seventh of the U.S. economy. It examines the most dramatic demographic change in this sector in the last century. But the issues we raise are likely to be of interest more broadly for what they say about the changing roles of women in contemporary society. Women\u27s entry into medicine is taken as dramatic evidence that the barriers to opportunity for women are rapidly falling in America. Does the experience of female physicians to date bear out this optimistic view? An alternative view is that gender roles remain deeply entrenched in our institutions and culture. Specifically, the gender division of household labor continues to constrain the choices of all women. The trade-offs between work and family may be clearest in the most demanding professions, such as law and medicine, which require a high degree of professional devotion. Our study builds on the fine histories of women in medicine written by Walsh, Morantz-Sanchez, and More. The analysis presented here focuses on the period since 1970, thus complementing the important studies of Bowman and colleagues and Bickel. Lorber examined the experiences of the generation of women who pioneered the transformation of the profession. With the benefit of additional decades of perspective, we are in a position to examine whether the role of gender in medicine is changing

Primary Care Physician Shortage: Increased Demand and Insufficient Supply

The Affordable Care Act (ACA) is attempting to reform the organization, delivery and reimbursement rates associated with the health care system. The current healthcare system supports the provision of fragmented, uncoordinated care, which has contributed to its high costs and has led to a system that is not strongly based on primary care. As a result of this system, the unfavorable stigma of the primary care field, and the much higher income made by specialists, there is a shortage of primary care physicians (PCPs). This paper will first describe and analyze the current primary care physician shortage and the factors that have contributed to this shortage. Next, it will describe current projections regarding the future PCP shortage and, in so doing, will establish that the current shortage will be exacerbated by both demographic changes and the increased demand for PCPs created by the ACA’s encouraged utilization of primary care. It will briefly outline the different models implemented in the ACA that are centered around or coordinated by PCPs and will thus lead to an increased demand for PCPs. This paper will then analyze the incentives put in place by the ACA to encourage augmentation of the primary care physician workforce to help address and alleviate the primary care shortage. Finally, this paper will argue that the ACA incentives are not adequate enough to solve the primary care physician shortage due to their lack of focus on alleviating the income gap between PCPs and specialists and their inconstant support from Congress

Solving Colorado's Shortage of Health Professionals: Final Evaluation Findings and Recommendations

This report shares evaluation findings from The Trust's Health Professions initiative, and recommends strategies to increase and sustain Colorado's health professions workforce. For example, creating awareness and readiness for health professions training; providing flexible training options and reaching out to students in rural areas; supporting faculty development and clinical training opportunities; expanding the reach and content of training programs; and strengthening community partnerships for recruitment and retention of health professionals

How Much Do You Love Grey’s Anatomy?

Does the prominence of medical Television Shows impact people’s decision to pursue a medical career? We are constantly told that the things we see in media and entertainment influences how we think about things, but not much research has been done regarding its ability to impact major life choices such as career choice. This paper investigates this by examining the causal relationship between television and interest in the pursuit of a medical career. An ordinary least squares model, created using time series data over the last 24 years, tested specifically the effect of the number and quality of medical television shows both on the rate of change in medical school applications for men and women and the proportion of female applicants. This study found that while medical tv shows don’t have a statistically significant impact on application rates for men or women, female-driven shows cause a larger proportion of the applicant pool to be female

Dissecting the Workforce and Workplace for Clinical Endocrinology, and the Work of Endocrinologists Early in Their Careers

[Excerpt] No national mechanism is in place for an informed, penetrating, and systematic assessment of the physician workforce such as that achieved by the National Science Foundation (NSF) for the periodic evaluation of the nation’s scientists and engineers. Likewise, knowledge of the workforce for clinical research is enigmatic and fragmentary despite the serial recommendations of “blue-ribbon” panels to establish a protocol for the recurrent assessment of clinical investigators early in their careers. Failure to adopt a national system for producing timely, high-quality data on the professional activities of physicians limits the application of improvement tools for advancing clinical investigation and ultimately improving clinical practice. The present study was designed as a pilot project to test the feasibility of using Web-based surveys to estimate the administrative, clinical, didactic, and research work of subspecialty physicians employed in academic, clinical, federal, and pharmaceutical workplaces. Physician members of The Endocrine Society (TES) were used as surrogate prototypes of a subspecialty workforce because of their manageable number and investigative tradition. The results establish that Web-based surveys provide a tool to assess the activities of a decentralized workforce employed in disparate workplaces and underscore the value of focusing on physician work within the context of particular workplaces within a subspecialty. Our report also provides a new and timely snapshot of the amount and types of research performed by clinically trained endocrinologists and offers an evidenced-based framework for improving the investigative workforce in this medical subspecialty

Investing in People

Foundations have long created programs to provide grants to individuals—most often in the form of fellowships, scholarships, and prizes. Several of these programs have become so prominent that they are now institutions in and of themselves. Consider just a few examples: the Pulitzer Prize, Fulbright Program, and MacArthur "genius" awards. Governments, as well as foundations large and small, fund individual support programs.The Robert Wood Johnson Foundation has generously allowed the authors of this report to examine its portfolio of individual support programs to explore what the authors believe are some of the strategic fundamentals underlying this type of programming that could be applied to future individual support grantmaking. The purpose of this study is to inform those interested in individual support programs about not only some of the strategy considerations underlying this type of grantmaking but what these programs can be expected to achieve—and under what circumstances.

Academic performance of psychiatrists compared to other specialists before, during, and after medical school.

OBJECTIVE: This study was designed to compare psychiatrists with other physicians on measures of academic performance before, during, and after medical school. METHOD: More than three decades of data for graduates of Jefferson Medical College (N=5,701) were analyzed. Those who pursued psychiatry were compared to physicians in seven other specialties on 18 performance measures. Analysis of covariance was used to control for gender effect. RESULTS: Compared to other physicians, psychiatrists scored higher on measures of verbal ability and general information before medical school and on evaluations of knowledge and skills in behavioral sciences during medical school, but they scored lower on United States Medical Licensing Examinations step 3. CONCLUSIONS: The results generally confirmed the authors\u27 expectations about psychiatrists\u27 academic performance. More attention should be paid to the general medical education of psychiatrists

Physician Income Prediction Errors: Sources and Implications for Behavior

Although income expectations play a central role in many economic decisions, little is known about the sources of income prediction errors and how agents respond to income shocks. This paper uses a unique panel data set to examine the accuracy of physicians' income expectations, the sources of income prediction errors, and the effect of income prediction errors on physician behavior. The data set contains direct survey measures of income expectations for medical students who graduated between 1970 and 1998, their corresponding income realizations, and a rich summary of the shocks hitting their medical practices. We find that income prediction errors were positive on average over the sample period, but varied significantly over time and cross-sectionally. We trace these results to persistent specialty-specific shocks, such as the growth of health maintenance organizations (HMOs) and other changes across health care markets. Physicians who experienced negative income shocks were more likely to respond by increasing their hours worked, allocating fewer of their work hours to teaching/research and more to patient care, and were more likely to switch specialties.

The struggling infectious diseases fellow: Remediation challenges and opportunities

Remediation of struggling learners is a challenge faced by all educators. In recognition of this reality, and in light of contemporary challenges facing infectious diseases (ID) fellowship program directors, the Infectious Diseases Society of America Training Program Directors\u27 Committee focused the 2018 National Fellowship Program Directors\u27 Meeting at IDWeek on Remediation of the Struggling Fellow. Small group discussions addressed 7 core topics, including feedback and evaluations, performance management and remediation, knowledge deficits, fellow well-being, efficiency and time management, teaching skills, and career development. This manuscript synthesizes those discussions around a competency-based framework to provide program directors and other educators with a roadmap for addressing common contemporary remediation challenges

Solving Colorado's Health Professionals Shortage: Initial Lessons Learned From the Health Professions Initiative Evaluation

Gives an overview of the trust's 2005-08 Health Professions Initiative to address expected shortages in all healthcare professions, its impact so far, and the strategies grantees are implementing to help strengthen the training infrastructure