Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary

Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001–2021 and determine if PGY1 salaries differ between these program types. Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001–2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021–2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. Results: The number of EM programs increased from 117 to 276 from 2001–2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016–2021. Mean for-profit affiliated program salary (55,658, n = 24) was 3,840 lower than mean nonprofit affiliated program salary (59,498, n = 203). For-profit affiliation was a significant predictor of lower 2021–2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = −1919.88, P = 0.010). Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016–2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit–affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.</p

Naegleria fowleri: Protein structures to facilitate drug discovery for the deadly, pathogenic free-living amoeba.

Naegleria fowleri is a pathogenic, thermophilic, free-living amoeba which causes primary amebic meningoencephalitis (PAM). Penetrating the olfactory mucosa, the brain-eating amoeba travels along the olfactory nerves, burrowing through the cribriform plate to its destination: the brain's frontal lobes. The amoeba thrives in warm, freshwater environments, with peak infection rates in the summer months and has a mortality rate of approximately 97%. A major contributor to the pathogen's high mortality is the lack of sensitivity of N. fowleri to current drug therapies, even in the face of combination-drug therapy. To enable rational drug discovery and design efforts we have pursued protein production and crystallography-based structure determination efforts for likely drug targets from N. fowleri. The genes were selected if they had homology to drug targets listed in Drug Bank or were nominated by primary investigators engaged in N. fowleri research. In 2017, 178 N. fowleri protein targets were queued to the Seattle Structural Genomics Center of Infectious Disease (SSGCID) pipeline, and to date 89 soluble recombinant proteins and 19 unique target structures have been produced. Many of the new protein structures are potential drug targets and contain structural differences compared to their human homologs, which could allow for the development of pathogen-specific inhibitors. Five of the structures were analyzed in more detail, and four of five show promise that selective inhibitors of the active site could be found. The 19 solved crystal structures build a foundation for future work in combating this devastating disease by encouraging further investigation to stimulate drug discovery for this neglected pathogen