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December 26, 1986, Vol 256, No. 24 >
ARTICLE | December 26, 1986

Health Care in Transition Consequences for Young Physicians FREE

[+] Author Affiliations

Reprint requests to Department of Long-Range Policy Analysis, Council on Long-Range Planning and Development, American Medical Association, 535 N Dearborn St, Chicago, IL 60610.


JAMA. 1986;256(24):3384-3390. doi:10.1001/jama.1986.03380240078034
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References

Individuals planning for a career in medicine must weigh a number of factors into their decisions. Increasingly, they must understand the nature of the socioeconomic environment of health care, including the extent of competition with other physicians and other health professionals; the degree of autonomy from health care institutions, government, and third-party payers; the impact of demographic or technological changes; and the economics of medical practice. This report analyzes the environment of medicine, emphasizing those elements that will be most important to medical students and resident physicians. It focuses on three stages of a physician's career: obtaining a medical education, beginning to practice medicine, and maintaining a viable practice.

(JAMA 1986;256:3384-3390)

REFERENCES

1 +
Council on Long-Range Planning and Development: The Environment of Medicine . Chicago, American Medical Association, 1985;.
2 +
Johnson DG: U.S Medical Students, 1950-2000 . Washington, DC, Association of American Medical Colleges, 1983;.
3 +
 Medical education in the United States 1978-1979 . JAMA 1980;;243:841-887.
4 +
 Medical education in the United States 1984-1985 . JAMA 1985;;254:1553-1639.
5 +
Annual Medical Student Graduation Questionnaire . Washington, DC, Association of American Medical Colleges, 1971;-1984.
6 +
Sandlson JI:  A crisis in medical education: The high cost of student financial assistance . N Engl J Med 1983;;308:1286-1289.
7 +
French FD:  The financial indebtedness of medical school graduates . N Engl J Med 1981;;304:563-565.
8 +
Bazzoli GJ:  Does educational indebtedness affect physician specialty choice? J Health Econ 1985;;4:1-19.
9 +
Board of Trustees: The Effect of Educational Indebtedness on the Career Choices of New Physicians , report E (1-83). Chicago, American Medical Association, 1983;.
10 +
Korcok M:  Medical education: Prosperitas interrupta . JAMA 1983;;249:12-16.
11 +
1984 COTH Survey of House-staff Stipends, Benefits, and Funding . Washington, DC, Association of American Medical Colleges, 1985;.
12 +
Sloan FA, Feldman RD, Steinwald AB:  Effects of teaching on hospital costs . J Health Econ 1983;;2:1-28.
13 +
Ament RP, Kobrinski EJ, Wood WR:  Case mix complexity differences between teaching and non-teaching hospitals . J Med Educ 1981;;56:894-903.
14 +
Horn SD, Bulkley G, Sharkey PD, et al:  Interhospital differences in severity of illness . N Engl J Med 1985;;313:20-24.
15 +
Schwartz WB, Newhouse JP, Williams AP:  Is the teaching hospital an endangered species? N Engl J Med 1985;;313:157-162.
16 +
Durenberger DF:  Who, how and when to pay for physicians' training . Business Health 1985;; 2:7-11.
17 +
Study of the Financing of Graduate Medical Education, Progress and Preview . New York, Arthur Young & Co, 1984;.
18 +
Stimmel B, Graettinger JS:  Medical students trained abroad and medical manpower . N Engl J Med 1984;;310:230-235.
19 +
Haglund K:  The new competition for residency slots . New Physician 1983;;5:12-16, 46.
20 +
Crowley AE:  Residency positions: Are there enough? JAMA 1984;;252:3386-3389.
21 +
Graettinger JS: Results of the NRMP . Evanston, Ill, National Resident Matching Program, 1985;.
22 +
Harmon RG:  Intern and resident organizations in the United States: 1934-1977 . Milbank Mem Fund Q 1978;;56:500-530.
23 +
Hough DE, Bazzoli GJ:  The economic environment of resident physicians . JAMA 1985;;253:1758-1762.
24 +
Reynolds RA, Duann DJ (eds): Socioeconomic Characteristics of Medical Practice 1985 . Chicago, American Medical Association, 1985;.
25 +
Statistical Abstract of the U.S., 1986 . Washington, DC, US Bureau of the Census, 1985;.
26 +
 Special Task Force on Professional Liability and Insurance : Professional Liability in the '80s . Chicago, American Medical Association, 1985;.
27 +
American Medical Association:  Practice environment of young physicians . SMS Rep 1984;;3:8.
28 +
Graduate Medical Education National Advisory Committee: Summary Report to the Secretary of the Department of Health and Human Services , Dept of Health and Human Services publication (HRA) 81-651. Health Resources Administration, 1980;, vol 1.
29 +
Roback G, Randolph L, Mead D, et al: Physician Characteristics and Distribution in the U.S., 1984 Edition . Chicago, American Medical Association, 1985;.
30 +
Haug JN, Roback GA, Martin BC: Distribution of Physicians in the United States, 1970 . Chicago, American Medical Association, 1971;.
31 +
Newhouse JP, Williams AP, Bennett BW, et al:  Where have all the doctors gone? JAMA 1982;;247:2392-2396.
32 +
Projections of Physician Supply in the U.S. , ODAM report 3-85. Washington, DC, Bureau of Health Professions, 1985;.
33 +
Henderson SR, Odem RJ, Ginsburg KM: Medical Groups in the U.S., 1980. Chicago, American Medical Association, 1982;.
34 +
Havlicek PL: Medical Groups in the U.S., 1984 . Chicago, American Medical Association, 1985;.
35 +
HMO Summary, June 1985 . Excelsior, Minn, Inter-Study, 1985;.
36 +
Simpson JB:  State certificate-of-need programs: The current status . Am J Public Health 1985;;75:1225-1229.
37 +
Report of the Massachusetts Task Force on Organ Transplantation . Boston, Massachusetts Task Force on Organ Transplantation, (October) 1984;.
38 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
39 +
Scitovsky AA, McCall N: Changes in the Costs of Treatment of Selected Illnesses, 1951-1964-1971 . Rockville, Md, National Center for Health Services Research, 1976;.
40 +
Showstack JA, Stone MH, Schroeder SA:  The role of changing clinical practices in the rising costs of hospital care . N Engl J Med 1985;; 313:1201-1207.
41 +
Scitovsky AA:  Changes in the costs of treatment of selected illnesses, 1971 to 1981 . Med Care 1985;;23:1345-1357.
42 +
Current Estimates From the National Health Interview Survey, United States, 1981 , Vital and Health Statistics series 10, No. 141. Washington, DC, National Center for Health Statistics, (October) 1982;.
43 +
 Center for Health Services Research and Development : 13th Periodic Survey of Physicians . Chicago, American Medical Association, March 1979;.
44 +
Projections of the Population of the United States, by Age, Sex, and Race: 1983 to 2080 , Current Population Reports series P-25, No. 925. US Bureau of the Census, (May) 1984;.
45 +
Starr P: The Social Transformation of American Medicine . New York, Basic Books Inc, 1982;.
46 +
Hospital Statistics, 1985 Edition . Chicago, American Hospital Association, 1985;.
47 +
Relman AS:  The new medical-industrial complex . N Engl J Med 1980;;303:963-970.
48 +
Pattison RV, Katz HM:  Investor-owned and not-for-profit hospitals: A comparison based on California data . N Engl J Med 1983;;309:347-353.
49 +
Becker ER, Sloan FA:  Hospitals ownership and performance . Econ Inquiry 1985;;23:21-36.
50 +
Frecko D:  Admissions fall but margins are up in '84 . Hospitals 1985;;59:70-72.
51 +
Source Book of Health Insurance Data 1982-1983 (1984 Update) . Washington, DC, Health Insurance Association of America, 1984;.
52 +
Gibson RM, Levit KR, Lazenby H, et al:  National health expenditures, 1983 . Health Care Financing Rev 1984;;6:1-29.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Council on Long-Range Planning and Development: The Environment of Medicine . Chicago, American Medical Association, 1985;.
2 +
Johnson DG: U.S Medical Students, 1950-2000 . Washington, DC, Association of American Medical Colleges, 1983;.
3 +
 Medical education in the United States 1978-1979 . JAMA 1980;;243:841-887.
4 +
 Medical education in the United States 1984-1985 . JAMA 1985;;254:1553-1639.
5 +
Annual Medical Student Graduation Questionnaire . Washington, DC, Association of American Medical Colleges, 1971;-1984.
6 +
Sandlson JI:  A crisis in medical education: The high cost of student financial assistance . N Engl J Med 1983;;308:1286-1289.
7 +
French FD:  The financial indebtedness of medical school graduates . N Engl J Med 1981;;304:563-565.
8 +
Bazzoli GJ:  Does educational indebtedness affect physician specialty choice? J Health Econ 1985;;4:1-19.
9 +
Board of Trustees: The Effect of Educational Indebtedness on the Career Choices of New Physicians , report E (1-83). Chicago, American Medical Association, 1983;.
10 +
Korcok M:  Medical education: Prosperitas interrupta . JAMA 1983;;249:12-16.
11 +
1984 COTH Survey of House-staff Stipends, Benefits, and Funding . Washington, DC, Association of American Medical Colleges, 1985;.
12 +
Sloan FA, Feldman RD, Steinwald AB:  Effects of teaching on hospital costs . J Health Econ 1983;;2:1-28.
13 +
Ament RP, Kobrinski EJ, Wood WR:  Case mix complexity differences between teaching and non-teaching hospitals . J Med Educ 1981;;56:894-903.
14 +
Horn SD, Bulkley G, Sharkey PD, et al:  Interhospital differences in severity of illness . N Engl J Med 1985;;313:20-24.
15 +
Schwartz WB, Newhouse JP, Williams AP:  Is the teaching hospital an endangered species? N Engl J Med 1985;;313:157-162.
16 +
Durenberger DF:  Who, how and when to pay for physicians' training . Business Health 1985;; 2:7-11.
17 +
Study of the Financing of Graduate Medical Education, Progress and Preview . New York, Arthur Young & Co, 1984;.
18 +
Stimmel B, Graettinger JS:  Medical students trained abroad and medical manpower . N Engl J Med 1984;;310:230-235.
19 +
Haglund K:  The new competition for residency slots . New Physician 1983;;5:12-16, 46.
20 +
Crowley AE:  Residency positions: Are there enough? JAMA 1984;;252:3386-3389.
21 +
Graettinger JS: Results of the NRMP . Evanston, Ill, National Resident Matching Program, 1985;.
22 +
Harmon RG:  Intern and resident organizations in the United States: 1934-1977 . Milbank Mem Fund Q 1978;;56:500-530.
23 +
Hough DE, Bazzoli GJ:  The economic environment of resident physicians . JAMA 1985;;253:1758-1762.
24 +
Reynolds RA, Duann DJ (eds): Socioeconomic Characteristics of Medical Practice 1985 . Chicago, American Medical Association, 1985;.
25 +
Statistical Abstract of the U.S., 1986 . Washington, DC, US Bureau of the Census, 1985;.
26 +
 Special Task Force on Professional Liability and Insurance : Professional Liability in the '80s . Chicago, American Medical Association, 1985;.
27 +
American Medical Association:  Practice environment of young physicians . SMS Rep 1984;;3:8.
28 +
Graduate Medical Education National Advisory Committee: Summary Report to the Secretary of the Department of Health and Human Services , Dept of Health and Human Services publication (HRA) 81-651. Health Resources Administration, 1980;, vol 1.
29 +
Roback G, Randolph L, Mead D, et al: Physician Characteristics and Distribution in the U.S., 1984 Edition . Chicago, American Medical Association, 1985;.
30 +
Haug JN, Roback GA, Martin BC: Distribution of Physicians in the United States, 1970 . Chicago, American Medical Association, 1971;.
31 +
Newhouse JP, Williams AP, Bennett BW, et al:  Where have all the doctors gone? JAMA 1982;;247:2392-2396.
32 +
Projections of Physician Supply in the U.S. , ODAM report 3-85. Washington, DC, Bureau of Health Professions, 1985;.
33 +
Henderson SR, Odem RJ, Ginsburg KM: Medical Groups in the U.S., 1980. Chicago, American Medical Association, 1982;.
34 +
Havlicek PL: Medical Groups in the U.S., 1984 . Chicago, American Medical Association, 1985;.
35 +
HMO Summary, June 1985 . Excelsior, Minn, Inter-Study, 1985;.
36 +
Simpson JB:  State certificate-of-need programs: The current status . Am J Public Health 1985;;75:1225-1229.
37 +
Report of the Massachusetts Task Force on Organ Transplantation . Boston, Massachusetts Task Force on Organ Transplantation, (October) 1984;.
38 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
39 +
Scitovsky AA, McCall N: Changes in the Costs of Treatment of Selected Illnesses, 1951-1964-1971 . Rockville, Md, National Center for Health Services Research, 1976;.
40 +
Showstack JA, Stone MH, Schroeder SA:  The role of changing clinical practices in the rising costs of hospital care . N Engl J Med 1985;; 313:1201-1207.
41 +
Scitovsky AA:  Changes in the costs of treatment of selected illnesses, 1971 to 1981 . Med Care 1985;;23:1345-1357.
42 +
Current Estimates From the National Health Interview Survey, United States, 1981 , Vital and Health Statistics series 10, No. 141. Washington, DC, National Center for Health Statistics, (October) 1982;.
43 +
 Center for Health Services Research and Development : 13th Periodic Survey of Physicians . Chicago, American Medical Association, March 1979;.
44 +
Projections of the Population of the United States, by Age, Sex, and Race: 1983 to 2080 , Current Population Reports series P-25, No. 925. US Bureau of the Census, (May) 1984;.
45 +
Starr P: The Social Transformation of American Medicine . New York, Basic Books Inc, 1982;.
46 +
Hospital Statistics, 1985 Edition . Chicago, American Hospital Association, 1985;.
47 +
Relman AS:  The new medical-industrial complex . N Engl J Med 1980;;303:963-970.
48 +
Pattison RV, Katz HM:  Investor-owned and not-for-profit hospitals: A comparison based on California data . N Engl J Med 1983;;309:347-353.
49 +
Becker ER, Sloan FA:  Hospitals ownership and performance . Econ Inquiry 1985;;23:21-36.
50 +
Frecko D:  Admissions fall but margins are up in '84 . Hospitals 1985;;59:70-72.
51 +
Source Book of Health Insurance Data 1982-1983 (1984 Update) . Washington, DC, Health Insurance Association of America, 1984;.
52 +
Gibson RM, Levit KR, Lazenby H, et al:  National health expenditures, 1983 . Health Care Financing Rev 1984;;6:1-29.

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