United we stand

Residency application statements can predict postresidency training

We sought to evaluate whether residency application statements regarding expected career paths are accurate predictors of early postresidency career paths. We evaluated 162 residents who completed a categorical medicine residency at Georgetown University Hospital between 1990 and 1998 to determine if their stated career plans (generalist practice, subspecialization, or undecided) at application predicted activity immediately after residency. Of 130 residents with defined postresidency plans at application, most 78 (60%) followed those career paths after graduation; 18 (67%) of 27 pursued their initial interest in generalist practice, and 60 (58%) of 103 pursued their stated interest in subspecialty training. We also noted a movement of residents toward generalism (79 [49%] of 162), despite low initial interest (27 [17%] of 162).

Physician relations in Canada: shooting inward as the circle closes

As economic disputes between physicians become more frequent, discussions between physicians are becoming increasingly important. Those seeking insight into how physician organizations might mediate these disputes may be able to learn from others who have had negotiating responsibilities for over a quarter of a century--the provincial medical associations in Canada. In this article we examine the structure, process, and outcomes of negotiations between physicians, with a focus on responses to new physician expenditure caps in Ontario, Alberta, and British Columbia. Early negotiations between physicians over changes in relative fees favored general practitioners because they were the dominant voting block within the associations. Despite fewer gains in the fee arena, specialists were willing to remain in the associations because all physicians generally enjoyed similar income growth. Under new physician expenditure caps, however, physicians have been unable to resolve conflicts over how to allocate income limits across specialties. Negotiations between physicians face expanding economic issues and diverging interests as expenditure caps force physicians to concentrate on total costs.

Subspecialization in internal medicine: a historical review, an analysis, and proposals for change

The recent decline in the production of primary care physicians has been associated with a decrease in the production of general internists and an increase in the number of medical subspecialists. A significant majority of entering internal medicine residents anticipate entering a medical subspecialty. This transition in the development of medical manpower, perceived by some as inappropriate, is analyzed in light of historical trends in the evolution of internal medicine and its subspecialties, and in conjunction with the roles played by the American Board of Internal Medicine and the National Institutes of Health. Evidence is presented that the creation of virtually independent subspecialty departments may have been detrimental to the education of physicians and not productive of the physician scientists they are assumed to create. Current recommendations for reform are reviewed and a new proposal is presented, suggesting increasing the length of the medical residency from 3 to 4 years, incorporating subspecialty training in one or more fields into the third year of the residency, removing "duration of training" as a requirement for board eligibility in a subspecialty, transferring the certification of technical competence in a procedure to local institutions, and creating investigational units in basic disciplines within the department of internal medicine that would serve as a resource for all the subspecialty divisions.