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January 1, 1997


JAMA. 1997;277(1):67-73. doi:10.1001/jama.1997.03540250075037

While spending hours poring over textbooks and devoting long nights on call, medical students may question their sanity for choosing medicine as their vocation. Students tacitly believe, however, that their investment of time and energy—as well as a considerable sum of money—will ensure a rewarding future. Many have faith that all their years of training will mean the freedom to practice the discipline they desire and that their income level will be commensurate with their degree of training.

Unfortunately, recent reports of employment difficulties for newly graduated American physicians have hinted to the contrary (Washington Post. March 12,1996:WH7; New York Times. April 15, 1995:A1). Dynamics in the medical marketplace and the shift toward more corporate arrangements for the delivery of health care are changing the need for physicians and the specific composition of the physician workforce. Even when new graduates are able to attain positions, the