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This Week in JAMA
September 2, 1998

This Week in JAMA

JAMA. 1998;280(9):763. doi:10.1001/jama.280.9.763
Medical Education Theme Issue

The ethnic and racial diversity of the US population is not mirrored by the composition of the medical profession; minority groups remain underrepresented in both academic medicine and clinical practice. In this issue, Barzansky and colleaguesArticle report that the number of minority group applicants to US medical schools for the class entering in 1997 declined 11.1% compared with 1996, and the number of minority students actually entering medical school in 1997 declined 8.4%. The Robert Wood Johnson Foundation Minority Medical Education Program was created to improve medical school acceptance rates for minority students. Cantor and coworkersArticle found that participants in this 6-week intensive educational program were more likely to be accepted to medical school for the class entering in 1997 than minority nonparticipants. In a related study, Palepu and colleaguesArticle found that minority faculty were less likely than white faculty to attain senior academic positions, even after adjusting for years as a faculty member, peer-reviewed publications, and research grant funding.


The Workforce Meets Market Forces

In their third annual study of the initial employment status of physicians completing residency training, Miller and colleaguesArticle surveyed residents completing their training at the end of the 1995-1996 academic year. Of graduating residents who participated in the survey, almost one quarter who had sought employment after their residencies reported having difficulty finding a position, and 7.1% did not have positions within 6 months after residency. In an editorial, Jacoby and MeyerArticle comment that the apparent shortage of job opportunities may indicate that the predicted physician surplus has arrived. In 2 related articles, Cooper and colleaguesArticle project that the increase in the number of nonphysician clinicians between 1995 and 2005 on a per capita basis will be twice that of the increase in the number of physicians and that the greatest growth will be among nonphysician clinicians who provide primary careArticle. In an editorial, Grumbach and CoffmanArticle question whether physicians and nonphysician clinicians will collaborate or compete in the changing health care market.

Shrinking Medical School Funding

Faculty practice plans, grants and contracts, and hospital support provided almost 80% of the revenues for the programs and activities of US medical schools in 1996-1997. Jones and colleagues report that the growth of these resources has continued but at a progressively slower rate over the past decade. The decline in the growth of medical school revenues is largely the result of decreasing growth of faculty practice plan revenues. The proportion of revenues from state and local government appropriations for public medical schools greatly exceeds that for private medical schools, which compensate with more funding from tuition, gifts, endowment funds, and grants.

. . . and Increasing Student Debt

The student loan debt of the 1997 medical school graduating class is the highest in 8 years. Beran and LawsonArticle report that graduates of public medical schools in 1997 had a mean educational debt of nearly $70,000; private medical school graduates had a mean debt of almost $100,000.Article

The Cover

"A hero of the American heartland, Wood brought to his art a love of the Iowa landscape and its homespun inhabitants, a subtle Midwestern humor, and an inherent respect for physical labor." Grant Wood, Family Doctor, 1940, American.

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A Piece of My Mind

"[O]ur success or failure in teaching empathy and humanism begins with the manner in which teaching itself is done." From "Hey! I'm a Teacher Too."

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