How the U.S. physician workforce is changing-2020 and beyond

These future doctors are training under the most difficult and stressful medical conditions the world has experienced in several generations-a global pandemic of a contagious respiratory pathogen. As such, they will have a unique perspective as they begin and pursue careers as practicing physicians.

 

Your next doctor or one you will see in 10-20 years is likely in medical school or a residency program in a United States medical center right now. Within 1-10 years, they will join the ranks of practicing physicians, as those doctors transition to non-clinical jobs, retire, or die.

These future doctors are training under the most difficult and stressful medical conditions the world has experienced in several generations-a global pandemic of a contagious respiratory pathogen. As such, they will have a unique perspective as they begin and pursue careers as practicing physicians.

More women physicians are training to be doctors.

Medical school enrollment looks more like the general population now.

For 3 years in a row, the number of women entering medical school has steadily increased and exceeded the member of men, while the number of men has decreased.

First year students

  • Male students -10, 560
  • Female students-11, 612

Total students

  • Male students- 42, 735
  • Female students- 44, 579

statistics from the Liaison Committee on Medical Education (LCME)

image from the American Medical Association

Due to the lag time of the numbers catching up, slightly more men than women graduated in 2020.

  • Male graduates- 10,517
  • Female graduates-10, 324

Among the 140,000 resident physicians, 64,000 are women.

Large numbers of women medical graduates pursue training in these fields-

  • internal medicine
  • family medicine
  • obstetrics/gynecology
  • pediatrics
  • dermatology
  • geriatrics
  • neurology
  • ophthalmology
  • psychiatry

 

But ethnic diversity is still low among physicians in training.

The nation’s medical schools need more diversity. The factors that create racial and ethnic inequities in other areas of society impact medical education also.

In 2019-2020, white students made up the majority of medical students although both the number and percentage have decreased, while the number of all other groups has increased.

Based on self identification, the Association of American Medical Colleges reports students are

  • White-46,205
  • American Indian/Alaska Native -199
  • Asian-20, 836
  • Black /African American-6,783
  • Hispanic, Latino, Spanish Origin-6,063
  • Native Hawaiian/Pacific Islander-76
  • Other-1,776
  • Multiple-8,621
  • Unknown-892
a male doctor using a tablet while working

 

After medical school, graduates enter residency training for a specialty. Medical residents, both male and female, are still predominantly white. Based on self-identification, race and ethnic origin of medical residents in 2019 is

  • White-76,964
  • Black-8009
  • Hispanic(any race)- 11,860
  • Asian-37,477
  • Multiracial- 4740
  • Unknown/other-13,135
  • Native American/Alaskan-190
  • Native Hawaiian/Pacific Islander-101
Female doctor looking at an xray

Citizenship of physicians in training

Through its certification program, the Educational Commission for Foreign Medical Graduates (ECFMG) evaluates students who attend a non U.S. medical school.

After ECFMG certification, physicians who wish to practice medicine in the United States must complete an accredited residency training program in the United States or Canada. This process will take at least 3 years. The physician will have to complete a residency program regardless of the training he or she has received overseas.

In 2019, 71% of 140,000 resident physicians were native born U.S. citizens. The rest were

  • Naturalized citizens- 8%
  • Permanent residents- 5%
  • Various permits-7%
  • Refugee/displaced persons-0.1%
  • Unknown status -7%

Goals of new physicians

“Most students, including minority, disadvantaged, and marginalized students, enter medical school pursuing a lifelong dream of practicing medicine with little sense of projected incomes or what specialty they would like to pursue.

Most specialty choices are likely based on social, educational, and health care experiences; experiences in medical school; and the prospect of a 30-plus-year career in an area of medicine that provides a level of personal comfort, support, and fulfillment.”

Thomas B. Free Medical School Tuition: Will It Accomplish Its Goals? JAMA. 2019;321(2):143–144. doi:10.1001/jama.2018.19457

 

The specialization of medical care- the good and the bad

On Match Day, occurring mid March every year,  graduating medical students learn which  residency program they will enter through the National Resident Matching Program , which “matches” them with available positions in residencies at medical centers all over the United States. A kind of medical “matchmaking” you could call it.

For many students, Match Day has become a quasi graduation celebration, with friends and family in attendance to share the “reveal”. In 2020 due to the viral pandemic, they had to settle for celebrating virtually.

This matching process determines who will care for our medical needs in the next 30-40 years; our family physicians, internists, pediatricians, general surgeons, obstetricians, and the multitude of other medical specialties. Most doctors will continue in the same specialty their entire career, although some  switch after a few or many years.

a female physician talking to a male patient

 

Some medical students know what speciality they want to pursue before they enter medical school, while others decide after trying the different types of medicine while students. We still have the traditional specialities that most students enter- (there are also many subspecialities under each of these categories.)

Primary care 

  • Family medicine
  • Internal medicine -(adult medicine)
  • Pediatrics-children and adolescents
  • Obstetrics/Gynecology- care of women’s health and pregnancy

Surgical specialities

  • General Surgery-  surgery on skin and internal organs
  • Orthopedics-bones and joints
  • Otorhinolaryngology- ear, nose, throat
  • Ophthalmology-eyes
  • Neurosurgery-the brain, spine, nerves
  • Plastic and Reconstructive surgery
  • Cardiac and vascular surgery

Others 

  • Dermatology-skin
  • Psychiatry-mental health
  • Anesthesiology-surgical sedation and pain relief
  • Emergency medicine- emergencies and trauma
  • Radiology- xrays and other imaging-CT, MRI, US
  • Pathology-laboratory medicine
  • Allergy
  • Physical medicine and rehabilitation
  • Oncology-treatment of cancer
  • Integrative and complementary medicine

As medical care has become more complex and technological, so have the specialties of physicians. This has produced a plethora of new highly specialized fields of practice.

  • Sleep medicine
  • Medical genetics and genomics
  • Pain management
  • Geriatrics- care of the elderly
  • Palliative care-managing diseases that cannot be cured and are likely terminal
  • Hospital medicine-care of patients admitted to a hospital
  • Critical care medicine-care of patients in an ICU (intensive care unit)
  • Aerospace medicine
  • Wound management
  • Medical informatics – use of computers and medical software in medicine
  • Bariatrics- treatment of obesity with or without surgery
  • Sports medicine-treatment of athletic injuries and fitness training
  • Transplant medicine- surgery to transplant organs and after care
  • Addiction medicine

A 2018 viewpoint in JAMA suggested that we need a new specialty, virtual medicine, to describe physicians who treat patients through a virtual medium, telemedicine or  web based, on a computer or a mobile app.

The onset of the SARS-CoV-2 pandemic forced physicians to find alternate ways of delivering care. Even emergency rooms and urgent care clinics were forced to redesign their work flow to care for ill and injured patients while not enabling spread of the virus to staff and other patients.

The risk of contagion halted most non-emergent in person care but physicians’ offices soon implemented alternate means of reaching out to patients-curb side consults, telephone, and virtual visits using smart phones and computers.

Health plans, including Medicare, supported these alternate delivery services with loosened restrictions on paying for virtual care.

Both patients and doctors benefited by this new model which seems destined to persist past the pandemic.

THE SURPRISING NEW DOCTORS CARING FOR YOU
photo from Lightstock.com(affiliate link) graphic created with Canva. This post is an update of a previous post of this title.

 

 

 

The problem-overspecialization in medical care

According to the New England Journal of Medicine,

“the progress of biomedical science is a major factor in the emergence of new subspecialities. There are some patients who benefit from highly focused knowledge and skills.”

All of these specialities mean more medical  knowledge and experience will be  available to both treat and prevent a diverse and growing  variety of disorders.

Today’s new specialist has high degree of expertise in their field, making them better able to treat your problem in the most efficient, effective, safest way.

But with a more narrow focus of experience, that doctor may be less familiar with other aspects of your medical status.

You may find your specialist recommends more testing, which may lead to more treatment some of which may not necessarily improve outcomes.

More specialized testing and treatments may increase the cost of medical care.

Dr. Sandeep Jauhar addresses this issue in this article from Time.

One Patient, Too Many Doctors: The Terrible Expense of Overspecialization

The challenge-increasing the primary care workforce

Primary care physicians can close this gap by coordinating care, especially for complex patients.

4,335 medical students and graduates matched to family medicine residency programs in 2020, the most in family medicine’s history as a specialty, and 487 more than 2019.

Family physicians make up the majority of the primary care physician workforce and mirror the geographic distribution of the U.S. population—practicing in rural and urban underserved communities

“Public health issues like the pandemic the world is experiencing now underscore the importance of a strong foundation in primary care at the front lines surveilling and treating the community.”

Gary LeRoy, MD, president of the American Academy of Family Physicians.
graphic provided by the American Academy of Family Physicians

 

I specialize in Family Medicine

I’ve often been asked ,”Why didn’t you specialize?” My answer, “I did. I specialize in Family Medicine.”

Once called “general practice”, Family Medicine is now a recognized specialty, requiring a residency and certification by  the American Board of Family Medicine.

 

Lightstock photos

Unless otherwise stated, the doctor photos in the post are from the Lightstock.com collection . Get a free 30 day trial at this affiliate link. (This blog can earn a commission if you buy photos which helps support the mission of Watercress Words.)

exploring the HEART of health care education

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

my regards, Dr. Aletha 

 

Women physician astronauts-exploring health in space

On September 12, 1992, Dr. Jamison and six other astronauts flew into space on the the space shuttle Endeavor, making her the first African American women in space. The crew flew 127 orbits around the Earth and returned to the Kennedy Space Center in Florida on September 20, 1992.

Why celebrate women physicians?

In 1860 the United States had 200 women physicians.

By 1900, there were 7000.

Since 1975, the number of female physicians has increased from 35,626 to 369,540 in 2020. Women physicians comprise 36% of actively practicing physicians.

And no longer the minority

In 2018, for the first time since Elizabeth Blackwell entered medical school in 1849,the first woman to do so, more women than men entered U.S. medical schools and half of all medical students are female. This trend will likely continue, as fewer men are applying to medical school and more women are.

September- Women in Medicine Month

We recognize, honor, and appreciate all women physicians in September every year. But a few have gone “above and beyond” in service to country and healthcare. One has even “sacrificed her life for space research.” Here are stories about some of them

Dr. Margaret Rhea Seddon

When she graduated from the University of Tennessee Medical School in 1973, Margaret Rhea Seddon was one of few women. She was the only woman in her surgical residency in Memphis. She also earned a pilot’s license.

While in college, she watched the Apollo 11 moon landing , which sparked her interest in space. In 1978, NASA chose her to be among the first class of six female Astronaut candidates.

Dr. Seddon served 30 days in space total on three separate missions.

  • Discovery, STS-51D, 1985
  • Columbia, STS-40, Spacelab Life Sciences in 1991
  • Columbia, STS-58, Spacelab Life Sciences-2, 1993

On the first two missions, Dr. Seddon served as Mission Specialist, and as Payload Commander in charge of life science research on the last.

After 19 years at NASA, she served as Assistant Chief Medical Officer for Vanderbilt Medical Group in Nashville. She founded Lifewing Partners which teaches aviation-based healthcare.

Dr.Seddon’s honors include induction into the Tennessee Aviation Hall of Fame, The Tennessee Women’s Hall of Fame, and the Astronaut Hall of Fame.

Dr. Seddon and her astronaut husband Robert L. Gibson have four children and three grandchildren. She belongs to the DAR, Daughters of the American Revolution, which recently honored her in their monthly newsletter (and from which I prepared this bio of her. )

The crew assigned to the STS-51D mission included (front left to right) Karol J. Bobko, commander; Donald E. Williams, pilot; M. Rhea Seddon, mission specialist; and Jeffrey A. Hoffman, mission specialist. On the back row, left to right, are S. David Griggs, mission specialist; and payload specialists Charles D. Walker, and E. Jake Garn (Republican Utah Senator). Launched aboard the Space Shuttle Discovery on April 12, 1985 at 8:59:05 am (EST), the STS-51D mission’s primary payloads were the TELESAT-1 (ANIK-C) communications satellite and the SYNCOM IV-3 (also known as LEASAT-3).

Dr. Mae Jemison

While an undergraduate at Stanford University in California, Mae Jemison felt and fought racial injustice, serving as President of the Black Student Union. She went on to earn a Doctorate of Medicine at Cornell University in 1981. She served in the Peace Corps as a Medical Officer in Africa, and then started a private medical practice.

As a child she was intrigued by the Space Program and wondered why there were no women astronauts. However, she was inspired by a fictional female astronaut played by African American actress Nichelle Nichols, Lieutenant Uhura on the Star Trek television show.

When Sally Ride became the first American woman in space in 1983, Dr. Jemison applied to the astronaut program at NASA in 1985. Due to the Space Shuttle Challenger disaster in 1986, NASA took a break from accepting new people. She applied again in 1987 and was one of 15 people chosen out of 2,000 applications.

On September 12, 1992, Dr. Jemison and six other astronauts flew into space on the the space shuttle Endeavor, making her the first African American women in space. The crew flew 127 orbits around the Earth and returned to the Kennedy Space Center in Florida on September 20, 1992.

Dr. Jemison left NASA in 1993 after serving as an astronaut for six years . She started The Jemison Group, a consulting company that encourages science, technology, and social change. She also began teaching environmental studies at Dartmouth College and directed the Jemison Institute for Advancing Technology in Developing Countries.

Dr. Jemison is leading the 100 Year Starship project through the United States Defense Advanced Research Projects Agency (DARPA). This project works to make sure human space travel to another star is possible within the next 100 years. She also serves on the Board of Directors for many organizations including; the Kimberly-Clark Corp., Scholastic, Inc., Valspar Corp., Morehouse College, Texas Medical Center, Texas State Product Development and Small Business Incubator, Greater Houston Partnership Disaster Planning and Recovery Task Force, and the National Institute of Biomedical Imaging and Bioengineering.

Dr.Jemison has been inducted into the National Women’s Hall of Fame, National Medical Association Hall of Fame and Texas Science Hall of Fame.

Perhaps one of her favorite “honors” was appearing in an episode of Star Trek. Dr. Jemison became the first real astronaut to be in Star Trek: The Next Generation. She played Lieutenant Palmer in the episode, “Second Chances.”

taken from a bio of Dr. Jemison by Kerri Lee Alexander, NWHM Fellow | 2018-2019
92-44303 — STS-47 Endeavour, Orbiter Vehicle (OV) 105, crew members and back-up payload specialists, wearing clean suits, pose for a group portrait in the Spacelab Japan (SLJ) module. The team is at the Kennedy Space Center’s (KSC’s) Orbiter Processing Facility (OPF) to inspect SLJ configuration and OV-105 preparations. Kneeling, from left, are back-up Payload Specialist Chiaki Naito-Mukai; Mission Specialist N. Jan Davis; and backup Payload Specialist Takao Doi. Standing, from the left, are Pilot Curtis L. Brown,Jr; Payload Commander Mark C. Lee; Jerome Apt; Payload Specialist Mamoru Mohri; Commander Robert L. Gibson; Mae C. Jemison; and back-up Payload Specialist Stanely L. Koszelak. Mohri, Mukai, and Doi represent the National Space Development Agency of Japan (NASDA). View provided by KSC with alternate KSC number KSC-92PC-1647. Photo credit: NASA

Independence, a space shuttle replica, on display at NASA in Houston, TX
The space shuttle replica Independence on display at Space Center Houston; photo by Raymond Oglesby during our visit to the center a few years ago

Dr. Laurel Salton Clark

Dr. Laurel Clark served her country as a flight surgeon with the U.S. Navy. She along with her husband Dr. Jonathon Clark joined NASA as astronauts.

Dr. Clark made her first space flight on Space Shuttle Columbia during STS-107 as a mission specialist. The extended-duration mission was dedicated to scientific research. The STS-107 crew successfully conducted more than 80 experiments.

KENNEDY SPACE CENTER, FLA. – STS-107 Mission Specialist Laurel Clark is helped with her helmet during suitup for launch. STS-107 is a mission devoted to research and will include more than 80 experiments that will study Earth and space science, advanced technology development, and astronaut health and safety. The payload on Space Shuttle Columbia includes FREESTAR (Fast Reaction Experiments Enabling Science, Technology, Applications and Research) and the SHI Research Double Module (SHI/RDM), known as SPACEHAB. Experiments on the module range from material sciences to life sciences. Liftoff is scheduled for 10:39 a.m. EST. credit NASA

On February 1, 2003  Clark and the STS-107 crew perished during re-entry as Columbia broke up over Texas en route to a landing in Florida. She amassed 15 days, 22 hours and 20 minutes in space.

At SPACEHAB in Cape Canaveral, Fla., STS-107 Mission Specialist Laurel Clark becomes familiar with equipment for the mission. STS-107 is a research mission, and the primary payload is the first flight of the SHI Research Double Module (SHI/RDM). The experiments range from material sciences to life sciences (many rats). Among the experiments is a Hitchhiker carrier system, modular and expandable in accordance with payload requirements. STS-107 is scheduled to launch in June 2002; credit NASA

During a memorial service at Johnson Space Center in Houston, Texas, on Feb. 4, 2003, President George W. Bush emphasized Clark’s love for her family and her work.

“Laurel Salton Clark was a physician and a flight surgeon who loved adventure, loved her work, loved her husband and her son,” he said.
A friend who heard Laurel speaking to Mission Control said there was a smile in her voice. Laurel conducted some of the experiments as Columbia orbited the Earth and described seeing new life emerged from a tiny cocoon. ‘Life,’ she said, ‘continues in a lot of places and life is a magical thing.'”

In this emotional interview, Dr. Jonathon Clark remembers his wife, who “sacrificed her life for space research.”

Dr. Jonathan Clark reflects on his late wife Dr. Laurel Clark

exploring the HEARTS of women in medicine and space

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

The International Space Station exhibit at Johnson Space Center

How people flew to the moon-exploring the HEART of health in space

Human bodies are designed for Earth, not outer space, so taking them into space and bringing them back safely was a monumental task and grave responsibility. And it was not accomplished perfectly-early on in 1967 the Apollo 1 spacecraft cabin caught fire and claimed the lives of three astronauts.

This affiliate link was founded by a woman M.D. , please check it out.
The M.D., Caroline J. Cederquist has spent her life’s work helping patients achieve healthy weight loss, through her years of clinical practice as a weight loss physician. Her understanding of what nutrition your body needs in order to achieve healthy weight loss, inspired her and her husband, The Foodie, to create bistroMD. Caroline wanted to provide her patients, and others struggling with weight, the ability to easily prepare healthy and delicious entrees at home.

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