Trends in urological manpower in the United States in 1986

Estimated urological manpower needs for the United States are reviewed and correlated with the nationwide urological work load. In addition, a limited attempt is made to assess the ideal urological work load. On the basis of this study a decrease in the production of urologists appears to be less necessary than has been proposed to date. If the present trend of increasing the length of urology residency training to 2 pre-urology years plus 4 years of urology continues, and if the influx of foreign trained graduates continues to decrease the problem of overproduction of urological specialists may be solved, since these 2 measures by themselves would reduce the annual certification in the United States to about 280 diplomates, which is 20 less than the estimated annual attrition of 300 practicing urologists. The 8,236 urologists in the United States counted by the American Medical Association in 1983 performed an average of 204 hospital procedures each, including 43 transurethral prostatic resections. The average load per urologist seems to be adequate to maintain diagnostic, therapeutic and surgical skills.     

A population-based study of the association of medical manpower with county trauma death rates in the United States.

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS)     

Training requirements for DXA technologists in the United States.

The purposes of this study were to determine, by state, the requirements for dual-energy X-ray absorptiometry(DXA) operators' training, knowledge of these state requirements, and factors that predicted state and International Society of Clinical Densitometry (ISCD) certification of DXA technologists. Seventeen states required registered technologist (RT) certification or authorized/licensed limited certification for DXA operators, 16 had no certification requirements, 12 required RT certification, and 5 had state-specific requirements. There were 9745 surveys mailed toDXA users including 50% Hologic Inc., 50% GE Lunar, and 100% Norland; 3148 surveys are included in this analysis. Among responders who indicated that their state did not have any certification requirements (n=1673), 1095(65.5%) were incorrect; there were requirements. Possession of state and ISCD certification was significantly correlated with the number of patients scanned per week (p相似文献   

The interlocking of American surgery: An analysis of surgical leadership in the United States, 1945 through 1985

To analyze surgical leadership in the United States from 1945 to 1985, 15 positions of influence have been identified. Appointments to these positions have been reviewed by age at appointment, medical school of graduation, site of residency training, solo appointments, and geographic distribution. A weighting scheme was designed to quantify institutional and personal performance. The 460 surgeons involved in this study graduated from 72 medical schools and 68 residency programs. The top ranking medical schools were Harvard, Johns Hopkins, University of Pennsylvania, Washington University in St. Louis, and Northwestern, which together accumulated 48 percent and 47 percent of all points and appointments, respectively. The top ranking residency training programs were Harvard, Johns Hopkins, the Mayo Clinic, Washington University in St. Louis, and the University of Pennsylvania, with Cornell, University of Michigan, Columbia, University of Minnesota, and the University of California in San Francisco occupying the second tier. Personal performances revealed that 40 percent of the top 20 surgeons were located in Southern-based institutions. Since 1965, geographic and institutional diversity has begun to appear in the surgical leadership.     

Epidemiology of hemodialysis vascular access in the United States

Reemergence of the importance of vascular access in the care of the chronic hemodialysis patient has gained prominence due to renewed interest in clinical outcomes and evidence-based interventions. Further fueled by anticipated regulatory changes in the reimbursement for dialysis care in the United States by 2011 and beyond, the drive to improve quality of care for hemodialysis patients has identified vascular access issues as a key contributor to outcomes. Focus has shifted from simply providing any hemodialysis vascular access to a strong preference for the use of native arteriovenous fistulas and subsequently to a need for reducing exposure to central venous catheters. Combined, these goals have forced a reevaluation of the role of arteriovenous grafts. The context and events associated with the evolution of thinking on these issues as well as available data supporting them are discussed. The key leadership role of nephrologists is emphasized along with a summary of problems and proposed solutions.     

An analysis of the need for pediatric surgeons in the United States

A questionnaire study covering all major population areas in the United States indicated that pediatric surgeons and potentially capable hospitals are already well-distributed throughout the country. The estimation of need for pediatric surgeons based on the area questionnaires is close to the present number of surgeons.A computer analysis was made to project numbers of pediatric surgeons per unit population to the year 200 with differing levels of trainee output. The study indicates the 14–15 training programs are sufficient to allow for slow, modest growth of the specialty if current population trends continue.     

Perilymphatic fistula: surgical experience in the United States

One survey sent to 6953 individual otolaryngologic practices and 106 departments of otolaryngology at teaching hospitals in the United States, and a more limited survey of 75 patients operated on for perilymphatic fistula (PLF) at the House Ear Institute, addressed aspects of managing PLF: surgical incidence, reliability of diagnostic test, preoperative observations, and disability after surgery. Of surgeons sampled, 93% estimated incidence of PLF surgery to be less than or equal to 1 per 1000 otolaryngologic outpatient visits. The most reliable diagnostic indicators were history, symptomatology, and tympanometric and electronystagmographic fistula tests. About 72% of surgeons reported less than 4 weeks' average delay before surgery. Most surgeons and patients (greater than or equal to 70%) rated length of disability before return to work, exposure to noise, travel by airplane, swimming, and heavy lifting, at several weeks to several months. Diving was the most restricted activity. Results suggest that incidence of surgery and disability with PFL in the United States is very limited.     

Manpower goals in American surgery. Implications for residency training. Future surgical manpower in the framework of total United States physicians.

Constraints on manpower are intrinsic in the establishment of standards of excellence. When such constraints are exerted by individual Boards, Societies, Colleges or Academies they should act to improve the quality of care; their weakness lies in their lack of control over non-members, or those who have failed to pass the examinations. Such manpower constraints become specific objectives or goals when the number of accredited specialists is specifically related to the size of the population served. Any such manpower planning must recognize the many uncertainties in the future of American medicine, and maintain wide elasticity in the planning process. Social and economic pressures render the consideration of specific manpower goals essential at this time. Data from the national surgical study (SOSSUS) make it possible to consider such goals. Manpower objectives for surgery or any other branch of medicine should be considered as a part of the total medical manpower outlook for the United States. Pressures to reduce the number of surgeons entering practice are notable at this time. These should be evaluated against other pressures to maintain or increase the number of hospital-based specialists in all fields as the total number of practitioners undergoes a major expansion over the next 25 years, and the pressure for specialty care is thereby increased. A reasonable balance between these two pressures would be a manpower goal for surgery that allowed a modest growth rate over the next 25-50 years. An example of such is the goal of limiting surgical practitioner growth to a 1% increase in the ratio to population, every 5 years. This would be in sharp contrast to the continuous explosive growth of numbers of surgeons, since World War II.     

Appendicitis mortality rates: Regional differences in the United States

The appendicitis death rates are much higher for all age groups in the Rocky Mountain region than any other section of the country. This relatively high mortality may be due to a greater incidence of the disease than in other parts of the United States. It is suggested that additional statistical studies of large numbers of cases be made in all sections of the country in order to determine whether the rate of occurrence or case fatality rates account for differences in mortality rates.     

Characterizing the geographic distribution of vascular surgeons in the United States

ObjectiveThe shortage of vascular surgeons can be attributed to multiple factors, including an aging population, the increasing demand for vascular surgeons, and an aging vascular surgery workforce. The distribution of vascular surgeons across the United States varies by locale; thus, the shortage affects regions of different sizes disproportionately. We collated the geographic data to characterize the current distribution of vascular surgeons with an emphasis on the practice location, population density, and population age.MethodsVascular surgeons were identified using the Physician Compare National Downloadable file from the Centers for Medicare and Medical Services. The counties were matched with each surgeon’s practice location. The locations were categorized into metropolitan, urban, or rural using the rural-urban continuum codes. Census Bureau data were used to match all counties with their population-level metrics. The distribution of vascular surgeons was analyzed by comparing the number of counties served, total patient population served, and patient population aged >50 and >65 years served. Finally, the density of vascular surgeons in the United States for the total population and for those aged >50 and >65 years was calculated.ResultsIn 2018, the U.S. population was 309.8 million, and there were 3145 counties. Of the 3145 counties, 533 (17%) had had a practicing vascular surgeon. The combined population of these counties was 213.8 million people (69% of the U.S. population). Stratified by age, the vascular surgeons in these 533 counties could treat 37.3 million people aged >50 years and 17.4 million people aged >65 years. However, 2612 counties (83%), with a total population of 96 million people (31% of the U.S. population), had had no practicing vascular surgeon. When stratified by age, 78.1 million people in the uncovered counties were aged >50 years and 35 million were aged >65 years. Of the 2612 uncovered counties, 48% were urban and 24% were rural.ConclusionsWe found a nationwide shortage of vascular surgeons, with urban and rural areas disproportionately affected negatively. Although encouraging vascular surgeons to practice in underserved areas would be an ideal solution, it is not pragmatic. Therefore, developing alternatives such as using primary care providers, investing in telehealth and developing transfer systems could be viable methods of providing vascular care to geographically isolated populations. These findings have significant implications for hospitals, patients, and vascular surgeons, who would all stand to benefit from efforts to address these disparities.