sonraki »

[vioxx]

Here is some data showing the relative job markets of the different specialties and subspecialties. Generally speaking, people in the primary care specialties have the easiest time finding a job. This information is from the most recent survey to appear in JAMA. The reference is JAMA, 280(9):777-83 1998 Sep 2. The unemployment rates for recent graduates during the survey period were:


Specialty                   Unemployed  Comment



Orthopedic Surgery             1.0   Best

Pulmonary Disease&Crit Care   1.3   Second Best

Emergency Medicine      1.5

Ob/Gyn            2.1

Otolaryngology         2.1

Urology            3.8

Dermatology         4.7

Family practice         4.9

Psychiarty         5.2

Cardiovascular disease      5.7

Hematology/oncology      6.0

Pulmonary disease      6.1

General Surgery         6.2

Gastroenterology      6.4

Neurology         6.5

Diagnostic radiology      6.7

Endocrinology         6.7

Rheumatology         6.8

Anesthesiology         7.3

Physical Med and Rehab      7.5

Nephrology         7.9

Critical Care Medicine      8.0

Plastic Surgery         9.2

Pediatrics         9.3

Infectious Disease      10.3

Internal Medicine      11.1

Ophthalmology         11.6

Oncology         12.5

Geriatric Medicine      14.3

Pathology - Anatomic&Clinical   14.7   Second Worst

Hematology         19.0   Worst

[sermet]

Radyasyon Onkolojisi'ne dair bir istatistik yok mu?

[Bora(PunK)]

Sermet kazanc onemli bir kriterse senin icin anesteziyi tavsiye ederim... Radyasyon onkolojisine girmen cok zor, anesteziye ise girebilirsin ve rad onk kadar da kazanabilirsin..

[sermet]

Yok, değil. Kazancı umursasaydım cerrah olurdum. Cerrah olmak(ABD'de) benim için daha kolay(ilişkilerim ve tecrübelerimden ötürü). Tıpta uzmanlık seçimi ile ilgili genişçe bir kitap okuduğum ve kitapta anlatıldğına göre  radyasyon onkolojisi benim hayal ettiğim alan. Para ve etiket kazanmanın türlü türlü yolları var. Radyasyon onkoloğu olmak bu yolların içinde bulunmasa gerek. Niye hemen hemen tüm uzmanlık dallarına dair istatistikler varken (kendi düşündüğüm alan olduğu ve merak ettiğm için özellikle) bu uzmanlık dalına dair bilginin olmadığını sordum sadece.

[Bora(PunK)]

Rasyasyon onkologu sayisi az oldugundan boyle istatistiklerde olmayabiliyorlar... Yoksa rad onkolojisinde is imkaninin zor olacagini sanmiyorum..
Ultimate Guide'mi okudugun kitap? Bu turlu kitaplara link vermek lazim siteden cunku gercekten onemli bilgiler iceriyorlar ve meslegin gelecegi ile ilgili ongoruleri oluyor. Bizim TRde hic karsilasmadigimiz bircok uzmanlik var Amerikada ve insan bunlari okumadan bilemiyor.

[Gamze Balci Camsari]

Bora' ya kesinlikle katiliyorum. Ozellikle cazip bulunabilecek ikili, uclu uzmanlik kombinasyonlar da incelenmeli bence. Daha iyi olacagi tabii ki garanti degil ama onumuzdeki secenekleri arttirarak yapacagimiz biraz zihin jimnastiginin de bir zarari olmayacaktir... 

[sermet]

 Evet, "Ultimate Guide...Choosing Medical Speciality". Çok güzel bir kitap. Kombine programlardan da bahsetmiş kitap. Kesinlikle çok yararlı, bu kitabın linkini koyulabilirse çok faydalı olur forumdaki arkadaşlarımız için. 

[vioxx]

Preview icin...
http://books.google.com.tr/books?id=t7ob9oXfZwIC&dq=&pg=PP1&ots=eHapDLQjCg&sig=pdM_n9wuWfTONYWVEnzksJ32hOs&prev=http://www.google.com.tr/search%3Fhl%3Dtr%26q%3DUltimate%2BGuide%2BChoosing%2BMedical%2BSpeciality%26btnG%3DGoogle%27da%2BAra%26meta%3D&sa=X&oi=print&ct=title#PPA13,M1

[dollycan]

Kitabi indirmek isteyenler icin link

http://mihd.net/5.4337/TUGtCaMS.rar.html
Password: http://forum.emedicina.us/

[Bora(PunK)]

Recent Studies and Reports on Physician Shortages in the U.S.
August 2007

Center for Workforce Studies

Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 1
Recent Studies and Reports on Physician Shortages in the U.S.
Over the past several years, a growing number of studies examining the U.S. physician workforce have concluded the nation, a state or a specialty is facing current or future shortages. The report is divided into three sections:
1) a summary of 15 state reports on physician shortages;
2) a summary of 16 specialty shortage reports

STATE REPORTS
Since 2002, there have been at least 15 studies of current or future state physician workforce needs. In
nearly all of these studies, the underserved and elderly populations are most likely to be affected.
Additionally, many of the state reports point out shortages in specialties that are featured in the specialty
report section, including allergy and immunology, cardiology, child psychiatry, dermatology,
endocrinology, neurosurgery, primary care, and psychiatry.
Arizona (2005) – “Still Far Below the National Average”
The 2005 Arizona Physician Workforce Study, prepared by the Arizona State University and University
of Arizona Health Sciences Center, concludes that while the growth in the physician workforce over the
past decade outpaced the increase in population, a number of specialties have decreased in numbers,
including allergists, cardiovascular surgeons, endocrinologists, gastroenterologists, hematologists, and
infectious disease specialists. Arizona’s high projected population growth combined with the limited
number of in-state medical education and training opportunities will make Arizona increasingly reliant
on recruiting physicians from other states at a time of projected national shortages.1
California (2004) – “Likely to Face Physician Shortage in 2015”
The University of California Office of Health Affairs and University of California Health Sciences
Committee commissioned a report on California’s physician workforce conducted by the University of
Albany’s Center for Health Workforce Studies. The report concludes that “growth in physician demand
is likely to outpace growth in physician supply by between 4.7% and 15.9%.” The population of
California is growing rapidly which will place great strains on the healthcare delivery system and the
physician workforce. More than one-fourth of the state’s practicing physicians were over age 55 in
2000. In addition, the state has a mal-distribution of physicians with 60% of the current physicians
practicing in only five counties.2 In part in response to this report, in 2006, the California Board of
Regents approved the establishment of a new medical school at the University of California at
Riverside.3
Florida (2005) – “All Agree Demand Outstrips Production”
According to staff analysis by the Board of Governors of the State University System of Florida,
“though data sources are conflicting on the exact number of physicians that will be needed, all agree
demand outstrips production.” A quarter of Florida’s practicing physicians are over 65 and only 10%
are under 35. Florida’s population is projected to increase 60% by 2030 and the aged population is
projected to grow by 124% in the same span which will dramatically increase demand for physician
services. 4 In 2006, the Florida Board of Governors approved the establishment of two new medical
schools.5
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 2
Georgia (2006) – “Physician Marketplace Needs New Physicians”
The Georgia Board for Physician Workforce conducts annual surveys of physicians completing their
final year of residency training in the state. The job market for new physicians is strong but seems to be
tightening as only 77% of job seekers graduating from GA residency programs received and accepted a
job offer, (down from 87% in 2005), and fewer are remaining in Georgia. Only 50% of the graduates
with confirmed practice plans are remaining in the state, down from 56% in 2002. Results of the 2006
survey indicate Georgia continues to rely heavily on other states and countries to train needed
physicians.6
Iowa (2007) – “Aging Population will Alter Demand for Physician Services”
After reviewing physician supply and demand data, a task force established by University of Iowa
Health Care leaders developed a set of recommendations for improving the physician supply that
focused on modest increases in physician education and training capacity as well as a detailed set of
recruitment and retention strategies. The five specialties perceived to be in greatest need were
psychiatry, neurosurgery, general internal medicine, orthopedic surgery, and cardiology.7
Kentucky (2005) – “Shortage will Continue to Pose Major Challenge”
A study from The University of Kentucky Center for Rural Health found a current and future projected
physician workforce shortage and suggests that the “physician shortage will continue to pose a major
challenge.” Currently, 2 out of 3 of the state’s counties are officially designated health professional
shortage areas (HPSAs) for primary care by the Health Resources and Services Administration (HRSA).
To make matters worse, approximately 400 of Kentucky’s currently practicing family physicians are age
60 or older and likely to retire in the near future.8
Massachusetts (2007) – “Physician Labor Market Continues to be Under Extreme Stress”
For six years in a row, the Massachusetts Medical Society has conducted a physician workforce study
and each successive report points to a strained health care market. This most recent report continues to
show the state facing critical or severe shortages in neurosurgery, anesthesiology, cardiology,
gastroenterology, family practice, internal medicine, psychiatry, and vascular surgery and adds urology
to the list. As the new health care initiative goes into effect, this could further strain the state’s ability to
meet demand for services.9
Michigan (2005) – “Significant Gap Between Supply and Demand in 2020”
A June 2005 analysis of the physician workforce conducted by the Michigan State Medical Society
projects that “each major region in Michigan will exhibit a significant gap between physician supply and
demand in 2020.” The aging of the population will drive the increased demand for physicians. Several
specialties that primarily serve the elderly are particularly at risk for shortages, including general
surgeons, radiologists, urologists, otolaryngologists, and ophthalmologists.10
Mississippi (2003) – “Extant Physician Shortage will Become More Severe”
Even before hurricane Katrina devastated the gulf coast region, Mississippi was facing a shortage of
physicians. Findings presented in a 2003 white paper by the Health Policy Research Center at
Mississippi State University indicate an “extant physician shortage will become more severe.” Over
half (56%) of the states physicians practice in four counties and 2 out of 3 counties are officially
designated health professional shortage areas (HPSAs) with high levels of chronic illness and poverty.
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 3
A survey of practicing physicians indicates that many are considering relocation or early retirement
which will likely exacerbate the current shortages.11
Nevada (2006) – “School Too Small to Meet State’s Growing Health Care Needs”
A 2006 report by LarsonAllen, a Minnesota consulting firm charged with reviewing Nevada medical
education capacity and need, recommends that the state develop a health sciences center in order to
dramatically increase medical school and graduate medical education training opportunities. With one
of the lowest physician to population ratios and one of the highest population growth rates in the nation,
the existing medical education system cannot keep up with the need.12
North Carolina (2007) – “State Likely to Face a Severe Shortage Over Next 20 Years”
A Task Force convened by the North Carolina Institute of Medicine concluded that without major
changes in the health care delivery system or significant increases in the number of physicians, the state
is likely to face a severe shortage of physicians. The projected shortages are not limited to physicians
and will also include nurse practitioners, physician assistants and certified nurse midwives. The
projected gap is mainly due to population growth, aging of the population and providers, and the
increasing prevalence of chronic diseases.13
Texas (2002) – “Physician to Population Ratios Increasingly Unfavorable”
The Texas Higher Education Coordinating Board released a report in 2002 stating that, “if the number of
physicians does not increase, the [physician to population] ratios will become increasingly unfavorable.”
While the number of Texas medical school graduates has remained relatively flat over the past twenty
years, the state’s population has grown by 50% in the same span. In addition, underserved populations
and the under-representation of Hispanics and African-Americans are critical issues for the state.14 In
June 2007, the governor of Texas signed legislation approved by the 80th Texas Legislature to fund the
final components necessary for the Texas Tech University Health Sciences Center El Paso School of
Medicine to become a fully operational four-year medical school.15
Oregon (2004) – “Looming Shortage of Physicians”
Oregon Health & Science University’s Center for Rural Health has been collecting workforce data since
the mid-70’s; 2004 data suggests a “looming shortage of physicians.” Population growth in Oregon
exceeds growth in the number of physicians; nearly half of the state’s practicing physicians are over 50
and approaching retirement age. This comes at a time when the state is already experiencing shortages
in rural areas and in several specialties, including rheumatology, nephrology, gastroenterology,
cardiology, allergy-immunology and pediatrics.16
Utah (2006) – “Shortages Exist in many Specialties”
In 2003, the Utah Medical Education Council sent a survey to all practicing physicians licensed in the
state to better understand the existing workforce and to forecast future supply and demand. There are
current shortages in pediatric neurology, child psychiatry, adult psychiatry, obstetrics & gynecology,
general surgery, dermatology, urology, and cardiology. The state will need to recruit up to 270
physicians a year in order to keep up with growth in demand due to the growth and aging of the
population and to replace loss of FTEs due to retirements. Given the nationwide shortages, it will be a
challenge to even maintain current recruitment levels.17
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 4
Wisconsin (2004) – “Who Will Care for Our Patients?”
A 2004 report from the Task Force on Wisconsin’s Future Physician Workforce, entitled “Who Will
Care for Our Patients? Wisconsin Takes Action to Fight a Growing Physician Shortage” concluded that
Wisconsin has current unmet needs for physician services that are likely to worsen in the foreseeable
future. Shortages in primary care physicians, general surgeons, and radiologists already exist in rural
areas of the state and many specialists are in demand and hard to recruit on a statewide basis. Demand
for physician services is projected to exceed even the most optimistic estimate of future physician
supply in the state due to population growth and the aging of the population. Demand for primary care
services is projected to increase by an additional 13.5% and is expected to exceed 20% for all other
physicians.18

[Bora(PunK)]

SPECIALTY SPECIFIC STUDIES
Recent workforce studies indicate that we face current and future shortages in a wide array of
specialties. In addition to potential shortages in primary care specialties, as the population ages, the
demand for specialists that provide care for patients over 65 will increase significantly. As indicated by
a number of the studies below, the aging of the population is expected to contribute to shortages in many
of these specialties.
Allergy and Immunology (2000) – “Shortage within Next Ten Years”
A June 2000 report prepared for the American Academy of Allergy, Asthma, and Immunology by
SUNY Albany’s Center for Health Workforce Studies concludes, “there will be a shortage of
allergist/immunologists within the next ten years.” Demand is rising and the supply of new physicians
will not be able to keep pace with the current retirement rate of practicing allergists and immunologists
and unable to meet the projected increase in demand.19
Anesthesia (2003) – “Current Shortfall of Anesthesiologists”
A 2003 assessment of the supply of and demand for anesthesiologists found a current shortage. There
was not enough data to determine with confidence how demand for anesthesiologists would change in
the coming years. If demand increases above 1.5%, the authors project a continued shortage through
2015.20
Cardiology (2004) – “Serious Shortage of Cardiologists”
The American College of Cardiology (ACC) Task Force on Workforce concluded that the U.S. is facing
a “serious shortage of cardiologists.” A report from their 35th Bethesda Conference, endorsed by the
American Heart Association and a host of other cardiology-related societies, predicts that, by 2020,
there will be a 20% decrease in the age-adjusted supply of cardiologists at the same time we will see a
substantial increase in the incidence and prevalence of cardiovascular disease due to the aging of
population and the epidemic of obesity. 21 22 23
Child Psychiatry (2006) – “Evident Shortage Will Continue Well into the Future”
A 2003 Academic Psychiatry article finds that, “despite the decades-long projection of an increasing
utilization of child and adolescent psychiatry services and an undersupply of child psychiatrists, the actual
growth and supply of child and adolescent psychiatrists has been very slow.” A 1990 report by the
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 5
Department of Health and Human Services concluded the nation should have over 30,000 child psychiatrists
but there are less than 7,000 currently practicing in the nation.24
Critical Care Workforce (2006) – “Growing Supply of Intensivists will be Insufficient”
In June 2003, Congress asked HRSA to examine the adequacy of the critical care workforce in response
to concerns that the number of pulmonary and critical care physicians would not be able to meet the
needs of the aging baby boomer population. HRSA worked with the College of Chest Physicians to
update physician workforce models to include critical care physicians and found that “demand for
intensitivists will continue to exceed available supply through the year 2020 if current supply and
demand trends continue.” 25
Dermatology (2004) – “Inadequate Supply of Dermatologists to Meet Demand”
In an article published in the Journal of the American Academy of Dermatology, “survey data
examining wait times, physician perception, use of physician extenders, searches for new employees,
and experience of recent graduates entering the workforce [indicates] there is an inadequate supply of
dermatologists to meet the demand for services.” Nearly half of practicing dermatologists believe their
community could use more dermatologists. One third are recruiting new associates and new graduates
are readily able to find jobs.26
Emergency Medicine (2006) – “National Crisis in Emergency Care”
In 2006, the IOM released a series of three reports on the future of emergency medicine concluding that
emergency departments and ambulatory services are overburdened, under-funded, and highly
fragmented. Patients face long waits in overcrowded emergency rooms and often needed on-call
specialists are not available. A significant contributing factor is that more and more patients are turning
to emergency departments for care because of lack of insurance, for after-hours care, or due to limited
options in rural communities. 27
Endocrinology (2003) – “Demand Will Exceed Supply from Now until 2020”
According to a study published jointly in the May 2003 issues of the journals Endocrine Practice,
Diabetes Care, and the Journal of Clinical Endocrinology & Metabolism, the supply of newly trained
endocrinologists will not be sufficient to offset retirements and future increases in demand. As it stands,
current demand exceeds supply by 15% and the aging of the population compounded with physician
retirements will exacerbate the situation. The authors present multiple models for estimating the future
demand for endocrinologists and even the conservative estimates predicate a widening shortage by
2020.28
Geriatric Medicine (2004) – “Severe and Worsening Shortage”
A report from the American Geriatrics Society (AGS) and the Association of Directors of Geriatric
Academic Programs (ADGAP) suggests a “severe and worsening shortage.” With only 7,000 practicing
geriatricians we are currently only meeting 35% of estimated need. The Alliance for Aging Research
estimated that another 14,000 geriatricians are needed to adequately care for the existing elderly
population. By 2030, they estimate the need to more than double to 36,000. However, 26% of geriatric
medicine GME slots are unfilled, and 54% of geriatric psychiatry slots are not filled. Financial
disincentives (low Medicare reimbursement rates) are cited as the largest barrier to entry to the field.29
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 6
Medical Genetics (2004) – “Situation is Critical”
An October 2004 Report of the Banbury Summit Meeting on Training of Physicians in Medical
Genetics states that “the medical genetics workforce situation is critical.” As the scope of practice for
geneticists increases beyond rare pediatric disorders and becomes increasingly relevant to common
health concerns (including some forms of cancer and a number of neurological and cardiovascular
disorders), declining numbers of physicians are going into the field. 58% of clinical genetics GME slots
are unfilled. 17 states currently have shortages and the 5 to 15 year forecast indicates further
shortages.30
Neurosurgery (2005) – “Severe Decline in Number of Active Neurosurgeons”
According to a study published in the February 2005 issue of the Journal of Neurosurgery the nation is
encountering a “severe decline in the number of active neurosurgeons and a static supply of residents.”
The number of practicing neurosurgeons has declined while at the same time there has been a significant
increase in the demand for neurosurgeons. Evidence cited includes a doubling in the average number of
journal-advertised academic and private neurosurgery positions per year between 1994 to1998 and 1999
to 2003. 31
Oncology (2007) – “Oncology Moving to a State of Acute Shortages in 2020”
A 2007 report in the Journal of Oncology Practice concludes that the nation will face a shortage of
oncologists if current cancer rates and practice patterns continue. Demand is projected to increase by
48% by 2020 due to the growth in the aged population and to the increasing number of cancer survivors.
Supply is only projected to increase by 14% by 2020 due to physician retirements and limited expected
growth in the number of oncology fellowship training slots. The authors note there are opportunities to
minimize the gap in supply and demand but that no single remedy alone can fully address the likely
shortage.32
Pediatric Subspecialties (2003) – Federal Expert Panel Created in Response to Shortage
In 2003, the Department of Health and Human Services (DHHS), through its Bureau of Maternal and
Child Health (MCHB/HRSA), created a federal Expert Panel on Pediatric Subspecialty Capacity in
response to growing concerns over shortages of pediatric subspecialists across the country. Though the
work of the Expert Panel is ongoing, early reports have identified current and future problems with the
pediatric specialty workforce leading to problems in access to appropriate subspecialty care for children
with special needs throughout the country. For example, a recent review of the pediatric rheumatology
workforce found that many children with juvenile arthritis and other serious autoimmune conditions are
often forced to seek care from adult specialists because of a lack of adequately trained pediatric
providers.33
Primary Care (2006) – “Primary Care on the Verge of Collapse”
In 2006, the American College of Physicians released a report entitled “The Impending Collapse of
Primary Care Medicine and Its Implications for the State of the Nation’s Health Care”. At a time of
growing demand for primary care due to growth in the number of people with chronic diseases and long
term care needs of an aging population, there has been a decline in the number of medical students
entering primary care. The authors cite a number of policy recommendations for averting a crisis,
including implementing the advanced medical home (a care coordination model), reforming
reimbursement policies, and creating financial incentives for improving quality and efficiency.34
Recent Studies/Reports on the Inadequacy of the U.S. Physician Supply
August 2007 7
Psychiatry (2003) – “Unclear Rate of Growth will Keep Up with Demand”
In the Winter 2003 issue of Academic Psychiatry, an analysis of the current psychiatric workforce trends
makes it doubtful “the rate of growth will be able to keep up with the rate of growth of demand.” The
average age of practicing psychiatrists is 55.7 and the percentage under 40 dropped from 24% in 1989 to
8% in 2002. Additionally, analysis of the Professional Activities Survey data reveals reductions in the
average number of hours worked per week and in the percent of time psychiatrists spend in direct patient
care.35
Rheumatology (2007) – “Shortage Exists Now and is Likely to Worsen”
In a 2007 Arthritis and Rheumatism article, the authors predict substantial excess in demand relative to
the supply of rheumatologists between 2005 and 2025. The nation is facing an increasing prevalence of
musculoskeletal diseases due to the growth and aging of the population at a time when the supply of
rheumatologists is not projected to increase. The authors note it appears there is a current shortage as a
survey of rheumatologists reveals an average wait for a new appointment of 38 days.36

[acantamoeba]

Bora Ophthalmology için chapter yok mu?