Changes in Specialty Choice 1987 - 1999

Robert C. Bowman, M.D.    Medical school graduates by class year and major specialties from the Masterfile 2005 version

2005 Masterfile

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

Allergy Immunology

79

68

73

61

67

42

32

44

41

56

73

87

Anesthesia

1141

1135

1111

1220

1155

1090

836

664

443

316

421

535

Pain Management (anesth)

36

34

44

76

67

65

83

67

49

26

27

39

Cardiology

455

473

484

437

382

369

279

294

269

270

285

349

Diagnostic Radiology

620

659

641

589

683

615

622

566

585

563

496

569

Emergency Medicine

612

599

616

642

707

743

804

822

878

998

934

952

Endocrinology

69

92

81

65

65

54

57

63

64

70

95

100

Family Medicine

1847

1633

1633

1662

1667

1778

2010

2285

2484

2622

2636

2459

Gastroenterology

274

303

288

290

244

217

153

134

168

165

191

241

General Surgery

534

555

540

542

580

566

593

665

627

675

680

668

Infectious Disease

132

155

131

138

110

117

112

121

130

136

137

136

Internal Medicine (general)

1918

1828

1681

1678

1767

1961

2092

2072

2169

2079

1977

1929

Internal Medicine Geriatrics

44

46

44

34

29

36

35

51

47

71

68

61

Medicine Pediatrics

14

11

22

20

38

67

132

189

248

249

290

292

Neurology

248

269

246

248

250

249

199

180

152

131

166

175

Nephrology

90

105

92

95

70

71

75

100

150

159

163

168

Neonatal Perinatal

77

79

66

65

65

50

46

54

41

66

72

100

Neurosurgery

119

133

129

119

141

127

134

123

136

132

112

142

Obstetrics-Gynecology

843

956

958

1010

1050

1045

1116

1060

1051

1062

1075

973

Psychiatry

809

812

744

651

620

526

499

414

438

423

467

390

Pediatrics

1096

1018

982

1023

1103

1108

1220

1231

1335

1409

1435

1444

Physical Medicine

247

251

270

233

226

235

215

217

197

175

153

129

Plastic Surgery

176

177

169

161

153

159

140

146

149

131

133

130

Pathology

252

252

237

270

265

236

218

206

202

189

151

130

Rheumatology

82

85

79

64

47

38

36

34

42

62

85

74

Neuroradiology

58

87

98

94

74

89

84

85

78

56

58

87

Radiation Oncology

147

139

141

124

129

118

119

105

124

79

71

67

Total

15740

15796

15424

15334

15342

15375

15492

15516

15940

15853

15943

15952

Health Policy Related Increase (managed care and primary care reforms, reports, panic) impacting choice of family medicine for the US MD Grads of 1994 - 1997 and greater retention of internal medicine residents in generalist choices for those in residency at the same time. This group graduated from medical school from 1991 - 1994.  

Health Policy Related Decrease related to managed care and health reform changes. Hospital support and neurology losses are seen in the 1993 1997 class years. The internal medicine career changes impacted earlier class years.

Decline/trough for primary care from Medicare, Medicaid, primary care changes, reports.

Growth, Demand, More Positions   Generalist pediatrics has had steady growth that may be a combination of health policy and admissions of more with commitment to generalist careers, particularly females. Emergency medicine, geriatrics, interventional radiology, and pain management have had growth as recent creations and increased demand. Neprology and dermatology growth involves more positions. Nephrology and obstetrics changes may have also been a result of increasing health policy support from Medicare and Medicaid.  

Increases As A Recovery or Rebound from managed care/health reform.

Subspecialty Training Effect, not a real decline or increase.

Lower Demand Or Decision To Limit Position

Medicine pediatrics has a greatly distorted appearance in the Masterfile. US seniors matching to MPD increased from 150 to 300 over this time period, but less than 20% of the 1987 1990 graduates can be found in medicine pediatrics. Subspecialization in MPD is rapid and progressive, with only a few years involving primary care.

Fixed in Place Certain careers are a constant across the time period: Dermatology (255 annual average), General Preventive Medicine (65), Hematology/Oncology and Oncology (173), Neurosurgery (128), Ophthalmology (421), All Orthopedics (559), Otorhinolaryngology (239), Pediatric Cardiology (45), Thoracic Surgery (100), and Urology (226). The limits on how many can enter basically determine the numbers, not medical student choice.

Attempts to explain career changes through unified theories involving controllable lifestyle, curricula, or grant funding make less sense than an equilibrium concept related to supply, demand, and health policy.

 

 

Medicine pediatrics has significant losses down to less than 10% remaining for the 1987 and 1988 graduates when compared to the NRMP match. More "appear" with each class year as fewer have subspecialized and changed away from medicine pediatrics. The most recent levels reflect the most recent graduates. Subspecialization rates may be made worse with health policy involving primary care as seen in declines in internal medicine choice also. Office Based Proportions in IM, FP, Pediatrics, Medicine Pediatrics

Five Periods of Health Policy and Physician Career Choice

Reimbursement and Physician Distribution - follow changes in Medicare funding

Flaws in the Concept of Controllable Lifestyle

Family Medicine Physician Distribution

Physician Workforce Studies

Primary Care Retention

www.ruralmedicaleducation.org

 

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