Does the United States have enough physicians?-Yes.For decades, experts have bemoaned a lack of sufficient primary care physicians in the United States. These fears came to a head during debate over the Affordable Care Act (ACA), when critics suggested that the millions of US residents gaining coverage under the ACA would further exacerbate the existing physician shortage. A 2011 American College of Surgeons report asserted that "even before [this] health care reform, the nation was headed for serious physician shortages and reform has only made it worse." 1 According to the updated report of the Association of American Medical Colleges (AAMC), released March 14, 2017, the AAMC still predicts a shortage of between 40 800 to 104 900 physicians by 2030. 2 Some have questioned the accuracy of these projections. Yet the ominous forecast of a physician shortage has already motivated significant reforms. During the last 15 years, the number of medical schools in the United States-including those with provisional or preliminary accreditations-has increased from 125 to 145. Concomitantly,medicalschoolenrollmenthasincreasedfrom16 488 to 21 030 students, an increase of 28% since 2002, and is expected to increase even further by 2018. 3 Additionally, over the last 5 years, the number of Accreditation Council for Graduate Medical Education programs has increased from 9022 to 9977, an increase of 10.6%, and the number of active residents (currently enrolled in a program) has increased from 115 293 to 124 409, an increase of 7.9%. 4 Since passage of the ACA, 22 million US residents have gained health care coverage and thousands of newly trained physicians have begun practicing. 5 Given these changes, it is worth reassessing the data on whether a physician shortage really exists.

IMPORTANCEThe average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown. OBJECTIVE To assess whether the health outcomes of White US citizens living in the 1% and 5% richest counties (hereafter referred to as privileged White US citizens) are better than the health outcomes of average residents in other developed countries. DESIGN, SETTING, AND PARTICIPANTSThis comparative effectiveness study, conducted from January 1, 2013, to December 31, 2015, identified White US citizens living in the 1% (n = 32) and 5% (n = 157) highest-income counties in the US and measured the following 6 health outcomes associated with health care interventions: infant and maternal mortality, colon and breast cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction. The study used Organisation for Economic Co-operation and Development data, CONCORD-3 cancer data, and Medicare data to compare their outcomes with all residents in 12 other developed countries: Australia,

for errors of language and a percentage in the Australia section.

Everyone wants the best physician. Patients want their physician to know medical information by heart, to possess diagnostic acumen, and to be well-versed in the latest tests and treatments. Finding the best physicians often involves looking for resumes with stellar attributes, such as having graduated at the top of a collegiate class, attended the best medical schools, completed internships and residency training at the nation's most prestigious hospitals, and been awarded the most competitive fellowships. Many medical schools, likewise, want only the smartest students, as assessed by the highest grade point averages and MCAT scores.This selection process has persisted for decades. But is it misguided? Do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?

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Key Points Question How commonly are drugs commercially available in the countries where they were tested? Findings This cross-sectional study found that 5 years after their approval in the US, 15% of novel drugs (5 of 34 drugs) were approved in all countries where they were tested; among 70 countries contributing research participants, 7% (5 countries) received market access to the drugs they helped test within 1 year of US approval and 31% (22 countries) did so within 5 years. Approvals were faster in high-income countries, and access was lowest in African countries. Meaning These findings suggest that substantial gaps exist between where drugs are tested and where they become available to patients, raising concerns about the equitable distribution of research benefits.

Unilateral lambdoid synostosis is the rarest form of single-suture craniosynostosis. Although various surgical approaches have been described, cranial vault remodeling remains the predominant approach. To aid in surgical planning, preoperative virtual surgical modeling using a patient's presenting computed tomography scan can be used to increase reconstructive precision and to reduce operative time. Presented is a 7-month-old male with unilateral lambdoid synostosis who underwent medically modeled cranial vault reconstruction.

To the Editor In a Viewpoint, Dr Emanuel and Ms Gudbranson 1 outlined the need to consider applicant abilities beyond surrogate measures of IQ when selecting medical school applicants. Although the authors highlighted emotional intelligence (EQ) as an alternative to IQ, other predictors of success in medicine should be considered as well.As alluded to by the authors, there is not a binary choice between IQ and EQ. A wide range of other intelligences, some of which may strongly predict medical school success, have been explored. 2 Formulaic intelligence, the ability to extrapolate from known or intuited formulas to novel problems triggered by overcoming adversity, may be a strong predictor of success both academically and personally, whereas grit, or resilience, is a better predictor of academic success in adolescents than IQ. 2 A minimum level of academically oriented intelligence, whether judged as formulaic intelligence, grit, or IQ, is needed-along with high EQ-for effective medical practice.Data from a systematic review highlighted the correlation between EQ and medical education core competencies, 3 whereas another review suggested that EQ education in medical school may be of value but that further study is warranted before its "wholesale adoption in any curriculum." 4 The role of specialty self-selection should also be considered because different skill sets may be of value for radiologists and geriatricians. Moreover, finding applicants with a high degree of creativity who possess at least a minimum level of EQ is valuable if medical schools are to train the next generation of leading physician scientists. Embracing diversity in the medical student body, including diversity of EQ and IQ levels within limits, may be of substantial value.If medical school recruiting practices are to change, it is important to heed the authors' call for change while also following the same principles of evidence-based medicine used when deciding on therapeutic interventions. A similar suggestion to deemphasize IQ at the expense of EQ was proposed in the veterinary literature more than a decade ago, and those authors called for further study to better elucidate the value of EQ. 5 Rigorous systematic reviews, public engagement, and further research may be helpful to better identify ideal characteristics beyond IQ for the next generation in medicine.