Without a substantially accelerated growth in graduate medical education, the physician workforce will fall short of the nation's needs, and competition for available residency positions will radically increase.
This report shows the results of a survey of 5604 faculty in departments of medicine, 4200 of whom had postdoctoral research training. As a follow-up to a previous study of research activity in the same population, this retrospective survey focused on location of training, source of funding, structure of the training program, impact of the training experience on career development, and respondents' recommendations for changes in training programs. A predominant finding is that most postdoctoral training occurred in medical schools, and the primary source of funding was the National Institutes of Health. For faculty members with the MD degree, being an active researcher and principal investigator for a peer-reviewed research grant were associated with length of training. The average length of time between the end of postdoctoral research training and obtaining the first peer-reviewed research grant was 24 months, regardless of length of training, source of training support, training site, or type of academic degree (MD, MD-PhD, or PhD). The results of this survey suggest a tentative formula to be a successful researcher in academic medicine: 2 or more years of postdoctoral research training, including formal course work in the fundamental sciences pertinent to biomedical research; 2 to 3 years of full research support from the academic institution until the first extramural grant is obtained; and commitment of at least 33% of time to research activities. The results also suggest directions for change and improvement in future research training programs.
Medical graduates in 1983 were in preclinical training when the Graduate Medical Education National Advisory Committee forecast a surplus of 70,000 physicians by 1990. Among the problems identified was the nuclear role of medical schools in affecting specialty choices. To understand this role further, the current study determined the stability and evolution of specialty preferences between the time of the Medical College Admission Test and the senior year of medical school. The study included 10,321 US medical school graduates in 1983. Eighty percent changed their specialty preference during this interval, demonstrating the substantial effects that medical schools have on specialty selection. The stability of early preferences ranged from 41% to 1%. Interest in primary care specialties declined among both men and women; interest in specialty care and supporting services increased during this five-year longitudinal study. These findings parallel shifts away from primary care among US medical school graduates in 1978 and 1983.
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