The authors explain the importance of recruiting U.S. medical graduates into psychiatry, give reasons for optimism about future recruitment, express concerns about problems that could hinder it, and recommend ways to address these concerns. Reasons for optimism include: features of the specialty, such as its focus on the doctor/patient relationship; its increasing job availability and incomes; its scientific achievements; the peaking and possible fading of the National Generalist Initiative; and a 5-year upward recruitment trend. Concerns are: low "overt" interest in psychiatry among entering medical students; clerkship directors' perceptions of a negative educational impact of managed care; graduating seniors' suboptimal satisfaction with their psychiatry clerkships; and what is likely to be a small impact of New Mexico legislation on prescribing privileges for psychologists. The authors make recommendations for addressing these concerns.
The findings point to one way of understanding better the influence of a medical school on its students' career choices. By using this model, each specialty may be able to develop studies to examine the complex interactions between students and specific medical schools.
The United States intelligence community has been under intense scrutiny from both inside and outside in the aftermath of September 11. Post mortem assessments of intelligence breakdowns may judge the events as more predictable than was in fact the actual reality. In a troubled world, when threats to national security can materialize very quickly, the intelligence community must be able to effectively and swiftly develop and implement plans to prevent further terrorist attacks on the homeland. Numerous scenarios need to be considered for the management of crisis situations. Intelligence actions must make it more difficult for terrorists to strike at their targets. The war on terror must confront a new generation of enemies who threaten to attack the United States with weapons of mass destruction. This essay will focus on the role of behavioral science and how related reforms within the intelligence community could improve its capability to respond to a huge challenge.
Since 1950, between three and ten percent of American medical school graduates selected psychiatric careers. Until 1989, the direction of the ratio of medical school applicants to acceptance was the best predictor for medical school graduates entering psychiatry; a declining ratio predicts more students become psychiatrists. The decrease in number of graduates selecting psychiatry for 1989, 1990 and 1991 suggest new factors may be influencing career decisions. Women continue to select psychiatry in a greater proportion than men. In an attempt to understand the historical context of these trends and suggest implications and actions for the next decade, this paper presents data on the psychiatric career choice of U.S. medical school graduates beginning with the medical school graduates of 1950.
From 1988 to 1993, recruitment of U.S. medical graduates into psychiatry has declined by more than one-third. This decline threatens to further exacerbate the shortage of psychiatrists projected by the Council on Graduate Medical Education. In May 1992, the American Association of Directors of Psychiatric Residency Training sponsored a 2-day conference to develop specific courses of action and an overall strategy to reverse this de-cline. Key recommendations from the conference are presented. The proposed actions are presented in a format that identifies the appropriate medical, educational, or psychiatric organization charged with a specific action's implementation.
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