Physician Workforce Issues

Nature and Function of the Physician Workforce

More than 15 centuries ago, the Greek physician Hippocrates advocated that all physicians pay attention to the individual patient. In this rebellion against the Cnidian convention that favored diagnosis and classification of diseases, Hippocrates modernized the practice of medicine. While the physician has historically trained as an apprentice and basic responsibilities have remained the same over time, the physician is no longer simply someone who is a skilled healer. Today's physician is a healer who is formally trained-and legally qualified-to practice medicine. More stringent standards have existed only since the early 20th century, when Abraham Flexner's report on the status of medical education in North America [Page 938]largely resulted in the advent of scientifically based university medical schools and teaching hospitals similar to those that had been established in Europe.

The physician workforce is presently composed of individuals educated and trained in primary care and various specialties. A primary-care physician is a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) who, as a generalist, serves as the patient's first entry point into the healthcare system; a specialist physician is one who is qualified to diagnose and care for specific ailments or injuries. Physicians also may choose to practice in surgical specialties, which include the branches of medicine that treat injury or disease by operative procedures, or medical specialties, which include the branches of medicine that deal with nonsurgical techniques.

Various specialty boards, recognized by the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA), individually certify physicians as specialists based on specific requirements, such as training, examination, and continuing education. Recognized specialties include the following: Allergy and Immunology, Anesthesiology, Colon and Rectal Surgery, Derma-to logy, Emergency Medicine, Family Practice, Internal Medicine, Medical Genetics, Neurological Surgery, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine and Rehabilitation, Plastic Surgery, Preventive Medicine, Psychiatry and Neurology, Radiology, Surgery, Thoracic Surgery, and Urology. A majority of the specialties also acknowledge various subspecialties.

Many factors influence the choice of specialization as well as the choice to pursue a career in medicine. These factors become more defined as the individual's career, status, and function change over time. Among these factors are career opportunities; academic opportunities; practical experience during medical school; role models or mentors in the specialty; length of training required; lifestyle and work hours, especially during residency; likelihood of obtaining a residency position; concern about loans and debt; call schedules; posttraining lifestyle, work hours, and financial rewards; intellectual challenges; interactions with patients; potential patient demographics; and within-specialty gender distribution. Medical students also have expressed that receiving early exposure to positive role models and opportunities in a certain specialty is likely to influence their career pursuits in that specialty.

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