A Model to Determine Workforce Needs for Endocrinologists in the United States Until 20201

The objective of this study was to define the workforce needs for the specialty of endocrinology, diabetes, and metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 yr was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the United States workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of which 2,389 (66%) were in office-based practice. Their median age was 49 yr. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 yr, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. Whereas this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g. diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.

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Comparing Microvascular Outcomes at a Large Integrated Health Maintenance Organization With Flagship Centers in the United States

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.130.6.779 ◽

2004 ◽

Vol 130 (6) ◽

pp. 779 ◽

Cited By ~ 12

Author(s):

Edgar A. Lueg

Keyword(s):

United States ◽

Health Maintenance Organization ◽

The United States ◽

Health Maintenance ◽

Integrated Health

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Career Plans of New Pediatricians: Results from a Survey of Residency Program Directors

PEDIATRICS ◽

10.1542/peds.88.4.861 ◽

1991 ◽

Vol 88 (4) ◽

pp. 861-866

Author(s):

Sarah E. Brotherton

Keyword(s):

United States ◽

Academic Staff ◽

Health Maintenance Organization ◽

Program Directors ◽

The United States ◽

Subspecialty Training ◽

Pediatric Practice ◽

Health Maintenance ◽

Pediatric Residency ◽

Residency Program Directors

Directors of pediatric residency programs in the United States, Puerto Rico, and Canada were surveyed regarding plans of graduating residents to determine whether new pediatricians experienced problems finding employment in light of a decreasing growth rate in the child population. Nearly 90% of directors responded, providing information on 1915 residents. Of the 1782 nonmilitary residents in the United States, 815 were entering general pediatric practice and one third (596) were entering subspecialty training. Nearly one half (379) of residents entering general pediatric practice were joining a small group practice, almost one fourth (184) were joining a larger group, 6% (48) were becoming solo practitioners, 7% (57) were joining a health maintenance organization, and nearly 8% (62) were joining a hospital or academic staff. Most residents in the United States experienced no difficulty finding a position and received multiple offers for jobs. Canadian residents were similar to residents in the United States, whereas the postresidency situations of graduates of military and Puerto Rican programs were very different. Despite manpower predictions to the contrary, comments by program directors indicated a demand for general pediatricians. This paper presents only the viewpoint of program directors; whether this perceived need illustrates an avid market for young general pediatricians merits further study.

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Primary Medical Care in the United States: Present Status and Future Prospects

International Journal of Health Services ◽

10.2190/bd15-g056-c8fd-vgm3 ◽

1972 ◽

Vol 2 (2) ◽

pp. 195-206 ◽

Cited By ~ 3

Author(s):

R. R. Huntley

Keyword(s):

United States ◽

Medical Care ◽

Minority Group ◽

Health Maintenance Organization ◽

The United States ◽

Future Prospects ◽

Rural People ◽

Health Maintenance ◽

Primary Medical Care ◽

Primary Physicians

The steady decline in primary physicians in the United States is documented. The increasingly severe maldistribution of physicians is examined in relation to the effect this has on primary care. The effect on the poor, rural people, and minority group people is particularly serious. Four approaches to the solution of this problem are identified and discussed in some detail: an increase in the output of physicians, an increase in the supply and use of ancillary support personnel, reform in the organization of medical care, and the creation of a new specialty of family practice. Special attention is devoted to the likely contribution of the Neighborhood Health Center and Health Maintenance Organization movements to solution of current problems in primary medical care.

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A Comparison of Ambulatory Care and Selected Procedure Rates in the Health Care Systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States

Healthcare Management Forum ◽

10.1016/s0840-4704(10)60978-7 ◽

1997 ◽

Vol 10 (4) ◽

pp. 26-34 ◽

Cited By ~ 2

Author(s):

Carolyn A. DeCoster ◽

Marvin Smoller ◽

Noralou P. Roos ◽

Edward Thomas

Keyword(s):

United States ◽

Primary Care ◽

Health Care ◽

Health Care Systems ◽

Health Maintenance Organization ◽

The United States ◽

Kaiser Permanente ◽

Financial Barriers ◽

Health Maintenance ◽

Care Systems

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports, Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.

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The Politics of Precaution

10.23943/princeton/9780691124162.001.0001 ◽

2012 ◽

Cited By ~ 6

Author(s):

David Vogel

Keyword(s):

United States ◽

Animal Feed ◽

The United States ◽

Hazardous Substances ◽

Risk Regulation ◽

Scientific Certainty ◽

European Public ◽

Wide Range ◽

Regulatory Controls ◽

Milk Hormones

This book examines the politics of consumer and environmental risk regulation in the United States and Europe over the last five decades, explaining why America and Europe have often regulated a wide range of similar risks differently. It finds that between 1960 and 1990, American health, safety, and environmental regulations were more stringent, risk averse, comprehensive, and innovative than those adopted in Europe. But since around 1990 global regulatory leadership has shifted to Europe. What explains this striking reversal? This book takes an in-depth, comparative look at European and American policies toward a range of consumer and environmental risks, including vehicle air pollution, ozone depletion, climate change, beef and milk hormones, genetically modified agriculture, antibiotics in animal feed, pesticides, cosmetic safety, and hazardous substances in electronic products. The book traces how concerns over such risks—and pressure on political leaders to do something about them—have risen among the European public but declined among Americans. The book explores how policymakers in Europe have grown supportive of more stringent regulations while those in the United States have become sharply polarized along partisan lines. And as European policymakers have grown more willing to regulate risks on precautionary grounds, increasingly skeptical American policymakers have called for higher levels of scientific certainty before imposing additional regulatory controls on business.

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Faculty Opinions recommendation of Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14029956.15487056 ◽

2012 ◽

Author(s):

Gregory Hawkins ◽

Rebecca Slager

Keyword(s):

United States ◽

Clinical Outcomes ◽

Acute Asthma ◽

The United States ◽

Age Related

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Sexuality in Later Life and Mental Health Among Older Black Gay Men

Innovation in Aging ◽

10.1093/geroni/igaa057.1005 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 313-314

Author(s):

Darlingtina Esiaka ◽

Alice Cheng ◽

Candidus Nwakasi

Keyword(s):

Mental Health ◽

Gay Men ◽

Later Life ◽

The United States ◽

Mental Wellbeing ◽

Self Identity ◽

Sexual Identities ◽

Age Related ◽

Wide Range ◽

Black Gay Men

Abstract Self-acknowledgement and integration of racial and sexual identities are significant to one’s overall sense of identity because of their implications for mental health and wellbeing. These issues are important as one ages because older people experience a wide range of factors that add layers to their ability to (re)integrate subsets of their identity into their overall self-identity such as age and age-related disabilities. This study examined the intersection of race and sexual identities on overall health status in older Black gay men, a demographic group that has historically received less attention. Data from the Social Justice Sexuality (SJS) survey of LGBTQ+ people of color which occurred over a 12-month period in the United States were analyzed. Participants (N=160), 50 years and over, responded to questions about their sexuality, social identity, family dynamics, community connection and engagement, and mental and physical health. Results show an association of mental wellbeing with racial and sexual identities. Further, results show that a strong sense of connection to other sexual minorities is positively associated with mental health in older Black gay men. We discuss the implication of findings for mental health interventions targeting this gendered population.

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Age-Related Chronic Diseases and Alzheimer’s Disease in Texas: A Hispanic Focused Study

Journal of Alzheimer s Disease Reports ◽

10.3233/adr-200277 ◽

2021 ◽

Vol 5 (1) ◽

pp. 121-133

Author(s):

Shyam Sheladia ◽

P. Hemachandra Reddy

Keyword(s):

United States ◽

Risk Factors ◽

Chronic Diseases ◽

Hispanic Americans ◽

The United States ◽

Modifiable Risk Factors ◽

American Population ◽

Hispanic American ◽

West Texas ◽

Age Related

The emergence of age-related chronic diseases within the United States has led to the direct increase of Alzheimer’s disease (AD) as well as other neurological diseases which ultimately contribute to the development of dementia within the general population. To be specific, age-related chronic diseases such as cardiovascular disease, high cholesterol, diabetes, and kidney disease contribute greatly to the advancement and rapid progression of dementia. Furthermore, unmodifiable risk factors such as advancing age and genetics as well as modifiable risk factors such as socioeconomic status, educational attainment, exercise, and diet further contribute to the development of dementia. Current statistics and research show that minority populations such as Hispanic Americans in the United States face the greatest burden of dementia due to the increase in the prevalence of overall population age, predisposing genetics, age-related chronic diseases, low socioeconomic status, as well as poor lifestyle choices and habits. Additionally, Hispanic Americans living within Texas and the rural areas of West Texas face the added challenge of finding appropriate healthcare services. This article will focus upon the research associated with AD as well as the prevalence of AD within the Hispanic American population of Texas and rural West Texas. Furthermore, this article will also discuss the prevalence of age-related chronic diseases, unmodifiable risk factors, and modifiable risk factors which lead to the progression and development of AD within the Hispanic American population of the United States, Texas, and rural West Texas.

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Expansion of Groundnut ringspot virus Host and Geographic Ranges in Solanaceous Vegetables in Peninsular Florida

Plant Health Progress ◽

10.1094/php-2011-0725-01-br ◽

2011 ◽

Vol 12 (1) ◽

pp. 34 ◽

Cited By ~ 6

Author(s):

Craig G. Webster ◽

William W. Turechek ◽

H. Charles Mellinger ◽

Galen Frantz ◽

Nancy Roe ◽

...

Keyword(s):

United States ◽

The United States ◽

Vegetable Production ◽

Viral Pathogen ◽

Geographic Ranges ◽

First Report ◽

Geographic Spread ◽

Wide Range ◽

Production Areas ◽

Solanaceous Plants

To the best of our knowledge, this is the first report of GRSV infecting tomatillo and eggplant, and it is the first report of GRSV infecting pepper in the United States. This first identification of GRSV-infected crop plants in commercial fields in Palm Beach and Manatee Counties demonstrates the continuing geographic spread of the virus into additional vegetable production areas of Florida. This information indicates that a wide range of solanaceous plants is likely to be infected by this emerging viral pathogen in Florida and beyond. Accepted for publication 27 June 2011. Published 25 July 2011.

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