Postgraduate Medical - Page 16
encourage the training of more primary care
physicians so as to promote cost-effective
medicine and to encourage physicians to practice
in underserved areas. Thus, 13 (out of
21) states succeeded in enacting legislation
that offers medical students financial aid or
scholarships as incentives to practice in remote
areas or inner city ghettos. These states
include Maryland, Rhode Island, North Carolina,
and Nebraska. Some states, such as
Pennsylvania, have increased their funding
directly for programs in family practice
training. Mandating the training of primary care
physicians can be successful in a state
like Washington, which serves a largely rural
population locally, and in adjacent states.
Most other states turned down quota systems.
Some schools are voluntarily setting goals
of steering students to become primary care
physicians in the hope of avoiding legisla-
tive coercion later on.
Pediatrics
Although some serious infectious diseases of
childhood have been conquered, children
will always need care for the usual viral
illnesses. Now, however, more attention is
being focused on the patient as a whole,
especially his or her behavioral problems. Thus
such issues as child abuse, drug addiction, and
suicide prevention are emerging areas of
concern for pediatricians.
A developing subspecialty is pediatric
emergency care. Increasing recognition of the
need for specialists in this area is reflected
by the fact that one-third of all emergency
room visits involve children. They frequently
present different problems than adults.
Those specializing in pediatric emergency care
usually complete a pediatric residency
and an emergency medicine fellowship. A special
five-year program for certification is
under consideration.
The next frontier to become open to
pediatricians will undoubtedly involve the
treatment of genetic diseases with drugs that
will become common because of advances
in genetic engineering technology that are
expected to take place in the near future.
Psychiatry
The field of psychiatry is undergoing
"remedicalization" in that the emphasis is now on
using medical therapy in the context of
hospital practice and closer affiliations with
other specialties. In addition, a strong move
toward subspecialization is developing, and
such areas as geriatric psychiatry, clinical
psychopharmacology, and forensic psychiatry
are emerging.
Diagnostic Radiology
New patterns of health care delivery coupled
with advances in imaging technology are
altering the professional schedules of
radiologists. They are now more frequently on
call, and more of them are practicing in
outpatient settings.
The expanded use of magnetic resonance imaging
(MRI), ultrasound, CAT scans,
and other technologies has brought radiologists
more intimately into the core of medical
practice. Nevertheless, radiological techniques
are used by other specialists as well, and
an intense jurisdictional debate is in
progress.
Subspecialization by means of fellowship
training in such areas as ultrasound or
pediatric radiology is increasing.
Emergency Medicine
The relatively new specialty is emerging as a
distinct entity, as indicated by the fact that
board certification now requires specialized
training in this area rather than merely pass-
ing the qualifying examinations.
Academic emergency medicine centers are now
aiming at securing high-quality
physicians with four years of training. As more
medical students are exposed to this
area, a very substantial upswing in the numbers
seeking admission to residency pro-
grams is expected.
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