Alvin E. Rodin

GMENAC report on U.S. physician manpower policies: Recommendations and reactions

After four years of study in the United States, the Graduate Medical Education National Advisory Committee (GMENAC) concluded that an excess of approximately 70,000 physicians will exist in 1990. Faced with a future surplus, GMENAC recommends that U.S. medical schools decrease enrollment levels by 10 percent relative to the 1978-79 level and severely restrict entrance of foreign medical graduates. Flaws identified in the GMENAC approach relate to the use of the delphi technique, the future role of nonphysician providers, and a lack of reliable data. The GMENAC report may provide impetus for an abrupt shift from expansionism to reductionism in U.S. physician manpower policy. Long range physician manpower planning has erred in the past, necessitating periodic reevaluation of national policy. A continuing balance between supply and demand, although ideal, can probably never be attained. Thus small adjustments in total supply and specialty mix will always be necessary. The GMENAC report, which is the most comprehensive study of U.S. physician manpower to date, requires serious consideration in this context.

William Osler and Arthur Conan Doyle Versus the Antivivisectionists: Some Lessons From History for Today

Reaction against vivisection for research reached its height in the last two decades of the 19th century and the first two of the 20th, and a resurgence began in the 1960s. Antivivisectionism was and is related, in part, to emphasis on humanitarian sentiments. Two humanitarian physicians defended vivisection as essential. Dr. Arthur Conan Doyle in 1886 justified the killing of rabbits to relieve human suffering from hydrophobia. In 1910, he objected to the antihuman campaign of the antivivisectionists. Dr. William Osler reacted similarly to the threat to vivisection. He gave emphatic evidence to investigative committees in the United States in 1900 and in Britain in 1907. Osler also performed vivisection. His experimentation included studies of pig typhoid and tapeworm cysts in pigs and of the fate of india ink injected into the lungs of kittens. Osler and Conan Doyle were but two of the many prominent physicians who helped stem the tide of antivivisection legislation near the turn of the century. A review of the elements that fostered antivivisectionism in the society of their time is relevant in understanding and reacting to similar sentiments in the present era.

Evaluation and Validation of a Course in Practice Management for Senior Residents

Many doctors reach the end of their specialist training to find that they need to cope well and efficiently with the business aspects of setting up and managing a medical practice-yet this has frequently been ignored in their education. This article describes the design and evaluation of a course in practice management offered to doctors near the end of their specialist training.