Matthew Menken

The coining oversupply of neurologists in the 1980s: Implications for neurology training programs

In 1980, the Graduate Medical Education National Advisory Committee (GMENAC) published a report suggesting that a surplus of approximately 2500 to 3500 neurologists would exist in 1990.’ If nothing else, this estimate called attention to issues confronting the neurologic community that transcend local concerns. While there are some who believe that the GMENAC estimate falls wide of the mark, nonetheless we need to ask whether presently available projections and empiric data call for constructive changes in our neurology training programs.

The challenges of health system reform: Where should neurology be going?

During t h e past 30 years, neurologists i n t h e United States and Canada have maintained close professional ties although they have carried out their daily tasks and responsibilities in health systems that are organized and financed in very different ways. Throughout this period, Canada’s health system has displayed a remarkable capacity to provide universal health insurance for the country’s 26 million people, without cost to the patient a t the time of service provision and with an average per capita cost that is about two-thirds tha t of the United States. By way of contrast, about 15% of Americans have no health insurance and receive relatively little care, yet national health care costs have risen more than 10% annually. These widely cited figures do not take into account the millions of underinsured people (including Medicaid beneficiaries) or the fact that US citizens spend about 10% of household income out of pocket for copayments, deductibles, medications, and other expenses that are not covered by their health insurance. Given different health systems, it is not surprising that the practice of neurology in these two countries is very different despite a similar burden of neurologic illness in the two popu1ations.l This is a good time for all neurologists to reconsider these disparities, because the major restructuring of the US health system that is in the offing is very likely to amplify the contrasts between the two health systems.2 Although the configuration of health reform is still unclear, it is part of the conventional wisdom that a shift toward a Canadian-style, nonprofit, single-payer system is politically unrealistic in a nation like the United States, with its strong cultural preference for pluralistic solutions and hedged compromises when confronted with complex social problems. The reform measures given best odds of enactment eschew a single-payer approach, relying instead upon market mechanisms to achieve a level of access and cost-containment comparable to that of Canada. My hunch is that a national poll of neurologists in 1994 would reveal widespread opposition to a single-payer system, with the majority of neurologists preferring a heterogeneous, market-oriented framework of entrepreneurial capitalism instead. In my view, the wisdom of this position at the present time is questionable.

Neurology for Non-Neurologists, 3rd Ed

by Wigbert C. Wiederholt, 357 pp., ill., Philadelphia, WB Saunders, 1995,

Rationalizing the use of diagnostic neurotechnology: a binational perspective.

37.00 For those neurologists with a long-standing interest in the education of medical students, residents, and practicing physicians in fields other than Neurology, Wiederholts book has been a valued asset, and it is good to have an updated version. This is the first appearance of this text designed to be carried in a pocket; I assume this means the pocket of a white lab coat, because it is too wide for the pocket of a jacket. …

Neurology workforce and the Residency Review Committee

It is the purpose of this commentary to discuss, in general terms, the range and scope of information about the efficacy of technology needed in neurologic practice, and to suggest a general approach to technology utilization under conditions of clinical doubt and uncertainty based, in part, upon the results of a binational study of neurologic practice and care in England and the United States

Emotions of a Physician: Discovering the Needs of Doctors to Understand Their Own Experiences

To the Editor: I agree with Professor Fishman that we cannot blame the accreditation process for graduate medical education, including the Residency Review Committee for Neurology, if we have an oversupply of neurologists or neurology training programs.1 On the other hand, we are entitled to question the accreditation process (and other institutions) if we imagine …

Estimating physician requirements for neurology

This is not a textbook, reference work, or subspecialty monograph, nor does its publication contribute to the author’s academic credentials in any neurologic sanctum sanctorum. It is a marvelous book that provides a fairly unique insight into the humanity of the doctor’s art, and thus has messages for all of us. It is a collection of meaningful moments in neurologic practice, and the author’s insights and reflections upon these critical incidents. It is a great (and inexpensive) gift for a curious or querulous spouse, or for doctor-bashing acquaintances. Having practiced neurology on both sides of the Atlantic, Dr. Fischer-Williams does not let the different social arrangements or financial incentives of the respective health systems get in the way of the special relationship we enjoy with patients, who expose for us their innermost selves. Nonetheless, the book is far more British than American. The author is not easily intimidated by technical wizardry, nor does she have much admiration for neurologists who always seem to be rushing from one appointment to the next, usually with the mindset of computer mainframe technicians keen to stop the nervous system from “going down.” In brief, the author is a generally educated physician whose professional encounters are reified by an awareness of the great ideas of our twin cultures. Once upon a time, all physicians were expected to have the kernel of a liberal education before entrance into medicine, and to continue liberal learning throughout life. That was before we were overwhelmed by the most prevalent disease of modern thought, the belief that the scientific method is the only source of knowledge, and that all the rest of a so-called liberal education (philosophy, famous books, art) is mere imagination, speculation, and opinion. It is with the highest praise for the anecdotes and commentaries of this book that I express certainty as to their dismal chances of success in the hands of most journal peer-reviewers.