BRIEF COMMUNICATION Analysis of Employment Data for Interventional Pulmonary Fellowship Graduates Hans J. Lee1, David Feller-Kopman1, Shaheen Islam2, Adnan Majid3, and Lonny Yarmus1 1
Division Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland; 2Division of Interventional Pulmonology, Ohio State University, Columbus, Ohio; and 3Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Abstract Rationale: Interventional pulmonology (IP) is a maturing field in the subspecialty of pulmonary medicine. Over the last few years, there has been an increased number of listed IP fellowship training programs in the United States and Canada, causing debate about the employment market for IP fellowship graduates. Objectives: To analyze employment data of IP fellowship graduates. Methods: Interventional pulmonary fellows, during their IP in-service examination, were surveyed on employment position after graduation. The survey occurred in May or June in the years 2012, 2013, and 2014. An IP position was defined as a position encompassing more than 60% of effort directly toward IP. Geographic location and practice structure (i.e., academic, private/hybrid, and existing or initiating IP practice) were collected and analyzed.
Measurements and Main Results: There was an 88.5% response rate, with 53 IP fellows participating in the survey. The majority of IP fellowship graduates (75%; 39/52) had positions in academic IP practices. All seven IP private practice positions were to create an IP program. One IP graduate was in a non-IP academic position, four were in non-IP private practice, one was in a research position, and one had no known employment. Most IP fellowship graduates were men (77.4%). Most IP positions were filled in states east of the Mississippi River; only 8 of 53 (15.1%) positions were filled in states west of the Mississippi river. Conclusions: Despite speculation about the scarcity of academic jobs after fellowship, recently trained IP fellows are more likely to practice in academic settings and join established practices. Keywords: interventional pulmonology; fellowship; employment
(Received in original form August 14, 2014; accepted in final form November 27, 2014 ) Correspondence and requests for reprints should be addressed to Hans Lee, M.D., Interventional Pulmonology, Pulmonary Disease and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Zayed Building 7125L, Baltimore, MD 21287. E-mail: [email protected] Ann Am Thorac Soc Vol 12, No 4, pp 549–552, Apr 2015 Copyright © 2015 by the American Thoracic Society DOI: 10.1513/AnnalsATS.201408-374OC Internet address: www.atsjournals.org
Interventional pulmonology (IP) is a maturing field in the subspecialty of pulmonary medicine. Training in IP requires at least 12 months of fellowship after completing residency in internal medicine and fellowship in pulmonary/ critical care medicine. This graduate medical education course spans a minimum of 7 years after medical school. The first American IP fellow graduated in 1998 from the Lahey Clinic (Burlington, MA). Currently, there are 28 IP fellowship programs listed in the United States and Canada for 2015 by the American Association of Bronchology Interventional Pulmonology (AABIP)/Association of Interventional Pulmonary Program Directors (AIPPD). The rapid and recent
increase in the number of listed IP fellowship training programs in the United States and Canada has led to debates on the saturation of the job market for young IP practitioners coming out of training (1). The regular assessment of the future health workforce supply and demand is key to setting policies that will help to ensure access to quality, cost-effective health care (2). In 2006, the Health Resources and Services Administration published physician supply and demand projections to 2020. There is consensus that by 2020 demand will outstrip supply, particularly within most medical subspecialties. There have been no published studies describing the IP workforce supply or demand.
Lee, Feller-Kopman, Islam, et al.: Employment Data for IP Fellowship Graduates
We collected data regarding the job market for fellowship-trained IP physicians to better understand the labor supply and the demand for IP physicians. The recent increase in IP training programs provided an opportunity to study a test in labor market forces. We hypothesized that recently trained IP graduates are less likely to practice in academic centers due to possible overexpansion of training programs.
Methods IP Fellows during their IP in-service examination were surveyed on employment position after graduation. The survey occurred in May or June in the years 2012, 2013, and 2014 during the end of their IP 549
BRIEF COMMUNICATION fellowships. Program directors were contacted regarding employment after graduation, and a Google search of physicians was used for graduates who had responded “no position” at the time of the survey. All collected data were deidentified of personal information before analysis. An IP position was defined as a “position encompassing .60% of effort toward IP.” Information on practice structure (i.e., academic, private/hybrid, and existing or initiating IP practice) was also captured. Geographic location by state was recorded. An independent, two-sample t test was performed comparing IP positions (IP academic and IP private practice) with non-IP positions (Excel version 14.0; Microsoft, Redmond, WA).
survey from the graduates’ fellowship directors in three of the four fellows from the class of 2014 who originally reported obtaining no position. The majority of newly created IP programs were in academic practices (18/25; 72%). There was an increasing number of new IP academic programs being created compared with IP private practice. All IP fellowship graduates who joined an expanding (existing) IP group were in an academic practice. There were two IP physicians who joined an IP academic practice outside the United States (China and Canada). Most of the IP fellowship graduates were men (41/53), with an increasing number of women in 2013 and 2014 (n = 2 in 2012, n = 5 in 2013, and n = 5 in 2014). The geographic results are illustrated in Figure 1. Most positions were filled in states east of the Mississippi River (i.e., in the eastern half of the continental United States); only 8 of 53 (15.1%) positions were filled in states west of the Mississippi River.
Results There were 53 fellows participating in the in-service exam survey. The overall response rate for all listed AABIP/AIPPD fellowship programs participation was 88.5%. There was 100% participation in 2012 and in 2013/ 2014; 14 of 16 and 18 of 22 fellowship programs participated in the in-service exam survey, respectively. There was a significant number of IP graduates obtaining IP positions compared with nonIP positions (P = 0.008). The majority of IP fellowship graduates (75%; 39/52) had positions in academic IP practices (Table 1). There was a smaller number (7/53; 13.2%) of fellows who had positions in IP private/hybrid practices. All seven positions in private/hybrid practices were to create an IP program. One IP graduate was in a non-IP academic position, four were in non-IP private practice, one was in a research position, and four had no definite employment in their last month of fellowship (class of 2014). Limited employment data were collected after the
Discussion The primary goal for this study was to evaluate data from job placement of recent IP fellowship graduates to better understand the labor market. To our knowledge, there have been no attempts to formally understand the IP labor market. Our initial hypothesis was that the expansion of number of training program would test the labor market and result in signals of oversaturation. To the contrary of our hypothesis and despite speculation of an overly saturated job market, recently trained IP fellows were able to obtain employment practicing IP in academic and private practice. They remain more likely to practice in academic settings and to join established practices primarily in the eastern half of the continental United States. This is not
surprising considering that IP fellowships have historically been concentrated in the northeastern United States. In addition, with the exception of the west coast, regions such as the midwest have been historically underserved by some subspecialists (3). In a recent study, a significant discrepancy of didactic knowledge existed between IP and general pulmonary practitioners, reflecting a missing benefit of having an IP practitioner in certain regions of the country (4). Studies are needed in IP to examine meaningful clinical outcomes and access to care. A potential explanation for the continued demand for IP practitioners may be coming from two areas: (1) an increase in new IP programs and (2) expansion of existing IP programs. The data for the last 3 years continue to show the creation of new IP programs in academics at similar rates in each year. None of the positions in the expanded IP practices was from private practice. The growth of new programs can expand the labor market by creating new employment positions. The geographic data also illustrate a potential future of new IP programs unfulfilled in states west of the Mississippi River (i.e., half of the United States). Although an argument can be made that there may be older existing IP physicians in these states, this would be unlikely given the initial growth of IP coming from the east coast. None of the 2014 graduating IP fellows who joined an existing IP practice had joined a practice that was formed in 2012. This would suggest that expansion of an IP program would likely take more than 2 years. The growth of IP jobs should continue to increase as long as there are new programs being developed that would eventually lead to expansion of programs. A potential inflection point or plateau in the labor demand curve may be when there are no new IP academic programs being started.
Table 1. Practice style of interventional pulmonology fellowship graduates, 2012–2014 Class
2014 2013 2012 Total
Number of Fellows
IP Academic*
IP Private/Hybrid*
Non-IP Academic
Non-IP Private
Creating IP Practice
Joining IP Group
No Position
21 17 15 53
12 14 13 39
5 2 0 7
1 0 0 1
1 1 2 4
10 11 4 25
6 6 6 18
1 0 0 1
Additional Training 1 0 0 1
Definition of abbreviation: IP = interventional pulmonology. *Position encompassing more than 60% effort toward interventional pulmonology.
550
AnnalsATS Volume 12 Number 4 | April 2015
BRIEF COMMUNICATION
NH X WA AK
VT 1
X
MT
X
X
OR X
ID
ND
MN
X
X
WI X
IA
NE
CA
1
1
1
UT
IN
2
1
KY
X
2
2
HI X
AZ X
NM X
AR
VA
X
X
LA
DE X
2
MD 1
NC
DC X
2
X
X 3
NJ 1
TN
OK
MS TX
CT 1
X
MO
RI 1
5
4
KS
MA 2
PA OH
IL
CO
2
4
1
X
NV
NY
MI
X
WY
X
WV X
SD
X
X
ME
SC X
AL 1
GA 1
1
FL X
Figure 1. Geographic distribution of interventional pulmonology positions for interventional pulmonology graduates, 2012 to 2014.
Our data indicated that, over a 3-year period, there had been no placement of formally trained IP fellowship graduates in several regions of the country because of the lack of demand or, more likely, because of the limited labor supply. Physician shortages have been well cited in the critical care specialty as well, from which in part the IP training pool is derived because fellows are also trained in pulmonary/critical care medicine (5, 6). Workload projections for surgical oncology were examined by Etzioni and colleagues, who found a growing demand for oncologic procedures driven by the aging of the U.S. population (7). They concluded that growth in demand, combined with surgeon shortages, would lead to decreased access to care for cancer patients with cancer. Although our study addresses only a portion of the supply labor market, further labor force planning in IP is necessary. It has important implications for patient outcomes, access to care, and graduate medical education, particularly regarding IP fellowships (8). The male predominance of the work force is comparable to the male
predominance of surgical subspecialties with similar length of training (9). However, there is a trend toward an increasing number of female IP physicians who may arguably change the workforce forecast (10). This trend is most likely to continue given the increasing number of female pulmonary/critical care fellows, who make up about 31% (8). The majority of fellowship graduates have entered into an academic practice; however, the trend over the 3 years was toward an increasing number of graduates entering IP private practice. The limitation of this analysis is that it may only reflect a short-term forecast due to only 3 years of recent data. However, the long-term forecast, even when using larger data pools, remains unpredictable due to unforeseeable market variability in the economy, reimbursements, and technological innovation. Although the response rate for the survey was high, not all IP fellowships participated in all 3 years, leaving our data incomplete. Also, the definition of IP position (.60% IP position) may be open
References 1 Yarmus L, Feller-Kopman D, Imad M, Kim S, Lee HJ. Procedural volume and structure of interventional pulmonary fellowships:
to differences in interpretation because the field is still not standardized. One of the graduates had responded as a non-IP academic position because this graduate was initiating and developing an IP program at an academic practice. Other data for the exit out of the supply market, such as the retirement, mortality, disability, and career change data of IP physicians, would be useful, but these data are currently unavailable by the American Medical Association Physician Masterfile. Conclusions
Despite speculation about the scarcity of academic jobs after fellowship, the market is not saturated. Recently trained IP fellows were more likely to practice in academic settings and to join established practices in the eastern half of the continental United States. Future expansion may be found in new geographical areas or in different practice types. n Author disclosures are available with the text of this article at www.atsjournals.org.
a survey of fellows and fellowship program directors. Chest 2013; 144:935–939. 2 U.S. Department of Health and Human Services, Health Resources and Services Administration. Bureau of Health Professions. Physician
Lee, Feller-Kopman, Islam, et al.: Employment Data for IP Fellowship Graduates
551
BRIEF COMMUNICATION supply and demand: projections to 2020; 2006 [accessed 2014 Aug 1]. Available from: http://bhpr.hrsa.gov/healthworkforce/reports/ physiciansupplydemand/default.htm. 3 Cooper RA. States with more physicians have better-quality health care. Health Aff (Millwood) 2009;28:w91–w102. 4 Lee HJ, Feller-Kopman D, Shepherd RW, Almeida FA, Bechara R, Berkowitz D, Chawla M, Folch E, Haas A, Gillespie C, et al. Validation of an interventional pulmonary examination. Chest 2013;143:1667–1670. 5 Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr; Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000;284:2762–2770.
552
6 Ewart GW, Marcus L, Gaba MM, Bradner RH, Medina JL, Chandler EB. The critical care medicine crisis: a call for federal action: a white paper from the critical care professional societies. Chest 2004;125: 1518–1521. 7 Etzioni DA, Liu JH, Maggard MA, O’Connell JB, Ko CY. Workload projections for surgical oncology: will we need more surgeons? Ann Surg Oncol 2003;10:1112–1117. 8 Cooper RA. Unraveling the physician supply dilemma. JAMA 2013;310: 1931–1932. 9 Association of American Medical College. 2012 physician specialty data book (November 2012) [accessed 2014 Aug 1]. Available from: https://www.aamc.org/data/ 10 Phillips SP, Austin EB. The feminization of medicine and population health. JAMA 2009;301:863–864.
AnnalsATS Volume 12 Number 4 | April 2015
Division Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland; 2Division of Interventional Pulmonology, Ohio State University, Columbus, Ohio; and 3Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Abstract Rationale: Interventional pulmonology (IP) is a maturing field in the subspecialty of pulmonary medicine. Over the last few years, there has been an increased number of listed IP fellowship training programs in the United States and Canada, causing debate about the employment market for IP fellowship graduates. Objectives: To analyze employment data of IP fellowship graduates. Methods: Interventional pulmonary fellows, during their IP in-service examination, were surveyed on employment position after graduation. The survey occurred in May or June in the years 2012, 2013, and 2014. An IP position was defined as a position encompassing more than 60% of effort directly toward IP. Geographic location and practice structure (i.e., academic, private/hybrid, and existing or initiating IP practice) were collected and analyzed.
Measurements and Main Results: There was an 88.5% response rate, with 53 IP fellows participating in the survey. The majority of IP fellowship graduates (75%; 39/52) had positions in academic IP practices. All seven IP private practice positions were to create an IP program. One IP graduate was in a non-IP academic position, four were in non-IP private practice, one was in a research position, and one had no known employment. Most IP fellowship graduates were men (77.4%). Most IP positions were filled in states east of the Mississippi River; only 8 of 53 (15.1%) positions were filled in states west of the Mississippi river. Conclusions: Despite speculation about the scarcity of academic jobs after fellowship, recently trained IP fellows are more likely to practice in academic settings and join established practices. Keywords: interventional pulmonology; fellowship; employment
(Received in original form August 14, 2014; accepted in final form November 27, 2014 ) Correspondence and requests for reprints should be addressed to Hans Lee, M.D., Interventional Pulmonology, Pulmonary Disease and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Zayed Building 7125L, Baltimore, MD 21287. E-mail: [email protected] Ann Am Thorac Soc Vol 12, No 4, pp 549–552, Apr 2015 Copyright © 2015 by the American Thoracic Society DOI: 10.1513/AnnalsATS.201408-374OC Internet address: www.atsjournals.org
Interventional pulmonology (IP) is a maturing field in the subspecialty of pulmonary medicine. Training in IP requires at least 12 months of fellowship after completing residency in internal medicine and fellowship in pulmonary/ critical care medicine. This graduate medical education course spans a minimum of 7 years after medical school. The first American IP fellow graduated in 1998 from the Lahey Clinic (Burlington, MA). Currently, there are 28 IP fellowship programs listed in the United States and Canada for 2015 by the American Association of Bronchology Interventional Pulmonology (AABIP)/Association of Interventional Pulmonary Program Directors (AIPPD). The rapid and recent
increase in the number of listed IP fellowship training programs in the United States and Canada has led to debates on the saturation of the job market for young IP practitioners coming out of training (1). The regular assessment of the future health workforce supply and demand is key to setting policies that will help to ensure access to quality, cost-effective health care (2). In 2006, the Health Resources and Services Administration published physician supply and demand projections to 2020. There is consensus that by 2020 demand will outstrip supply, particularly within most medical subspecialties. There have been no published studies describing the IP workforce supply or demand.
Lee, Feller-Kopman, Islam, et al.: Employment Data for IP Fellowship Graduates
We collected data regarding the job market for fellowship-trained IP physicians to better understand the labor supply and the demand for IP physicians. The recent increase in IP training programs provided an opportunity to study a test in labor market forces. We hypothesized that recently trained IP graduates are less likely to practice in academic centers due to possible overexpansion of training programs.
Methods IP Fellows during their IP in-service examination were surveyed on employment position after graduation. The survey occurred in May or June in the years 2012, 2013, and 2014 during the end of their IP 549
BRIEF COMMUNICATION fellowships. Program directors were contacted regarding employment after graduation, and a Google search of physicians was used for graduates who had responded “no position” at the time of the survey. All collected data were deidentified of personal information before analysis. An IP position was defined as a “position encompassing .60% of effort toward IP.” Information on practice structure (i.e., academic, private/hybrid, and existing or initiating IP practice) was also captured. Geographic location by state was recorded. An independent, two-sample t test was performed comparing IP positions (IP academic and IP private practice) with non-IP positions (Excel version 14.0; Microsoft, Redmond, WA).
survey from the graduates’ fellowship directors in three of the four fellows from the class of 2014 who originally reported obtaining no position. The majority of newly created IP programs were in academic practices (18/25; 72%). There was an increasing number of new IP academic programs being created compared with IP private practice. All IP fellowship graduates who joined an expanding (existing) IP group were in an academic practice. There were two IP physicians who joined an IP academic practice outside the United States (China and Canada). Most of the IP fellowship graduates were men (41/53), with an increasing number of women in 2013 and 2014 (n = 2 in 2012, n = 5 in 2013, and n = 5 in 2014). The geographic results are illustrated in Figure 1. Most positions were filled in states east of the Mississippi River (i.e., in the eastern half of the continental United States); only 8 of 53 (15.1%) positions were filled in states west of the Mississippi River.
Results There were 53 fellows participating in the in-service exam survey. The overall response rate for all listed AABIP/AIPPD fellowship programs participation was 88.5%. There was 100% participation in 2012 and in 2013/ 2014; 14 of 16 and 18 of 22 fellowship programs participated in the in-service exam survey, respectively. There was a significant number of IP graduates obtaining IP positions compared with nonIP positions (P = 0.008). The majority of IP fellowship graduates (75%; 39/52) had positions in academic IP practices (Table 1). There was a smaller number (7/53; 13.2%) of fellows who had positions in IP private/hybrid practices. All seven positions in private/hybrid practices were to create an IP program. One IP graduate was in a non-IP academic position, four were in non-IP private practice, one was in a research position, and four had no definite employment in their last month of fellowship (class of 2014). Limited employment data were collected after the
Discussion The primary goal for this study was to evaluate data from job placement of recent IP fellowship graduates to better understand the labor market. To our knowledge, there have been no attempts to formally understand the IP labor market. Our initial hypothesis was that the expansion of number of training program would test the labor market and result in signals of oversaturation. To the contrary of our hypothesis and despite speculation of an overly saturated job market, recently trained IP fellows were able to obtain employment practicing IP in academic and private practice. They remain more likely to practice in academic settings and to join established practices primarily in the eastern half of the continental United States. This is not
surprising considering that IP fellowships have historically been concentrated in the northeastern United States. In addition, with the exception of the west coast, regions such as the midwest have been historically underserved by some subspecialists (3). In a recent study, a significant discrepancy of didactic knowledge existed between IP and general pulmonary practitioners, reflecting a missing benefit of having an IP practitioner in certain regions of the country (4). Studies are needed in IP to examine meaningful clinical outcomes and access to care. A potential explanation for the continued demand for IP practitioners may be coming from two areas: (1) an increase in new IP programs and (2) expansion of existing IP programs. The data for the last 3 years continue to show the creation of new IP programs in academics at similar rates in each year. None of the positions in the expanded IP practices was from private practice. The growth of new programs can expand the labor market by creating new employment positions. The geographic data also illustrate a potential future of new IP programs unfulfilled in states west of the Mississippi River (i.e., half of the United States). Although an argument can be made that there may be older existing IP physicians in these states, this would be unlikely given the initial growth of IP coming from the east coast. None of the 2014 graduating IP fellows who joined an existing IP practice had joined a practice that was formed in 2012. This would suggest that expansion of an IP program would likely take more than 2 years. The growth of IP jobs should continue to increase as long as there are new programs being developed that would eventually lead to expansion of programs. A potential inflection point or plateau in the labor demand curve may be when there are no new IP academic programs being started.
Table 1. Practice style of interventional pulmonology fellowship graduates, 2012–2014 Class
2014 2013 2012 Total
Number of Fellows
IP Academic*
IP Private/Hybrid*
Non-IP Academic
Non-IP Private
Creating IP Practice
Joining IP Group
No Position
21 17 15 53
12 14 13 39
5 2 0 7
1 0 0 1
1 1 2 4
10 11 4 25
6 6 6 18
1 0 0 1
Additional Training 1 0 0 1
Definition of abbreviation: IP = interventional pulmonology. *Position encompassing more than 60% effort toward interventional pulmonology.
550
AnnalsATS Volume 12 Number 4 | April 2015
BRIEF COMMUNICATION
NH X WA AK
VT 1
X
MT
X
X
OR X
ID
ND
MN
X
X
WI X
IA
NE
CA
1
1
1
UT
IN
2
1
KY
X
2
2
HI X
AZ X
NM X
AR
VA
X
X
LA
DE X
2
MD 1
NC
DC X
2
X
X 3
NJ 1
TN
OK
MS TX
CT 1
X
MO
RI 1
5
4
KS
MA 2
PA OH
IL
CO
2
4
1
X
NV
NY
MI
X
WY
X
WV X
SD
X
X
ME
SC X
AL 1
GA 1
1
FL X
Figure 1. Geographic distribution of interventional pulmonology positions for interventional pulmonology graduates, 2012 to 2014.
Our data indicated that, over a 3-year period, there had been no placement of formally trained IP fellowship graduates in several regions of the country because of the lack of demand or, more likely, because of the limited labor supply. Physician shortages have been well cited in the critical care specialty as well, from which in part the IP training pool is derived because fellows are also trained in pulmonary/critical care medicine (5, 6). Workload projections for surgical oncology were examined by Etzioni and colleagues, who found a growing demand for oncologic procedures driven by the aging of the U.S. population (7). They concluded that growth in demand, combined with surgeon shortages, would lead to decreased access to care for cancer patients with cancer. Although our study addresses only a portion of the supply labor market, further labor force planning in IP is necessary. It has important implications for patient outcomes, access to care, and graduate medical education, particularly regarding IP fellowships (8). The male predominance of the work force is comparable to the male
predominance of surgical subspecialties with similar length of training (9). However, there is a trend toward an increasing number of female IP physicians who may arguably change the workforce forecast (10). This trend is most likely to continue given the increasing number of female pulmonary/critical care fellows, who make up about 31% (8). The majority of fellowship graduates have entered into an academic practice; however, the trend over the 3 years was toward an increasing number of graduates entering IP private practice. The limitation of this analysis is that it may only reflect a short-term forecast due to only 3 years of recent data. However, the long-term forecast, even when using larger data pools, remains unpredictable due to unforeseeable market variability in the economy, reimbursements, and technological innovation. Although the response rate for the survey was high, not all IP fellowships participated in all 3 years, leaving our data incomplete. Also, the definition of IP position (.60% IP position) may be open
References 1 Yarmus L, Feller-Kopman D, Imad M, Kim S, Lee HJ. Procedural volume and structure of interventional pulmonary fellowships:
to differences in interpretation because the field is still not standardized. One of the graduates had responded as a non-IP academic position because this graduate was initiating and developing an IP program at an academic practice. Other data for the exit out of the supply market, such as the retirement, mortality, disability, and career change data of IP physicians, would be useful, but these data are currently unavailable by the American Medical Association Physician Masterfile. Conclusions
Despite speculation about the scarcity of academic jobs after fellowship, the market is not saturated. Recently trained IP fellows were more likely to practice in academic settings and to join established practices in the eastern half of the continental United States. Future expansion may be found in new geographical areas or in different practice types. n Author disclosures are available with the text of this article at www.atsjournals.org.
a survey of fellows and fellowship program directors. Chest 2013; 144:935–939. 2 U.S. Department of Health and Human Services, Health Resources and Services Administration. Bureau of Health Professions. Physician
Lee, Feller-Kopman, Islam, et al.: Employment Data for IP Fellowship Graduates
551
BRIEF COMMUNICATION supply and demand: projections to 2020; 2006 [accessed 2014 Aug 1]. Available from: http://bhpr.hrsa.gov/healthworkforce/reports/ physiciansupplydemand/default.htm. 3 Cooper RA. States with more physicians have better-quality health care. Health Aff (Millwood) 2009;28:w91–w102. 4 Lee HJ, Feller-Kopman D, Shepherd RW, Almeida FA, Bechara R, Berkowitz D, Chawla M, Folch E, Haas A, Gillespie C, et al. Validation of an interventional pulmonary examination. Chest 2013;143:1667–1670. 5 Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr; Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000;284:2762–2770.
552
6 Ewart GW, Marcus L, Gaba MM, Bradner RH, Medina JL, Chandler EB. The critical care medicine crisis: a call for federal action: a white paper from the critical care professional societies. Chest 2004;125: 1518–1521. 7 Etzioni DA, Liu JH, Maggard MA, O’Connell JB, Ko CY. Workload projections for surgical oncology: will we need more surgeons? Ann Surg Oncol 2003;10:1112–1117. 8 Cooper RA. Unraveling the physician supply dilemma. JAMA 2013;310: 1931–1932. 9 Association of American Medical College. 2012 physician specialty data book (November 2012) [accessed 2014 Aug 1]. Available from: https://www.aamc.org/data/ 10 Phillips SP, Austin EB. The feminization of medicine and population health. JAMA 2009;301:863–864.
AnnalsATS Volume 12 Number 4 | April 2015
