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Is Anyone Paying Attention?

Dr. Block is Editor-in-Chief, CHEST.

Correspondence to: A. Jay Block, MD, Master FCCP, Seagle Bldg, Suite 408, 408 W University Ave, Gainesville, FL 32601; e-mail: editor{at}chestnet.org

Work force studies often reflect common prejudices, cost-saving philosophies, rumor and innuendo, but little data. An exception to this rule exists in the recently published Committee on Manpower of Pulmonary and Critical Care Societies (COMPACCs) study.¹ As I read it, there is a shortage of pulmonary and critical care specialists now and this shortage will get worse in the future. These conclusions are based on real survey data with excellent physician participation.

This is no surprise to me, since I have some personal observations to back up these conclusions. In 28 years of training pulmonary fellows, I do not remember more than two who had any difficulty in finding a job. Mostly, the fellows were besieged with job offers. In reviewing the personnel services of this journal for the past 8 years, there are usually between 10 pages and 20 pages of advertisements for positions available as opposed to one or two total positions sought.

In the 1990s, common wisdom told us that we were training too many specialists. Perhaps this was true for many specialties, but it was never validated for the pulmonary and critical care physicians. Medical schools tried to cut the number of fellows trained in all specialties, including ours.

I must apologize for picking on the state of Florida in this discussion, but I live there, was involved in all the matters that occurred, and have little knowledge of affairs in other states. Not only did the medical schools cut the numbers of fellows trained, but the American Lung Association (ALA) suddenly prevented the Florida Lung Association (or any other state associations) from funding clinical fellows. I was distressed by this decision because in 1979, the division heads from the three medical schools in Florida initiated the Pulmonary Wintercourse sponsored by the Florida Thoracic Society and the Florida Lung Association. The single purpose for founding this course was to raise money to fund the training of clinical fellows. This goal was accomplished, and the Florida Lung Association funded the training of one fellow in each of the three institutions for 18 years. Since 1997, however, funding has been restricted by the ALA to research, including money generated by the Wintercourse. I was one of the three division heads that started the course. I felt betrayed in 1997 when the money could not be used for the purpose that we originally intended. I strongly believe that the ALA restrictions should now be lifted in the wake of the publication of recent data that support more fellowship training. That was the original intention, but it was sidetracked by national events. The decision should be reversed. In fact, I believe that clinical fellowship training in general should be funded again by both the National Institutes of Health and the ALA in every state.

Sue Pingleton has written recently of the merits of the COMPACCs study.² There will only be merits from this study if behavior changes and the gap between needed specialists and practicing pulmonary and critical care physicians is closed by training. Even if a follow-up study is done, it will report no new information if we do not act now.

With new leadership in the ALA, I ask why the local funds are still restricted? I am told that the Professional Education and Research Committee of the Florida Lung Association cannot allocate all the monies available now since the ALA must approve everything that is funded, even at the local level. This includes all research grants and excludes fellowships. Does this make any sense in 2001? I am sure that this question applies not only to Florida but to the whole country. We can make a difference in the manpower status, but we must do the right thing. Is anyone paying attention?

References

1. Angus, DC, Kelly, MA, Schmitz, RJ, et al (2000) Committee on Manpower for Pulmonary, and Critical Care Societies. 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 284,2762-2770[Abstract/Free Full Text]
2. Pingleton, SK (2001) Committee on Manpower of Pulmonary, and Critical Care Societies: a report to membership Chest 120,327-328[Free Full Text]

This article has been cited by other articles:

				J. L. Kirkwood and N. Edelman Research Fellowships in Pulmonary and Critical Care Chest, January 1, 2002; 121(1): 1 - 1. [Full Text] [PDF]

This Article Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Block, A. J. Search for Related Content PubMed PubMed Citation Articles by Block, A. J.