Smith R D, Prichard R W
Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Ohio 45267.
Hum Pathol. 1987 Nov;18(11):1089-96. doi: 10.1016/s0046-8177(87)80374-x.
Pathology has become less attractive to US medical graduates by every measure available to us. In 1981, 2.3 per cent of US medical school seniors planned a pathology career; by 1986, a steady decline had reached 1.6 per cent. In absolute numbers, adjusted for the response rate to the AAMC questionnaire, this means that the 290 seniors entering pathology in 1981 had fallen to 205 by 1986. FMGs enter pathology through the matching program in greater numbers than any other specialty. Our data show that slightly less than a third of current first-year pathology residents are FMGs, mainly from Caribbean and Mexican medical schools. The decline in US graduates entering pathology has resulted almost entirely from a drop in the number of men choosing the field. In 1984, 286 male US graduates matched in pathology, but this number dropped to 150 in 1985 and 149 in 1986. The group entering in 1985 was the first who will need 5 years to be eligible for certification in the anatomic pathology/clinical pathology programs. During the same years, the 116 women who matched in 1984 were followed by 111 in 1985 and 100 in 1986. The effect of the American Board of Pathology's change in requirements is not easily analyzed. The figures for residents entering, given above, would suggest that the requirements discouraged men, especially, from entering the field. This hypothesis is supported by our questionnaire data and by anecdote concerning the pressure felt by graduating seniors to finish their postgraduate training as fast as they can and start paying off their average debt of $33,650. Pathology still seems to attract people who like to teach, study interesting case material, and do research. The percentage of PhD/MDs entering pathology is almost 10 times as high as their percentage among graduating seniors. Discouragement against entering pathology came from a perceived shortage of job openings, negative statements from other physicians (including pathologists), the addition of a fifth-year requirement, and lack of patient contact. The last is hard to account for because pathology would obviously not offer the opportunities to see patients that exist in the clinical specialties, but it was prominent in the concerns of residents answering our questionnaire. The picture that emerges from our data is one of a specialty passing through a difficult period in attracting new talent into its ranks. The first step in dealing with the problem would seem to be recognizing its existence.(ABSTRACT TRUNCATED AT 400 WORDS)
从我们所能掌握的各项指标来看，病理学对美国医学毕业生的吸引力已有所下降。1981年，美国医学院大四学生中有2.3%计划从事病理学职业；到1986年，这一比例持续下降，降至1.6%。按美国医学协会问卷的回复率进行调整后，从绝对数字来看，这意味着1981年进入病理学领域的290名大四学生到1986年已降至205名。外国医学毕业生通过配对计划进入病理学领域的人数比其他任何专业都多。我们的数据显示，目前病理学专业一年级住院医师中略少于三分之一是外国医学毕业生，主要来自加勒比地区和墨西哥的医学院。美国毕业生进入病理学领域人数的下降几乎完全是由于选择该领域的男性人数减少。1984年，有286名美国男性毕业生与病理学专业配对，但这一数字在1985年降至150名，1986年降至149名。1985年进入该领域的这批人是第一批需要5年时间才有资格获得解剖病理学/临床病理学项目认证的人。在同一时期，1984年与病理学专业配对的116名女性，1985年有111名，1986年有100名。美国病理学委员会要求的变化所产生的影响难以轻易分析。上述关于住院医师进入情况的数据似乎表明，这些要求尤其阻碍了男性进入该领域。我们问卷调查的数据以及一些轶事都支持了这一假设，这些轶事涉及即将毕业的大四学生感受到的尽快完成研究生培训并开始偿还平均33,650美元债务的压力。病理学似乎仍然吸引着那些喜欢教学、研究有趣病例材料并从事研究的人。进入病理学领域的医学博士/哲学博士的比例几乎是他们在大四毕业生中所占比例的10倍。阻碍人们进入病理学领域的因素包括：认为职位空缺不足；其他医生（包括病理学家）的负面评价；增加了第五年的要求；以及缺乏与患者的接触。最后一点很难解释，因为病理学显然不会像临床专业那样提供接触患者的机会，但在回答我们问卷的住院医师的担忧中，这一点却很突出。从我们的数据中呈现出的情况是，这个专业在吸引新人才加入其队伍方面正经历一段艰难时期。解决这个问题的第一步似乎是认识到它的存在。（摘要截选至400字）
