Trends in medicine

Culinary Course Offerings in Medical Schools Grow

Last April, when Yale Medical School, in partnership with the Yale New Haven Health System, opened the doors to the new Digestive Health Center in North Haven, it included the Irving and Alice Brown Teaching Kitchen. This kitchen has become the home for one of the medical school’s newest courses: Defining “Healthy”: Culinary Medicine for Chronic Disease Prevention. 

The course, co-taught by Nate Wood, MD, and Max Goldstein, the lead dietitian chef, integrates instruction in nutrition, cooking, and evidence-based science. Wood and Goldstein work with students to identify the health-promoting components of evidence-based diets and gain an understanding of how diet impacts disease. And students do all the cooking. 

Wood said that the motivation for the course stemmed from the knowledge gaps he saw between dietetics, medicine, and cooking. Dieticians know how to plan for a healthy diet but not necessarily how to cook. Chefs have the skills to make a meal but typically don’t receive training in nutrition. And physicians, who combat diseases brought on by a poor diet, often serve as a first point of contact for people interested in making better choices. 

“Food is a problem, but it can also be a solution, especially if we can bridge the gap among physicians, dietitians, chefs, and patients. Culinary medicine is not only vital to patient care, but it can also provide necessary nutrition education for students, medical trainees, and health care professionals,” Wood said.

Yale is not the only school to provide instruction in culinary medicine. The first training kitchen, the Goldring Center for Culinary Medicine at Tulane University’s School of Medicine, opened in 2012 and the number of programs offering such courses continues to grow. The Health Meets Food culinary medicine curriculum has now been integrated into 33 medical schools, as well as some residency and nursing programs. 

Given the Choice, Most Physicians Would Choose Medicine Again. Most Would Even Opt for the Same Specialty.

Medscape recently published its 2023 Physician Income report. For this year’s report, over 10,000 providers, across 29 specialties, submitted responses.

We provide highlights from the report below:

Amidst the well-documented physician shortage and effects of the pandemic, which further reduced the supply of providers, it is not surprising that physician incomes are continuing to increase. From 2018 to 2023, the average physician income increased from $299,000 to $352,000. In 2023, Specialists’ compensation averaged $382,000, and Primary Care Physicians (PCPs) averaged $265,000. Male physicians continue to make more than women, with average salaries 19 percent higher for PCPs and 27 percent higher for specialists. The gap between the sexes, however, is smaller in 2023 than it was in previous years for both groups.

The top 10 highest paid specialties have remained relatively unchanged for the past decade with the exception of Plastic Surgery, which now garners the highest annual compensation ($619,000). Average pay increased the most from last year among Oncology (+13 percent), Gastroenterology (+11 percent), Anesthesiology, Radiology, Critical Care, and Urology (all +10 percent). The specialties with the biggest declines from last year include Ophthalmology (-7 percent), Emergency Medicine (-6 percent), Physician Medicine and Rehab, Nephrology, Allergy & Immunology, and Rheumatology (all -5 percent).

Most physicians (52 percent) feel that they are compensated fairly. Satisfaction does not correlate perfectly with average compensation, as physicians in some of the lower-paying specialties are among the most likely to report that they are satisfied. Physicians who work in Psychiatry (68 percent), Dermatology (65 percent), Public Health and Preventative Medicine (65 percent), and Critical Care (63 percent) are the most likely to feel compensated fairly. And, with the exception of Dermatology, none of the specialties fall within the top ten highest paid. Physicians working in Infectious Disease (35 percent), Ophthalmology (42 percent), Internal Medicine (43 percent), and Nephrology (43 percent) are the least likely to feel satisfied with their pay.

Almost three-quarters (73 percent) of physicians reported that they would choose medicine again and most would choose their specialty. Almost all Plastic Surgeons (97 percent), Urologists (96 percent), and Orthopedists (95 percent) would opt for their specialty again. The least likely to say that they would choose their specialty again are physicians working in family medicine (66 percent) and Internal Medicine (61 percent).

Physicians feel rewarded by their expertise and their relationships with patients, although they name many challenges. Just under one-third of respondents (30 percent) said that the work itself or “being very good at what I do” is the most rewarding part of the job. An additional 24 percent named “gratitude/relationships formed with patients,” and 19 percent said “helping others and doing good”. When asked about the challenges, physicians responded with a variety of items, including rules/regulations (21 percent), long hours (16 percent), dealing with difficult patients (15 percent), dealing with Medicare and/or insurers (13 percent), and working with electronic health records (13 percent), among others.

On average physicians spend 15.5 hours per week on administrative duties. This includes an average of nine hours on EHR documentation weekly. Specialists who spent an average of 18 (plus) hours per week on these duties, include Physical Medicine and Rehabilitation (19 hours), Critical Care (18), Internal Medicine (18), Nephrology (18), Neurology (18), and Oncology (18). On the other end of the spectrum, Anesthesiologists (9) and Ophthalmologists (10) spent fewer hours on administrative work.

555 Vacant Emergency Medicine Resident Positions Remain Following National Match Day

According to social media reports, this year's National Resident Matching Program left 555 unfilled positions in emergency medicine. While the positions will likely be filled in the Supplemental Offer and Acceptance Program, it is noteworthy because, as recently as three to four years ago, the specialty was among the most competitive. This year’s number of vacancies more than doubled last year’s 219 unfilled positions, but in 2021 just 14 vacancies remained post-match. 

Several emergency medicine groups published a joint statement reacting to the open positions on the American College of Emergency Physicians website. In the statement, they noted that a combination of many factors likely influenced this year’s outcome. “Many have speculated about factors such as workforce projections, increased clinical demands, emergency department (ED) boarding, economic challenges, the impact of the COVID-19 pandemic, and the corporatization of medicine, among many others.”  

An interview between Medscape and Robert McNamara, MD, Chair of Emergency Medicine at Temple University and Chief Medical Officer of the American Academy of Emergency Medicine, provided additional insight into two of the factors: workforce projections and the corporatization of emergency medicine. In December 2021, the Annals of Emergency Medicine published a study projecting an oversupply of emergency physicians by 2030. In McNamara’s view, the suggestion of an oversupply may have deterred prospective entrants into the field who worry about finding a job and repaying loans. 

"Emergency medicine residents always have among the highest debt of any specialty," McNamara said. "They have a strong sense of social justice and often don't come from privileged backgrounds ... so they're likely to accumulate debt."

He also added that emergency medicine positions tend to fall under corporate entities more often than physician-run groups. The corporate focus on profit can lead to burnout and a lack of “physician autonomy.” 

Moving forward, the joint statement announced the creation of a Match Task Force with heavy emergency medicine representation to further understand the reasoning behind the unfilled positions and create mitigation strategies for the future.

Medical Schools Incorporate More LGBTQ-Focused Programs into their Curriculums

Studies show that individuals who identify as LGBTQ report worse health care experiences and poorer health outcomes. But in following the lead of the AAMC, medical schools are working to remedy these health inequities by incorporating more LGBTQ-focused initiatives into their curriculums. 

Below, we highlight a few medical schools with notable LGBTQ-focused programs. 

For prospective medical students interested in pursuing an education that includes rigorous preparation in LGBTQ care, U.S. News recently published useful tips from medical school administrators and professors that will assist you in gauging the strength of a program’s curriculum. 

  • Inquire about how LGBTQ+ topics are integrated into the required coursework. "Offering it as a requirement really does put the teeth behind it in the curriculum, saying this is something for all students," Dr. Steven Rougas, Director of the Doctoring Program at Brown University's Warren Alpert Medical School, said.

  • Look for LGBTQ+ clinics and/or institutes for study and research. "Looking for centers is how I would go about doing it," Dane Whicker, Clinical Psychologist and Director of Gender and Sexual Diversity initiatives in the Office of Equity, Diversity, and Inclusion at Duke University School of Medicine, said. He also noted that a particularly good sign is a center that conducts research and provides comprehensive treatment programs. 

  • Ask about how LGBTQ+ courses are developed and updated. "One key question is how the institution plans for change," Dr. John A. Davis, the University of California-San Francisco School of Medicine's Associate Dean for Curriculum, wrote to the U.S. News in an email. "Areas particularly involving gender identity and expression and sexuality are rapidly changing, and curriculum must keep up with that. How an institution plans for that type of rapid change says a lot,” he wrote.

Biden Administration Works to Improve Nutrition and Health Education in Medical School Curriculums

Despite the prevalence of obesity and related diseases, including type 2 diabetes, hypertension, heart disease, cancer, and stroke in the US, there is little training on nutrition in American medical schools. 

Dr. Stephen Devries, a cardiologist and co-lead of the Nutrition Education Working Group at the Harvard School of Public Health, spoke about this gap in the medical curriculum on a recent AMA podcast. “Nutrition just hasn't been recognized as a priority in medical education, despite the fact that dietary changes are well recognized to be the leading risk factor for premature death and disability in the United States. On average, medical students spend about 19 hours over the course of four years in medical school on nutrition. But much of that is related to biochemistry and topics that are important but not directly clinically relevant for patients. So in the absence of meaningful nutrition education, what are medical students to think when they graduate, other than the fact that nutrition must not be very important in their training because they only learned about drugs and procedures?” he said. 

Due to the public health concern and the costs related to poor nutrition, government representatives are starting to speak up. From the House of Representatives to the White House, there are calls for action to improve education and outreach on nutrition and diet-related disease from medical schools to elementary schools. Earlier this year, following a congressional briefing with the Nutrition Education Working Group at the Harvard School of Public Health, Congressman McGovern (D, MA) and Congressman Burgess (R, TX) passed a bipartisan resolution in the House calling for “medical schools, residency, and fellowship programs to provide nutrition education that demonstrates the connection between diet and disease.” The resolution will encourage federal agencies to prioritize funding for medical “programs that incorporate substantive training in nutrition and diet sufficient for physicians and health professionals to meaningfully incorporate nutrition interventions and dietary referrals into medical practice.” 

In late September, the White House hosted its first Conference on Hunger, Nutrition, and Health in over 50 years where they unveiled a formal strategy to promote better nutrition and improve food security. The administration announced $8 billion in commitments, underneath five pillars, involving stakeholders from non-profits to universities to tech start-ups. The second pillar, “Integrate Nutrition and Health,” is most heavily geared towards medical students and physicians. Some of the named actions include:

  • A commitment by the American College of Lifestyle Medicine (ACLM) to make an in-kind donation of $24.1 million to improve nutrition training for medical professionals

  • A first-ever Medical Education Summit on Nutrition in Practice organized by the AAMC and ACGME to convene 150 medical education leaders

  • A signed pledge by many leading health organizations (including the National Medical Association and National Hispanic Medical Association) to take action on strengthening health professionals’ nutrition education

  • A commitment by The University of South Carolina School of Medicine Greenville to make a $4.8 million in-kind donation to assist in the implementation of its Lifestyle Medicine curriculum for interested medical schools and to provide content guidance to the National Board of Medical Examiners

AMA and AAMC Urge Supreme Court to Continue Allowing Medical Schools to Consider Race/Ethnicity in Admissions Decisions

The U.S. Supreme Court is taking two cases that could prevent medical schools’ current practice of considering race/ethnicity in admissions decisions: Students for Fair Admission Inc. v. President and Fellows of Harvard College and Students for Fair Admission Inc. v. University of North Carolina et al. The first considers if Harvard’s admissions processes penalize Asian Americans and in turn violate Title VI of the Civil Rights Act. The second North Carolina case asks if the Supreme Court should overturn a 2003 decision, Grutter v. Bollinger, which allows race to be used as a component of admissions decisions. 

In response to the Supreme Court’s review of the upcoming cases, the AMA and AAMC, along with 40 other organizations, submitted an amicus brief urging the court to “take no action that would disrupt the admissions processes the nation’s health-professional schools have carefully crafted in reliance on this court’s longstanding precedents.” The brief notes the key role that diversity in medical school admissions plays in reducing health disparities by increasing the number of minority practitioners, who are more likely to serve in minority communities, and also by increasing the effectiveness of all physicians through a more diverse learning and training environment. The brief points to scientific research and studies showing the benefits of diversity, saying that “Preventing medical educators from continuing to consider diversity in admissions … would literally cost lives and diminish the quality of many others.” The brief also suggests the possibility that overruling the use of race in admissions decisions may, “...potentially trigger a spiral of severe and self-reinforcing decreases in diversity in the health care professions. States that have banned race-conscious admissions have seen the number of minority medical school students drop by roughly 37% as a result.”

Pandemic Spurs Medical Residents to Unionize

Residency is known to be grueling. And during the covid-19 pandemic, the pressure upon residents only increased. As a result, a growing number of residents at hospitals within the U.S. are forming unions to formalize decisions related to pay and working conditions. Sunyata Altenor, Communications Director for the Committee of Interns and Residents (CIR), the nation’s largest resident’s union, said, “Every year, we had one or two new organizing campaigns, but once COVID hit, that number pretty much tripled.” She continued, “It was a massive wave, and we anticipate that it will continue to grow.” Currently, 15 percent of medical residents in more than 60 hospitals are unionized and represented by CIR, while a smaller proportion have either formed a local union or joined a larger medical provider union. 

Oversight organizations, including the AAMC and the AMA, provide high-arching policy guidance on unions but leave the decision-making to the hospital and the residents who work there. According to Janis Orlowski, MD and AAMC Chief Health Care Officer, “The AAMC leaves it to each institution and its house staff to determine how to achieve the best possible education, working conditions, and patient care.” The AMA, for its part, notes that its policy on resident unions strongly encourages separating academic issues from union-covered employment conditions. They note also that unions must abide by the AMA Principles of Medical Ethics, which disallow “such organizations or any of its members from engaging in any strike by the withholding of essential medical services from patients.”

The benefits of unions include providing medical residents a collective voice to negotiate more favorable pay and working conditions. The Accreditation Council for Graduate Medical Education (ACGME) regulates the maximum number of working hours for residents, but not salary. In 2021, according to AAMC data, first-year residents earned just below $60K on average, with many working up to 80 hours weekly. And while working conditions vary by hospital and department, unions can also provide residents more control over their intense work schedules and demands. For example, University of Washington’s Resident and Fellow Physician Union-Northwest (RFPU) won the right for pregnant residents to decline 24-hour shifts. 

Other union benefits include encouraging departments to clearly delineate the rules and rights of residents, and improve social justice efforts through additional support and means to report racial (or other) discrimination for residents of color or sexual minorities. Proponents of resident unions including Kaley Kinnamon, MD and Resident at the University of Vermont Medical Center, which recently voted to launch a residents’ union, noted that unions also bolster the conditions that allow residents to focus on providing the best patient care. “In order to take good care of others, we need to be able to care for ourselves,” she said. “We love being residents and caring for patients. But we can’t do that well if we neglect ourselves.” 

There are also downsides to resident unionization. For one, there is a significant financial cost, particularly post-pandemic when many hospitals are still financially vulnerable. While hospitals receive federal funding to support resident salaries, most come from the hospital itself. There is also a drawback in creating blanket conditions for all hospital residents during training, as there is a need for flexibility and differentiation between departments based on residents’ learning needs. One resident, interviewed by AAMC, noted that surgical residents are required to fulfill a certain number of cases and hours—regardless of union negotiations—in order to qualify for board certification. Furthermore, hospitals have raised the concerning nature of a strike, which would make it almost impossible to adequately staff the hospital.   

Jason Sanders, MD, and Executive Vice President for Clinical Affairs at the University of Vermont Health Network, suggests that hospital leaders pay attention, but look beyond immediate questions of unionization, to focus on the bigger picture. “Whether or not residents have a union, their concerns exist. The question we leaders need to ask ourselves is, how are we going to address them?” he said.

Osteopathic Medicine Continues to Grow in Popularity

Osteopathic medicine is one of the fastest growing segments in healthcare, according to the American Osteopathic Association’s (AOA) Osteopathic Medical Profession Report. The number of osteopathic medical students has grown by 77 percent in the last ten years, which has led to an 81 percent increase in the total number of DOs (including practicing physicians, residents, and medical students). Today, there are an estimated 122,236 in the physician workforce, just over one in four medical students are currently pursuing a Doctor of Osteopathic Medicine (DO) degree, and an estimated 36,500 medical students are expected to matriculate into a DO program this school year (up 2,700 from last year). 

Demographic highlights:

  • Practicing DOs predominantly fall within a younger cohort. Just over two-thirds of practicing physicians are under 45 (35 percent are under 35, and 32 percent are between 35 and 44). 

  • In 2022, 43 percent of the practicing DOs were female, an upward trend that has continued over time (40 percent in 2015, and 32 percent in 2010). Almost half of practicing physicians (47 percent) are female and under 45. 

  • Most DOs tend to practice near where they completed their education, and DO programs are typically located in medically underserved regions. The states with the largest number of DOs include: California (8.3 percent), Pennsylvania (8.1 percent), Florida (7.9 percent), Michigan (6.6 percent), New York (6.4 percent), and Texas (6.1 percent).

  • Since 2020, the Accreditation Council on Graduate Medical Education (ACGME) has overseen the accreditation of all graduate medical education (allopathic and osteopathic). DO graduates also participate in the National Resident Matching Program (NRMP). The report notes that 2022 brought a new record level of placement for participating DOs, with 7,049 graduates placing into residency programs in 41 specialties. This is up 7 percent from the previous year. 

  • DOs predominantly work in primary care specialties. The top fields include family medicine, internal medicine, and pediatrics. Among the remaining 43 percent who opt into other specialties, the top fields include: Emergency medicine, Anesthesiology, Obstetrics and Gynecology, General surgery, and psychiatry. 

Related: Alternatives to Allopathic Medical Programs in the United States

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