Responses to questions about the specialty of family practice as a career.

This article provides answers to many of the questions medical students ask about the specialty of family practice. It is the fourth update of a previous article and was developed in response to feedback from medical students at the 1997 National Congress of Student Members held by the American Academy of Family Physicians. Students at the 1998 Congress also identified areas of interest and concern. This article discusses the hours and income of the family physician, the scope of medical practice in the specialty, required continuing medical education and board certification, family practice residency training and combined-specialty training.

Entry of US medical school graduates into family practice residencies: 1997-1998 and 3-year summary.

This is the 17th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 16.6% of the 15,894 graduates of US medical schools between July 1996 and June 1997 were first-year family practice residents in October 1997, compared with 15.9% in 1996 and 14.6% in 1995. This is the highest percentage since this series of studies began in 1980-1981 (12.8%). Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1997 than were residents from privately funded schools, 19.8% compared with 11.8%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1997 at 25.8%; the Middle Atlantic and New England regions reported the lowest percentages at 11.7% and 10.7%, respectively. Nearly half of the medical school graduates (48.1%) entering a family practice residency program as first-year residents in October 1997 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates of colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Results of the 1998 National Resident Matching Program: family practice.

The 1998 National Resident Matching Program (NRMP) results reflect a change in the perceptions and choices of physicians entering graduate medical education in the United States. Ninety-one fewer positions were filled in family practice residency programs in 1998, as well as 21 fewer in primary care internal medicine, 12 fewer in primary care pediatrics, and 13 fewer in internal medicine-pediatric programs. In contrast, 49 more positions were filled in anesthesiology, and 12 more US seniors chose diagnostic radiology, two "marker" disciplines that have recently been market sensitive. Thirty-four more positions were also filled in each of categorical internal medicine and pediatrics programs, where trainees are "pluripotential" with perceived options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the demands of managed care and the needs of rural and underserved populations continue to offer a market for family physicians, family practice may have experienced a "primary care backlash" though the 1998 NRMP.

Entry of US medical school graduates into family practice residencies: 1996-1997 and 3-year summary.

BACKGROUND AND OBJECTIVES: This is the 16 report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 15.9% of the 16,029 graduates of the US medical schools between July 1995 and June 1996 were first-year family practice residents in October 1996, compared with 14.6% in 1995 and 13.4% in 1994. This is the highest percentage since 1980-1981 (12.8%), when this series of studies began. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1996 than were residents from privately funded schools, 19.1% compared with 11.2%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1996 at 24%; the Middle Atlantic and New England regions reported the lowest percentage at 11.4% and 9.9%, respectively. Nearly half of the medical school graduates (48.4%) entering a family practice residency program as first-year residents in October 1996 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs.

Results of the 1997 National Resident Matching Program: family practice.

The 1997 National Resident Matching Program (NRMP) results reveal all-time highs for the number of positions filled in family practice residencies (2,905) and the number of positions filled with US seniors (2,340). This is the largest number of US seniors choosing family practice in the history of the NRMP. Of the 65 additional positions filled through the NRMP, compared with 1996 (2,905 versus 2,840), 64 were filled with additional US seniors (2,340 versus 2,276). Continuing a trend begun in 1992, the 1997 results showed more positions filled in family practice residencies on July 1 than in the previous year, with 3,570 in 1997, compared with 3,494 in 1996. Internal medicine residencies matched 128 more US seniors in 1997, and pediatric residencies matched 63 more US seniors. Of the US seniors matching through the NRMP, only 37.5% are predicted to practice as generalists. In the past 5 years, family practice has been the choice of 71.5% of additional US seniors choosing primary care. The continued record increased interest in family practice as a career, coupled with the nation's need for more family physicians, demands increased support for the nation's family practice residency programs.

Entry of US medical school graduates into family practice residencies: 1995-1996 and 3-year summary.

This is the 15th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 14.6% of the 16,124 graduates of US medical schools between July 1994 and June 1995 were first-year family practice residents in October 1995, compared with 13.4% in 1994 and 12.3% in 1993. This is the highest percentage since 1980-1981 (12.8%), when this series of studies began. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1995 than were residents from privately funded schools, 18% compared with 9.7%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1995 at 24.8%; the Middle Atlantic and New England regions continued with the lowest percentages at 7.6% and 9.3%, respectively. Approximately one in two medical school graduates (46.7%) entering a family practice residency program as first-year residents in October 1995 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. The average percentage for each medical school for the last 3 years is reported. In addition, the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs are reported.

Results of the 1996 National Resident Matching Program: family practice.

The results of the 1996 National Resident Matching Program (NRMP) set records in the number of positions filled in family practice residencies, with a 10.8% increase over 1995 (2,840 vs 2,563) and a 9.4% increase in positions filled with US seniors (2,276 vs 2,081). This is the largest number of US seniors choosing family practice in the history of the NRMP. A total of 196 (6.7%) more positions were offered in family practice through the NRMP, compared with 1995 (3,137 vs 2,941). Thus, 195 of these additional 196 positions were filled with US seniors. In keeping with the trend begun in 1992, 242 more positions were filled on July 1, 1996, than 1995 (3,494 vs 3,252), for a fill rate of 97.8%. Internal medicine residencies matched 67 fewer US seniors in 1996, while pediatric residencies matched 85 more US seniors. During the past 4 years, family practice has been the choice of 82.6% of the additional US seniors choosing a primary care residency. With continued record increased interest in family practice as a career choice and the need for more family physicians, priority support for the nation's family practice residency programs continues to be of critical importance.

Results of the 1995 National Resident Matching Program: family practice.

The 1995 National Resident Matching Program (NRMP) results broke records in the number of positions filled in family practice residencies, with an increase of 11.8% over 1994 figures (2,563 vs 2,293) and an increase of 12.5% in positions filled with US seniors (2,081 vs 1,850). This is the largest number of US seniors choosing family practice in the NRMP's history. In keeping with the trend that began in 1992, 7% more positions were filled on July 1, 1995, than were filled at the same time in 1994 (3,252 vs 3,040). Internal medicine residencies matched 74 more US seniors in 1995, and pediatric residencies matched 84 more US seniors. Given the anticipated career choices of students entering residency training in the generalist disciplines (95% of students matching in family practice, 60% of students matching in pediatrics, and 45% of students matching in internal medicine), it is expected that 33.5% of the class of 1995 (Liaison Committee on Medical Education-accredited medical schools) will practice as generalists. First-year positions offered in family practice through the NRMP increased 6%, and the number of Accreditation Council on Graduate Medical Education-accredited family practice residency programs increased 3% (421 vs 410). With continued increased interest in family practice as a career choice and the need for more family physicians, support for the nation's family practice residency programs continues to be of critical importance.

Anaerobic pericarditis: case report and review.

Purulent pericarditis is uncommon and is rarely caused by anaerobic bacteria. We describe a 58-year-old man with purulent pericarditis secondary to infection with Bacteroides fragilis; the most likely source for the B. fragilis infection was subsequently found to be a ruptured appendix. His pericarditis eventually resolved after drainage of purulent fluid and treatment with antibiotics directed against B. fragilis. We also review 29 cases of anaerobic pericarditis previously reported in the English-language literature (we excluded those cases due to actinomyces). In 17 cases only anaerobic bacteria were isolated, while in 13 anaerobes were isolated with a mixture of facultative and/or aerobic bacteria. The cases were secondary to a contiguous focus of infection or occurred via hematogenous seeding. Treatment of both anaerobic pericarditis and purulent pericarditis due to aerobic bacteria entails adequate drainage and appropriate antibiotic therapy, and in all cases there should be a search for the source of the organism infecting the pericardium.

Use of polymerase chain reaction for laboratory diagnosis of herpes simplex virus encephalitis.

Polymerase chain reaction was used to detect herpes simplex virus (HSV) specific deoxyribonucleic acid (DNA) sequences in acute and convalescent cerebrospinal fluid (CSF) and brain tissue of a 78-year-old man and in CSF of a neonate who died of complications owing to herpes simplex virus encephalitis (HSVE). Polymerase chain reaction (PCR) was carried out for 35 cycles with a set of primers that bracketed a 92 base pair segment unique to the HSV DNA polymerase gene. Amplified DNA was electrophoresed on 3 percent agarose gel, blotted onto a nylon membrane, and probed with 32p-labeled oligonucleotide internal to the primers. The HSV specific DNA sequences were detected in the specimens from both patients. No HSV specific DNA was detected in CSFs from 20 patients with suspected Lyme disease or neurosyphilis. Polymerase chain reaction is a rapid and noninvasive technique for the diagnosis of HSVE.

Prevention of Epstein-Barr virus-induced B-cell outgrowth by interferon alpha.

An in vitro system for determining the efficacy of interferon alpha (IFN-alpha) in preventing B-cell outgrowth due to Epstein-Barr virus (EBV) was developed. Unfractionated cord blood mononuclear cells, T-cell-depleted cord blood mononuclear cells, or adult T-cell-depleted mononuclear cells were exposed to IFN-alpha for 18 to 20 h followed by incubation with the B95-8 strain of EBV for 2 h. B-cell outgrowth was monitored by microscopic examination, [3H]thymidine incorporation, and Epstein-Barr nuclear antigen detection. Cell density and viral inoculum both affected the sensitivity of outgrowth to IFN-alpha. IFN-alpha was most effective when added at each feeding after infection as well as before infection with EBV. The mean of the lowest IFN-alpha concentration tested at which transformation failed to occur after infection with the B95-8 strain of EBV at a 50% transforming dose of 10(2.0) to 10(3.0)/ml was similar for unfractionated cord blood mononuclear cells, T-cell-depleted cord blood mononuclear cells, and adult T-cell-depleted mononuclear cells. The B95-8 strain and clinical EBV isolates required similar IFN-alpha concentrations to prevent outgrowth. In this system, IFN-alpha at pharmacologically achievable concentrations prevented EBV-induced B-cell outgrowth. These data indicate that IFN-alpha deserves further study as a potential therapeutic agent for EBV-induced syndromes.

A flow cytometric technique for quantitation of B-cell activation.

A flow cytometric method for enumeration of intracytoplasmic antibody-containing cells was developed. Flow cytometry was found to yield results comparable to traditional fluorescence microscopy in cells stimulated to produce intracytoplasmic antibody by either pokeweed mitogen or Epstein-Barr virus. This technique offers several advantages over traditional fluorescence microscopy, including objective measurement of fluorescence intensity and rapid analysis of large numbers of cells.

Bacteriological aspects of a case of Brucella suis infection.

Brucella sinus biotype 1 was isolated from the blood of a 55 year old Tongan woman patient in Auckland Hospital. Problems in identification of this organism are described and discussed

Isolation of Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus at Auckland Hospital.

Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus were each isolated three times at Auckland Hospital, over a one year period. Relevant clinical particulars of the major cases are given, and problems of isolation, identity and treatment discussed.