Policy & Practice


Salary Affects Specialty Choice

When it comes to choosing a specialty, U.S. medical graduates are more concerned with their earning power than with medical liability costs, according to a study published in the September issue of Obstetrics and Gynecology. Procedure-based and hospital-based specialties, which generally are associated with higher incomes, are the most likely to have residency positions filled by U.S. medical graduates, the researchers found, even when the specialty had higher professional liability costs. For example, U.S. medical students filled more than 90% of the residency positions in neurosurgery and orthopedic surgery where medical liability insurance costs are high but so are average incomes. In contrast, U.S. students filled 70% of the available residency positions in obstetrics and gynecology, according to the American College of Obstetricians and Gynecologists. But the researchers noted that students also may be attracted to high-earning fields because of the technical challenges or the ability to have a more controllable lifestyle. The results are based on data from the 2004 National Resident Matching Program, the American Medical Association, the Medical Group Management Association, and a major Massachusetts liability insurer.

Greater Folic Acid Fortification

Officials at the March of Dimes are calling on the federal government to require higher levels of folic acid fortification in grain food. The request, which reflects a long-held policy of the March of Dimes, comes on the heels of new research showing that folic acid fortification in grain foods has resulted in a one-third drop in serious birth defects of the brain and spine. The Food and Drug Administration currently requires 140 mcg of folic acid per 100 g of grain. Since 1996, the March of Dimes has recommended that the FDA set the level in enriched grain foods at 350 mcg per 100 g of grain.

Pesticide Studies

A proposal from the Environmental Protection Agency would ban the inclusion of pregnant women and children in all new third-party intentional dosing research involving pesticides intended for submission to the agency. The proposal says that EPA officials will neither conduct nor support any intentional dosing studies that involve pregnant women or children. “We are pursuing a rigorous set of protections for human research participants,” Susan B. Hazen, principal deputy assistant administrator in the EPA's Office of Prevention, Pesticides, and Toxic Substances said in a statement. The agency has come under fire recently from congressional Democrats for relying on studies that involve intentionally dosing human subjects with pesticides. More information is available at

Reporting Neonatal Herpes

A group of experts in obstetrics and gynecology and pediatrics is calling on the Centers for Disease Control and Prevention to request reporting of cases of neonatal herpes from all states and U.S. territories. The call to action, which was published in the September issue of the journal Sexually Transmitted Diseases, notes that a lack of reliable epidemiological data may be partly responsible for the continued development of neonatal herpes cases. While diseases such as congenital syphilis are reportable in 47 states, only 7 states—Connecticut, Florida, Massachusetts, Nebraska, Ohio, South Dakota, and Washington—require reporting of neonatal herpes. The CDC can request reports on various conditions, but the states have the regulatory authority to require reporting. The epidemiological data from reported cases of neonatal herpes would help to resolve debates over testing, treatment, and prevention strategies, the researchers wrote. The analysis was supported by GlaxoSmithKline Inc.

Census Bureau Statistics

The Census Bureau reports that 45.8 million Americans were without health insurance in 2004, up from 45 million in 2003. While the increase is statistically small, it means that “an additional 860,000 Americans live without the safety net of health insurance,” J. Edward Hill, M.D., president of the American Medical Association, said in a statement. “As the decrease in employment-based health insurance continues, the AMA renews its call for health insurance solutions that put patients in the driver's seat, along with their physicians,” Dr. Hill said. Some of these solutions may include refundable tax credits inversely related to income and individually selected and owned health insurance, he said. In other statistics, the number of people with health insurance increased by 2 million to 245.3 million between 2003 and 2004. Those covered by government health insurance rose from 76.8 million in 2003 to 79 million.

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