The Journal of the American Osteopathic Association
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The Balanced Budget Act of 1997 and continuing changes put into place by the Educational Commission on Foreign Medical Graduates (ECFMG) are altering the environment for graduate medical education (GME) in ways that threaten osteopathic graduate medical education in particular. Hospital revenue is decreasing due to declines in Medicare GME and patient-care reimbursements. The new 3-year rolling average methodology for counting "house staff" makes it likely that unfilled positions will be eliminated. ⋯ Approximately 25% of all allopathic GME positions in the United States are filled by international medical graduates. If this applicant pool decreases, allopathic medical programs may turn to osteopathic medical graduates as the only other available pool of individuals to fill program positions. At a time when allopathic internship positions are already unfilled and 30% of osteopathic medical graduates enter allopathic first-year programs, further inroads by allopathic programs could severely impact osteopathic GME efforts.
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The authors analyzed mode of delivery and resuscitation rates in a group of 1410 newborns. Comparisons were made between vaginal and cesarean deliveries, and these were further stratified with regard to whether cesarean section was performed as a routine elective procedure or whether an indication existed that necessitated operative delivery of the child (nonelective). ⋯ The risk of resuscitation after repeat elective cesarean section was low, and this risk increased significantly in the nonelective cesarean delivery group. As the risk of resuscitation after elective repeat cesarean sections is not significantly increased, it may not be necessary that a pediatrician be present at these deliveries.