Academic manpower needs in allergy and clinical immunology

The problem of manpower deficits in the field of allergy in the United States has long been recognized. As far back as 1929, the results of a survey presented to the American Association for the Study of Allergy revealed that of 35 “leading” medical schools, only eight offered formal training in this newly emerging field of allergy.’ After a lapse of 17 yr, the Subcommittee on Undergraduate Education of the AAA undertook to determine the status of training in allergy in 66 medical schools in 1946.2 According to criteria defined by the subcommittee, fewer than half the schools surveyed had acceptable curricula, 12 having no formal instruction whatsoever. Carrying this theme forward, manpower deficits in the field of allergy once again were uncovered in 1976 by a committee of the AAA and the American Board of Allergy and Immunology, a conjoint board of the American Board of Internal Medicine and the American Board of Pediatrics.3 This information, derived from polling 37 academic and practicing allergists in the United States holding key positions in the national allergy societies, emphasized the need for additional practicing allergists to fulfill ideal doctor-to-patient ratios. The committee also suggested that three to four academic allergists would be required at each of the United States medical schools to carry out research and teaching at all levels. Based on these data, the 1976 deficit of academic allergists was estimated at 400. The committee believed that to supplement the work of the 400 allergists, 750 to 1,000 clinical immunologists engaged in practice and laboratory endeavors additionally would be required at that time to apply immunologic techniques to patient diagnosis and care. By the committee’s estimate, unless dramatic increases in rates of training were initiated, it would take about 100 yr to make up the deficit of specialists in these fields. The National Study of Internal Medicine Manpower. VII. Residency and Fellowship Training 1976 I977 through 1980-l 981 ,.i although confirming the deficit of such trainees, was able to demonstrate some progress toward the goal of increasing the number of academic allergists/immunologists. They found an average of 65 first-yr trainees in allergy/immunology subspecialty fellowship programs for the 5 yr period with an increase of these fellows planning an academic career from 14% in 19761977 to 28% in 1980198 1. These projections were quite in contrast to the subsequently released 1980 report of the GMENAC4 that predicted a surplus of allergists/immunologists within 10 yr. To further delineate the manpower requirements for patient care and teaching in the academic medical centers, the Immunology, Allergic, and Immunologic Diseases Program of the National Institute of Allergy and Infectious Diseases in 1980 sought further information pertinent to this subject. Chairpersons of Departments of Internal Medicine and Pediatrics at each of the 124 United States medical schools were contacted through written correspondence with telephone follow-up and invited to comment on professional staffing needs for teaching and care within inpatient and outpatient services under their purviews. Of particular interest was information to indicate whether they believed that coverage for allergy and for clinical