Kindig D A
Wisconsin Network for Health Policy Research, University of Wisconsin-Madison, School of Medicine, USA.
Baxter Health Policy Rev. 1996;2:149-82.
Physician workforce issues were among the most hotly debated components of the recent national health care reform effort. What are the United States' goals for its physician workforce? Will market forces be adequate to achieve these goals, or will regulatory intervention be needed? This chapter provides public and private policymakers with a framework for arriving at reasonable conclusions about this important subcomponent of national health policy. Physician supply and requirements are discussed first. A picture of the current U.S. physician workforce is presented, together with details of its size and the physician-to-population ratio. Future growth of the physician workforce is projected, and future requirements are discussed along with the potential for both surpluses and shortages in some areas. Graduate medical education, a crucial topic in this discussion, is covered. The issue of substitution of nonphysician providers for physicians is considered next, with special attention paid to the capabilities of nonphysician providers in performing certain tasks, as well as the productivity and cost-effectiveness questions involved. While the physician supply in the United States may be adequate overall, gaps in service and problems with access to services persist in many rural and inner-city areas. The geographic distribution of the physician workforce and the balance of subspecialists and generalists are addressed. Other topics of discussion include the need for greater minority representation in the physician workforce and the evolving role of the physician executive. Finally, this chapter ends with a wrap-up of policy considerations and themes central to the new delivery system of the twenty-first century. These themes include market forces versus regulation, cost containment and workforce cost-effectiveness, the global role of the United States, and nonfinancial barriers to access to care, as well as the impact of technology and the role of physician scientists.
医师劳动力问题是近期全国医疗保健改革努力中争论最为激烈的组成部分之一。美国对其医师劳动力的目标是什么？市场力量是否足以实现这些目标，还是需要监管干预？本章为公共和私人政策制定者提供了一个框架，以便就这一国家卫生政策的重要子组成部分得出合理结论。首先讨论医师供应和需求。介绍了美国当前医师劳动力的情况，包括其规模细节以及医师与人口的比例。预测了医师劳动力的未来增长，并讨论了未来需求以及某些领域出现过剩和短缺的可能性。涵盖了研究生医学教育这一讨论中的关键话题。接下来考虑非医师提供者替代医师的问题，特别关注非医师提供者执行某些任务的能力，以及所涉及的生产力和成本效益问题。虽然美国的医师供应总体上可能充足，但在许多农村和城市中心地区，服务差距和获得服务的问题仍然存在。探讨了医师劳动力的地理分布以及专科医生和全科医生的平衡。其他讨论话题包括医师劳动力中需要增加少数族裔代表以及医师管理人员角色的演变。最后，本章以对政策考虑因素和21世纪新医疗服务体系核心主题的总结结束。这些主题包括市场力量与监管、成本控制和劳动力成本效益、美国的全球角色、获得医疗服务的非财务障碍，以及技术的影响和医师科学家的作用。
