Goodman D C, Fisher E S, Little G A, Stukel T A, Chang C H
Department of Pediatrics Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
Eff Clin Pract. 2001 Jul-Aug;4(4):143-9.
In the past 30 years, the number of neonatologists has increased while total births have remained nearly constant. It is not known how equitably this expanded workforce is distributed.
To determine the geographic distribution of neonatologists in the United States.
1996 American Medical Association physician masterfiles; 1999 survey of all U.S. neonatal intensive care units; 1995 American Hospital Association hospital survey; and 1995 U.S. vital records.
The number of neonatologists and neonatal mid-level providers per live birth within 246 market-based regions.
The neonatology workforce varied substantially across neonatal intensive care regions. The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 with an interquintile range of 3.5 to 8.5. The weakly positive correlation between neonatologists and neonatal mid-level providers per live birth is not consistent with substitution of neonatal mid-level providers for neonatologists (Spearman rank-correlation coefficient, 0.17; P < 0.01). There was no difference in the percentage of neonatal fellows in the lowest and highest workforce quintile (14% vs. 16%) or in the percentage of neonatologists engaged predominantly in research, teaching, or administration (14% in lowest and highest quintiles).
The regional supply of neonatologists varies dramatically and cannot be explained by the substitution of neonatal mid-level providers or by the presence of academic medical centers. Further research is warranted to understand whether neonatal intensive care resources are located in accordance with risk and whether more resources improve newborn outcomes.
在过去30年中，新生儿科医生的数量有所增加，而总出生人数几乎保持不变。目前尚不清楚这一扩大的劳动力队伍的分布是否公平。
确定美国新生儿科医生的地理分布。
1996年美国医学协会医生主档案；1999年对美国所有新生儿重症监护病房的调查；1995年美国医院协会医院调查；以及1995年美国生命记录。
246个基于市场的区域内每例活产的新生儿科医生和新生儿中级医疗服务提供者的数量。
新生儿重症监护区域的新生儿科劳动力差异很大。每10000例活产的新生儿科医生数量从1.2到25.6不等，四分位间距为3.5到8.5。每例活产的新生儿科医生与新生儿中级医疗服务提供者之间的弱正相关与新生儿中级医疗服务提供者替代新生儿科医生的情况不一致（斯皮尔曼等级相关系数，0.17；P<0.01）。在劳动力水平最低和最高的五分之一组中，新生儿研究员的百分比没有差异（分别为14%和16%），主要从事研究、教学或管理工作的新生儿科医生的百分比也没有差异（最低和最高五分之一组均为14%）。
新生儿科医生的区域供应差异很大，无法用新生儿中级医疗服务提供者的替代或学术医疗中心的存在来解释。有必要进行进一步的研究，以了解新生儿重症监护资源的配置是否与风险相匹配，以及更多的资源是否能改善新生儿的结局。
