Rizza Robert A, Vigersky Robert A, Rodbard Helena W, Ladenson Paul W, Young William F, Surks Martin I, Kahn Richard, Hogan Paul F
Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, USA.
Endocr Pract. 2003 May-Jun;9(3):210-9. doi: 10.4158/EP.9.3.210.
The objective of this study was to define the workforce needs for the specialty of Endocrinology, Diabetes, and Metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 years was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the U.S. workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of whom 2,389 (66%) were in office-based practice. Their median age was 49 years. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 years, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. While this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g., diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.
本研究的目的是确定1999年至2020年美国内分泌、糖尿病和代谢专业的劳动力需求。构建了一个可能影响未来20年内内分泌科医生供需平衡的因素的互动模型。该模型使用了来自广泛来源的数据，并在由内分泌科医生赞助组织的专家小组指导下开发。我们确定了美国劳动力中内分泌科医生的当前和预计数量及人口统计学特征，以及1999年至2020年预期的供需平衡。1999年劳动力中有3623名成人内分泌科医生，其中2389名（66%）从事门诊工作。他们的年龄中位数为49岁。20世纪90年代，内分泌科医生的总门诊量和所提供的服务（尤其是糖尿病方面）大幅增加。目前，内分泌科医生的首次预约等待时间比其他医生更长。与人员基本稳定的平衡健康维护组织相比，目前全国内分泌科医生的供应估计比需求低12%。过去5年进入市场的内分泌科医生数量持续下降，从1995年的200人降至1999年的171人。即使这种下降趋势突然停止，该模型预测从现在到2020年需求仍将超过供应。由于预计管理式医疗的增长，2000年至2008年期间这一差距会缩小，但此后由于人口老龄化和内分泌专业劳动力老龄化，差距会再次扩大。纳入其他因素，如预计的实际收入增长和与年龄相关的内分泌疾病（如糖尿病和骨质疏松症）患病率上升，会进一步加剧短缺。如果进入劳动力队伍的内分泌科医生数量保持在1999年的水平，从现在到2020年，成人内分泌科医生的需求将继续超过供应，并且从2010年起差距将逐渐扩大。目前的分析表明，进入劳动力队伍的内分泌科医生数量将不足以满足未来需求。这些数据表明，应采取措施阻止正在接受培训的内分泌科医生数量持续下降，并应考虑采取行动增加未来几年从事临床工作的内分泌科医生数量。
