Stimmel B
Mount Sinai School of Medicine, City University of New York, NY 10029.
JAMA. 1992 Oct 21;268(15):2060-5.
While a number of issues have diminished the attractiveness of primary care residency programs to USGs, the absolute number of residents in these programs has increased rather than diminished over the past decade, although the proportion of USGs choosing these fields has decreased. In the current arena of medical practice, there are many reasons why these fields are not among the most attractive, and there are several remedies that could be applied to increase their attractiveness. Focusing on medical schools as the sole cause of this dilemma, however, is the least effective way of accomplishing this objective; in addition, this will allow those truly able to increase interest in these fields, such as state and federal governments, to have a reason for not doing so. As long as the medical marketplace is sufficiently large enough to accommodate more than the number of graduates from US medical schools in "desirable" residency training positions, one can never effectively "force" a choice of residency training, nor should one. Primary care can be among the most rewarding of specialties, if adequately supported. It is this support that is lacking and must be addressed.
虽然一些问题降低了基层医疗住院医师培训项目对美国医学生（USGs）的吸引力，但在过去十年中，这些项目的住院医师绝对数量有所增加而非减少，尽管选择这些领域的美国医学生比例有所下降。在当前的医疗实践领域，这些领域并非最具吸引力存在诸多原因，也有几种补救措施可用于提高其吸引力。然而，将医学院校视为这一困境的唯一原因是实现这一目标最无效的方式；此外，这会让那些真正有能力提高对这些领域兴趣的方面，比如州政府和联邦政府，有理由不这么做。只要医疗市场足够大，能够容纳超过美国医学院校毕业生在“理想”住院医师培训岗位的数量，就永远无法有效地“迫使”人们选择住院医师培训，也不应该这样做。如果得到充分支持，基层医疗可以成为最有意义的专业领域之一。正是这种支持的缺乏必须得到解决。
