McCrindle B W, Starfield B, DeAngelis C
Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland.
Pediatrics. 1992 Oct;90(4):573-81.
This study was undertaken to describe subspecialty characteristics and practices of the population of pediatricians given the ongoing controversy regarding a projected manpower oversupply of general pediatricians. A questionnaire was mailed to a national random sample of 1620 United States physicians listed in the American Medical Association's Physician Masterfile as being in office-based pediatric practice. The final response rate was 63%. Seventy percent of respondents designated their practices as "general pediatrics" versus 17% as "general pediatrics with a specific subspecialty interest" and 13% as "subspecialty practice." The general pediatricians with a specific subspecialty interest were intermediate in the proportion that had some training in a pediatric fellowship program (general pediatricians with a specific subspecialty interest, 63% versus general pediatricians, 14%, P < .0001, and pediatricians with a subspecialty practice, 92%, P < .0001) and that were certified in a pediatric subspecialty by the American Board of Pediatrics (general pediatricians with a specific subspecialty interest 16% versus general pediatricians, 2%, P < .0001, and pediatricians with a subspecialty practice, 62%, P < .0001). They were also intermediate in the proportion involved in various academic pursuits. Their practices, however, more closely resembled general pediatricians than pediatricians with a subspecialty practice in their location, setting, associates, and commitment to primary care. They were more likely than general pediatricians to utilize or provide specialized tests or procedures. A large percentage of pediatricians incorporate subspecialty elements into their general pediatric practices. Models of current and projected pediatric manpower supply need to be reassessed in light of this form of practice.
鉴于目前关于普通儿科医生预计人力供应过剩的争议，本研究旨在描述儿科医生群体的亚专业特征和实践情况。向美国医学协会医师主文件中列出的1620名从事门诊儿科实践的美国医生全国随机样本邮寄了一份问卷。最终回复率为63%。70%的受访者将他们的实践指定为“普通儿科”，17%为“有特定亚专业兴趣的普通儿科”，13%为“亚专业实践”。有特定亚专业兴趣的普通儿科医生在接受儿科 fellowship 项目培训的比例方面处于中间水平（有特定亚专业兴趣的普通儿科医生为63%，普通儿科医生为14%，P <.0001，亚专业实践的儿科医生为92%，P <.0001），以及在美国儿科学会获得儿科亚专业认证的比例方面也处于中间水平（有特定亚专业兴趣的普通儿科医生为16%，普通儿科医生为2%，P <.0001，亚专业实践的儿科医生为62%，P <.0001）。他们在参与各种学术活动的比例方面也处于中间水平。然而，在地点、环境、同事关系和对初级保健的投入方面，他们的实践更类似于普通儿科医生，而不是亚专业实践的儿科医生。他们比普通儿科医生更有可能使用或提供专门的检查或程序。很大比例的儿科医生将亚专业元素纳入其普通儿科实践中。鉴于这种实践形式，需要重新评估当前和预计的儿科人力供应模式。
