Cooper Richard A
Health Policy Institute, Medical College of Wisconsin, Milwaukee 53226, USA.
J Contin Educ Health Prof. 2005 Winter;25(1):8-14. doi: 10.1002/chp.3.
For five decades, medical education policy in the United States has been built around the expectation that, if too few physicians were produced, additional physicians would be available from other countries. That policy is examined in the context of the desire for an ever-increasing number of physicians who will provide an ever-expanding array of services in the future. This reality is juxtaposed against the realities that the medical education infrastructure in the United States has yet to respond to the projected needs of the future. Also, other countries have growing needs for English-speaking physicians, particularly the developing countries from which most such physicians migrate. I explore the history of physician migration to the United States, catalogue the countries of origin, examine the attitudes of current students and physicians about migration, and consider the consequences that are likely for donor countries if even higher levels of migration are stimulated. I conclude that the deepening shortages of physicians now being experienced in this country cannot be rectified without substantial increases in the flow of physicians from developing to developed countries. The challenges that this will create call for mutual understanding and a high degree of discipline and creativity among all countries if global health care needs are to be respected.
五十年来，美国的医学教育政策一直基于这样一种预期：如果本国培养的医生数量过少，可从其他国家补充。在未来需要越来越多的医生来提供不断扩大的服务范围这一背景下，对该政策进行审视。这一现实与美国医学教育基础设施尚未满足未来预计需求的现实形成对比。此外，其他国家对会讲英语的医生需求也在增加，尤其是那些多数此类医生移民来源的发展中国家。我探究了医生移民到美国的历史，列出了来源国，考察了当前学生和医生对移民的态度，并考虑如果刺激更高水平的移民，对输出国可能产生的后果。我得出结论，如果没有大幅增加从发展中国家到发达国家的医生流动，美国目前正经历的医生严重短缺问题将无法得到解决。如果要尊重全球医疗保健需求，这将带来的挑战需要所有国家相互理解以及高度的自律和创造力。
