Pathman Donald E, Fryer George E, Phillips Robert L, Smucny John, Miyoshi Thomas, Green Larry A
Program on Health Professions and Primary Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
J Rural Health. 2006 Fall;22(4):285-93. doi: 10.1111/j.1748-0361.2006.00048.x.
Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians.
To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support.
Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001.
From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.
These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s.
一些观察人士认为，国家卫生服务团（NHSC）的临床医生除了提供临时人员配备外，还对他们所服务社区的非NHSC医生队伍的长期增长做出了贡献；另一些人则担心NHSC临床医生与其他当地医生形成竞争，并阻碍了其他当地医生的供应。
评估在获得NHSC人员配备支持的农村医疗服务不足县，非NHSC基层医疗医生队伍的长期变化，并与没有NHSC支持的医疗服务不足县的医生队伍变化进行比较。
利用美国医学协会和NHSC的数据，我们比较了1981年至2001年期间，农村全县卫生专业人员短缺地区两个子集中非NHSC基层医疗医生与人口比例的变化：（1）20世纪80年代初以及此后许多年由NHSC医生、执业护士和/或医师助理提供人员配备的141个县；（2）1979年至2001年期间没有NHSC临床医生的所有142个农村卫生专业人员短缺地区县。
从1981年到2001年，由NHSC临床医生提供人员配备的县，每10000人口中非NHSC基层医疗医生的平均增加量为1.4人，而没有NHSC临床医生的县平均增加量较小，为0.57人。在对基线县人口统计学和医疗资源进行调整后，NHSC支持的县中非NHSC基层医疗医生与人口平均比例增加幅度更大这一发现仍然显著（P < 0.001）。2001年，NHSC支持的县中，由于NHSC而额外增加的非NHSC医生估计数量为141个受支持县共增加294名医生，即每个NHSC支持的县平均增加2名医生。在这20年中，更多NHSC支持的县其非NHSC基层医疗医生队伍增长到每3500人有1名以上医生，但失去卫生专业人员短缺地区指定的NHSC支持县并不比未受支持的县多。
这些数据表明，NHSC在20世纪80年代和90年代对其临床医生工作的农村医疗服务不足县的非NHSC基层医疗医生队伍做出了积极贡献。
