Freeman Joshua, Ferrer Robert L, Greiner K Allen
Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
Acad Med. 2007 Feb;82(2):133-8. doi: 10.1097/ACM.0b013e31802d8d242.
Eliminating health disparities will be difficult as long as many rural and disadvantaged inner-city communities remain medically underserved. The authors argue that the current debate on physician workforce policy has not adequately emphasized medical schools' social mission to educate physicians who will improve health care access and equity; fulfilling that mission means training students who will deliver primary care to underserved people. But fewer medical students are entering primary care specialties and practicing in underserved areas, and students who have the characteristics that make them likely to select such careers are increasingly uncommon among medical school matriculants. Unless there is a dramatic change, the imbalance will only become worse. The authors argue that the epidemiology of medical student career choice is sufficiently understood to permit schools to accept applicants with those characteristics, both demographic and individual, that are known to increase the probability of students caring for populations in need after graduation. Programs that have selected students on the basis of those predictors have been successful in increasing the distribution of doctors to primary care specialties and underserved areas, but these have not been of sufficient scope. The authors present a proposal for prioritizing medical school admissions to favor applicants who, rather than delivering just high grades, will contribute to improving America's health care outcomes.
只要许多农村地区和处境不利的市中心社区在医疗服务方面仍然不足，消除健康差距就将困难重重。作者认为，当前关于医生劳动力政策的辩论没有充分强调医学院的社会使命，即培养能够改善医疗服务可及性和公平性的医生；履行这一使命意味着培养那些将为服务不足人群提供初级保健的学生。但是，进入初级保健专业并在服务不足地区执业的医学生越来越少，而在医学院录取新生中，具有可能选择此类职业特征的学生也越来越罕见。除非发生巨大变化，否则这种不平衡只会变得更糟。作者认为，对医学生职业选择的流行病学有足够的了解，使学校能够录取具有那些人口统计学和个人特征的申请者，这些特征已知会增加学生毕业后为有需要人群提供护理的可能性。基于这些预测因素选拔学生的项目在增加初级保健专业医生和服务不足地区医生的分布方面取得了成功，但这些项目的规模还不够大。作者提出了一项建议，即优先考虑医学院招生，青睐那些不仅成绩优异，而且将有助于改善美国医疗保健成果的申请者。
