Dorner F H, Burr R M, Tucker S L
Department of Business Administration, Trinity University, San Antonio, TX 78212.
Acad Med. 1991 Sep;66(9):540-4.
The uneven geographic distribution of physicians has been identified as a significant problem for the delivery of health care services. The present study examined one of the factors that contribute to the distribution of physicians; how far they move from their residency sites to establish their first practices. In 1989, the authors selected a random sample of 701 U.S. residency programs in the ten specialties with the most practitioners, and measured the distance each of these physicians moved to his or her first practice location. Of the 701 programs, 58.5% provided usable information about 2,612 physicians. Of these physicians, over 40% had moved less than 10 miles from their residencies, and over 50% had moved less than 75 miles. Comparisons among the physicians from the various specialties showed that the primary care physicians moved significantly shorter distances than did those from the other specialties. In the last two decades, many efforts have been made to increase the geographic distribution of physicians. The evidence from this study suggests that so far as the distances that physicians move from their practice sites are concerned, little has changed. Recent graduates of residency programs show no more tendency to move far from their residency sites than did their counterparts 30 years ago, as reported in the literature.
医生分布不均衡已被视为医疗服务提供过程中的一个重大问题。本研究考察了影响医生分布的一个因素：他们从住院医师培训地点到首次执业地点的迁移距离。1989年，作者从美国十个从业人数最多的专业中随机抽取了701个住院医师培训项目，并测量了这些医生各自到其首次执业地点的迁移距离。在这701个项目中，58.5%提供了有关2612名医生的可用信息。在这些医生中，超过40%的人从住院医师培训地点迁移的距离不到10英里，超过50%的人迁移距离不到75英里。对不同专业医生的比较显示，初级保健医生迁移的距离明显短于其他专业的医生。在过去二十年里，人们为增加医生的地理分布做出了许多努力。这项研究的证据表明，就医生从执业地点迁移的距离而言，情况几乎没有改变。正如文献中所报道的那样，住院医师培训项目的近期毕业生与30年前的同行相比，并没有更倾向于远离其住院医师培训地点。
