Odisho Anobel Y, Fradet Vincent, Cooperberg Matthew R, Ahmad Ardalan E, Carroll Peter R
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California 94143-1695, USA.
J Urol. 2009 Feb;181(2):760-5; discussion 765-6. doi: 10.1016/j.juro.2008.10.034. Epub 2008 Dec 16.
The adequacy of the urologist work force in absolute numbers and relative distribution is unclear. To develop effective policies addressing the needs of an aging population we must better understand the urologist work force. We assessed the geographic distribution of urologists throughout the United States at the county level and determined the county characteristics associated with increased urologist density.
County level data from the Department of Health and Human Services Area Resource File and the United States Census were analyzed in this ecological study. Logistic regression and ordinal logistic regression models were built to identify predictors of urologist density, defined as the number of urologists per 100,000 individuals. National patterns of urologist density were mapped graphically at the county level.
Overall 63% of the counties in the United States lack a urologist. Based on multivariate models urologists were less likely to be found in nonmetropolitan counties (OR 0.57, 95% CI 0.46-0.72) and rural counties (OR 0.03, 95% CI 0.02-0.06) than in metropolitan counties, which confirmed visually mapped models. Patterns of urologist density also appeared to be influenced by climate and county education levels rather than by traditional socioeconomic measures. Urologists younger than 45 years old were 3 times less likely to be located in nonmetropolitan and rural counties than their older counterparts.
The uneven distribution of urologists throughout the United States is likely to worsen as younger physicians continue to cluster in urban areas. Governing bodies must consider this distribution in their calls for increasing the number of training positions.
泌尿外科医生劳动力在绝对数量和相对分布上是否充足尚不清楚。为了制定有效的政策来满足老龄化人口的需求，我们必须更好地了解泌尿外科医生劳动力情况。我们评估了美国各县泌尿外科医生的地理分布，并确定了与泌尿外科医生密度增加相关联的县特征。
在这项生态学研究中，分析了来自卫生与公众服务部区域资源文件和美国人口普查的县级数据。构建了逻辑回归和有序逻辑回归模型，以确定泌尿外科医生密度的预测因素，泌尿外科医生密度定义为每10万人中的泌尿外科医生数量。在县级以图形方式绘制了泌尿外科医生密度的全国模式。
总体而言，美国63%的县没有泌尿外科医生。基于多变量模型，与大都市县相比，在非大都市县（比值比0.57，95%置信区间0.46 - 0.72）和农村县（比值比0.03，95%置信区间0.02 - 0.06）发现泌尿外科医生的可能性较小，这证实了直观绘制的模型。泌尿外科医生密度模式似乎也受气候和县级教育水平影响，而非传统社会经济指标。45岁以下的泌尿外科医生在非大都市和农村县工作的可能性比年长同行低3倍。
随着年轻医生继续聚集在城市地区，美国泌尿外科医生分布不均的情况可能会恶化。管理机构在呼吁增加培训岗位数量时必须考虑这种分布情况。
