Shomaker T Samuel
Tex Med. 2009 Nov 1;105(11):e1.
The United States is facing serious physician workforce challenges. These include a shortage of physicians; declining interest in primary care; a maldistribution of doctors, particularly in inner-city and rural areas; the lack of a coherent workforce planning mechanism; and a workforce that does not reflect the diversity of the general population. Texas has many of the same issues, but problems are magnified by a historically low physician-to-population ratio; a rapidly growing and increasingly diverse population; and significant access-to-care issues, driven by a large uninsured population. This article reviews the current status of the US physician workforce and the challenges facing the nation over the next 20 years, and compares the national situation with prevailing and future conditions in Texas. Unless current trends are altered, Texas will face a growing shortage of physicians (particularly in primary care and certain specialty areas) that will be worse in rural and border areas. Although Texas medical schools are increasing enrollment, the growth in their graduate medical education slots is not keeping pace, creating a bottleneck that will constrain growth in the number of practicing physicians.
美国正面临严重的医生劳动力挑战。这些挑战包括医生短缺；对初级保健的兴趣下降；医生分布不均，尤其是在市中心和农村地区；缺乏连贯的劳动力规划机制；以及劳动力构成未能反映普通人群的多样性。得克萨斯州也存在许多相同的问题，但由于医生与人口比例历来较低、人口迅速增长且日益多样化，以及大量未参保人口导致的重大医疗服务可及性问题，使得这些问题更加严重。本文回顾了美国医生劳动力的现状以及未来20年该国面临的挑战，并将全国情况与得克萨斯州当前及未来的状况进行了比较。除非当前趋势得到改变，否则得克萨斯州将面临日益严重的医生短缺问题（尤其是在初级保健和某些专科领域），农村和边境地区的情况将更糟。尽管得克萨斯州的医学院校正在增加招生人数，但其研究生医学教育名额的增长却跟不上步伐，从而形成了一个瓶颈，将限制执业医生数量的增长。
