University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
Ann Intern Med. 2010 Jan 19;152(2):118-22. doi: 10.7326/0003-4819-152-2-201001190-00186. Epub 2009 Dec 14.
Universal coverage and multiple initiatives to improve health care delivery are crucial components of health care reform. However, the missing link has been a plan to rapidly address the primary care workforce crisis for the underserved. The authors propose a link between primary care graduate medical education and care for the underserved in community health centers, where expansion will be necessary for the anticipated increase in Medicaid and insured patients. This can be achieved by establishing primary care teaching health centers in expanded community health centers, which have established a patient-centered medical home practice environment. Residents would receive their final year of training in these centers, and then have the incentive of National Health Service Corps debt repayment if they subsequently practice in an underserved area. Primary care residents being trained in this setting would immediately increase the clinical capacity of community health centers and ultimately expand the primary care physician workforce. This proposal addresses the primary care physician workforce crisis and the associated key problems of limited access for the underserved and suboptimal primary care graduate medical education.
全民覆盖和多项改善医疗服务提供的举措是医疗改革的关键组成部分。然而，缺失的一环一直是一项计划，旨在迅速解决服务不足人群的初级保健劳动力危机。作者提出了将初级保健研究生医学教育与社区卫生中心服务不足人群联系起来的方案，因为对于预计增加的医疗补助和有保险的患者来说，社区卫生中心的扩张是必要的。这可以通过在扩大的社区卫生中心建立初级保健教学医疗中心来实现，这些中心已经建立了以患者为中心的医疗家庭实践环境。居民将在这些中心接受最后一年的培训，如果他们随后在服务不足的地区行医，将获得国家卫生服务团债务偿还的激励。在这种环境中接受培训的初级保健住院医师将立即增加社区卫生中心的临床能力，并最终扩大初级保健医生的劳动力。这一提议解决了初级保健医生劳动力危机以及相关的关键问题，即服务不足人群的就诊机会有限和初级保健研究生医学教育不佳。
