Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 202, Lebanon, NH 03766, USA.
Pediatrics. 2011 Jan;127(1):19-27. doi: 10.1542/peds.2010-0150. Epub 2010 Dec 20.
This study examines growth in the primary care physician workforce for children and examines the geographic distribution of the workforce.
National data were used to calculate the local per-capita supply of clinically active general pediatricians and family physicians, measured at the level of primary care service areas.
Between 1996 and 2006, the general pediatrician and family physician workforces expanded by 51% and 35%, respectively, whereas the child population increased by only 9%. The 2006 per-capita supply varied by >600% across local primary care markets. Nearly 15 million children (20% of the US child population) lived in local markets with <710 children per child physician (average of 141 child physicians per 100 000 children), whereas another 15 million lived in areas with >4400 children per child physician (average of 22 child physicians per 100 000 children). In addition, almost 1 million children lived in areas with no local child physician. Nearly all 50 states had evidence of similar extremes of physician maldistribution.
Undirected growth of the aggregate child physician workforce has resulted in profound maldistribution of physician resources. Accountability for public funding of physician training should include efforts to develop, to use, and to evaluate policies aimed at reducing disparities in geographic access to primary care physicians for children.
本研究考察了儿童初级保健医生劳动力的增长情况，并考察了劳动力的地理分布情况。
利用国家数据计算了临床活跃的普通儿科医生和家庭医生的当地人均供应量，以初级保健服务区为测量单位。
1996 年至 2006 年间，普通儿科医生和家庭医生的劳动力分别增长了 51%和 35%，而儿童人口仅增长了 9%。2006 年的人均供应量在当地初级保健市场之间差异超过 600%。近 1500 万儿童（占美国儿童人口的 20%）居住在每儿童医生人数<710 人的当地市场（每 10 万儿童有 141 名儿童医生），而另有 1500 万儿童居住在每儿童医生人数>4400 人的地区（每 10 万儿童有 22 名儿童医生）。此外，近 100 万儿童居住在没有当地儿童医生的地区。几乎所有 50 个州都存在类似的医生分布不均的极端情况。
总体儿童医生劳动力的无方向增长导致了医生资源的严重分布不均。对医生培训的公共资金问责制应包括努力制定、使用和评估旨在减少儿童获得初级保健医生的地理差异的政策。
