Midtling J E, Barnett P G, Blossom H J, Burnett W H
Family Practice Residency Program, Natividad Medical Center, Salinas, CA 93912.
West J Med. 1990 Mar;152(3):317-21.
Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.
自1963年以来，加利福尼亚州的医生数量翻了一番，但家庭医生和全科医生的数量却有所下降。以诊所为基础的初级保健医生与人口的比例也有所下降。毕业后医学教育主要由患者护理收入提供资金，但门诊护理的低报销率使得初级保健专业的培训尤其依赖公共支持。医疗保险、退伍军人管理局和加利福尼亚大学每年提供超过3.25亿美元，以支持加利福尼亚州的毕业后医学教育。联邦和州拨款计划每年为该州的家庭医生培训提供500万美元，但这些计划的拨款实际已有所减少。加利福尼亚州的家庭医学住院医师培训项目不成比例地集中在县医院，那里的资金短缺使它们特别容易受到拨款计划削减的影响。如果要培训更多的家庭医生，就需要额外的资源。
