美国矫形外科医生劳动力的城乡纵向差距。
Longitudinal urban-rural discrepancies in the US orthopaedic surgeon workforce.
机构信息
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, Yale Physicians Building, 800 Howard Avenue, 1st Floor, New Haven, CT, 06519, USA.
出版信息
Clin Orthop Relat Res. 2013 Oct;471(10):3074-81. doi: 10.1007/s11999-013-3131-3. Epub 2013 Jun 26.
BACKGROUND
It is unclear whether the supply of orthopaedic surgeons can meet the needs of a growing and aging population. This may be especially concerning in rural areas where there are known disparities in overall healthcare provision.
QUESTIONS/PURPOSES: We therefore (1) determined urban-rural trends in the US physician and orthopaedic workforce (including the age of that workforce) from 1995 to 2010; (2) geographically mapped the physician and orthopaedic distribution; and (3) examined urban-rural changes in select nonorthopaedic musculoskeletal provider (chiropractor and podiatrist) workforces from 2000 to 2010.
METHODS
County-level provider data from 1995 to 2010 were obtained from the Department of Health and Human Services. This was aggregated to Hospital Referral Regions and ranked by Rural-Urban Continuum Code. Hospital Referral Region-level data were mapped to identify geographic trends. Total physician and orthopaedic surgeon workforce data were averaged across the most urban and rural regions for the study period.
RESULTS
There were urban-rural discrepancies in the physician and orthopaedic workforce from 1995 to 2010 with fewer orthopaedic surgeons in rural areas than urban areas (6.52 versus 8.73 per 100,000 in 2010; p=0.001). Furthermore, orthopaedic surgeons in rural areas were older than their urban counterparts, with a workforce age ratio (age>55: age<55 years) of 0.92 versus 0.65 in 2010 (p=0.024). From 2000 to 2010, the rural chiropractor and podiatrist workforces showed tremendous growth of 229.6% and 279.9%, respectively.
CONCLUSIONS
There were significant urban-rural orthopaedic surgeon workforce discrepancies from 1995 to 2010. Concurrent growth in chiropractor and podiatrist numbers shows significant trends in the musculoskeletal provider workforce that warrant continuing observation and analysis.
LEVEL OF EVIDENCE
Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
背景
目前尚不清楚骨科医生的供应是否能够满足不断增长和老龄化人口的需求。在整体医疗服务提供方面存在明显差异的农村地区，这可能尤其令人担忧。
问题/目的：因此，我们（1）从 1995 年到 2010 年确定了美国医生和骨科医生劳动力的城乡趋势（包括劳动力的年龄）；（2）对医生和骨科医生的分布进行了地理绘图；（3）检查了 2000 年至 2010 年期间选择的非骨科肌肉骨骼提供者（脊椎按摩师和足病医生）劳动力的城乡变化。
方法
从 1995 年到 2010 年，从卫生与公众服务部获得了县级提供者数据。将这些数据汇总到医院转诊区，并按农村-城市连续体代码进行排名。对医院转诊区的数据进行了映射，以确定地理趋势。在研究期间，将医生和骨科医生劳动力的总数据平均分配到最城市和最农村的地区。
结果
1995 年至 2010 年，医生和骨科医生的劳动力存在城乡差异，农村地区的骨科医生人数少于城市地区（2010 年每 100,000 人分别为 6.52 名和 8.73 名；p=0.001）。此外，农村地区的骨科医生比城市地区的医生年龄更大，2010 年的劳动力年龄比（年龄>55 岁：年龄<55 岁）为 0.92 比 0.65（p=0.024）。从 2000 年到 2010 年，农村地区的脊椎按摩师和足病医生劳动力分别增长了 229.6%和 279.9%。
结论
1995 年至 2010 年，骨科医生的劳动力存在明显的城乡差异。脊椎按摩师和足病医生人数的同期增长表明肌肉骨骼提供者劳动力存在重大趋势，值得继续观察和分析。
证据水平
四级，经济和决策分析。有关证据水平的完整描述，请参见作者指南。
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