Fellowship Division, American Congress of Obstetricians and Gynecologists, Washington, DC; and the Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Obstet Gynecol. 2013 Dec;122(6):1295-8. doi: 10.1097/AOG.0000000000000011.
Selection of a practice setting affects duty hours, practice autonomy, institutional relationships, administrative responsibilities, personal finances, and professional satisfaction. To identify national trends in practice settings reported by the College, we evaluated responses by Fellows (and Junior Fellows) in active practice from six College surveys on professional liability issues between 1992 and 2012. Although half of Fellows remained in an independent private practice, a decline was observed among solo health care practitioners (from 32% in 1992 to 19% in 2012). Direct employment increased either in hospital systems (from 5% to 15%) or as academic faculty (from 9% to 12%). The proportion of Fellows employed by either health maintenance organizations (from 4% to 2%) or the government (2%) remained low. We anticipate that practice settings will be increasingly influenced by health care reform, team-based care with use of nonphysician clinicians, physician age, and increasing subspecialization. Future surveys of Fellows about their practice settings, preferably required at the time of Maintenance of Certification, will aid in evaluating practice settings and their influence on quality of care, cost containment, and health care provider satisfaction.
实践环境的选择会影响工作时间、实践自主性、机构关系、行政职责、个人财务和职业满意度。为了确定学院报告的实践环境中的全国趋势，我们评估了 1992 年至 2012 年期间，学院关于专业责任问题的六次调查中活跃执业的研究员（和初级研究员）的回应。尽管一半的研究员仍留在独立的私人执业中，但单独行医的医疗从业者数量有所下降（从 1992 年的 32%降至 2012 年的 19%）。直接受雇于医院系统的研究员人数增加（从 5%增至 15%）或成为学术教师的人数增加（从 9%增至 12%）。受雇于医疗保健维护组织（从 4%降至 2%）或政府（2%）的研究员比例仍然较低。我们预计，实践环境将越来越受到医疗改革、基于团队的护理、使用非医师临床医生、医师年龄和日益专业化的影响。未来对研究员关于其实践环境的调查，最好在维持认证时要求进行，将有助于评估实践环境及其对护理质量、成本控制和医疗保健提供者满意度的影响。
