肝胆胰外科培训：北美肝胆胰外科劳动力评估
Training in Hepatopancreatobiliary Surgery: Assessment of the Hepatopancreatobiliary Surgery Workforce in North America.
作者信息
Minter Rebecca M, Alseidi Adnan, Hong Johnny C, Jeyarajah D Rohan, Greig Paul D, Dixon Elijah, Thumma Jyothi R, Pawlik Timothy M
机构信息
*Departments of Surgery and Learning Health Sciences, University of Michigan Health System, Ann Arbor, MI †Department of Surgery, Virginia Mason Medical Center, Seattle, WA ‡Department of Surgery, Medical College of Wisconsin, Milwaukee, WI §Department of Surgery, Methodist Hospital Dallas, TX ¶Department of Surgery, University of Toronto, Ontario, Canada ||Department of Surgery, University of Calgary, Alberta, Canada **Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI ††Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
出版信息
Ann Surg. 2015 Dec;262(6):1065-70. doi: 10.1097/SLA.0000000000001096.
OBJECTIVE
Evaluate the current status of Hepatopancreatobiliary (HPB) Surgery workforce in North America.
BACKGROUND
HPB fellowships have proliferated, with HPB surgeons entering the field through 3 pathways: transplant surgery, surgical oncology, or HPB surgery training. Impact of this growth is unknown.
METHODS
An anonymous survey was distributed to 654 is used as HPB surgeons from October 2012 to January 2013. Questions evaluated satisfaction with job availability after training and description of current practice. Nationwide Inpatient Sample (NIS) data from 2003 to 2010 was queried to describe the growth of HPB cases in the United States; these data were compared to prior HPB workforce projections performed using 2003 NIS data.
RESULTS
A total of 416 HPB surgeons responded (66%). HPB surgeons are concentrated in a small number of states/provinces with a lack of HPB surgeon workforce in central United States. HPB graduates from 2008 to 2012 report increased difficulty in identifying an HPB-focused practice versus prior to 2008. Mature HPB surgery practices report a composition of 25% to 50% non-HPB operative cases. Fifty-one percent of respondents reported an opinion that current HPB Surgeon production was excessive; however, 2010 NIS data demonstrate that major HPB surgery cases have grown significantly more than was previously projected using 2003 NIS data.
CONCLUSIONS AND RELEVANCE
A cohesive strategy for responsibly responding to the HPB surgical workforce requirements of North America is needed. Elevation of training standards, standardization of requirements for certification, and careful modeling that accounts for regionalization of care should be pursued to prevent overtraining and decentralization of HPB surgical care in the future.
目的
评估北美肝胰胆（HPB）外科医生队伍的现状。
背景
HPB专科培训项目激增，HPB外科医生通过三条途径进入该领域：移植外科、外科肿瘤学或HPB外科培训。这种增长的影响尚不清楚。
方法
2012年10月至2013年1月，向654名HPB外科医生发放了一份匿名调查问卷。问题包括对培训后工作机会的满意度以及对当前执业情况的描述。查询了2003年至2010年的全国住院患者样本（NIS）数据，以描述美国HPB病例的增长情况；将这些数据与之前使用2003年NIS数据进行的HPB医生队伍预测进行了比较。
结果
共有416名HPB外科医生回复（66%）。HPB外科医生集中在少数几个州/省，美国中部缺乏HPB外科医生。2008年至2012年毕业的HPB医生报告称，与2008年之前相比，找到专注于HPB的执业机会更加困难。成熟的HPB外科执业机构报告称，非HPB手术病例占25%至50%。51%的受访者认为目前HPB外科医生的产出过多；然而，2010年NIS数据显示，主要HPB手术病例的增长幅度明显超过了之前使用2003年NIS数据预测的幅度。
结论及意义
需要制定一项连贯的战略，以负责地应对北美的HPB外科医生队伍需求。应提高培训标准，规范认证要求，并进行仔细的模型构建以考虑医疗服务的区域化，以防止未来HPB外科医疗出现过度培训和分散化的情况。
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