扩大医学专业的准入机会可能会改善贫困和农村社区的全科医生招聘情况：对全科医生出身地和当前工作地点的调查。

Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.

作者信息

Dowell J, Norbury M, Steven K, Guthrie B

机构信息

School of Medicine, University of Dundee, Scotland, UK.

Head of Division of Undergraduate Medical Education, School of Medicine Deanery, Ninewells Hospital and Medical School, Level 8, Room LB8 001, Mail box 16, DD1 9SY, Dundee, UK.

出版信息

BMC Med Educ. 2015 Oct 1;15:165. doi: 10.1186/s12909-015-0445-8.

DOI:10.1186/s12909-015-0445-8

PMID:26428081

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4591588/

Abstract

BACKGROUND

Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice.

METHOD

The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes.

RESULTS

A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries.

CONCLUSION

This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the impact of widening access on service delivery more broadly.

摘要

背景

在英国，扩大医疗服务可及性是一个顽固的问题，其政治重要性日益增加，有相关有力的社会正义论据，但缺乏对服务提供产生影响的明确证据。来自美国的证据表明，扩大可及性可能会改善对服务不足社区的医疗服务。此外，已证明农村出身是与农村医疗实践最密切相关的因素。然而，关于英国社会经济和农村背景以及随后的执业地点的证据尚未得到探讨。本研究的目的是调查医学院申请时全科医生（GP）的社会经济和农村背景与其当前执业的人口统计学特征之间的关联。

方法

本研究设计为对在苏格兰执业的全科医生进行横断面电子邮件调查。医学院申请时全科医生的社会经济状况使用自我编码的国家统计局社会经济分类进行评估。申请时的英国邮政编码用于定义城乡位置。当前执业地区的贫困程度和偏远程度使用苏格兰国民保健服务（NHS）基于注册患者邮政编码定义的指标进行衡量。

结果

向2050名拥有有效可访问电子邮件地址的苏格兰全科医生发送了调查问卷，801人（41.5%）回复。父母从事半常规或常规职业的全科医生在贫困地区执业的几率是父母为管理和专业职业的全科医生的4.3倍（95%置信区间1.8 - 10.2，p = 0.001）。来自苏格兰偏远和农村背景的全科医生更有可能在苏格兰偏远地区执业，来自英国其他国家的全科医生也是如此。