Laraque-Arena Danielle, Frintner Mary Pat, Cull William L
State University of New York, Upstate Medical University, Syracuse, NY.
Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.
Acad Pediatr. 2016 May-Jun;16(4):401-10. doi: 10.1016/j.acap.2015.10.004. Epub 2015 Oct 22.
To examine whether resident characteristics and experiences are related to practice in underserved areas.
Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area.
Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area.
Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children.
探讨住院医师的特征和经历是否与在服务欠缺地区的执业情况相关。
对2009年毕业的全国儿科住院医师随机样本（n = 1000）和少数族裔住院医师额外样本（n = 223）进行横断面调查。我们使用加权逻辑回归分析住院医师特征（背景、价值观、住院医师经历和执业目标）与以下两项指标之间的关系：1）在服务欠缺地区执业的期望；2）在服务欠缺地区的住院医师培训后职位。
回复率为57%。41%的住院医师表示他们期望在服务欠缺地区执业。在那些已经接受住院医师培训后职位的人中，38%报告在服务欠缺地区任职。以服务义务换取贷款/奖学金以及初级保健/学术儿科执业目标是在服务欠缺地区执业期望的最强预测因素（调整优势比分别为4.74，95%置信区间1.87 - 12.01；调整优势比为3.48，95%置信区间1.99 - 6.10）。其他显著预测因素包括医院医师执业目标、初级保健执业目标、住院医师选拔中患者人群种族/族裔多样性的重要性、医学院之前照顾服务欠缺家庭的早期计划、拥有研究生或医学学位的母亲以及普遍主义价值观量表得分较高。服务义务和初级保健/学术儿科执业目标也是在服务欠缺地区接受住院医师培训后工作的最强预测因素。
诸如服务义务、人文主义价值观以及服务服务欠缺人群的愿望等学员特征，为政策和公共资金能够用于支持具有这些特征的医生以纠正照顾儿童的医生分布不均问题带来了希望。
