Blanchard Janice, Petterson Stephen, Bazemore Andrew, Watkins Kayla, Mullan Fitzhugh
J. Blanchard is associate professor, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.S. Petterson is research director, Robert Graham Center, Washington, DC.A. Bazemore is director, Robert Graham Center, Washington, DC.K. Watkins is research assistant, Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC.F. Mullan is Murdock Head Professor of Medicine and Health Policy, Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC.
Acad Med. 2016 Oct;91(10):1416-1422. doi: 10.1097/ACM.0000000000001184.
Shortages of generalist physicians in primary care and surgery have been projected. Residency programs that expose trainees to community-based health clinics and rural settings have a greater likelihood of producing physicians who later practice in these environments. The objective of this study was to characterize the distribution of residency training sites in different settings for three high-need specialties-family medicine, internal medicine, and general surgery.
The authors merged 2012 data from the Accreditation Council for Graduate Medical Education Accreditation Data System and 2010 data from the Centers for Medicare and Medicaid Services hospital cost report to match training sites with descriptive data about those locations. They used chi-square tests to compare the characteristics and distribution of residency programs and training sites in family medicine, internal medicine, and general surgery.
The authors identified 1,095 residency programs and 3,373 training sites. The majority of training occurred in private, not-for-profit hospitals. Only 48 (of 1,390; 4%) family medicine training sites and 43 (of 936; 5%) internal medicine training sites were community-based health clinics. Seventy-eight (6%) family medicine sites, 8 (1%) internal medicine sites, and 16 (2%) general surgery sites were located in rural settings. One hundred thirty (14%) internal medicine sites were Department of Veterans Affairs medical facilities compared with 78 (6%) family medicine sites and 94 (9%) general surgery sites (P < .001).
Relatively little training occurs in rural or community-based settings. Expanding training opportunities in these low-access areas could improve physician supply there.
预计基层医疗和外科领域的全科医生会短缺。让住院医师培训项目的学员接触社区健康诊所和农村地区，更有可能培养出日后在这些环境中执业的医生。本研究的目的是描述三个高需求专业（家庭医学、内科和普通外科）在不同环境下住院医师培训地点的分布情况。
作者将研究生医学教育认证委员会认证数据系统的2012年数据与医疗保险和医疗补助服务中心医院成本报告的2010年数据合并，以使培训地点与有关这些地点的描述性数据相匹配。他们使用卡方检验来比较家庭医学、内科和普通外科住院医师培训项目及培训地点的特征和分布。
作者确定了1095个住院医师培训项目和3373个培训地点。大多数培训发生在私立非营利性医院。在1390个家庭医学培训地点中，只有48个（4%）是社区健康诊所；在936个内科培训地点中，只有43个（5%）是社区健康诊所。78个（6%）家庭医学培训地点、8个（1%）内科培训地点和16个（2%）普通外科培训地点位于农村地区。130个（14%）内科培训地点是退伍军人事务部医疗设施，相比之下，家庭医学培训地点有78个（6%），普通外科培训地点有94个（9%）（P < .001）。
在农村或社区环境中的培训相对较少。在这些医疗服务可及性低的地区扩大培训机会，可以改善那里的医生供应情况。
