Colwill Jack M, Frey John J, Baird Macaran A, Kirk John W, Rosser Walter W
From the Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia (JMC); the Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (JJF); the Department of Family Medicine and Community Health, University of Minnesota, Minneapolis (MAB); the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (JWK); and the Department of Family Medicine, Queen's University, Kingston, Canada (WWR).
J Am Board Fam Med. 2016 Jul-Aug;29 Suppl 1:S54-9. doi: 10.3122/jabfm.2016.S1.160017.
A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction. These changes and examples of changes in medical student and residency education also have the potential to positively affect the primary care workforce. The authors conclude that, without substantive educational and health system reform, the ability to truly serve as a personal physician and adhere to the values of continuity, responsibility, and accountability will continue to be threatened.
一群早期学术家庭医学领域的资深领导者，基于他们自己的临床经验以及在学术健康中心担任住院医师和学生教师的经历，反思成为一名私人医生的意义。认识到国家和地方系统层面临床护理和教育的变化给私人医生的角色带来了巨大的新要求，这个资深团队给出了该学科在不断变化的时代中如何前行的例子。不同组织形式的医疗服务，如加拿大安大略省的家庭健康团队模式；大型医疗系统中针对人群的基于价值的支付方式；以及联邦政府对人群报销政策的变化，都可能对医生满意度产生积极影响。这些变化以及医学生和住院医师教育方面的变化示例，也有可能对基层医疗劳动力产生积极影响。作者总结道，如果没有实质性的教育和卫生系统改革，真正成为一名私人医生并坚守连续性、责任和问责制价值观的能力将继续受到威胁。
