教学医疗中心的初级保健住院医师：他们在住院医师培训后在服务不足地区执业的意愿。

Primary Care Residents in Teaching Health Centers: Their Intentions to Practice in Underserved Settings After Residency Training.

机构信息

Z. Talib is associate professor of medicine and of health policy and management, George Washington University School of Medicine & Health Sciences, Washington, DC. M.M. Jewers is a doctoral candidate and research scientist, Department of Health Policy & Management, George Washington University Milken Institute School of Public Health, Washington, DC. J.H. Strasser is a doctoral candidate and senior research associate, Department of Health Policy & Management, George Washington University Milken Institute School of Public Health, Washington, DC. D.K. Popiel is assistant professor of medicine, George Washington University School of Medicine & Health Sciences, Washington, DC. D.G. Goldberg is associate professor, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. C. Chen is director, Division of Medicine and Dentistry, Health Resources and Services Administration, Rockville, Maryland. H. Kepley is special assistant to the director, National Center for Health Workforce Analysis, Health Resources and Services Administration, Rockville, Maryland. F. Mullan is a professor of health policy and management, Department of Health Policy & Management, George Washington University Milken Institute School of Public Health, a professor of pediatrics, George Washington University School of Medicine & Health Sciences, and codirector, George Washington University Health Workforce Institute, Washington, DC. M. Regenstein is professor, Department of Health Policy & Management, George Washington University Milken Institute School of Public Health, Washington, DC.

出版信息

Acad Med. 2018 Jan;93(1):98-103. doi: 10.1097/ACM.0000000000001889.

DOI:10.1097/ACM.0000000000001889

PMID:28834845

Abstract

PURPOSE

To describe the residents who chose to train in teaching health centers (THCs), which are community-based ambulatory patient care sites that sponsor primary care residencies, and their intentions to practice in underserved settings.

METHOD

The authors surveyed all THC residents training in academic years 2013-2014, 2014-2015, and 2015-2016, comparing their demographic characteristics with data for residents nationally, and examined THC residents' intentions to practice in underserved settings using logistic regression analysis.

RESULTS

The overall survey response rate was 89% (1,031/1,153). THC resident respondents were similar to residents nationally in family medicine, geriatrics, internal medicine, obstetrics-gynecology, pediatrics, and psychiatry in terms of gender, age, race, and ethnicity. Twenty-nine percent (283) of respondents came from a rural background, and 46% (454) had an educationally and/or economically disadvantaged background. More than half (524; 55%) intended to practice in an underserved setting on completion of their training. Respondents were more likely to intend to practice in an underserved area if they came from a rural background (odds ratio 1.58; 95% confidence interval 1.08, 2.32) or disadvantaged background (odds ratio 2.81; 95% confidence interval 1.91, 4.13).

CONCLUSIONS

THCs attract residents from rural and/or disadvantaged backgrounds who seem to be more inclined to practice in underserved areas than those from urban and economically advantaged roots. THC residents' intentions to practice in underserved areas indicate that primary care training programs sponsored by community-based ambulatory patient care sites represent a promising strategy to improve the U.S. health care workforce distribution.

摘要

目的

描述选择在以社区为基础的门诊患者护理站点（教学保健中心，THC）接受培训的住院医师，以及他们在服务不足地区执业的意愿。

方法

作者调查了所有在 2013-2014、2014-2015 和 2015-2016 学年接受培训的 THC 住院医师，将他们的人口统计学特征与全国范围内的住院医师数据进行比较，并使用逻辑回归分析检查 THC 住院医师在服务不足地区执业的意愿。

结果

总体调查回复率为 89%（1153 名中的 1031 名）。THC 住院医师受访者在性别、年龄、种族和民族方面与全国范围内的家庭医学、老年医学、内科、妇产科、儿科和精神病学住院医师相似。29%（283 名）的受访者来自农村背景，46%（454 名）有教育和/或经济劣势背景。超过一半（524 名；55%）的受访者希望在完成培训后在服务不足的地区执业。如果他们来自农村背景（优势比 1.58；95%置信区间 1.08，2.32）或劣势背景（优势比 2.81；95%置信区间 1.91，4.13），则更有可能打算在服务不足的地区执业。