与医学毕业生服务不足人群工作意向相关的因素：推进劳动力多样性的政策含义。
Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.
机构信息
A.N. Garcia is a fellow with the National Clinician Scholars Program at the University of California, Los Angeles. At the time of submission, the author was a general and preventive medicine resident, California Department of Public Health, Sacramento, California, assigned to the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. The project was conceived while the author was a medical student at the University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9284-3790. T. Kuo is adjunct associate professor of epidemiology, UCLA Fielding School of Public Health, and health sciences associate professor of family medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. The author also directs the Division of Chronic Disease and Injury Prevention and the Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California; ORCID: http://orcid.org/0000-0002-4120-8559. L. Arangua is a policy analyst, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; ORCID: http://orcid.org/0000-0001-9105-3885. E.J. Pérez-Stable is director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland. This project was conceived while the author was professor of medicine and chief, Division of General Internal Medicine, Department of Medicine, and director, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, San Francisco, California.
出版信息
Acad Med. 2018 Jan;93(1):82-89. doi: 10.1097/ACM.0000000000001917.
PURPOSE
Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP).
METHOD
Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models.
RESULTS
Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP.
CONCLUSIONS
Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.
目的
鉴于美国所有专业的医生短缺情况预计将不成比例地影响到服务不足地区，作者试图探讨与医学院毕业生为服务不足人群（IWUP）工作的意愿最相关的因素。
方法
对 2010-2012 年美国医学协会医学研究生院毕业问卷调查（n=40846）的数据进行了分析。使用卡方检验和逻辑回归模型检查变量（人口统计学、职业偏好、债务负担、进入贷款宽恕计划的意图）。
结果
受访者包括 49.5%（20228/40846）的女性、16.6%（6771/40837）的少数族裔（URM）和 32.4%（13034/37342）的初级保健意向。教育债务中位数为 16 万美元。女性（调整后的优势比[OR]1.59，95%置信区间[CI]1.49，1.70）、少数民族（URM）（调整后的 OR 2.50，95%CI 2.30，2.72）、打算进入贷款宽恕计划（调整后的 OR 2.44，95%CI 2.26，2.63）、打算从事初级保健（调整后的 OR 1.65，95%CI 1.54，1.76）和强调非临床职业（调整后的 OR 1.23，95%CI 1.11，1.37）的受访者更有可能报告 IWUP。在选择非临床重点专业和职业的人群中，以及在教育和消费者债务负担较大的人群中，少数民族与其他少数民族和白人相比，报告 IWUP 的可能性几乎是其两倍。
结论
研究结果表明，医生的特征可能与填补服务不足地区的劳动力缺口有关。调整财政激励计划，以支持具有 IWUP 特征的医生领导人和专家，可能会补充初级保健领域的类似政策，并可能对服务不足地区的健康公平产生关键影响。
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