Kozakowski Stanley M, Travis Alexandra, Marcinek Julie P, Bentley Ashley, Fetter Gerald T
Medical Education Division, American Academy of Family Physicians.
Fam Med. 2017 Oct;49(9):679-685.
The purpose of medicine as a profession is to meet the health needs of people and communities. Despite empirical evidence worldwide that an appropriate foundation of primary care in a health care system leads to improved health outcomes, improved experience of health care, a reduction in health disparities, and lower overall cost of care, publicly available data from National Resident Matching Program® (NRMP) and the American Osteopathic Association (AOA) Intern/Resident Registration Program show that PGY-1 family medicine and primary care positions offered in the NRMP Match continue to grow, but are losing ground in comparison to the growth of non-primary care specialties. In ACGME-accredited family medicine programs, DO students have been displacing non-US citizen IMGs while the proportion of US seniors has remained stable over the past decade. The impact of the displacement of non-US citizen IMGs by DO students in ACGME programs is unknown and deserves future research. Continuing trends in the growth of non-primary care specialties should raise great concern that the current primary shortage will be exacerbated, not serving the needs of the population. A major overhaul of the graduate medical education (GME) system is required to align the medical education system with the transformation of the health care system needed to improve quality, population health, and cost control.
医学作为一门专业的目的是满足个人和社区的健康需求。尽管全球有实证证据表明,医疗保健系统中适当的初级保健基础可带来改善的健康结果、更好的医疗保健体验、减少健康差距以及降低总体医疗成本,但来自国家住院医师匹配计划®(NRMP)和美国骨科协会(AOA)实习生/住院医师注册计划的公开数据显示,NRMP匹配中提供的PGY-1家庭医学和初级保健职位持续增加,但与非初级保健专科的增长相比正在失去优势。在ACGME认可的家庭医学项目中,过去十年里,博士生一直在取代非美国公民的国际医学毕业生,而美国高年级学生的比例保持稳定。博士生取代ACGME项目中非美国公民国际医学毕业生的影响尚不清楚,值得未来研究。非初级保健专科持续增长的趋势应引起极大关注,即当前的初级保健短缺将加剧,无法满足人群需求。需要对研究生医学教育(GME)系统进行重大改革,以使医学教育系统与改善质量(人群健康和成本控制)所需的医疗保健系统转型保持一致。