PAHO/WHO Collaborating Centre for Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14040-902, Brazil.
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
Hum Resour Health. 2024 Oct 10;22(1):69. doi: 10.1186/s12960-024-00943-8.
In the European Union and peripheral countries, the availability of physicians working in primary health care services (PHCS) varies greatly and all countries report shortages and difficulties in recruiting more. The broad consensus that giving access to PHCS to all is a policy priority, reinforced by the lessons learned during the COVID-19 pandemic, implies that a sufficient fit-for-purpose workforce is available. This article focuses on physicians and reports on what countries have done, and with what success, to attract more medical students to a career in PHCS.
We conducted a scoping review of articles in PubMed and Cochrane Library, and of grey literature in websites of international agencies, think-tanks, international non-governmental organizations, and European Commission-funded projects, published between January 2018 and February 2024.
The search retrieved 1,143 records, of which 45 were eligible for the scoping review; 25 focused on medical students. The documents report interventions in 12 countries, 14 by individual education institutions, mostly in the form of exposure of diverse duration to general/family practice in the medical curriculum (specific modules, residencies, rotations, placements, mentorship), and 11 policy interventions at national level, such as increases in the number of training places for primary health care (PHC) specialties and improvement of working conditions.
Accessible PHCS require the availability of a fit-for-purpose workforce of multiprofessional teams, in which specially trained physicians play a central role. To address shortages, many countries increased training opportunities, a necessary step, but not sufficient. More students must accept to opt for a PHC specialty, in a context of competition with other fields of practice also in need of more students, such as public health, geriatrics, or mental health. Success requires the collaboration of numerous actors, including professional councils and organizations, and regulation bodies that specialists tend to dominate. By making PHCS a political and policy priority, decision-makers can help make attraction more effective, but to do so, they need access to convincing evidence and information on good practices that only research can produce.
在欧盟及其周边国家，从事初级卫生保健服务（PHCS）的医生的供应情况差异很大，所有国家都报告说短缺并且难以招募更多的医生。人们广泛认为，让所有人都能获得 PHCS 是一项政策优先事项，这一观点得到了 COVID-19 大流行期间经验教训的强化，这意味着有足够数量的适合目的的劳动力。本文重点关注医生，并报告各国为吸引更多医学生从事 PHCS 工作而采取的措施以及取得的成功。
我们对 PubMed 和 Cochrane Library 中的文章以及国际机构、智库、国际非政府组织和欧盟委员会资助项目网站上的灰色文献进行了范围综述，检索时间为 2018 年 1 月至 2024 年 2 月。
检索到 1143 条记录，其中 45 条符合范围综述的标准；其中 25 条专注于医学生。这些文献报告了 12 个国家的干预措施，其中 14 项由个别教育机构实施，主要形式是在医学课程中（特定模块、住院医师、轮转、实习、指导）对普通/家庭实践进行不同时长的接触，11 项是国家层面的政策干预，例如增加初级卫生保健（PHC）专业的培训名额和改善工作条件。
可及的 PHCS 需要有一支适合目的的多专业团队的劳动力，其中经过专门培训的医生发挥着核心作用。为了解决短缺问题，许多国家增加了培训机会，这是必要的一步，但还不够。在与其他同样需要更多学生的实践领域（如公共卫生、老年医学或心理健康）竞争的背景下，必须有更多的学生选择 PHC 专业。成功需要众多行为者的合作，包括专业委员会和组织以及监管机构，而这些机构往往由专家主导。通过将 PHCS 作为政治和政策优先事项，决策者可以帮助吸引更多的人，但要做到这一点，他们需要获得有说服力的证据和良好实践的信息，而这些只能通过研究来提供。
