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错误的解决方案:为何美国不需要更多医学院来解决医生短缺问题。

The Wrong Fix: Why America Doesn't Need More Medical Schools to Solve the Physician Shortage.

作者信息

Lakhan Shaheen E

机构信息

Medical Office, Click Therapeutics, Inc., New York, USA.

Department of Neurology, Western University of Health Sciences, Pomona, USA.

出版信息

Cureus. 2025 Jun 13;17(6):e85935. doi: 10.7759/cureus.85935. eCollection 2025 Jun.

Abstract

The United States is grappling with a physician shortage, but the solution does not lie in simply opening more medical schools. As a physician-scientist and former founding dean of a medical school, I argue that the true bottleneck is not the number of medical school graduates but the insufficient number of residency training positions. Since the Balanced Budget Act of 1997, which froze the number of Medicare-funded residency slots, the United States has seen a steady increase in medical graduates, yet the availability of residency spots has stagnated. This mismatch between undergraduate medical education (UME) expansion and the lack of corresponding growth in graduate medical education (GME) is the key issue. This editorial explores the structural flaws in the current system, particularly the artificial cap on residency slots, and critiques the recent push to open new medical schools without addressing the underlying problem in residency training. Drawing on personal experience and data, I examine the consequences of this mismatch, including the vast number of unmatched graduates, a growing physician shortage, and the inefficient use of educational resources. I propose policy reforms, including lifting the federal GME cap, creating public-private partnerships, leveraging technology for AI-augmented supervision, and adopting hybrid training models to modernize GME. Only by expanding and modernizing residency programs in tandem with UME growth can the U.S. effectively resolve its physician shortage and ensure that the medical graduates of today are trained and ready to meet the healthcare needs of tomorrow.

摘要

美国正面临医生短缺的问题,但解决方案并非仅仅是开设更多医学院校。作为一名医生科学家以及一所医学院的前创始院长,我认为真正的瓶颈并非医学院毕业生的数量,而是住院医师培训岗位数量不足。自1997年《平衡预算法案》冻结了医疗保险资助的住院医师岗位数量以来,美国医学院毕业生数量稳步增加,但住院医师岗位的可获得性却停滞不前。本科医学教育(UME)的扩张与研究生医学教育(GME)缺乏相应增长之间的这种不匹配是关键问题。这篇社论探讨了当前体系中的结构性缺陷,尤其是住院医师岗位的人为上限,并批评了近期在未解决住院医师培训根本问题的情况下开设新医学院校的做法。借鉴个人经验和数据,我研究了这种不匹配的后果,包括大量未匹配的毕业生、日益严重的医生短缺以及教育资源的低效利用。我提出了政策改革建议,包括取消联邦GME上限、建立公私合作伙伴关系、利用技术进行人工智能辅助监督以及采用混合培训模式以使GME现代化。只有通过与UME增长同步扩大和现代化住院医师培训项目,美国才能有效解决医生短缺问题,并确保今天的医学毕业生得到培训,准备好满足明天的医疗保健需求。

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