Gottlieb J, Fields S K, Hojat M, Veloski J J
Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Acad Med. 1995 Dec;70(12):1125-33.
This study was undertaken to promote communication among faculty regarding the impact of a proposed goal that 50% of the graduates of Jefferson Medical College enter generalist careers. Since the opinions and attitudes of faculty regarding career decisions may directly or indirectly influence students, the authors investigated faculty's views of the optimal ratio of primary care to non-primary care physicians in the workforce and their perceptions of the effect on medical education, research, and health care delivery if the 50% goal were to be mandated.
A questionnaire was mailed in January 1994 to all 684 salaried faculty of Jefferson Medical College. Respondents' opinions about the optimal primary care to non-primary care ratio and their perceptions of the effects of implementing the 50% goal on 21 areas related to medical education, research, and health care delivery were examined using a Likert-type scale. Obstacles perceived by non-primary care physicians as preventing their practice of primary care were also among the outcome measures.
A total of 275 completed questionnaires were received (40% response rate; 72 primary care physicians, 141 non-primary care physicians, and 62 non-physicians). The median and mode of an optimal primary care to non-primary care ratio were both 50/50. Faculty, in general, perceived that implementing the 50% goal would enhance public access to primary care, physician-patient relationships, utilization of non-physicians, and the career satisfaction of generalists. They predicted decreases in costs of care, freedom of career choice, funding, and interest in research. The primary care physicians perceived greater enhancements of the image of physicians, quality of care, and satisfaction of generalists and subspecialists than did the non-primary care physicians. Gender and age did not affect the perceptions. A lack of appropriate training was identified by 45% and a lack of interest by 28% of the non-primary care physicians as major obstacles to their practice of primary care medicine.
The faculty members' positive and negative views of the proposed reform can provide useful information to the institution in understanding the potential impediments to increasing the numbers of generalist graduates. The generalists had significantly different views from the subspecialists about the impact of increasing the proportion of primary care physicians on health care delivery and research. In general the primary care physicians were more likely to view the proposed changes as beneficial than were the non-primary care physicians.
本研究旨在促进教员之间就一项拟议目标的影响进行交流，该目标是让杰斐逊医学院50%的毕业生从事全科医疗职业。由于教员对职业决策的意见和态度可能直接或间接地影响学生，作者调查了教员对劳动力中初级保健医生与非初级保健医生的最佳比例的看法，以及他们对如果强制实施50%的目标对医学教育、研究和医疗服务的影响的认知。
1994年1月向杰斐逊医学院所有684名受薪教员邮寄了一份问卷。使用李克特量表来考察受访者对初级保健与非初级保健的最佳比例的意见，以及他们对实施50%目标对与医学教育、研究和医疗服务相关的21个领域的影响的认知。非初级保健医生认为妨碍他们从事初级保健工作的障碍也在结果测量范围内。
共收到275份完整问卷（回复率为40%；72名初级保健医生、141名非初级保健医生和62名非医生）。初级保健与非初级保健的最佳比例的中位数和众数均为50/50。总体而言，教员认为实施50%的目标将增加公众获得初级保健的机会、改善医患关系、提高非医生人员的利用率以及提高全科医生的职业满意度。他们预计医疗费用、职业选择自由度、资金和研究兴趣会降低。与非初级保健医生相比，初级保健医生认为医生形象、医疗质量以及全科医生和专科医生的满意度会有更大提升。性别和年龄不影响这些认知。45%的非初级保健医生认为缺乏适当培训，28%的非初级保健医生认为缺乏兴趣是他们从事初级保健医学的主要障碍。
教员对拟议改革的积极和消极看法可以为该机构提供有用信息，以了解增加全科毕业生数量的潜在障碍。全科医生和专科医生对增加初级保健医生比例对医疗服务和研究的影响有显著不同的看法。总体而言，初级保健医生比非初级保健医生更倾向于认为拟议的变革是有益的。
