Anderson R J
Department of Rheumatology and Immunology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Med. 1995 Jul;99(1):74-81. doi: 10.1016/s0002-9343(99)80108-9.
The recent decline in the production of primary care physicians has been associated with a decrease in the production of general internists and an increase in the number of medical subspecialists. A significant majority of entering internal medicine residents anticipate entering a medical subspecialty. This transition in the development of medical manpower, perceived by some as inappropriate, is analyzed in light of historical trends in the evolution of internal medicine and its subspecialties, and in conjunction with the roles played by the American Board of Internal Medicine and the National Institutes of Health. Evidence is presented that the creation of virtually independent subspecialty departments may have been detrimental to the education of physicians and not productive of the physician scientists they are assumed to create. Current recommendations for reform are reviewed and a new proposal is presented, suggesting increasing the length of the medical residency from 3 to 4 years, incorporating subspecialty training in one or more fields into the third year of the residency, removing "duration of training" as a requirement for board eligibility in a subspecialty, transferring the certification of technical competence in a procedure to local institutions, and creating investigational units in basic disciplines within the department of internal medicine that would serve as a resource for all the subspecialty divisions.
近期初级保健医生数量的减少与普通内科医生数量的下降以及医学亚专科医生数量的增加有关。绝大多数新入职的内科住院医师预计会进入医学亚专科领域。一些人认为这种医学人力发展的转变是不合适的，本文根据内科及其亚专科发展的历史趋势，并结合美国内科医学委员会和美国国立卫生研究院所发挥的作用，对这一转变进行了分析。有证据表明，实际上独立的亚专科科室的设立可能对医生的教育有害，而且无法培养出人们认为它们能够造就的医学科学家。本文回顾了当前的改革建议，并提出了一项新提议，建议将住院医师培训时长从3年增加到4年，将一个或多个领域的亚专科培训纳入住院医师培训的第三年，取消“培训时长”作为亚专科委员会资格认证的一项要求，将某项操作的技术能力认证转移到当地机构，并在内科部门内设立基础学科的研究单位，作为所有亚专科部门的资源。
