Seifer S D, Vranizan K, Grumbach K
Center for the Health Professions, University of California, San Francisco 94143-1364, USA.
JAMA. 1995 Sep 6;274(9):685-91.
To determine the relationship between graduate medical education and physician practice location.
Cross-sectional analysis of physicians in active practice in 1993, classified by state of graduate medical education and stratified by specialty and professional activity. Logistic regression analysis was used to examine predictors of physicians remaining to practice in the same state in which they trained.
There were 82,871 allopathic physicians (national random sample) and 15,076 osteopathic physicians (universe) who completed graduate medical education between 1980 and 1992.
Practice location in the same state as graduate medical education.
Overall, 51% of physicians are practicing in the state in which they obtained their graduate medical education (range among states, 6% to 71%). Generalist physicians are more likely than specialists to remain in their state of graduate medical education (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.33 to 1.40) There is a weak negative association between the number of physicians in training per capita in a state and the likelihood of a physician remaining in the state to practice (OR, 0.90; 95% CI, 0.90 to 0.91, for an increment in resident supply of 10 per 100,000 population). New York and Massachusetts, the states with the highest numbers of residents per capita, retained 51% and 49%, respectively, of their graduates, placing them near the median among states.
Most physician training and practice locations function as a national market, with physicians dispersing relatively widely after completing graduate medical education. States that produce high numbers of physicians per capita do not appear to play a unique role in training physicians to serve a national market. These findings pose challenges for states attempting to modify their physician supply and specialty mix.
确定毕业后医学教育与医生执业地点之间的关系。
对1993年仍在执业的医生进行横断面分析，按毕业后医学教育所在州分类，并按专业和职业活动进行分层。采用逻辑回归分析来检验医生留在其接受培训所在州执业的预测因素。
1980年至1992年间完成毕业后医学教育的82871名对抗疗法医生（全国随机样本）和15076名整骨疗法医生（总体）。
在与毕业后医学教育所在州相同的州执业。
总体而言，51%的医生在其获得毕业后医学教育的州执业（各州范围为6%至71%）。全科医生比专科医生更有可能留在其毕业后医学教育所在州（优势比[OR]为1.36；95%置信区间[CI]为1.33至1.40）。一个州人均接受培训的医生数量与医生留在该州执业的可能性之间存在微弱的负相关（每10万人口中住院医生供应增加10人时，OR为0.90；95%CI为0.90至0.91）。纽约和马萨诸塞州人均居民数量最多，分别留住了其毕业生的51%和49%，使其在各州中接近中位数。
大多数医生培训和执业地点形成了一个全国性市场，医生在完成毕业后医学教育后分布相对广泛。人均培养医生数量多的州在培训医生以服务全国市场方面似乎并未发挥独特作用。这些发现给试图调整其医生供应和专业组合的州带来了挑战。
