Mullan F, Politzer R M, Gamliel S, Rivo M L
Bureau of Health Professions, Rockville, MD 20857.
Milbank Q. 1994;72(3):385-98.
National commissions, medical philanthropies, scholars, and policy analysts agree that the key to improved health care access and cost containment is a physician workforce built on a generalist foundation. They propose a national system to allocate a specific and limited number of graduate medical education (GME) positions. The Council on Graduate Medical Education recommended that training positions be limited to 110 percent of the graduates of U.S. allopathic and osteopathic medical schools and that the system graduate 50 percent into primary care practice (50/50-110 proposal). The 50/50-110 option would significantly modify GME training: surgical and support specialty positions would be reduced, and increased numbers of medical and pediatric residents would enter general practice. This workforce composition would facilitate provision of universal health care access and help control costs--the basic tenets of reform.
国家委员会、医学慈善机构、学者和政策分析师一致认为，改善医疗保健可及性和控制成本的关键在于建立在通科基础上的医师队伍。他们提议建立一个国家系统，以分配特定且有限数量的毕业后医学教育（GME）岗位。毕业后医学教育委员会建议，培训岗位应限制在美国全科和骨科医学院毕业生人数的110%以内，并且该系统应有50%的毕业生进入初级保健实践（50/50 - 110提议）。50/50 - 110方案将显著改变毕业后医学教育培训：外科和辅助专科岗位将减少，更多的内科和儿科住院医师将进入全科实践。这种劳动力构成将有助于提供全民医疗保健服务并有助于控制成本——这是改革的基本原则。
