Christakis N A, Jacobs J A, Messikomer C M
Department of Sociology, University of Pennsylvania, Philadelphia 19104.
Ann Intern Med. 1994 Nov 1;121(9):669-75. doi: 10.7326/0003-4819-121-9-199411010-00008.
Current proposals to reform the health care system call for a physician work force composed of at least 50% generalists. Achieving this objective will likely require that some physicians who are currently specialists become generalists. We sought to determine the extent of such change before any concerted reform efforts and the types of physicians most amenable to such change.
Retrospective cohort study.
335,438 physicians in active practice.
Rates of change between 1982 and 1986 in self-defined specialties, analyzed with demographic methods and logistic regression.
In 1982, our participants comprised 134,647 (40.1%) generalists and 200,791 (59.9%) specialists. Over the 4-year period of the study, 8319 (6.2%) of the generalists became specialists and 4322 (2.2%) of the specialists became generalists. Although physicians younger than 40 years of age were more likely than those older than 40 years of age to switch into generalist disciplines, specialist physicians between the ages of 40 and 69 years (who accounted for 62.0% of the physician work force) made most of the moves into generalist fields (58.4%). After adjustment for other factors, the physicians most likely to switch into generalist disciplines were women, subspecialty internists, emergency medicine physicians, subspecialty pediatricians, and pathologists. In 1986, the 130,650 physicians (38.9%) in this cohort who considered themselves generalists were supplemented by another 49,226 (14.7%) who considered themselves to have a secondary interest in generalist practice. Physicians with such a secondary interest in 1982 constituted 65% of the new generalists in 1986.
Our findings support three principal conclusions. First, change from specialist to generalist disciplines is not uncommon, even for physicians older than 40 years of age. Second, many physicians already consider a generalist discipline to be a secondary emphasis of their practices. And third, efforts to retrain specialists to be generalists might effectively target those physicians predisposed to become generalists.
当前医疗体系改革提议要求医师队伍中至少50%为全科医生。要实现这一目标，可能需要一些目前的专科医生转变为全科医生。我们试图在任何协同改革努力之前确定这种转变的程度以及最易于发生这种转变的医生类型。
回顾性队列研究。
335438名在职医生。
采用人口统计学方法和逻辑回归分析1982年至1986年期间自我定义专业的变化率。
1982年，我们的参与者包括134647名（40.1%）全科医生和200791名（59.9%）专科医生。在研究的4年期间，8319名（6.2%）全科医生转变为专科医生，4322名（2.2%）专科医生转变为全科医生。虽然40岁以下的医生比40岁以上的医生更有可能转向全科医学领域，但40至69岁的专科医生（占医师队伍的62.0%）中有大部分（58.4%）转向了全科医学领域。在对其他因素进行调整后，最有可能转向全科医学领域的医生是女性、亚专科内科医生、急诊医学医生、亚专科儿科医生和病理学家。1986年，该队列中认为自己是全科医生的130650名医生（38.9%），又有另外49226名（14.7%）认为自己对全科医学实践有次要兴趣的医生加入。1982年有这种次要兴趣的医生占1986年新全科医生的65%。
我们的研究结果支持三个主要结论。第一，从专科向全科领域的转变并不罕见，即使对于40岁以上的医生也是如此。第二，许多医生已经将全科医学领域视为其执业的次要重点。第三，将专科医生重新培训为全科医生的努力可能有效地针对那些倾向于成为全科医生的医生。
