Schroeder S A
Robert Wood Johnson Foundation, Princeton, NJ 08543-2316.
Inquiry. 1994 Fall;31(3):266-75.
Managing the health care workforce will have important implications for costs, quality, and access. Factors influencing supply include the production of new professionals, their relative effort, and rates of retirement. Demand will depend upon the development of new diseases, new drugs, and technologies, as well as the growth of managed care, which uses fewer physicians, fewer specialists, and more midlevel practitioners. There is a general consensus that there are too many physicians, especially specialists. Reducing the number of residency positions would reduce supply, predominantly by slowing importation of international physicians. Obstacles to workforce reform include a distrust of supply projections, skepticism about governmental planning, conservatism of established institutions, and the reality that some hospitals would lose positions and resources.
管理医疗保健劳动力队伍将对成本、质量和可及性产生重要影响。影响供应的因素包括新专业人员的培养、他们的相对工作量以及退休率。需求将取决于新疾病、新药和新技术的发展，以及管理式医疗的增长，管理式医疗使用的医生更少、专科医生更少，而中级从业者更多。人们普遍认为医生太多了，尤其是专科医生。减少住院医师培训岗位数量将减少供应，主要是通过减缓国际医生的引进。劳动力改革的障碍包括对供应预测的不信任、对政府规划的怀疑、现有机构的保守主义，以及一些医院将失去岗位和资源的现实。
