Rabinowitz H K
Department of Family Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
N Engl J Med. 1993 Apr 1;328(13):934-9. doi: 10.1056/NEJM199304013281307.
To help address the geographic and specialty maldistribution of physicians, Jefferson Medical College initiated the Physician Shortage Area Program (PSAP) in 1974. This unique program, which combines a selective medical school admissions policy with a special educational program, has been shown to be successful in increasing the number of family physicians in rural and underserved areas, but it is not known whether they remain in this type of practice.
Graduates of the PSAP were tracked longitudinally and compared with their non-PSAP classmates. Information was obtained about the retention of family physicians in rural areas and areas with a physician shortage over the previous five years, the geographic and specialty choices of more recent graduates, and the recruitment of applicants into the program.
Of the 47 PSAP graduates from the classes of 1978 through 1981, reported on earlier, the number who combined a career in family medicine with practice in a rural area or one with a physician shortage remained unchanged, although there was substantial attrition among non-PSAP graduates practicing family medicine in rural (32 percent) and underserved (40 percent) areas. Among the 101 PSAP graduates of the classes of 1982 through 1986, the results were similar to those for the first four classes. Overall, PSAP graduates from the classes of 1978 through 1986 were approximately four times as likely as non-PSAP graduates to practice family medicine (55 percent vs. 13 percent), to practice in a rural area (39 percent vs. 11 percent), and to practice in underserved areas (33 percent vs. 8 percent). They were approximately 10 times more likely to combine a career in family medicine with practice in a rural (26 percent vs. 3 percent) or underserved (23 percent vs. 2 percent) area. Overall, 85 percent of PSAP graduates were either practicing a care specialty or practicing in a rural or small metropolitan area or one with a shortage of physicians. In parallel with national trends, the number of applicants and matriculants to the program decreased during the past decade, so that the percentage of available places filled decreased from 97 percent to 33 percent. However, there has been a recent increase in the number of applicants and matriculants.
The results of this study indicate that the PSAP was successful in increasing the number of family physicians in rural and underserved areas as well as in retaining them. This suggests that medical schools can have a substantial influence on the distribution of physicians according to specialty choice and the geographic location of their practices, principally through admission criteria.
为帮助解决医生在地理分布和专业分布上的不均衡问题，杰斐逊医学院于1974年启动了医生短缺地区项目（PSAP）。这个独特的项目将医学院的选择性招生政策与特殊教育项目相结合，已被证明在增加农村和医疗服务不足地区的家庭医生数量方面取得了成功，但尚不清楚这些医生是否会继续从事这类工作。
对PSAP的毕业生进行纵向跟踪，并与非PSAP的同学进行比较。获取了以下信息：过去五年中农村地区和医生短缺地区家庭医生的留用情况、近期毕业生的地理和专业选择，以及该项目申请人的招募情况。
在之前报告的1978年至1981届的47名PSAP毕业生中，将家庭医学职业与农村地区或医生短缺地区的工作相结合的人数没有变化，尽管在农村（32%）和医疗服务不足（40%）地区从事家庭医学工作的非PSAP毕业生有大量流失。在1982年至1986届的101名PSAP毕业生中，结果与前四届相似。总体而言，1978年至1986届的PSAP毕业生从事家庭医学工作的可能性是非PSAP毕业生的四倍左右（55%对13%），在农村地区工作的可能性是非PSAP毕业生的四倍左右（39%对11%），在医疗服务不足地区工作的可能性是非PSAP毕业生的四倍左右（33%对8%）。他们将家庭医学职业与农村（26%对3%）或医疗服务不足（23%对2%）地区的工作相结合的可能性大约是非PSAP毕业生的10倍。总体而言，85%的PSAP毕业生要么从事护理专业，要么在农村或小城市地区或医生短缺地区工作。与全国趋势一致，在过去十年中，该项目的申请人和录取人数有所减少；因此，可用名额的录取率从97%降至33%。不过，最近申请人和录取人数有所增加。
本研究结果表明，PSAP在增加农村和医疗服务不足地区的家庭医生数量以及留住这些医生方面取得了成功。这表明医学院校可以主要通过录取标准，对医生根据专业选择和执业地理位置的分布产生重大影响。
