Cooper R A
Health Policy Institute, Medical College of Wisconsin, Milwaukee 53226, USA.
Ann Thorac Surg. 1995 Nov;60(5):1541-6. doi: 10.1016/0003-4975(95)00797-O.
Medicine is entering an unprecedented era of provider abundance, including both physician and nonphysician providers. Over the next several decades, the projected number of primary care physicians will be more than adequate to meet national needs, although there is no assurance that any number of physicians will create an equitable distribution. At the same time, a growing surplus of specialists is projected. A balanced abundance in both primary care and specialty medicine will continue if approximately 33% of first-year residents ultimately practice primary care and 67% become specialists. In contrast, a shift to 50:50, as has been proposed by the Committee on Graduate Medical Education and others, will lead to a superabundance in primary care and a potential deficiency in specialty medicine later in the 21st century. Under either scenario, maintaining balance will be aided by those physicians with sufficient generalist skills to enable them to practice at the interface of primary care and specialty medicine, the domain of "middle care." The nation will be well served by educational policy that imparts such generalist expertise to medical students and that creates a workforce of highly skilled physicians capable of caring for patients in the technologically advanced clinical environment of the future.
医学正进入一个医疗服务提供者极为充裕的前所未有的时代，其中包括医师和非医师医疗服务提供者。在未来几十年里，预计初级保健医师的数量将足以满足国家需求，尽管无法保证任何数量的医师能实现公平分配。与此同时，预计专科医生的过剩情况将日益严重。如果大约33%的一年级住院医师最终从事初级保健工作，67%成为专科医生，那么初级保健和专科医学的供需将继续保持平衡。相比之下，正如研究生医学教育委员会及其他机构所提议的那样，若比例变为50:50，将会导致21世纪后期初级保健医生供过于求，而专科医学可能出现短缺。在这两种情况下，具备足够全科技能、能够在初级保健与专科医学的交叉领域（即“中级医疗”领域）执业的医师，将有助于维持平衡。若教育政策能向医学生传授此类全科专业知识，并打造一支能够在未来技术先进的临床环境中为患者提供护理的高技能医师队伍，那么国家将受益匪浅。
