Kletke P R, Emmons D W, Gillis K D
Policy Development Unit, American Medical Association, Chicago, IL 60610, USA.
JAMA. 1996 Aug 21;276(7):555-60.
To examine current trends in practice organization among postresident patient care physicians in the United States.
The American Medical Association's Socioeconomic Monitoring System (SMS), a series of periodic surveys of nationally representative samples of nonfederal postresident patient care physicians. Physicians were divided into 3 categories based on the organization of their main practice. They were classified as employee physicians if they had no ownership interest in their practice, as self-employed solo physicians if they were in 1-physician practices in which they had an ownership interest, and as self-employed group physicians if they were in multiple-physician practices in which they had an ownership interest.
Nonfederal, postresident patient care physicians who provided more than 47 000 responses to SMS surveys between 1983 and 1994.
The proportion of nonfederal postresident patient care physicians who were employees between 1983 and 1994.
Between 1983 and 1994, the proportion of patient care physicians practicing as employees rose from 24.2% to 42.3% (P<.001), the proportion self-employed in solo practices fell from 40.5% to 29.3% (P<.001), and the proportion self-employed in group practices fell from 35.3% to 28.4% (P<.001). Most of these changes occurred in the latter half of the 12-year period. These trends, which are evident in virtually every segment of the patient care physician population, are especially prominent among young physicians. The growing proportion of employee physicians is associated with increases in the earnings of employee physicians relative to those of self-employed solo physicians.
Current trends in the US health care system are rapidly changing the career opportunities of patient care physicians and, hence, physicians' choice of practice arrangement.
研究美国住院后从事患者护理工作的医生在执业机构方面的当前趋势。
美国医学协会的社会经济监测系统（SMS），这是一系列对具有全国代表性的非联邦住院后患者护理医生样本进行的定期调查。医生根据其主要执业机构分为三类。如果他们在执业机构中没有所有权权益，则被归类为雇员医生；如果他们在自己拥有所有权权益的单人执业机构中工作，则被归类为个体经营单人医生；如果他们在自己拥有所有权权益的多人执业机构中工作，则被归类为个体经营团体医生。
1983年至1994年间对SMS调查提供了超过47000份回复的非联邦住院后患者护理医生。
1983年至1994年间非联邦住院后患者护理医生中作为雇员的比例。
1983年至1994年间，作为雇员执业的患者护理医生比例从24.2%升至42.3%（P<0.001），个体经营单人执业的比例从40.5%降至29.3%（P<0.001），个体经营团体执业的比例从35.3%降至28.4%（P<0.001）。这些变化大多发生在这12年期间的后半段。这些趋势在患者护理医生群体的几乎每个细分领域都很明显，在年轻医生中尤为突出。雇员医生比例的增加与雇员医生相对于个体经营单人医生收入的增加有关。
美国医疗保健系统的当前趋势正在迅速改变患者护理医生的职业机会，从而改变医生对执业安排的选择。
