Sullivan R B, Watanabe M, Whitcomb M E, Kindig D A
Department of the History of Medicine, School of Medicine, University of Wisconsin, Madison 53706, USA.
JAMA. 1996 Sep 4;276(9):704-9.
The size, geographic distribution, and specialty mix of the US physician workforce continue to interest American health policy analysts. Evidence suggests that the United States is on the verge of a serious oversupply of physicians, particularly nongeneralist physicians. Canada faces some of the same problems in physician supply, cost, and distribution as does the United States. Unlike the American states, however, the Canadian provinces, which have responsibility for financing health care, have in recent years made changes in their physician workforce policies that address these problems. Of particular note, Canadian provinces have developed policies that limit medical school enrollments, adjust the specialty training mix to better accord with needs, and establish physician practice location incentives. This article proceeds on the assumption that historical and contemporary similarities between medical care systems in Canada and the United States make comparisons between them potentially valuable. It offers a historical perspective on the evolution of workforce planning in the 2 countries and identifies 3 periods of policy development. It also compares and contrasts the relative size and specialty composition of the Canadian and US workforces and discusses how Canadian initiatives have diverged from American policy. Unless the United States devises its own coordinated workforce strategy, it will have considerable difficulty limiting physician workforce growth and influencing specialization and distribution in the future.
美国医生劳动力的规模、地理分布和专业构成一直是美国卫生政策分析师关注的焦点。有证据表明，美国即将面临医生严重供过于求的局面，尤其是专科医生。加拿大在医生供应、成本和分布方面面临着与美国类似的一些问题。然而，与美国各州不同的是，负责医疗保健融资的加拿大各省近年来在其医生劳动力政策方面做出了一些改变，以解决这些问题。特别值得注意的是，加拿大各省制定了限制医学院招生人数、调整专科培训结构以更好地符合需求以及建立医生执业地点激励机制等政策。本文基于这样一种假设展开，即加拿大和美国医疗保健系统在历史和当代的相似性使得对它们进行比较可能具有价值。它提供了两国劳动力规划演变的历史视角，并确定了政策发展的三个阶段。它还比较和对比了加拿大和美国劳动力的相对规模和专业构成，并讨论了加拿大的举措与美国政策的不同之处。除非美国制定出自己的协调劳动力战略，否则未来在限制医生劳动力增长以及影响专业化和分布方面将面临相当大的困难。
