Cohen J J, Whitcomb M E
Association of American Medical Colleges (AAMC), Washington, D.C. 20037, USA.
Acad Med. 1997 Jan;72(1):13-6.
A few years ago, most opinion leaders and workforce analysts believed that the number of generalist physicians in the United States was much too low. The AAMC responded to this concern by convening a task force to review the evidence bearing on the U.S. supply of generalist physicians and to make recommendations for action by the AAMC and its member institutions. In 1992, the task force called for at least half the graduates of U.S. allopathic medical schools to enter practice as generalists and for medical schools to design their educational programs to promote an affinity for generalism among their students. Since that time, however, research findings have suggested that the current size of the country's generalist physician workforce in relation to projected need may indeed be adequate. In light of these recent observations, the authors asked whether the task force's major recommendations remain valid. In this article, they state their reasons for thinking that it definitely does. After reviewing the recent research findings mentioned above, the authors show that simply to maintain the current size of the generalist physician workforce, a marked increase will be needed in the number of U.S. medical school graduates who choose to become generalists. In the aggregate, this amounts to roughly half the graduating classes of LCME-accredited medical schools, as called for by the AAMC in 1992. (The authors predict that international medical graduates will not make up a significant percentage of the country's generalist workforce, and that U.S. medical school graduates will be the predominant source of these physicians in the future.) Equally important, the new educational approaches being created by medical schools to embed generalism in their curricula are necessary to ensure that all graduates, regardless of their specialty choices, be well grounded in the principles and skills of "general physicians" so they can function well in the new health care system that is rapidly evolving.
几年前，大多数意见领袖和劳动力分析师认为，美国全科医生的数量过低。美国医学教育协会（AAMC）针对这一担忧，召集了一个特别工作组，以审查与美国全科医生供应相关的证据，并就AAMC及其成员机构的行动提出建议。1992年，该特别工作组呼吁美国所有opathic医学院至少一半的毕业生以全科医生的身份执业，并要求医学院设计其教育计划，以促进学生对全科医学的喜爱。然而，自那时以来，研究结果表明，就预计需求而言，该国目前全科医生劳动力的规模可能确实足够。鉴于这些最新观察结果，作者们询问特别工作组的主要建议是否仍然有效。在本文中，他们阐述了认为这些建议绝对有效的理由。在回顾了上述最新研究结果后，作者们表明，仅为维持目前全科医生劳动力的规模，选择成为全科医生的美国医学院毕业生数量将需要大幅增加。总体而言，这相当于LCME认证医学院毕业班人数的大约一半，这正是1992年AAMC所要求的。（作者预测，国际医学毕业生在美国全科医生劳动力中所占比例不会很大，美国医学院毕业生将是未来这些医生的主要来源。）同样重要的是，医学院正在创建的新教育方法，即将全科医学融入其课程中，对于确保所有毕业生，无论其专业选择如何，都能在“全科医生”的原则和技能方面打下坚实基础，以便他们能在快速发展的新医疗体系中良好发挥作用而言是必要的。
