Taylor D H, Leese B
National Primary Care Research and Development Centre, University of Manchester.
BMJ. 1997 Jun 21;314(7097):1806-10. doi: 10.1136/bmj.314.7097.1806.
To describe the recruitment and retention of general practitioners and changes in their time commitment from 1 October 1990 to 1 October 1994.
Retrospective analysis of yearly data.
England and Wales.
General practitioners in unrestricted practice.
Numbers of general practitioners moving into and out of general practice; proportion of general practitioners practising less than full time; proportion of general practitioners having unchanged time commitment over the study period; and proportion of general practitioners leaving general practice in 1991 who were subsequently practising in 1994.
Numbers of general practitioners entering general practice (1565 in 1990, 1400 in 1994) fell over the study period as did the numbers leaving general practice (1488 in 1990, 1115 in 1994). The net effect was an increase in both the total and full time equivalent general practitioners practising from 1 October 1990 (26,757 full time equivalents) to 1 October 1994 (27,063 full time equivalents). Numbers of general practitioners practising full time were decreasing whereas part time practice was increasing; women were more likely to practise part time. 35.5% (43/121) of women practising full time and 17.8% (24/135) of men practising full time who left practice in 1991 were practising again in 1994.
Simply using total numbers of general practitioners or net increase to describe workforce trends masks much movement in and out of general practice and between differing time commitments. Recruitment and retention issues need to be separated if reasonable policies are to be developed to assure the necessary general practitioner workforce for a primary care led NHS.
描述1990年10月1日至1994年10月1日期间全科医生的招募与留用情况以及他们工作时间投入的变化。
对年度数据进行回顾性分析。
英格兰和威尔士。
不受限制执业的全科医生。
进入和离开全科医疗行业的全科医生数量；非全职执业的全科医生比例；在研究期间工作时间投入未变的全科医生比例；1991年离开全科医疗行业且在1994年仍在执业的全科医生比例。
在研究期间，进入全科医疗行业的全科医生数量（1990年为1565人，1994年为1400人）下降，离开全科医疗行业的数量（1990年为1488人，1994年为1115人）也下降。净效应是，从1990年10月1日（26757个全职等效人员）到1994年10月1日（27063个全职等效人员），执业的全科医生总数和全职等效人员数量均有所增加。全职执业的全科医生数量在减少，而兼职执业的情况在增加；女性更有可能兼职执业。1991年离开执业岗位的全职执业女性中有35.5%（43/121）、全职执业男性中有17.8%（24/135）在1994年再次执业。
仅用全科医生总数或净增加数来描述劳动力趋势掩盖了全科医疗行业内外以及不同工作时间投入之间的大量变动情况。如果要制定合理政策以确保由初级医疗主导的国民健康服务体系拥有必要的全科医生劳动力，就需要将招募和留用问题区分开来。
