DeLisa J A, Jain S S, Kirshblum S
Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, Newark 07103-2406, USA.
Am J Phys Med Rehabil. 1998 Jul-Aug;77(4):311-6. doi: 10.1097/00002060-199807000-00010.
Decision makers at the federal and state level are considering, and some states have enacted, a reduction in total United States residency positions, a shift in emphasis from specialist to generalist training, a need for programs to join together in training consortia to determine local residency position allocation strategy, a reduction in funding of international medical graduates, and a reduction in funding beyond the first certificate or a total of five years. A 5-page, 24-item questionnaire was sent to all physiatry residency training directors. The objective was to discern a descriptive database of physiatry training programs and how their institutions might respond to cuts in graduate medical education funding. Fifty-eight (73%) of the questionnaires were returned. Most training directors believe that their primary mission is to train general physiatrists and, to a much lesser extent, to train subspecialty or research fellows. Directors were asked how they might handle reductions in house staff such as using physician extenders, shifting clinical workload to faculty, hiring additional faculty, and funding physiatry residents from practice plans and endowments. Physiatry has had little experience (29%; 17/58) with voluntary graduate medical education consortiums, but most (67%; 34/58) seem to feel that if a consortium system is mandated, they would favor a local or regional over a national body because they do not believe the specialty has a strong enough national stature. The major barriers to a consortium for graduate medical education allocation were governance, academic, fiscal, bureaucratic, and competition.
联邦和州一级的决策者正在考虑，并且一些州已经颁布了相关措施，包括减少美国住院医师职位总数、将重点从专科培训转向全科培训、要求各项目联合组成培训联盟以确定当地住院医师职位分配策略、减少对国际医学毕业生的资金投入，以及减少首次获得证书后或总共五年之后的资金投入。一份5页、包含24个条目的问卷被发送给了所有物理医学与康复住院医师培训主任。目的是识别出物理医学与康复培训项目的描述性数据库，以及这些机构可能如何应对研究生医学教育资金的削减。58份（73%）问卷被返还。大多数培训主任认为他们的主要任务是培养普通物理医学与康复医师，在较小程度上培养亚专科或研究员。主任们被问及他们可能如何应对住院医师人数的减少，比如使用医师助理、将临床工作量转移给教员、雇佣更多教员，以及从实践计划和捐赠基金中为物理医学与康复住院医师提供资金。物理医学与康复领域在自愿性研究生医学教育联盟方面经验很少（29%；17/58），但大多数（67%；34/58）似乎觉得如果强制实行联盟体系，他们会倾向于地方或地区性机构而非全国性机构，因为他们认为该专业在全国层面的地位不够强大。研究生医学教育分配联盟面临的主要障碍包括管理、学术、财政、官僚作风和竞争。
