Dunn M R, Miller R S, Richter T H
Division of Graduate Medical Education, American Medical Association, Chicago, Ill 60610, USA.
JAMA. 1998 Sep 2;280(9):809-12, 836-45. doi: 10.1001/jama.280.9.809.
In response to growing concerns that continued unlimited governmental funding of graduate medical education (GME) would lead to a physician surplus, Congress enacted provisions in the Balanced Budget Act (BBA) of 1997 to limit further growth, as well as to encourage reductions in GME. The measures incorporated in this section of the BBA reflect recommendations made by a number of major professional associations. The question now is how effective these efforts will be and whether they will produce unintended or deleterious consequences. We report the changes occurring in GME from 1993 to 1997, focusing on changes prior to and since the enactment of the BBA. The total number of residents in GME programs has remained relatively constant from 1993 to 1997. The number of residents entering GME programs without prior GME experience has also remained constant; however, over the same period, the number entering a new program with some prior GME experience has fallen by 5.8%. The number of international medical graduates in all GME programs has increased 12.4% during this same period, while the number of US allopathic medical school graduates has decreased 4.4%. As federal and state initiatives are introduced to change the number and distribution of GME positions, it is critical that the American Medical Association and other professional organizations monitor GME tracking data more systematically and accurately than ever before.
由于人们越来越担心政府对研究生医学教育（GME）的无限制资金投入持续下去会导致医生过剩，国会在1997年的《平衡预算法案》（BBA）中制定了相关条款，以限制其进一步增长，并鼓励削减研究生医学教育投入。《平衡预算法案》这一部分所纳入的措施反映了一些主要专业协会提出的建议。现在的问题是这些努力将有多大成效，以及它们是否会产生意想不到的或有害的后果。我们报告了1993年至1997年期间研究生医学教育发生的变化，重点关注《平衡预算法案》颁布之前和之后的变化。1993年至1997年，研究生医学教育项目中的住院医师总数相对保持稳定。没有研究生医学教育前期经历而进入该项目的住院医师人数也保持稳定；然而，在同一时期，有一些研究生医学教育前期经历而进入新项目的人数下降了5.8%。在此期间，所有研究生医学教育项目中的国际医学毕业生人数增加了12.4%，而美国全科医学院毕业生人数下降了4.4%。随着联邦和州采取举措来改变研究生医学教育岗位的数量和分布，美国医学协会和其他专业组织比以往任何时候都更系统、准确地监测研究生医学教育跟踪数据至关重要。
