Baer L D, Ricketts T C, Konrad T R, Mick S S
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599-7590, USA.
Med Care. 1998 Nov;36(11):1534-44. doi: 10.1097/00005650-199811000-00003.
The authors examined whether international medical graduates (IMGs) constitute a greater percentage of the US physician workforce in rural underserved areas than in rural non-underserved areas. Research findings could help policymakers determine whether the role of international medical graduates in compensating for local physician shortages counterbalances international medical graduates' potential for exacerbating a national oversupply.
This research was based on data from the American Medical Association Physician Masterfile and the Bureau of Health Professions' Area Resource File. The authors calculated the percentage international medical graduates of all US primary care physicians in rural areas, stratified by the Health Professional Shortage Area (HPSA) designation of underservice.
The study showed that international medical graduates do constitute a greater percentage of US primary care physicians in rural areas with physician shortages than in rural areas without physician shortages. This finding held true at the national, Census region, and state scales of analysis, but to varying degrees. The finer the scale of analysis, the greater the variation in international medical graduates' practice in rural, underserved areas. There was substantial interstate variation in the extent to which international medical graduates practice in rural underserved areas.
International medical graduates do help reduce rural physician shortages, but interstate variation points to the role of state policies in influencing international medical graduates' distribution in rural, underserved areas. Such variation also can come about from many different causes, so there is a need for further research to determine why international medical graduates help compensate for physician shortages more so in some states than in others.
作者研究了在农村医疗服务欠缺地区，国际医学毕业生在美国医生劳动力中所占的比例是否高于农村医疗服务非欠缺地区。研究结果有助于政策制定者确定国际医学毕业生在弥补当地医生短缺方面所起的作用，是否能抵消其可能加剧全国医生供应过剩的影响。
本研究基于美国医学协会医生主档案和卫生职业局地区资源档案中的数据。作者计算了农村地区所有美国初级保健医生中，国际医学毕业生的比例，并按医疗服务欠缺的卫生专业人员短缺地区（HPSA）指定进行分层。
研究表明，在有医生短缺的农村地区，国际医学毕业生在美国初级保健医生中所占的比例确实高于没有医生短缺的农村地区。这一发现在国家、人口普查区域和州层面的分析中均成立，但程度各异。分析的层面越精细，国际医学毕业生在农村医疗服务欠缺地区的执业差异就越大。国际医学毕业生在农村医疗服务欠缺地区的执业程度在州与州之间存在显著差异。
国际医学毕业生确实有助于减少农村地区的医生短缺，但州与州之间的差异表明了州政策在影响国际医学毕业生在农村医疗服务欠缺地区分布方面的作用。这种差异也可能由许多不同原因导致，因此需要进一步研究，以确定为什么国际医学毕业生在某些州比在其他州更能帮助弥补医生短缺。
