Rabinowitz H K, Diamond J J, Markham F W, Hazelwood C E
Center for Medical Education Research and Policy, and Department of Family Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
JAMA. 1999 Jan 20;281(3):255-60. doi: 10.1001/jama.281.3.255.
The shortage of physicians in rural areas is a longstanding and serious problem, and national and state policymakers and educators continue to face the challenge of finding effective ways to increase the supply of rural physicians.
To determine the direct and long-term impact of the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) on the rural physician workforce.
Retrospective cohort study.
A total of 206 PSAP graduates from the classes of 1978 to 1991.
The PSAP graduates currently practicing family medicine in rural and underserved areas of Pennsylvania, compared with all allopathic medical school graduates in the state, and with all US and international allopathic graduates. All PSAP graduates were also compared with their non-PSAP peers at JMC regarding their US practice location, medical specialty, and retention for the past 5 to 10 years.
The PSAP graduates account for 21% (32/150) of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% (206/14710) of graduates from those schools (relative risk [RR], 19.1). Among all US and international medical school graduates, PSAP graduates represent 12% of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in underserved areas. Overall, PSAP graduates were much more likely than their non-PSAP classmates at JMC to practice in a rural area of the United States (34% vs 11%; RR, 3.0), to practice in an underserved area (30% vs 9%; RR, 3.2), to practice family medicine (52% vs 13%; RR, 4.0), and to have combined a career in family practice with practice in a rural area (21% vs 2%; RR, 8.5). Of PSAP graduates, 84% were practicing in either a rural or small metropolitan area, or one of the primary care specialties. Program retention has remained high, with the number of PSAP graduates currently practicing rural family medicine equal to 87% of those practicing between 5 and 10 years ago, and the number practicing in underserved areas, 94%.
The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas.
农村地区医生短缺是一个长期存在的严重问题，国家和州政策制定者及教育工作者仍面临着寻找有效途径增加农村医生供应的挑战。
确定杰斐逊医学院（JMC）的医生短缺地区项目（PSAP）对农村医生队伍的直接和长期影响。
回顾性队列研究。
共有1978年至1991级的206名PSAP毕业生。
将目前在宾夕法尼亚州农村和服务欠缺地区从事家庭医学的PSAP毕业生，与该州所有opathic医学院毕业生以及所有美国和国际opathic毕业生进行比较。还将所有PSAP毕业生与其在JMC的非PSAP同龄人在过去5至10年的美国执业地点、医学专业和留用情况进行比较。
PSAP毕业生占毕业于该州7所医学院之一且在宾夕法尼亚州农村执业的家庭医生的21%（32/150），尽管他们仅占这些学校毕业生的1%（206/14710）（相对风险[RR]，19.1）。在所有美国和国际医学院毕业生中，PSAP毕业生占宾夕法尼亚州农村所有家庭医生的12%。在服务欠缺地区执业的PSAP毕业生结果类似。总体而言，PSAP毕业生比他们在JMC的非PSAP同学更有可能在美国农村地区执业（34%对11%；RR，3.0），在服务欠缺地区执业（30%对9%；RR，3.2），从事家庭医学（52%对13%；RR，4.0），以及将家庭医学职业与农村地区执业相结合（21%对2%；RR，8.5）。在PSAP毕业生中，84%在农村或小都市地区或从事初级保健专业之一。项目留用率一直很高，目前从事农村家庭医学的PSAP毕业生人数相当于5至10年前执业人数的87%，在服务欠缺地区执业的人数为94%。
经过22年多，PSAP对农村医生队伍产生了不成比例的重大影响，且这种影响随着时间持续存在。基于这些项目结果，政策制定者和医学院可以对农村地区医生短缺问题产生重大影响。
