Increasing the Supply of Rural Family Physicians: Recent Outcomes From Jefferson Medical College's Physician Shortage Area Program (PSAP)
Increasing the Supply of Rural Family Physicians: Recent Outcomes From Jefferson Medical College's Physician Shortage Area Program (PSAP)
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DOI：
10.1097/acm.0b013e31820add6c
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发表时间：
2011-02-01
影响因子：
7.4
通讯作者：
Santana, Abbie J.
中科院分区：
文献类型：
--
作者：
Rabinowitz, Howard K.;Diamond, James J.;Santana, Abbie J.
目的农村地区初级保健医生的短缺是一个长期存在的问题，严重影响了获得保健的机会。尽管先前的研究表明，医学院的农村项目——如杰斐逊医学院的医生短缺地区项目（PSAP）——显著增加了农村劳动力，但决定这些项目是否继续成功是很重要的。方法：作者从杰弗逊纵向研究中获得了2394名PSAP和非PSAP毕业生的2007年实习地点和专业，这些毕业生来自11个以前未报道的杰弗逊毕业班（1992-2002）。他们确定了PSAP毕业生与非PSAP毕业生从事农村家庭医学的相对可能性，以及所有PSAP毕业生与非PSAP毕业生在宾夕法尼亚州农村县执业的相对可能性。结果与非PSAP毕业生相比，PSAP毕业生更有可能从事农村家庭医学工作（32.0%[31/97]对3.2%[65/ 2004]；相对风险[RR] = 9.9，可信区间[CI] 6.8 ~ 14.4, P < .001），也更有可能在宾夕法尼亚州农村从事任何专科工作（PSAP毕业生24.7%[24/97]对非PSAP毕业生2.0% [40/ 2004];RR = 12.4, CI 7.8 ~ 19.7, P < .001）。结论：尽管近几十年来医疗保健发生了重大变化，杰弗逊的PSAP仍然是一个成功的模式，大大增加了农村家庭医生的供应和分布。特别是随着医疗保险即将扩大，农村居民获得医疗服务将需要更多的医疗服务提供者。考虑到新的农村医生培训补助计划，这些结果对计划开发类似农村项目的医学院也很重要。
PurposeThe shortage of primary care physicians in rural areas is an enduring problem with serious implications for access to care. Although studies have previously shown that medical school rural programs-such as Jefferson Medical College's Physician Shortage Area Program (PSAP)-significantly increase the rural workforce, determining whether these programs continue to be successful is important.MethodThe authors obtained, from the Jefferson Longitudinal Study, the 2007 practice location and specialty for the 2,394 PSAP and non-PSAP graduates of 11 previously unreported Jefferson graduating classes (1992-2002). They determined the relative likelihood both of PSAP versus non-PSAP graduates practicing rural family medicine and of all PSAP versus non-PSAP graduates practicing in Pennsylvania's rural counties.ResultsPSAP graduates were much more likely both to practice rural family medicine than their non-PSAP peers (32.0% [31/97] versus 3.2% [65/2,004]; relative risk [RR] = 9.9, confidence interval [CI] 6.8-14.4, P < .001) and to practice any specialty in rural Pennsylvania (PSAP 24.7% [24/97] versus non-PSAP 2.0% [40/2,004]; RR = 12.4, CI 7.8-19.7, P < .001).ConclusionsDespite major changes in health care in recent decades, Jefferson's PSAP continues to represent a successful model for substantially increasing the supply and distribution of rural family physicians. Especially with the forthcoming expansion in health insurance, access to care for rural residents will require an increased supply of providers. These results may also be important for medical schools planning to develop similar rural programs, given the new Rural Physician Training Grants program.