Benchmarking the US physician workforce - An alternative to needs-based or demand-based planning
Benchmarking the US physician workforce - An alternative to needs-based or demand-based planning
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DOI：
10.1001/jama.276.22.1811
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发表时间：
1996-12-11
影响因子：
120.7
通讯作者：
Wennberg, JE
中科院分区：
文献类型：
--
作者：
Goodman, DC;Fisher, ES;Wennberg, JE
客观。-提出以人口为基础的基准作为替代需求或需求为基础的规划，以估计美国及其区域医疗保健市场的合理规模，临床活跃的医生队伍。1993年美国医学协会和美国骨科协会医师主要文件的横断面分析。美国306个医院转诊地区的常住人口。主要结果测量。根据年龄和性别人口差异以及区域外医疗保健利用调整的专业临床活跃医生的人均数量，将测量的医生队伍与4个基准进行比较：大范围内的人员配置（240万成员）健康维护组织（HMO），一个以管理式护理为主的医院转诊区域（明尼阿波利斯，明尼苏达州），一个以收费服务为主的医院转诊地区（威奇托，堪萨斯州），以及拟议的“平衡”医生供应（50%的全科医生）。居住在人均多面手劳动力高于基准的医院转诊地区的美国人口比例在HMO基准中为96%，在威奇托为60%，在明尼阿波利斯为27%。74%的人口的专家劳动力超过了所有3个基准，通才的人均劳动力与各地区通才的比例无关（Pearson相关系数=0.06; P=.26）。以人口为基础的基准提供了实际的优势，需要或需求为基础的规划，估计一个合理规模的人均劳动力的临床活跃的医生。HMO和医疗保健市场基准内的医生劳动力表明区域医生就业和服务的机会各不相同。多面手与专家的比例并不能衡量全国或特定地区多面手劳动力供应的充足性。衡量不同规模的医生劳动力与人口结果之间关系的研究将指导未来区域基准的选择。
Objective.-To propose population-based benchmarking as an alternative to needs- or demand-based planning for estimating a reasonably sized, clinically active physician workforce for the United States and its regional health care markets.Design.-Cross-sectional analysis of 1993 American Medical Association and American Osteopathic Association physician masterfiles.Population.-The resident population of the 306 hospital referral regions in the United States.Main Outcome Measures.-Per capita number of clinically active physicians by specialty adjusted for age and sex population differences and out-of-region health care utilization, The measured physician workforce was compared with 4 benchmarks: the staffing within a large (2.4 million members) health maintenance organization (HMO), a hospital referral region dominated by managed care (Minneapolis, Minn), a hospital referral region dominated by fee-for-service (Wichita, Kan), and the proposed ''balanced'' physician supply (50% generalists).Results.-The proportion of the US population residing in hospital referral regions with a higher per capita generalist workforce than the benchmark was 96% for the HMO benchmark, 60% for Wichita, and 27% for Minneapolis. The specialist workforce exceeded all 3 benchmarks for 74% of the population, The per capita workforce of generalists was not related to the proportion of generalists among regions (Pearson correlation coefficient=0.06; P=.26).Conclusions.-Population-based benchmarking offers practical advantages to needs- or demand-based planning for estimating a reasonably sized per capita workforce of clinically active physicians. The physician workforce within the benchmarks of an HMO and health care markets indicates the varying opportunities for regional physician employment and services. The ratio of generalists to specialists does not measure the adequacy of the supply of the generalist workforce either nationally or for specific regions. Research measuring the relationship between physician workforces of different sizes and population outcomes will guide the selection of future regional benchmarks.