Comparison of Physician Workforce Estimates and Supply Projections
Comparison of Physician Workforce Estimates and Supply Projections
复制标题
DOI：
10.1001/jama.2009.1461
复制
发表时间：
2009-10-21
影响因子：
120.7
通讯作者：
Buerhaus, Peter I.
中科院分区：
文献类型：
--
作者：
Staiger, Douglas O.;Auerbach, David I.;Buerhaus, Peter I.
美国医生供应的背景估计一直基于可能高估劳动力中老年医生数量的数据。目的比较使用美国医学会医生主文件(Masterfile)数据的医生劳动力估计和供应预测与使用美国人口普查局当前人口调查(CPS)数据的估计和预测。设计、设置和参与者使用主文件和CPS的年度数据对1979至2008年间按年龄和性别划分的在职医生数量的就业趋势进行平行回顾队列分析。最近的劳动力趋势被用来按年龄预测未来的医生供应。主要结果衡量在10岁年龄组中每周至少工作20小时的医生的年数量。结果在样本期间的平均年份，CPS估计活跃医生比MasterFILE少6.7万(10%)(95%可信区间[CI]，57 00078 000；P<；.001)，几乎完全是由于55岁或以上的活跃医生较少。CPS估计的年轻医生(年龄25-34岁)比MasterFILE更多，在最后15年中，两者的差距扩大到平均17000人(12%)(95%CI，13000-22000；P<；.001)。CPS对更多年轻医生的估计与第一年住院医生数量的历史增长一致，而对老年医生较少的CPS估计与老年医生较低的联邦医疗保险账单一致。基于CPS和Masterfile数据的预测表明，2005至2020年间，在职医生的数量将增加约20%。然而，使用CPS数据对2020年的预测估计活跃医生比使用Masterfile数据的预测少近10万(9%)(9%对105万)，并估计65岁或以上的活跃医生的比例较小(9%对18%)。女性医生比例的增加对医生供应预测的影响很小，因为与男性医生不同，女性医生被发现在55岁后仍保持着他们的工作活动。结论与Masterfile数据相比，使用CPS数据进行的估计发现，更多的年轻医生进入劳动力大军，更少的老年医生保持活跃，导致估计现在和未来的医生队伍越来越小。贾玛2009；302(15)：1674-1680
Context Estimates of physician supply in the United States have been based on data that may overestimate the number of older physicians in the workforce.Objective To compare physician workforce estimates and supply projections using the American Medical Association Physician Masterfile (Masterfile) data with estimates and projections using data from the US Census Bureau Current Population Survey (CPS).Design, Setting, and Participants Parallel retrospective cohort analyses of employment trends of the number of active physicians by age and sex using annual data from the Masterfile and the CPS between 1979 and 2008. Recent workforce trends were used to project future physician supply by age.Main Outcome Measure Annual number of physicians working at least 20 hours per week in 10-year age categories.Results In an average year in the sample period, the CPS estimated 67 000 (10%) fewer active physicians than did the Masterfile (95% confidence interval [CI], 57 00078 000; P < .001), almost entirely due to fewer active physicians aged 55 years or older. The CPS estimated more young physicians (ages 25-34 years) than did the Masterfile, with the difference increasing to an average of 17 000 (12%) during the final 15 years (95% CI, 13 000-22 000; P < .001). The CPS estimates of more young physicians were consistent with historical growth observed in the number of first-year residents, and the CPS estimates of fewer older physicians were consistent with lower Medicare billing by older physicians. Projections based on both the CPS and the Masterfile data indicate that the number of active physicians will increase by approximately 20% between 2005 and 2020. However, projections for 2020 using CPS data estimate nearly 100 000 (9%) fewer active physicians than projections using the Masterfile data (957 000 vs 1 050 000), and estimate that a smaller proportion of active physicians will be 65 years or older (9% vs 18%). The increasing proportion of female physicians had little effect on physician supply projections because, unlike male physicians, female physicians were found to maintain their work activity after age 55 years.Conclusion Compared with the Masterfile data, estimates using the CPS data found more young physicians entering the workforce and fewer older physicians remaining active, resulting in estimates of a smaller and younger physician workforce now and in the future. JAMA. 2009;302(15):1674-1680