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A study of the workforce in emergency medicine: 1999

ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 3-15页

作者： Moorhead, JC Gallery, ME Hirshkorn, C Barnaby, DP Barsan, WG Conrad, LC Dalsey, WC Fried, M Herman, SH Hogan, P Mannle, TE Packard, DC Perina, DG Pollack, CV Rapp, MT Rorrie, CC Schafermeyer, RW Oregon Hlth Sci Univ Dept Emergency Med Portland OR 97201 USA Amer Coll Emergency Phys Irvine CA USA Lewin Grp Falls Church VA USA Mt Sinai Sch Med Dept Emergency Med New York NY USA Univ Michigan Dept Emergency Med Ann Arbor MI 48109 USA St Joseph Hosp Dept Emergency Med Denver CO USA Robert Wood Johnson Univ Hosp Dept Emergency Med New Brunswick NJ USA Amer Coll Emergency Phys Washington DC USA Wesley Long Moses Cone Hosp Dept Emergency Med Greensboro NC USA Baylor Univ Med Ctr Dept Emergency Med Dallas TX USA Univ Virginia Hlth Sci Ctr Dept Emergency Med Charlottesville VA USA Penn Hosp Dept Emergency Med Philadelphia PA 19107 USA Washington Univ Sch Med & Hlth Dept Emergency Med Washington DC USA Carolinas Med Ctr Dept Emergency Med Charlotte NC 28203 USA

Study objective: We estimate the total number of physicians practicing clinical emergency medicine during a specified period, describe certain characteristics of those individuals to estimate the total number of full-time equivalents (FTEs) and the total number of individuals needed to staff those FTEs, and compare the data collected with those data collected in 1997. Methods: Data were gathered from a survey of a random sample of 2,153 hospitals drawn from a population of 5,329 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, and the total number of physicians working during the period from June 6 to June 9, 1999. Demographic data on the individuals were also collected. Results: A total of 940 hospitals responded (a 44% return rate). These hospitals reported that a total of 6,719 physicians were working during the specified period, or an average of 7.85 persons scheduled per institution. The physicians were scheduled for a total of 347,702 hours. The average standard for FrE was 40 clinical hours per week. This equates to 4,346 FTEs or 5.29 FTEs per institution. The ratio of persons to FrEs was 1.48:1. With regard to demographics, 83% of the physicians were men, and 82% were white. Their average age was 42.6 years. As for professional credentials, 42% were emergency medicine residency trained, and 58% were board certified in emergency medicine;50% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 5,064 hospitals with EDs and given that the data indicate that there are 5.35 FTEs per ED, the total number of FTEs is projected to be 27,067 (SE=500). Given further that the data indicate a physician/FTE ratio of 1.47:1, we conclude that there are 39,746 persons (SE=806) needed to staff those FTEs. When adjusted for persons working at more than on

关键词：美国医院协会证明/统计学和数值数据急救医学/教育急诊室医院实习医师和住院医师职务/统计学和数值数据医务人员医院/标准医务人员医院/供应和分配人员配备和时间安排/统计学和数值数据专业场所/统计学和数值数据前瞻性研究薪金和附加福利/统计学和数值数据美国工作负荷量/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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The distribution of rural female generalist physicians in the United States

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JOURNAL OF RURAL HEALTH 2000年第2期16卷 111-118页

作者： Doescher, MP Ellsbury, KE Hart, LG Univ Washington Dept Family Med Sch Med Seattle WA 98195 USA

Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physician Masterfile. Percentages and numbers of female physicians by professional activity, specialty type, and geographic location are reported. Findings reveal there were fewer than 7,000 female allopathic physicians practicing in rural America in 1996. The proportion of generalist female physicians who practice in rural settings was significantly lower than the proportion who practice in urban locations. Although members of then most recent 10-year medical school graduation cohort of female generalist physicians remained significantly underrepresented in rural areas. States varied dramatically in rural female generalist underrepresentation. Should female generalists continue to be underrepresented in rural locations, the rural physician shortage will nit be resolved quickly. Effective strategies to improve rural female physician placement and retention need to be identified and implemented to improve rural access to physician care.

关键词：美国医学协会卫生服务易得程度/统计学和数值数据缺医地区医师家庭/供应和分配医师女/供应和分配专业场所/统计学和数值数据乡村卫生服务/人力美国女(雌)性人类男(雄)性

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Educating generalist physicians for rural practice: How are we doing?

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JOURNAL OF RURAL HEALTH 2000年第1期16卷 56-80页

作者： Geyman, JP Hart, LG Norris, TE Coombs, JB Lishner, DM Univ Washington Sch Med Dept Family Med Seattle WA 98195 USA Univ Washington Sch Med WWAMI Rural Hlth Res Ctr Dept Family Med Seattle WA 98195 USA

Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by federal and state governments to promote the choice of rural practice among physicians. This comprehensive literature review uns based on MEDLINE and Health STAR searches, content review of more than 125 relevant articles and review of other materials provided by members of the Society of Teachers of Family Medicine Working Group on Rural Health. To the extent possible, a particular focus was directed to "small rural" communities of less than 10,000 people. Significant progress has been made in arresting the downward trend in the number of physicians in these communities but 22 million people still live in health professions shortage areas. This report summarizes the successes and failures of medical education and government programs and initiatives that are intended to prepare and place more generalist physicians in rural practice. It remains clear that the educational pipeline to rural medical practice is long and complex, with many places for attrition along the way Much is now known about how to select, train and place physicians in rural practice but effective strategies must be as multifaceted as the barriers themselves.

关键词：家庭医学/教育家庭医学/人力缺医地区模型教育人员选用/方法医师家庭/供应和分配专业场所/统计学和数值数据乡村卫生服务/人力美国美国卫生保健研究和质量评估署人类

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Multi-method assessment of access to primary medical care in rural Colorado

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 113-121页

作者： Fryer, GE Drisko, J Krugman, RD Vojir, CP Prochazka, A Miyoshi, TJ Miller, ME Univ Colorado Hlth Sci Ctr Denver CO 80220 USA

The objectives of this study include conducting an analysis of access to primary medical care in rural Colorado through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indices. Analyses examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads that might result from every rural Coloradoan's exclusive use of the nearest generalist physician as a regular source of care. Using American Medical Association Physician Masterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files (Census of Population and Housing, 1990), the authors calculated distance to the nearest primary care physician for residents of each of the 1,317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the nearest provider for care. Straight-line mileage to primary medical care was modest for rural Coloradoans-a median distance of 2.5 miles. Almost two-thirds (65 percent) of the population resided within 5 miles, and virtually all residents (99 percent) were within 30 miles of a generalist physician. However, had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries depict access to primary medical care and corresponding consumer difficulty more fully than in previous studies. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.

关键词：科罗拉多数据说明统计卫生服务易得程度/标准卫生服务研究/方法医师家庭/供应和分配医师家庭/利用人口密度初级卫生保健/人力初级卫生保健/利用专业场所/统计学和数值数据乡村卫生服务/人力乡村卫生服务/利用旅行工作负荷量人类

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Dimensions of retention: A national study of the locational histories of physician assistants

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 391-402页

作者： Larson, EH Hart, LG Goodwin, MK Geller, J Andrilla, C Univ Washington Sch Med Dept Family Med WWAMI Rural Hlth Res Ctr Seattle WA 98195 USA

This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice. Through a survey, physician assistants listed all the places they had practiced since completing their physician assistant training, making it possible to classify the career histories of physician assistants as "all rural," "all urban," "urban to rural" or "rural to urban." The study examined the retention of physician assistants in rural practice at several levels: in the first practice, in rural practice overall and in states. Physician assistants who started their careers in rural locations were more likely to leave them during the first four years of practice than urban physician assistants, and female rural physician assistants were slightly more likely to leave than men. Those starting in rural practice had high attrition to urban areas (41 percent);however a significant proportion of the physician assistants who started in urban practice settings left for rural settings (10 percent). This kept the total proportion of physician assistants in rural practice at it steady 20 percent. While 21 percent of the earliest graduates of physician assistant training programs have had exclusively rural careers, only 9 percent of physician assistants with four to seven years of experience have worked exclusively in rural settings. At the state level, generalist physician assistants were significantly more likely to leave states with practice environments unfavorable to physician assistant practice in terms of prescriptive authority, reimbursement and insurance.

关键词：专业场所/统计学和数值数据问卷调查乡村卫生服务/人力美国市区卫生服务/人力

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Effects of second office and hospital consulting practices of physicians on rural communities

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 179-189页

作者： Hicks, LL Hassinger, E Taparanskas, W UNIV MISSOURI 324 CLARK HALLCOLUMBIAMO 65211 USA

This research examined the prevalence of second offices and hospital consulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of services through these practices, the characteristics of counties and hospitals involved, and the practice organization of participating physicians. The assessment of the factors was conducted within the conceptual framework of community and physician characteristics, practice form and organization, and health system resources. In 1993, 64 of the 93 nonmetropolitan counties in Missouri, gained, on average, 1.3 full-time equivalent physicians through second office and hospital consulting practices. Eighteen nonmetropolitan counties lost, on average, 0.4 full-time equivalent physicians through these practices;11 nonmetropolitan counties were not affected. The majority of physicians engaged in these two types of practices are nonprimary care specialists. Consequently, in addition to the net contribution to total physician service availability, many nonmetropolitan counties gained access locally to a wider variety of specialty services. This change in availability of physician services, not generally incorporated in decisions, needs to be considered when policy efforts are undertaken to change the spatial and specialty distribution of physicians.

关键词：职业选择卫生保健调查/方法卫生服务易得程度卫生服务研究医院乡村/人力院内诊疗医务人员医院/供应和分配密苏里医师/统计学和数值数据医师/供应和分配医师办公室专业场所/统计学和数值数据转诊和会诊/组织和管理乡村卫生服务/人力女(雌)性人类男(雄)性

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The effects of physician in-migration to rural Colorado (1992 to 1995)

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 190-195页

作者： Fryer, GE Stine, C Vojir, C Miyoshi, T Miller, M UNIV COLORADO HLTH SCI CTRDEPT FAMILY MEDBOX B1551180 CLERMONTDENVERCO 80220 USA

This paper reports the results of an analysis of the American Medical Association Masterfile. The purpose of this study was to examine changes in health care accessibility in rural Colorado from 1992 to 1995, and to describe the pattern of in-migration of physicians to nonmetropolitan statistical area counties of the state during that period. The number of direct patient care providers increased from 532 to 700 (31.6%) during the three-year period vs. a growth of 11.2 percent in the general population of nonmetropolitan statistical area counties. Of the 700 physicians serving residents of Colorado's 52 rural counties, 308 (44%) had been practicing in their community since 1992. The rate of departure from nonmetropolitan statistical area practice sites in 1992 was 26.4 percent (140 of 532). Physicians new to their rural practice locations were younger and proportionally more female, but they were similar in primary medical specialty to doctors who had remained in their 1992 sites. Population to physician and to primary care physician ratios were much more favorable for 1995 than for 1992. Accessibility to care was most improveed in counties with fewer than 10,000 inhabitants.

关键词：美国医学协会职业选择科罗拉多卫生保健调查卫生服务易得程度/统计学和数值数据卫生服务易得程度/发展趋势缺医地区医师/统计学和数值数据医师/供应和分配专业场所/统计学和数值数据乡村卫生服务/人力乡村卫生服务/组织和管理美国女(雌)性人类男(雄)性

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Is the target income hypothesis an economic heresy?

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MEDICAL CARE RESEARCH AND REVIEW 1996年第3期53卷 243-266页

作者： Rizzo, JA HARVARD UNIV SCH MED CAMBRIDGE MA 02138 USA

This study is the first to relate physician-specific measures of target and actual income to pricing decisions. We find that a higher ratio of target to actual income leads to a significant price increase among self-employed,fee-for-service primary care physicians, with an elasticity of approximately 0.3, but not among self-employed primary care physicians who are not paid on a fee-for-service basis. Thus we find evidence of target income pricing when, as in the case of fee-for-service practices, physicians stand to gain financially from their pricing decisions. Although the target income hypothesis (TIH) has been criticized for lacking firm grounding in economic theory, this article argues that the notion of targets has a long history in economic theory and pricing to achieve a target is not new. Moreover, a variety of economic explanations render such behavior consistent with profit maximizing objectives.

关键词：按诊疗收费计划/经济学费用医疗/统计学和数值数据卫生服务研究收入/发展趋势模型经济计量学医师家庭/经济学医师家庭/供应和分配诊疗工作管理医学/经济学专业场所/经济学专业场所/统计学和数值数据美国女(雌)性人类男(雄)性

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International medical graduates in rural America: The 1987 distribution of physicians who entered the US medical system between 1969 and 1982

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JOURNAL OF RURAL HEALTH 1996年第5期12卷 423-431页

作者： Mick, SS Sutnick, AI UNIV MICHIGAN SCH PUBL HLTHDEPT HLTH POLICY & MANAGEMENT109 OBSERVANN ARBORMI 48109 USA

This study examines the differential location on Dec. 31, 1987, in nonmetropolitan U.S. counties of a cohort of international medical graduates (IMGs) (n=246,754) certified by the Educational Commission for Foreign Medical Graduates between 1969 and 1982, and a matched group of U.S. medical graduates (USMGs). Analysis of counties grouped into categories of population size revealed disparities across certain U.S. census divisions. IMGs were distributed disproportionately in the West North Central and East South Central census divisions. The implications of the IMG presence in numerous rural counties is discussed from the perspective of recent policy proposals to reduce the number of IMGs in the United States.

关键词：卡方分布数据收集外国医学研究生/供应和分配卫生服务易得程度卫生服务研究/方法专业场所/统计学和数值数据乡村卫生服务/人力美国人类

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THE IMPACT OF PHYSICIAN CHARACTERISTICS IN CONDITIONAL CHOICE MODELS FOR HOSPITAL-CARE

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JOURNAL OF HEALTH ECONOMICS 1992年第1期11卷 43-62页

作者： BURNS, LR WHOLEY, DR UNIV ARIZONA COLL BUSINESS & PUBL ADMSCH PUBL ADMTUCSONAZ 85721 CARNEGIE MELLON UNIV DEPT SOCIAL & DECIS SCIPITTSBURGHPA 15213

Recent research has investigated the determinants of the specific hospitals to which patients are admitted. Data limitations have led researchers to examine the effects of patient and hospital characteristics while ignoring the role of physician characteristics. In this study we analyze the effects of all three sets of factors on hospital choice in the greater Phoenix area during 1989. Our results suggest that physician characteristics are strong determinants of hospital choice, accounting for much of the explained variation. Differences in hospital quality and cost, on the other hand, exert significant effects on hospital choice but explain relatively little variation.

关键词：亚利桑那卫生服务范围/统计学和数值数据选择行为诊断相关患者组/统计学和数值数据费用和收费/统计学和数值数据卫生服务研究/方法医院死亡率医院/分类医院/统计学和数值数据医院/利用模型统计学医师/分类医师/统计学和数值数据医师/利用专业场所/统计学和数值数据卫生保健质量/统计学和数值数据回归分析运输人类

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