好英语网美国到2015年将短缺医生6万
RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
加州里弗赛德——在南加州饱受经济危机创伤的“内陆帝国”(Inland Empire)地区，奥巴马总统的医疗法案预期将在2014年为逾30万人带来医疗保险。但保险覆盖率并不是医疗服务：当地卫生专家认为，该地区的医生数量将很难满足需求。而且，这种短缺已经存在。
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
美国其他地区，包括密西西比三角洲、底特律以及凤凰城郊区，都面临同样的问题。美国医学院协会(The Association of American Medical Colleges)预计，2015年全国将出现6.29万名医生的短缺。到2025年，随着保险范围扩大以及婴儿潮人群老龄化引发医疗护理需求的增长，这个数字将增加一倍。即使没有医疗法案，2025年医生的短缺数量仍将超过10万人。
Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.
卫生专家，包括很多支持这项法案的人称，在2014年，该法案会开始把约3000万美国人纳入覆盖范围，而政府或者医疗界将很难在此之前缩小这一缺口。因为一般培养一名医生的时间是10年。
“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”
“除了整形和皮肤科医生外，我们各种医生都缺，”加利福尼亚大学里弗赛德分校医学院院长G.·理查德·奥尔兹(G. Richard Olds)称。这所新医学院的成立在一定程度上就是为了解决该地区医生资源匮乏的问题。“10年内，无论怎样努力，我们都将有着5000名医生的缺口。”
Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.
专家把医生稀缺称为“隐性问题”。病人虽然能得到救治，但这个过程经常是缓慢和艰难的。在里弗赛德，很多居民看病要开车去很远的地方，其他人则要在等待名单上保受煎熬。这里还有急诊室滥用和取消治疗的情况。
“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”
“这引发了治疗延后以及病情恶化，”加州医学会(California Medical Association)的负责人达斯廷·科科伦(Dustin Corcoran)称，该医学会有3.5万名医生成员。人们“进入医疗系统要通过急诊部，而不是靠和给他们提供日常医疗保健的初级保健医生建立关系，而这些医生本可能防止病人的病情进一步恶化。”
In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.
内陆帝国地区包括里弗赛德县和圣贝纳迪诺县，这里已经出现了医生严重匮乏的情况。里弗赛德县的人口数量在2000年代大幅膨胀42%，增加了64.4万多人。尽管美国最大的房地产泡沫之一已经破裂，而且里弗赛德-圣贝纳迪诺-安大略市区地区的失业率为11.8%，但这里的人口数量还在不断上涨。
But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.
然而医生数量的增长却一直滞后。一个很大的原因是因为该地区不能吸引医生，因为医生可能在附近的橘子县或者洛杉矶找到薪酬更为丰厚的工作和更好的居住环境。
A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.
一个政府委员会建议，在任何地区，每10万居民中应该有60至80名初级保健医生，及85至105名专科医生。而在内陆帝国地区，每10万居民只有40名初级保健医生和70名专科医生。这两项数据都是加利福尼亚州最差的。
Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.
另外，在2008年，全国只有不足半数的初级保健医生接收了新医疗补助病人，这使得穷人即使有拥有享受医疗补助的资格，也很难得到医疗服务。医疗补助的扩大占了奥巴马总统医疗法案中全部覆盖增长的三分之一以上。
Providers say they are bracing for the surge of the newly insured into an already strained system.
医疗提供者称，他们正准备迎接激增的新保险人群加入到原本已经吃紧的系统中。
Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.
在全美，除了受法律规定扩大医疗保险覆盖范围和人口增长的影响外，另一个增加医疗需求的因素是婴儿潮人群的老龄化。医疗保险官员预测，入保人数将在2025年激增至7320万人，比今年的5070千万人增加44%。
“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”
“美国老年人对医疗服务的需求量远超从前，”美国医学院协会会长达雷尔·G.·基尔希(Darrell G. Kirch)称。“老年人更可能患有有多种慢性疾病，需要更深入、协调的治疗。”
The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.
卫生专家称，医生资源一直未能保持同步增长，这种情况将来也不会改变。虽然医学院的入学人数在上升，但还是不及人口增长速度。医学院毕业生的培训职位数量也比较滞后。平均来说，年轻一代医生要比他们的前任工作时间短。而且全国三分之一的医生都在54岁以上，马上就要面临退休。
Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.
医生的工资也是一个问题。过去15年中，医学院学生选择从事初级保健医疗的数量已经减少，因为初级保健医生和骨科医生、放射科医生等专科医生相比，他们之间的工资差距在拉大。医疗集团管理学会(Medical Group Management Association )的一项研究发现，在2010年，初级保健医生的年薪约为20万美元，而专科医生的年薪一般都在这个数字的两倍左右。
The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.
奥巴马政府已经采取措施缩小缺口。医疗法案中将2013年和2014年医疗补助的基层治疗费用上调，还拨款培养新的初级保健医生，对他们在医料资源不足的社区服务进行奖励，并计划强化社区健康中心。
But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.
但这项法案预期将在未来10年中增加约3千名基层医生。然而全美社区所需数量为4.5万人。
Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.
加州的很多卫生专家称，他们虽然欢迎扩大医疗保险覆盖范围，但预计该州还没有准备好去满足这些新的需求。因为医生的短缺，我们“应该更加明智地利用现有资源，”非营利性组织加州医疗基金会(California Health CareFoundation)的负责人马克·D·史密斯(Mark D. Smith)称。