To the Editor The Viewpoint by Ms Gudbranson and colleagues calculating the number of physicians needed in the United States did not consider the numerous roles that physicians play in the health care sector.¹ If administrative workload, teaching of trainees (medical students, residents, and fellows), and research are included, the estimates may be quite different. The administrative burden of billing, coding, and entering data in electronic medical records requires several extra hours of work per week. No physician can be expected to assign 100% of their time to clinical care, and although some previously published models account for clinical full-time equivalents,² it is unclear whether Gudbranson and colleagues took this into consideration. Furthermore, models accounting for clinical full-time equivalents project a serious shortage of physicians over the next decade. A report prepared for the Association of American Medical Colleges notes that the demand for physicians in 2025 will exceed supply by 46 100 to 90 400.² Physicians in the United States (excluding residents) work an average of 49.6 hours per week compared with 44.9 hours for lawyers, 43.0 hours for engineers, and 37.3 hours for registered nurses.³ This estimate does not take into account being on call when physicians need to be immediately available but not present on-site.

致编辑Gudbranson女士及其同事计算美国所需医生人数的观点并未考虑医生在卫生保健领域所扮演的众多角色。¹如果包括行政工作量，受训者（医学生，居民和研究员）的教学和研究，则估计值可能会大不相同。电子病历中计费，编码和输入数据的管理负担每周需要多花费几个小时的时间。不能期望有医生将其100％的时间分配给临床护理，尽管某些先前发表的模型解释了临床全日制等效性，[ ^2]目前尚不清楚Gudbranson及其同事是否考虑了这一点。此外，考虑到临床全职当量的模型预计在未来十年内医生将严重短缺。报告对协会美国医学院校的笔记准备，在2025年医师需求将46 100超过90名400供应²在美国医师（不含居民）的工作，平均每周49.6小时与44.9小时比较律师，工程师43.0小时和注册护士37.3小时。³当医生需要立即就职但不在现场时，此估算未考虑到待命状态。