In this second part of the article on the Residency System in North America we analyse the impact of the changes in the management and financing of healthcare on the evolution of training. The restriction of financial resources introduced by the third-party payer system and duty hour regulations ultimately deterioraterd the quality of training and the conduct of research by residents. The potential strategies to sustain and improve the Residency System at the end of the first quarter of the 21st century are commented.
En esta segunda parte del artículo sobre el Sistema de Residencia en Norteamérica se analiza la evolución de la formación del residente que estuvo fuertemente condicionada por los cambios en la gestión y la financiación del cuidado sanitario. La llegada del sistema de pagos a terceros (third-party payers) y otros factores, como la regulación del horario laboral, acabaron deteriorando la calidad del aprendizaje y la práctica de la investigación por parte del residente. Se comentan las posibles estrategias para sostener y mejorar el sistema de Residencia al finalizar el primer cuarto del sigloXXI.
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