全民健保後外科醫師人力之調查與分析

Investigation and Analysis of Surgical Manpower after Implementation of National Health Insurance

張金堅(King-Jen Chang) ； 陳炯年(Chiung-Nien Chen) ； 朱樹勳(Shu-Hsun Chu)

《Journal of Medical Education》 2卷3期 (1998/09) Pp. 273-281

https://doi.org/10.6145/jme.199809_2(3).0007

摘要

為避免外科醫師的傳承發生断層，並探索其中原因，本研究利用衛生署提供之全國外科醫師人力檔及中華民國外科醫學會所提供之會員資料，進行問卷調查。分成二部分進行：1．針對全國外科醫師發出3386份問卷回收1346份，扣除10份無效問卷，共1336份有效問卷，回收率39.5%。2．針對全國地區敎學醫院以上之外科部主任進行問卷人力調查，共發出120份問卷，回收有效問卷58份，回收率48.3%。調查結果顯示，有91%的受訪醫院住院醫師不足，有50%的受訪醫院主治醫師不足，不願從事外科工作及外科人力不足的主要原因有健保支付制度的影響(28.3%)，工作繁重(17.6%)，工作壓力太大(15.6%)，收入不佳(13.0%)及價值觀改變(11.7%)等。目前外科醫師對工作的滿意度，表示尚可以上者有56.8%，表示不滿意者有42.6%，目前有49%的外科醫師考慮離開外科工作。有11.2%的外科醫師已經離開外科工作，其主要原因為健保給付不合理，太過勞累，壓力太大及怕醫療糾紛。離開後他們從事的科別以家醫科最多占70%，其次為內兒科占11.2%，若解決以上問題亦有三成的醫師不願意重回外科工作。總之，外科醫師確已嚴重不足，而外科人力不足及流失的原因，是多發性的。現階段最大問題是健保給付制度不合理，工作繁重壓力大和醫療糾紛多。

關鍵字

全民健保 ； 外科人力 ； 醫療品質

並列摘要

It has been difficult to recruit an adequate number of surgical residents in recent years, not only in local general hospitals but also in medical centers. This study investigated the causes of the manpower shortage in surgical residents.
We used data on surgical manpower provided by the health department and a survey of the directory of members of the Surgical Association R.O.C. by questionnaire for data collection. Data collection was divided into two parts. The first part involved the distribution of the study questionnaire, which was mailed to each of the 3386 qualified surgeons in Taiwan. A total of 1336 (39.5%) completed questionnaires were returned. The second part of data collection involved the distribution of the same questionnaire to each of the 120 chiefs of surgical departments in qualified surgical training hospitals in Taiwan. A total of 58 (48.3%) completed questionnaires were returned. The data showed that 91% of hospitals had manpower deficiencies for surgical residents, and 50% of them had a manpower deficiency for attending surgeons. The major causes of the manpower deficiencies were considered to be inappropriate payment from health insurance programs (28.3%), heavy workload (17.6%), heavy work pressure (15.6%), poor income potential (13.0%), increased risk of medical legal problems (12.7%), and change of social values and point of view (11.7%). Career satisfaction was indicated by 56.8% of surgeons who completed the questionnaire while the remaining respondents (42.6%) were not satisfied. Fourty-Nine percent of surgeons were considering quitting their surgical practice and11.2% had already quit their practices. Twenty percent of respondents who had already quit their surgical careers had changed their specialty to family physician, while 11.2% of them had changed to internists or pediatricians. Even if the above adverse factors were corrected,30%of surgeons who had quit their surgical careers expressed that they would not return to them.
There are multiple reasons for the deficiency and loss of surgical manpower. Major causes for the manpower shortage include inappropriate payment from health insurance programs, heavy workloads and the increased risk of medical legal problem encountered in surgical practice. Prompt and simultaneous correction of these three factors may end the vicious cycle of surgical manpower deficiency. (Full Text in Chinese)

並列關鍵字

Surgical manpower ； Health insurance ； quality assurance