北部區域榮民醫院主治醫師服務意願影響因素初探

A preliminary exploration of factors affecting attending physicians' willingness to provide care in veterans hospitals located in northern Taiwan

張志慶(Chih-Chin Chang)

指導教授 ： 丁志音

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2013年)

https://doi.org/10.6342/NTU.2013.01629

摘要

偏遠地區醫事人力不足之問題，是當前世界共同之健康人力問題之一，榮民醫院因成立時的歷史因素，多位於偏遠地區，監察院99年5月專案調查研究報告指出，欠缺下鄉支援之誘因，為各榮民醫院醫師人力不足主因。本研究採用質性研究的方法，採用立意取樣的抽樣策略，針對具備榮民醫院服務經驗的10位醫師進行深度訪談，了解醫師在醫院的工作概況及觀感，透過樣本資料整理分析，挖掘醫師面臨執業地區、機構的選擇，所考量的各項因素。
訪談樣本資料顯示，要讓沒有服務義務的醫師志願前往偏遠的榮民醫院服務，應提供高於都會區的薪資條件，多數醫師認為，「薪資」雖然不是唯一的條件，卻是基本條件，其他如工作負荷的公平合理，及醫療團隊、工作氛圍等條件所具之優勢，可稍彌補薪資條件的不足。家庭是選擇至東部地區服務的重要考量，不良的績效制度會影響醫師留任意願，專業的發展舞台則是長期留任的重要因素。
建議榮民醫院應妥善運用現有的整合措施，需要視醫院發展特色及業務需要，提升營運效能，縮小薪資條件差距，改變組織文化，建立有良好互動的醫療團隊，讓醫師能有專業發展空間，才是醫師留任服務的長期誘因。

關鍵字

主治醫師 ； 服務意願

並列摘要

Health care manpower shortage in remote areas is a common health human resources issue worldwide. Due to various historical factors, many hospitals belonging to the veteran hospital system in Taiwan are located in remote areas. The Control Yuan in a research report released in May 2010 has noted that lack of incentives for encouraging physician to serve in remote health care settings is a major factor contributing to physician shortage in these areas. This study aims to explore the work conditions and perceptions of various professional experiences of physicians who have ever practiced in less prestigious hospitals, and factors affecting their decision making when they have to make career choices.
By applying a qualitative method and basing on purposeful sampling principle, this research collected data through face-to-face in-depth interviews from 10 physicians who had been practicing at veteran hospitals located in less urban sites.
The results indicate that a salary which is higher than that of physicians practicing in large cities, especially in major metropolitan areas, is of central concern for participants who would like to volunteer to work in rural areas when they do not have obligation to do so. The salary, most physicians stressed, was not the only but was the fundamental consideration. Other factors such as fairness in workload assignment, great peer support and team work, and overall organizational atmosphere are necessary in making up for inadequate payment policy. Family-related considerations were at the heart of working in Eastern Taiwan, the most isolated and least urbanized area of the island. What also matters are effective physician performance systems, and the opportunities for professional development, which constitute the most essential factors for long-term retention.
To encourage physicians to serve in remote areas, the Veterans Hospital has to properly utilize the existing integration measures. By taking into account the long-term development goals of the Veterans hospital system and its operational needs, it should improve operational efficiency, reduce the pay gap, re-shape organizational cultures, build strong and supportive medical teams, and provide professional development opportunities to sustain physician retention services.

並列關鍵字

attending physicians ； veterans hospital

參考文獻

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