影響不同職級醫師專科選擇因素之探討

Factors Affecting Choice of Specialty in Different Level of Physicians

莊惠雯(Hui-Wen Chuang)

指導教授 ： 王國照 ； 邱亨嘉

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2003年)

摘要

研究背景與目的：
目前我國醫事人力存在的問題不患寡而患不均，專家學者認為全民健康保險實施之後，醫療市場價格有了明顯的改變，進而影響醫學生專科選擇的態度，然而在財務考量之餘，醫學生在進行專科選擇時是否受其他因素所影響，期發展影響不同職級醫師專科選擇的預測因子，實是本研究主要探討的方向，希望能藉以作為醫學教育及醫療政策制訂時之參考。
研究方法：
本研究為横斷式調查法，研究對象以高雄醫學大學附設中和紀念醫院的主治醫師、住院醫師，以及高雄醫學大學醫學系七年級的醫學生為主，分別施予結構式問卷，並以SPSS10.0 for window版進行不同職級醫師之人口學特質、學習經驗，與服務科別的不同，與各影響選科因素（保險制度與市場需求、學習經驗、專業知識，以及個人價值觀）得分間的差異分析，並以邏輯式廻歸發展影響不同職級醫師進行科別選擇的預測因子。
研究結果：
主治醫師與住院醫師對於影響科別選擇因素的面向感受程度相當一致，分別為學習經驗、保險制度與市場需求、專業知識，個人價值觀等影響面向。而實習醫師對於保險制度與市場需求的影響面向感受程度位居首位，其餘排序與其他職級醫師相同。
保險制度與市場需求、學習經驗、專業知識、個人價值觀等四個影響面向均可作為影響醫師科別選擇的預測因子。其中個人價值觀的影響面向有最強的預測力，即個人價值觀的影響面向得分每增加一分，會增加選擇其他取向科別的機會平均高達50%，而選擇外科系取向科別的機會減少近20%。而專業知識的影響面向次之，即專業知識的影響面向得分每增加一分，則選擇其他科別的機會會減少24.7%。再來則為學習經驗的影響面向，即學習經驗的影響面向得分上每增加一分，則選擇其他取向科別的機會會減少11.4%。最後是保險制度與市場需求的影響面向，即保險制度與市場需求的影響面向的得分每增加一分，則選擇外科系取向的機會會增加6.7%。
結論與建議：
就醫學教育而言，可改進傳統的教學方式、或建立完整的教學系統、或發展尖端的醫療技術或儀器等。此外更應建立完善見實習課程的教學制度，以增加醫學生對臨床工作的興趣，更可使他們充分瞭解醫療專科的未來發展。
就政府單位與保險機構而言，建議調高人力不足科的保險給付，並針對選擇欲發展科別的醫師給予較好的給付或補助。並提供補助款給醫學校院及醫學中心，以發展完善的教學系統及增加學術研究的經費，建立完善的見實習課程的教育制度。

關鍵字

主治醫師 ； 住院醫師 ； 實習醫師 ； 科別選擇

並列摘要

Background and objectives：
Since the implementation of National Health Insurance program in 1995, medical market changed drastically in Taiwan. Medical professional groups thought that National Health Insurance did influence the attitude of physicians and their choice of specialty, as well as distribution of physicians’ manpower. The aim of our study was to identify the factors affecting choice of specialty among the different level of physicians, and hope to develop the ability to predict.
Methods：
Using the set questionnaire, we inquired 411 visiting staffs and residents at Kaohsiung Medical University Chung-ho Memorial Hospital and 471 seventh year medical students at Kaohusiung Medical University, and asked about factors that could affect their choice of specialty. Using a Likert-type scale, our study target rated potential influences on their specialty choices from 1, very negative, to 5, very positive. The overall response rate was 43.31%.
Results：
Factors affecting the choice of specialties for visiting staff and resident were the same. There were learning experiences at school and training hospital, insurance payment and market demand, professional knowledge, and personal value. And factors affecting intern are similar to those. There were insurance payment and market demand, learning experiences at school and training hospital, professional knowledge, and personal value.
In this study, I found that four factors (learning experiences at school and training hospital, insurance payment and market demand, professional knowledge, and personal value) were the best indicators to predict physician’s choice of their specialties.
Of those four affecting factors, personal value was the most powerful indicator. When the score of personal value gains 1 point, the opportunity of physician’s choice of other-orient specialty increases 50%, while the opportunity of surgical-orient specialty decreases 20%.
When the score of professional knowledge gains 1 point, the opportunity of physician’s choice of other-orient specialty decreases 24.7%. When the score of learning experiences at school and training hospital gains 1 point, the opportunity of physician’s choice of other-orient specialty decreases 11.4%. And finally, when the score of insurance payment and market demand gains 1 point, the opportunity of physician’s choice of surgical-orient specialty increases 6.7%.
Discussion：
From this study, I was able to make the following suggestions, and I believe this will help to better medical education and government input in health system. Medical schools should try to change the traditional teaching methods, at the same time overhaul the teaching system in order to develop the most advanced medical technology and provide the cutting-edge knowledge. This will attract the clerks and interns to the institution and receive the proper education they deserved. Hopefully, through this they will become a knowledgeable and compassionate physician.
As for government input in health, firstly, I suggested to disproportionally increase payment to the specialties that are short of manpower, thus the patients of the different diseases can receive the proper care. Secondly, probably the most important point is to provide additional subsidy to the medical school, hopefully through better medical teaching, the better physician could be trained. Finally, subsidizing for the medical center, this will provide the up to date clerk and intern medical education.

並列關鍵字

Visiting staff ； Resident ； Intern ； Choice for specialty

參考文獻

參考文獻

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行政院衛生署。(1988)。專科醫師分科及甄審辦法。台北：行政院衛生署。

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