台灣急診主治醫師急診工作規劃的分析

An Analysis of Career Planning among Emergency Attending Physicians in Taiwan

陳維恭(Wei-kung Chen) ； 劉文斌(Wen-Pin Liu) ； 林克潢 (Kw-Huang Lin) ； 林光隆(Kuang-Lung Lin)

《Journal of Emergency Medicine, Taiwan》 6卷3期 (2004/09) Pp. 349-357

摘要

目的：急診醫師人力問題，一直是台灣急診醫學發展重要的課題，但在這方面的分析及探討卻十分的少。本研究的目的是希望能對急診主治醫師在急診工作的規劃做進一步的分析，以提供急診未來人力規劃上的參考。
材料與方法：本研究是以郵寄問卷調查的方法進行，問卷對象是全台各醫院服務於急診的主治醫師。調查內容包括急診主治醫師工作規劃以及影響其規劃的因素。其中明確表達急診服務時間者，被分為有及無長期急診服務打算兩組，長期服務打算是指預訂在急診服務十年以上者。此外，針對服務於不同醫院等級的主治醫師，就十六項有關離開急診的原因及二十二項有關工作壓力的來源進行分析。
結果：共有46家醫院的128份有效問卷進入分析。明確回答預計留在急診時間的有97位，另31位是視狀況再決定要在急診服務的時間。其中有11%（11/97）預計3年內會離開急診，6年內會離開急診的有36%（35/97），而願意留在急診工作的時間10年以上的只有47%(46/97)。比較有無長期服務打算的兩組醫師發現，影響長期服務打算的因素中，以大夜班數及急診工作影響日常情緒的因素上有顯著的差異。急診主治醫師認為會離開急診的原因以壓力太大(69%)及生活不規則(67%)最多。而工作壓力來源最多的是隨時可能爆發的醫療糾紛（85%）。
結論：急診主治醫師留在急診工作的狀況仍不穩定。未來在做人力規劃時，一定要審慎考慮，以避免造成惡性循環。而要維持急診人力的穩定，解決急診醫師在工作壓力上的問題則是當務之急。

關鍵字

急診 ； 急診醫師 ； 人力

並列摘要

Background: Emergency physician manpower is very important issue in the development of emergency medicine. However, the problems related to career plans of physicians in the Emergency Department (ED) have rarely been discussed. The purpose of this study was to analyze the career plans of emergency attending physicians. The data may be used as a reference for manpower resource designation.
Method: Questionnaires were sent by mail to emergency attending physicians of Taiwan. The contents of the questionnaire included items related to career planning and the factors affecting the physicians' career choices. Time of planning to stay at ED, longer than 10 years or short than 10 years was categorized into two group. Long term employment in the ED was defined as 10 years. There were 16 items related to reasons for leaving the ED and 22 items related to stress in the ED.
Results: Forty-six hospitals ( respondent rate=22%) and 128 useable questionnaires were entered into the analysis. Ninety-seven physicians had answered how long they plan to work in the ED. Among them, 11% (11/97) will leave EDs in first 3 years, while 36% (35/97) leave in 6 years. Only 47 % remained working in the ED for more than 10 years. The factors affecting willingness to stay in the EDs for more than 10 years were investigated. There were significant differences between willing and unwilling physicians with regard to shiftwork and emotional effects of work. The most common reasons given for leaving the ED were stress (69%) and irregular working hours(67%). The most commonly reported source of stress was medical legal problems (85%).
Conclusion: Attending physician manpower of ED was under an unstable status. To maintain stable emergency physician manpower in the future, it is very important to resolve the stress which emergency physicians must cope with to stabilize the physicians manpower of ED.

並列關鍵字

career planning ； emergency department ； emergency physicians ； manpower