我國實施醫學系一般公費生制度已有30年的歷史,其主要原始目的有二,第一、確保醫療資源缺乏地區,持續保有足夠的醫師從事高品質的醫療服務,第二、確保冷門的醫學領域,持續擁有足夠數量的醫師選擇執業。為瞭解此項政策之永續效果,本計畫以問卷調查方式,針對1995至2004年間服務期滿的公費生醫師,就其後續的執業狀況,包括專科選擇、執業地點、執業機構,以及對此項制度的意見、看法等項目,進行資料蒐集及分析研究。研究期間自2005年4月至2006年4月止,共發出938份問卷,其中寄還的問卷有309份,回收率為33%。研究結果顯示:服務期滿後的公費生醫師大多數是在人口集中的大城市,以及區域級以上的醫院服務,所選擇的科別與全國醫師的選擇有類似的分佈情形,並沒有偏重冷門科別的執業選擇。公費生醫師對醫學院校時期所受的養成教育多持肯定的態度,但是有一半的人對畢業後的受訓制度並不滿意;有一半的人表示如果能夠重新選擇,並不會選擇進入醫學系公費生培育計畫;有2/3 的人認為現行制度並不能夠達到原定的政策目標。公費生醫師對此制度的不滿意項目包括:專科選擇的限制及缺乏彈性、政策改變過於頻繁以及畢業後訓練制度的缺失。本研究認為現行醫學系一般公費生制度的功能,僅在為個人成為醫師的期望,提供另一道途徑,在培育具有熱忱的醫師,以服務偏遠地區民眾或從事冷門科系醫療方面,效果不彰,不能為國家政策的需要,持續提供足量的醫師人力,因此不但不能達到其策略性的公共利益,反而引起公費生醫師的不滿。本研究建議政府部門應重新檢討一般公費生醫師培育制度,慎重從政策面探討制度的變更甚至存廢問題,才能建立良善制度,善用國家資源,落實醫師培育成效。
The government sponsored general physician training program was implemented in Taiwan more than 30 years ago. The program has two main goals. Firstly, to ensure an adequate number of medical doctors serve in medical resources deprived areas on a regular basis and secondly to ensure all medical specialities recruit adequate numbers of medical doctors. This study investigated the sustained outcomes of the program. In total, 938 questionnaires were distributed to government-sponsored medical graduates who completed their training and service terms between 1995 and 2004. Items such as career status, specialty certified, practice institute and site and comments on the program were included. The study period was from April 2005 to April 2006 and 309 completed questionnaires were collected. The response rate was 33%. The results of the data analysis indicated most of the medical doctors now practice in large hospitals in big cities. The distribution of specialties choice was similar to the national average and an inadequate distribution of doctors in unpopular specialties still exists. Government sponsored medical graduates were satisfied with their school education; however, half of them were not satisfied with their post-graduate training. The same proportion would not consider the same program if they had to make the choice again. Two thirds of the doctors believed that the program did not achieve its original goals. The negative opinions included restrictions on specialty selection, frequent changes in the program and the limitations of the available postgraduate training programs. Most doctors participated the program in order to become doctors rather than to achieve the goals of the program. The program seemed unable to accomplish its original purposes and in the process also received constant negative comments from the programs' participants. We concluded that the program should be thoroughly reinvestigated in terms of its adequacy and its ability to achieve its goals.
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