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  • 學位論文

影響基層診所醫師生涯滿意度之相關因子分析

Factors associated with office-basede physicians' career satisfaction

指導教授 : 陳端容

摘要


中文摘要 世界衛生組織擬定全民健康的目的, 期望能藉由落實基層醫療保健來促進民眾健康, 因此, 基層醫療, 已被視為維護大眾健康極重要的一環; 台灣社會經過各個階段的變遷影響, 醫師的執業選擇也趨近於先進已開發的國家, 尤其最近全民健保的實施, 更對醫師的生涯規劃, 有著極其重要的影響; 近年台灣的醫療市場發展, 財團爲求多角經營牟利, 大力介入醫療產業, 台灣醫師的就業趨勢, 也愈來愈受到外在環境的干擾. 再看台灣整體的封閉式醫療結構仍未改變, 使得醫師一但選擇診所執業, 便不易與醫院取得聯繫, 醫院享有的最新醫療資訊與技術, 無法甚至不願移轉至基層醫師, 使得基層醫師的醫療品質受到民眾質疑, 醫師的專業發展亦受到阻礙難以與時俱進; 不能有效的利用基層醫療資源, 不僅增加醫療成本, 更讓基層醫師人力無法得到妥善的運用, 病患在醫院間流轉, 卻仍得不到完整的醫療照顧,醫院也視病患為衝量的財源, 不斷的安排檢驗與重複門診, 如此失衡的醫療生態, 如何降低醫療費用的支出? 因此, 健全的基層醫療才是維護大眾健康及降低醫療成本的有效工具. 醫師在其職業生涯中, 會在醫院繼續服務, 或是走向基層執業, 其間的選擇決定因素, 國內外已有許多理論與實證研究, 但選擇到基層執業的醫師, 其專業滿意度及身心狀況, 在卻少有研究深入探討. 在現況眾多不利基層診所執業的因素影響下, 正在基層診所的醫師面對如此複雜的競爭環境, 其身心狀況是否有足夠的抗壓性來面對這些挑戰? 執業醫師對本身工作的滿意度是否符合當初選擇基層的期許? 本研究以民國91年衛生署登記基層西醫診所之資料, 篩減後的8925間診所為對象, 將診所醫師個人背景, 執業前經歷, 執業現況與健康狀況為自變項, 執業生涯滿意度為依變項, 郵寄設計問卷, 回收1132份, 粗估無法寄達者5%, 回收率13.4%, 研究結果發現, 個人背景裡的執業型態單獨執業及聯合診所要比受僱醫師生涯滿意度高, 年齡輕的組群較年長者滿意度高; 執業前在醫院裡曾擔任科部主管的經驗者有較佳的執業滿意度; 執業現況中, 非為經濟因素選擇基層執業者以及持續與醫院受訓時相同科別執業者的滿意度較高; 而健康狀況三個構面分數較高較健康者的職業生涯滿意度比分數較低較不健康者為佳. 由本研究最終分析結果, 女性或是健康狀態較佳的醫師, 曾在醫院有行政主管經歷, 持續原來的科別, 沒有經濟壓力, 年齡較輕且是在聯合診所型態較短的工作時間, 這些條件下, 基層執業生涯滿意度會較高.

並列摘要


ABSTRACT The World Health Organization (WHO) draws up the Chapter of All-Person Health in an attempt to enhance public health by thoroughly materializing the medical care at the grass-roots level. The office-based level medical care has been, as a result, deemed to play a important role in safeguarding public health. In Taiwan in the wake of the significant transformation in various phases, doctors and physicians in practice are at the level of that in advanced developed countries in terms of the choice available to them in the professional practice. The National Health Insurance policy, which has been put into enforcement recently, has cast an extremely significant impact upon doctors in their career prospects. In recent years in Taiwan, the consortium have been trying hard to give a hand in the medical care industry in an attempt to gain profits. The doctors in Taiwan must be increasingly subject to the interference by the external environments. On the other hand, nevertheless, the overall closed type medical treatment structure remains unchanged. As a result, once a doctor chooses to practice in the clinic, he/she can hardly get in touch with hospitals. In fact, hospitals enjoy the most up-to-date medical resources and technology which those people in hospital management are reluctant to get down to the office-based level doctors. As a discouraging result, the office-based level doctors can hardly win public trust in terms of the quality of their services and, in turn, can hardly get their professionalism upgraded in line with the times. That means a rise of the medical care costs on the one hand and a waste of office-based level doctor resources, leaving patients puzzled amidst hospitals without comprehensive overall care. In the eyes of the hospital management, patients mean the very sources of their revenues. Patients are arranged to receive repeated and repeated diagnoses and outpatient treatments. Under such environment of the medical care being out of balance, how can the expenditures for medical care costs possibly come down? In fact, only wholesome office-based level medical care will be the very tool to safeguard public health and bring the medical care cost down. In their professional careers, will doctors choose to continually serve with hospitals or choose to serve patients at the office-based level? To answer this question, there have been many theoretical and empirical studies conducted either in Taiwan and the world over. To doctors who choose to serve patients at the office-based level, are they satisfied with their profession? What is their physical and mental status amidst the profession? There have been rare studies to answer such questions. With numerous factors against practice at office-based level clinics, are doctors serving with the office-based level clinics healthy enough to deal with all those pressures and to tackle such challenges? Are the doctors satisfied enough with the profession to live up to the expectation when they chose such kind of practice? The Study takes 8,925 clinics selected out of the office-based level clinics (excluding Chinese herbal clinics and older than 70 years old clinic in charge doctors) accredited with the Department of Health (DOH) in 2002 as the samples. The questionnaire was designed to be aimed at the individual backgrounds, experiences accumulated before they practiced as a doctor, status quo of the professional practice and health conditions as the independent variables and level of satisfaction in the profession as the dependent variables. A total of 1,132 copies of the questions were successfully retrieved. The rough estimate indicates that 5% of the questionnaires failed to reach the target samples. The questionnaires indicate a successful retrieval rate of 13.4%. The findings yielded through the study indicate that in personal backgrounds, doctors serving at their own individual clinics and serving in concerted clinics responded with higher satisfaction level than doctors being hired. Doctors of younger age groups show higher satisfaction levels than their senior counterparts. Doctors who had headed the hospitals’ departments or sections before the professional practice responded with a higher satisfaction level. In their current professional practice, those who chose to serve in the office based level not in financial income consideration and those who are serving in the departments the same as the specialists in the resident training respond with a higher satisfaction level. In the scores rated in the three aspects, those doctors that are healthier, with higher scores respond with higher satisfaction level than their counterparts with lower scores and that are less healthy. The final analysis of the study indicates that doctors in healthier physical conditions, having headed departments or sections in hospitals, serving in the categories the same as their previous internship training, free of financial pressure, serving in concerted clinics, still as a junior show a higher satisfaction level at the office-based services.

參考文獻


江東亮. (1992). 公元二千年台灣地區醫師人力的供給與地理分布之
石賢彥: 基層醫療的趨勢及生涯規劃, 台北醫學大學演講; 2002.
楊慧芬, 季瑋珠; 公費醫師執業科別地點執業機構型態之趨勢研究:
李龍騰: 家庭醫學-社區導向之基層醫療保健., 行政院衛生署, 2000.
師、住院醫師未來職業方式及其影響性. 行政院衛生署委託研

被引用紀錄


陳怡穎(2005)。總額制度下醫院醫療管理措施與醫師自評對醫療決策之影響〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2005.02089
劉巧菁(2006)。市場競爭對西醫基層醫師執業收入的影響〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-1704200715021111

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