我国三城市社区卫生服务中心临床医师队伍现状调查

A survey on current status of clinicians in community health-care service centers of three cities in China

目的了解我国部分城市社区卫生服务中心临床医师队伍现状及存在的问题，为制定相关政策提供客观依据。方法在天津市、南京市、武汉市各选取2个城区，对6区全部共62个社区卫生服务中心进行问卷调查，并进行小组访谈。结果①62个社区卫生服务中心中医保定点单位60个，占96．8％；59个为国家及公立医疗机构举办；中心全部开展了社区公共卫生与基本医疗服务；运行较好；②在册医师1664人，平均年龄（45±11）岁，45岁及以上医师942人，占总数的56．6％，35岁以下仅占24．4％；医学大专及以下学历占70．1％。③874名中高级技术资格医师中，具备全科专业技术资格38人，占4．4％。④1024名临床类别的执业、执业助理医师中，注册范围为内科专业者538人，占52．5％；注册全科专业65人，占6．3％。全科诊室应诊医师257名，注册全科专业45人，占17．5％。⑤近三年临床医师晋升105人，其中晋升全科专业17人，占16．2％。⑥临聘医师354人，占在岗医师的20．0％。结论①社区卫生服务中心全科诊室医师超范围行医问题严重；②临床医师晋升全科专业意愿不强、报考比例太低；③全科医师数量明显不足，队伍整体素质偏低，年龄老化；④建议加大投入、完善政策，提高岗位吸引力；加强全科医师管理与执法监督，杜绝超范围行医。

Objective To understand current status and problems existed among clinicians workforce in several community health-care service centers of China to provide evidence for relevant policymaking. Methods Sixty-two community health-care service centers were selected from two districts each in Tianjin, Nanjing and Wuhan Cities, respectively, for the survey with questionnaire and focus group discussion. Results （1）Fifty-eight of 62 community health-care service centers surveyed （93.5 percent） were qualified as a legal entity, 60 （96. 8 percent） registered as medical insurance institutions designated by government, and 59 （95. 2 percent ） were state-owned or run by state-owned hospitals. All the 60 institutions provided service in public health and essential medical care for communities and were economically running relatively good. （2）There were totally 1664 registered clinicians with an average age of 45 years （and a standard deviation of 11 ）, 942 of them （56. 6 percent） at age above 45, 406 （24.4 percent） at age below 35, and 1166 （70. 1 percent） with college education. （3）Thirty-eight of 874 clinicians with medium or senior professional titles （4. 4 percent） were qualified as general practitioners （GPs）. （4） Five hundred and thirty-eight of 1024 licensed clinicians or assistant clinicians （52. 5 percent） were registered as internists for permit to practice medicine, and 65 registered as GPs （6. 3 percent）. There were totally 257 GPs in general practice clinics and 45 of them registered as GPs （ 17.5 percent） for permit to practice medicine. （5）One hundred and five clinicians were promoted in the past three years and 17 of them were registered as GPs （ 16.2 percent）. （6）Three hundred and fifty-four clinicians were temporarily employed （21.3 percent） of those in service. Conclusions （1）A lot of clinicians at general practice consultation rooms in community health-care service centers practiced medicine often beyond their duties registered. （2） Few clinicians extended their willingness to be promoted as GPs, with too lower percentage of them taking promotion examinations. （3）The number of GPs was in short obviously and quality of GPs was poor in general with their relatively older age. （4）It is suggested that more investment should be input, relevant policies perfected, attraction to GP position increased, human resource management and legal management of GPs strengthened, and non-registered practicing behavior should be eliminated by government.