医师多点执业政策“叫好不叫座”的原因及对策研究

Policies Related to Physician Multi-site Practice:Good But Difficult to Implement

背景目前医师多点执业政策存在"叫好不叫座"的情况,探讨其原因及对策有助于促进多点执业政策的深入推进。目的探讨医师多点执业政策"叫好不叫座"的原因,并提出相关对策与建议。方法采用目的抽样法,在苏南、苏中、苏北3个地区分别选取3个不同等级(三级、二级、一级)的医疗机构,然后采取方便抽样法,在9个医疗机构选取符合本研究标准的医师为调查对象。于2017年7—8月,采用自行设计的调查问卷对纳入的医师进行调查。问卷的主要内容包括:医师的基本情况,对医师多点执业的认知和态度(包括是否赞成、对人才流动情况的认知、影响人才流动的因素、对取消编制的看法、多点执业的阻力来源、可能引发的问题、医师多点执业过程中医疗纠纷的责任归属)。共发放问卷204份,回收有效问卷194份,问卷的有效回收率为95.1%。结果 194例医师中,赞成医师多点执业者152例(78.4%)。认为所在医疗机构人才流动率非常高/高者占15.5%(30/194)。认为影响人才流动的因素为工资待遇、个人职业发展、工作环境者分别占80.4%(156/194)、69.1%(134/194)、63.4%(123/194)。认为编制管理对人才的流动带来羁绊者占76.8%(149/194)。对于取消编制这一政策的态度上,非常赞同/赞同者分别占40.7%(79/194)。认为医师多点执业的阻力来源于所在医院者占71.6%(139/194)。认为医师多点执业可能引发的问题为分散了医师的时间和精力、医疗风险责任归属无明确界定、导致医师工作量的增加者分别占69.1%(134/194)、64.4%(125/194)、55.2%(107/194)。认为医师多点执业过程中医疗纠纷的责任为第一执业单位和多点执业单位共同承担者占61.3%(119/194)。结论江苏省医师对多点执业的总体赞成率较高,但注册率较低。"叫好不叫座"的原因主要为编制管理、第一执业单位的阻碍、医疗风险责任归属不明确等,应针对具体问题采取有效措施,推动医师多点执业政策落实。

Background Currently policies associated with physician multi-site practice are popular but difficult to implement,to explore further promote its causes and countermeasures contributes to the promotion of policies related to physician multi-site practice.Objective To explore the reasons for policies associated with physician multi-site practice which are popular but difficult to implement,and propose targeted suggestions.Methods We conducted this study in a convenience sample of physicians who met the criteria from 9 medical institutions purposively sampled from southern,central and northern Jiangsu(1 primary,1 secondary,and 1 tertiary medical institutions from each region)between July and August 2017.We surveyed these physicians with a self-designed questionnaire for obtaining the data concerning demographic characteristics,perceptions and attitude of multi-site practice(including the level of support for multi-site practice,employee turnover,the associated factors for employee turnove,attitude toward the cancellation of staffing,the hindrances for the implementation of multi-site practice policies,the problems possibly caused by multi-site practice,the parties responsible for medical malpractice occurred during multi-site practice).Of the 204 questionnaires administered,194 of them were responsive,achieving a 95.1%response rate.Results Of the 194 respondents,78.4%(152/194)approved practicing in multiple sites;15.5%(30/194)held that employee turnover rate at their own institution was high/very high;80.4%(156/194)thought that payment,69.1%(134/194)thought that personal career development and 63.4%(123/194)thought that working environment were associated factors for employee turnover;76.8%(149/194)considered that staffing management hindered employee turnover;40.7%(79/194)approved/strongly approved cancellation of staffing;71.6%(139/194)thought that multi-site practice was impeded by the regulations of their own hospital;69.1%(134/194),4.4%(125/194),5.2%(107/194)thought that the problems possibly caused by multi-site practice were distraction of physicianso time and energy,unclear responsible parties for healthcare risks,increased workload,respectively;61.3%(119/194)considered that their primary and secondary practice sites should be coresponsible for the medical disputes occurred during practicing in multiple sites.Conclusion A majority of physicians in Jiangsu Province are in support of multi-site practice but only a minority of them have registered for multi-site practice,which may be caused by staffing management,hindrances from the first practice hospital and unclear parties liable for medical malpractice occurred during practicing in multiple sites and so on.Therefore,targeted interventions for specific problems should be taken to promote the implementation of multi-site practice policies.