公立医院管理者和医师的多点执业利弊权衡差异分析

Analysis on Difference in Weighing the Pros and Cons Between Managers and Physicians in Public Hospital Towards Physician Multisite Practice

目的:分析公立医院管理者和医师对多点执业风险、收益和难度之权衡的异同,为推进和完善医师多点执业政策提供参考。方法:对浙江省19家二、三级医院的管理者和医师进行自制问卷调查,对变量进行统计描述。结果:就多点执业风险而言,管理者高感知体验集中于对医院管理运营的冲击(4.67±0.95);医师高感知体验在于个人承担医疗纠纷赔偿的经济压力(3.57±0.92)。就多点执业收益而言,管理者高感知体验在促进医师薪酬市场化(3.57±0.95);医师经济和非经济相关收益感知均处于高感知水平。就多点执业难度感知而言,管理者高感知体验在多点执业无法实现公立医院的预期收益(3.59±0.96)、以公立医院医师为供给侧开展多点执业非常艰难(3.52±0.94);而医师无高感知体验。结论:政府在出台或调整医师多点执业政策时,需要在保证患者利益的前提下,针对管理者和医师这两个公立医院内部最主要的利益相关者,结合双方在多点执业收益、风险、难度的差异化体验,探索有助于我国医师多点执业政策推行的发力点。

Objective: To analyze the similarities and differences between public hospital managers and physicians on the risk, benefit and difficulty of physicians multisite practice, so as to provide evidence for promoting and improving physician multisite practice policy. Methods: Managers and physicians from 19 secondary and tertiary hospitals in Zhejiang province were investigated by self-made questionnaire, and the variables were statistically described. Results: As to physician multisite practice risk, managers’ high perceived risk conception focused on the impact on hospital management and running(4.67±0.95), and physicians’ high perceived risk conception lied in the economic pressure of individuals to bear medical dispute compensation(3.57±0.92). As to physician multisite practice benefit, managers’ high perceived benefit conception was promoting the marketization of physicians’ compensation(3.57±0.95), and both physicians’ economic and non-economic related benefit perceptions were at a high level. As far as the perception of physician multisite practice difficulty, managers believed that physician multisite practice could not achieve the expected revenue of public hospitals(3.59±0.96), and it was very difficult to implement physician multisite practice policy based on provisions of public hospital physicians(3.52±0.94), while physicians did not have high difficulty perception items. Conclusions: In introducing or adjusting the physician multisite practice policy, the government should aim at the two main stakeholders in public hospitals on the premise of ensuring the interests of the patients, and combine different experiences of both managers and physicians on benefit, risk and difficulty of physician multisite practice, explore the starting point which is helpful to the implementation of physician multisite practice policy.