基于利益相关者认知的广东省医师多点执业调查分析
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摘要
背景推动医师多点执业有助于促进不同医疗机构之间人才的纵向和横向交流,合理配置区域的卫生人才资源,最大限度帮扶基层医疗卫生机构的发展,同时为全科医生的培养、成长提供平台和机会。广东省从2010-01-01起作为全国首个试点的省份,出现了媒体热、公立医院冷淡、医生观望的尴尬局面。目的从政策损益补偿角度了解当前医师、管理者和卫生政策研究专家对多点执业的支持程度。方法 2011年5月—2012年8月,通过问卷的方式对广东省15家公立医院425名医师和10家公立医院的119名管理者和卫生政策研究专家进行调查。调查内容包括:对多点执业的态度、对多点执业前景的认知、有无多点执业的想法或冲动/对多点执业的效果评价、认为多点执业最大受益者为谁、认为多点执业最大受损者为谁。结果 70.4%(299/425)的医师赞成推行医师多点执业,44.5%(53/119)的管理者和卫生政策研究专家赞成推行医师多点执业。关于医师多点执业的最大受益者,38.6%(164/425)的医师认为患者受益最大,其次38.4%(163/425)的医师认为第二执业机构受益最大,而仅有16.9%(72/425)的医师认为医师受益最大。42.0%(50/119)的管理者和卫生政策研究专家认为最大受益者是医师。关于医师多点执业的最大受损者方面,71.1%(302/425)的医师和77.3%(92/119)的管理者和卫生政策研究专家认为所在医院受损最大。结论利益相关者对医师多点执业支持态度差异较大;关于医师多点执业受益分析,管理者和卫生政策研究专家的观点与医师的观点出现较大的分歧,却一致认为医师所在医院是医师多点执业的最大受损者。
Background Promoting multiple-site physician practices facilitates vertical and horizontal mobility of talents among different medical institutions and regional rational allocation of medical talents,gives supports for the development of primary healthcare institutions to the utmost extent,and provides a platform and opportunities for the training and growth of general practitioners.Since January 1 st,2010,Guangdong Province,the first pilot province in China to put multiple-site physician practices into practice,has encountered an embarrassing situation of enthusiastic media coverage,public hospitals' indifference and multiple doctors' wait-and-see attitude.Objective To investigate the levels of support for multiple-site physician practices from the perspectives of stakeholders(physicians,managers and health policy research experts) of such practices.Methods A questionnaire survey was conducted among 425 physicians from 15 public hospitals and 119 medical administrators and health policy research experts from 10 public hospitals in Guangdong Province from May 2011 to August2012.The survey covered the following aspects:attitude towards multiple-site physician practices,perceptions of the prospect of multiple-site physician practices,thoughts or impulses about/evaluation of multiple-site physician practices,and biggest beneficiaries and losers of multiple-site physician practices.Results Multiple-site physician practices received supports from70.4%(299/425) of the physicians,and 44.5%(53/119) of the medical administrators and health policy research experts.Patients,and the second practice setting were thought as the biggest beneficiaries of multiple-site physician practices in 38.6%(164/425),and 38.4%(163/425) of the physicians,respectively.But 16.9%(72/425) of the physicians,and 42.0%(50/119)of the medical administrators and health policy research experts thought that physicians were the biggest beneficiaries of multiplesite physician practices.The first practice setting was considered as the biggest loser of multiple-site physician practices by71.1%(302/425) of the physicians,and 77.3%(92/119) of the medical administrators and health policy research experts.Conclusion The stakeholders have different attitudes toward multiple-site physician practices.Although physicians and medical administrators and health policy research experts show different views on the biggest beneficiaries of multiple-site physician practices,all of them agree that the first practice setting of the physicians is the biggest loser of such practices.
Background Promoting multiple-site physician practices facilitates vertical and horizontal mobility of talents among different medical institutions and regional rational allocation of medical talents,gives supports for the development of primary healthcare institutions to the utmost extent,and provides a platform and opportunities for the training and growth of general practitioners.Since January 1 st,2010,Guangdong Province,the first pilot province in China to put multiple-site physician practices into practice,has encountered an embarrassing situation of enthusiastic media coverage,public hospitals' indifference and multiple doctors' wait-and-see attitude.Objective To investigate the levels of support for multiple-site physician practices from the perspectives of stakeholders(physicians,managers and health policy research experts) of such practices.Methods A questionnaire survey was conducted among 425 physicians from 15 public hospitals and 119 medical administrators and health policy research experts from 10 public hospitals in Guangdong Province from May 2011 to August2012.The survey covered the following aspects:attitude towards multiple-site physician practices,perceptions of the prospect of multiple-site physician practices,thoughts or impulses about/evaluation of multiple-site physician practices,and biggest beneficiaries and losers of multiple-site physician practices.Results Multiple-site physician practices received supports from70.4%(299/425) of the physicians,and 44.5%(53/119) of the medical administrators and health policy research experts.Patients,and the second practice setting were thought as the biggest beneficiaries of multiple-site physician practices in 38.6%(164/425),and 38.4%(163/425) of the physicians,respectively.But 16.9%(72/425) of the physicians,and 42.0%(50/119)of the medical administrators and health policy research experts thought that physicians were the biggest beneficiaries of multiplesite physician practices.The first practice setting was considered as the biggest loser of multiple-site physician practices by71.1%(302/425) of the physicians,and 77.3%(92/119) of the medical administrators and health policy research experts.Conclusion The stakeholders have different attitudes toward multiple-site physician practices.Although physicians and medical administrators and health policy research experts show different views on the biggest beneficiaries of multiple-site physician practices,all of them agree that the first practice setting of the physicians is the biggest loser of such practices.
引文
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[4]丁丽莎,肖柳珍,姜虹.区域注册制度下广东省三甲医院医师多点执业政策认知及意愿状况调查[J].医学与社会,2018,31(5):17-18,27.DOI:10.13723/j.yxysh.2018.05.006.DING L S,XIAO L Z,JIANG H.Investigation on cognition and willingness of doctor multi-sited policy under regional registration system of third grade&class A hospitals in Guangdong Province[J].Medicine and Society,2018,31(5):17-18,27.DOI:10.13723/j.yxysh.2018.05.006.
[5]宋宝香,祝嫦娥,夏晨彬.医师对多点执业政策的认知情况研究[J].中国全科医学,2019,22(1):79-84.DOI:10.12114/j.issn.1007-9572.2019.01.017.SONG B X,ZHU C E,XIA C B.Physicians'perceptions of the policies related to multi-site practice[J].Chinese General Practice,2019,22(1):79-84.DOI:10.12114/j.issn.1007-9572.2019.01.017.
[6]张引.医师多点执业的积极作用分析[J].医学与社会,2010,23(2):12-14.DOI:10.3870/YXYSH.2010.02.005.ZHANG Y.An analysis of positive effect of flexible medical practice[J].Medicine and Society,2010,23(2):12-14.DOI:10.3870/YXYSH.2010.02.005.
[7]吴东单.我国医师多点执业过程中的法律问题探讨:以上海市为研究个案[J].中国医院,2016,20(12):48-51.DOI:10.3969/j.issn.1671-0592.2016.12.017.WU D D.Discussion of the legal issues in the process of doctor multi-sited licensed:case study on Shanghai[J].Chinese Hospitals,2016,20(12):48-51.DOI:10.3969/j.issn.1671-0592.2016.12.017.
[8]黄辉华,余昌胤,张年,等.基于扎根理论的医院管理者视角下医师多点执业现存问题及对策的质性研究[J].中国全科医学,2019,22(1):91-96.DOI:10.12114/j.issn.1007-9572.2019.01.019.HUANG H H,YU C Y,ZHANG N,et al.Hospital managers'perspectives on the problems and countermeasures in multiplesite physician practices:a qualitative study based on grounded theory[J].Chinese General Practice,2019,22(1):91-96.DOI:10.12114/j.issn.1007-9572.2019.01.019.
[9]刘洋,王磊.对新医改医师多点执业试点政策的思考[J].中国医院管理,2011,31(5):1-2.DOI:10.3969/j.issn.1001-5329.2011.05.001.LIU Y,WANG L.Thought of physician multi-site profession pilot in new medical reform[J].Chinese Hospital Management,2011,31(5):1-2.DOI:10.3969/j.issn.1001-5329.2011.05.001.
[10]吕国营,孙鹏飞.医师多点执业与社区首诊制的实现[J].中国初级卫生保健,2009,23(12):31-33.DOI:10.3969/j.issn.1001-568X.2009.12.014.LYU G Y,SUN P F.Multi-spot medical practice and realization of community clinic[J].Chinese Primary Health Care,2009,23(12):31-33.DOI:10.3969/j.issn.1001-568X.2009.12.014.
[11]赵汝成.我国临床医师和医院管理者对医师多点执业的态度差异调查[J].医学与社会,2017,30(11):60-63.DOI:10.13723/j.yxysh.2017.11.018.ZHAO R C.Study on attitude difference between clinicians and hospital managers on multi-site physician practice in China[J].Medicine and Society,2017,30(11):60-63.DOI:10.13723/j.yxysh.2017.11.018.
[12]余园园,张秀敏,郑伊琳,等.我国公立医院医师多点执业的利弊分析[J].医学与社会,2018,31(6):8-10,20.DOI:10.13723/j.yxysh.2018.06.003.YU Y Y,ZHANG X M,ZHENG Y L,et al.Analysis of positive and negative aspects on physician dual practice of public hospitals in China[J].Medicine and Society,2018,31(6):8-10,20.DOI:10.13723/j.yxysh.2018.06.003.
[13]邓娅,邓世雄.医师多点执业的研究和探索[J].重庆医学,2011,40(9):922-923.DOI:10.3969/j.issn.1671-8348.2011.09.039.DENG Y,DENG S X.Research and exploration of doctor's multipoint practice[J].Chongqing Medicine,2011,40(9):922-923.DOI:10.3969/j.issn.1671-8348.2011.09.039.
[14]林凯程,林海波,田柯,等.卫生管理者对医师多点执业认知的调查研究[J].中国全科医学,2013,16(16):1904-1906.DOI:10.3969/j.issn.1007-9572.2013.06.027.LIN K C,LIN H B,TIAN K,et al.Cognitions of health administrators on physicians'multi-sited license[J].Chinese General Practice,2013,16(16):1904-1906.DOI:10.3969/j.issn.1007-9572.2013.06.027.
[15]关于城市卫生支援农村卫生工作的意见[J].中国初级卫生保健,2003,17(1):3.Opinions on urban health supporting rural health work[J].Chinese Primary Health Care,2003,17(1):3.
[16]陈王华,沈春明,徐洁.医师多点执业问题刍议[J].中国卫生事业管理,2010,27(6):397-398.DOI:10.3969/j.issn.1004-4663.2010.06.014.CHEN W H,SHEN C M,XU J.Discussing the issue of doctors'multi-site practice[J].Chinese Health Service Management,2010,27(6):397-398.DOI:10.3969/j.issn.1004-4663.2010.06.014.
[17]王咏梅,鞠永和,苗木.医联体下医师多点执业的机遇与困境[J].现代医院管理,2018,16(2):55-57.WANG Y M,JU Y H,MIAO M.Opportunity and dilemma of multipoint practice under medical association[J].Modern Hospital Management,2018,16(2):55-57.
[2]胡志民,黄建始,田玲,等.医师多点执业的影响因素及管理探讨[J].中国医院,2009,13(6):35-38.DOI:10.3969/j.issn.1671-0592.2009.06.009.HU Z M,HUANG J S,TIAN L,et al.Doctor multi-sited licensed influence factors and management measures[J].Chinese Hospitals,2009,13(6):35-38.DOI:10.3969/j.issn.1671-0592.2009.06.009.
[3]王庆文,李和辉.医师多点执业政策执行的影响因素[J].重庆医学,2011,40(16):1651-1652.DOI:10.3969/j.issn.1671-8348.2011.16.040.WANG Q W,LI H H.The influencing factors of the implementation of doctor's multi-point practice policy[J].Chongqing Medicine,2011,40(16):1651-1652.DOI:10.3969/j.issn.1671-8348.2011.16.040.
[4]丁丽莎,肖柳珍,姜虹.区域注册制度下广东省三甲医院医师多点执业政策认知及意愿状况调查[J].医学与社会,2018,31(5):17-18,27.DOI:10.13723/j.yxysh.2018.05.006.DING L S,XIAO L Z,JIANG H.Investigation on cognition and willingness of doctor multi-sited policy under regional registration system of third grade&class A hospitals in Guangdong Province[J].Medicine and Society,2018,31(5):17-18,27.DOI:10.13723/j.yxysh.2018.05.006.
[5]宋宝香,祝嫦娥,夏晨彬.医师对多点执业政策的认知情况研究[J].中国全科医学,2019,22(1):79-84.DOI:10.12114/j.issn.1007-9572.2019.01.017.SONG B X,ZHU C E,XIA C B.Physicians'perceptions of the policies related to multi-site practice[J].Chinese General Practice,2019,22(1):79-84.DOI:10.12114/j.issn.1007-9572.2019.01.017.
[6]张引.医师多点执业的积极作用分析[J].医学与社会,2010,23(2):12-14.DOI:10.3870/YXYSH.2010.02.005.ZHANG Y.An analysis of positive effect of flexible medical practice[J].Medicine and Society,2010,23(2):12-14.DOI:10.3870/YXYSH.2010.02.005.
[7]吴东单.我国医师多点执业过程中的法律问题探讨:以上海市为研究个案[J].中国医院,2016,20(12):48-51.DOI:10.3969/j.issn.1671-0592.2016.12.017.WU D D.Discussion of the legal issues in the process of doctor multi-sited licensed:case study on Shanghai[J].Chinese Hospitals,2016,20(12):48-51.DOI:10.3969/j.issn.1671-0592.2016.12.017.
[8]黄辉华,余昌胤,张年,等.基于扎根理论的医院管理者视角下医师多点执业现存问题及对策的质性研究[J].中国全科医学,2019,22(1):91-96.DOI:10.12114/j.issn.1007-9572.2019.01.019.HUANG H H,YU C Y,ZHANG N,et al.Hospital managers'perspectives on the problems and countermeasures in multiplesite physician practices:a qualitative study based on grounded theory[J].Chinese General Practice,2019,22(1):91-96.DOI:10.12114/j.issn.1007-9572.2019.01.019.
[9]刘洋,王磊.对新医改医师多点执业试点政策的思考[J].中国医院管理,2011,31(5):1-2.DOI:10.3969/j.issn.1001-5329.2011.05.001.LIU Y,WANG L.Thought of physician multi-site profession pilot in new medical reform[J].Chinese Hospital Management,2011,31(5):1-2.DOI:10.3969/j.issn.1001-5329.2011.05.001.
[10]吕国营,孙鹏飞.医师多点执业与社区首诊制的实现[J].中国初级卫生保健,2009,23(12):31-33.DOI:10.3969/j.issn.1001-568X.2009.12.014.LYU G Y,SUN P F.Multi-spot medical practice and realization of community clinic[J].Chinese Primary Health Care,2009,23(12):31-33.DOI:10.3969/j.issn.1001-568X.2009.12.014.
[11]赵汝成.我国临床医师和医院管理者对医师多点执业的态度差异调查[J].医学与社会,2017,30(11):60-63.DOI:10.13723/j.yxysh.2017.11.018.ZHAO R C.Study on attitude difference between clinicians and hospital managers on multi-site physician practice in China[J].Medicine and Society,2017,30(11):60-63.DOI:10.13723/j.yxysh.2017.11.018.
[12]余园园,张秀敏,郑伊琳,等.我国公立医院医师多点执业的利弊分析[J].医学与社会,2018,31(6):8-10,20.DOI:10.13723/j.yxysh.2018.06.003.YU Y Y,ZHANG X M,ZHENG Y L,et al.Analysis of positive and negative aspects on physician dual practice of public hospitals in China[J].Medicine and Society,2018,31(6):8-10,20.DOI:10.13723/j.yxysh.2018.06.003.
[13]邓娅,邓世雄.医师多点执业的研究和探索[J].重庆医学,2011,40(9):922-923.DOI:10.3969/j.issn.1671-8348.2011.09.039.DENG Y,DENG S X.Research and exploration of doctor's multipoint practice[J].Chongqing Medicine,2011,40(9):922-923.DOI:10.3969/j.issn.1671-8348.2011.09.039.
[14]林凯程,林海波,田柯,等.卫生管理者对医师多点执业认知的调查研究[J].中国全科医学,2013,16(16):1904-1906.DOI:10.3969/j.issn.1007-9572.2013.06.027.LIN K C,LIN H B,TIAN K,et al.Cognitions of health administrators on physicians'multi-sited license[J].Chinese General Practice,2013,16(16):1904-1906.DOI:10.3969/j.issn.1007-9572.2013.06.027.
[15]关于城市卫生支援农村卫生工作的意见[J].中国初级卫生保健,2003,17(1):3.Opinions on urban health supporting rural health work[J].Chinese Primary Health Care,2003,17(1):3.
[16]陈王华,沈春明,徐洁.医师多点执业问题刍议[J].中国卫生事业管理,2010,27(6):397-398.DOI:10.3969/j.issn.1004-4663.2010.06.014.CHEN W H,SHEN C M,XU J.Discussing the issue of doctors'multi-site practice[J].Chinese Health Service Management,2010,27(6):397-398.DOI:10.3969/j.issn.1004-4663.2010.06.014.
[17]王咏梅,鞠永和,苗木.医联体下医师多点执业的机遇与困境[J].现代医院管理,2018,16(2):55-57.WANG Y M,JU Y H,MIAO M.Opportunity and dilemma of multipoint practice under medical association[J].Modern Hospital Management,2018,16(2):55-57.