一般公費醫師離島醫院服務期滿後留任意願之研究—以金門醫院為例

Abstract

相較於台灣本島，離島地區的醫療資源相對不足，尤其醫師人力羅致困難，居民多有｢不平等就醫｣之觀感；政府衛生主管機關透過公費醫師培育及偏鄉離島下鄉優惠服務年限等措施，提高公費醫師至離島服務意願，企圖改善離島地區民眾就醫可近性，以達成平等就醫和照顧弱勢團體的目的。另一方面，留住符合地區需求之醫師人才，離島醫院始得以降低民眾轉診率、提高醫療滿意度，最終提昇醫院整體醫療營收，因此留才是離島醫院的經營的重要課題。 隨著離島開放觀光，交通日益發達，兩岸人民往來頻繁，經濟蓬勃發展，又在政府｢醫療在地化｣的政策下，離島醫院不斷充實醫療硬體設備，全民健保給付點數(值)相對保障，醫療極具發展潛力；反觀本島醫院醫師飽和與競爭，醫師升遷困難，待遇相對於工作量則逐年下降，形勢有利於離島醫師留任意願。 金門醫院自民國九十四年改制為行政院衛生署立醫院以來，台灣地區一般公費醫師成為醫師的重要來源之一，近年下鄉醫師創造可觀的醫療營收成長，為使金門醫院的永續經營與發展，有必要探討影響此一醫師族群之留任意願因素，形成醫院的留才策略。 本研究乃一質性研究，以深入訪談方式訪問公費醫師，發現除了傳統的個人因素，如個人屬性與職涯規劃，組織因素，如管理制度、賦權管理、升遷與薪資制度，社會支持因素，尤其是家人支持與工作滿意度會影響公費醫師的留任意願外，離島的｢在地體驗｣是一個重要的干擾變數，或能解決前述傳統因素的問題或阻礙，本身對留任意願也有正面效果。

Medical resources are scarcer in the outer islands compared with the island of Taiwan. Of these, medical professionals are especially hard to come by, and many outer-island residents feel that there are health care disparities; government authorities have attempted to raise the willingness of government-sponsored physicians to practice in the outer islands through government-sponsored training of physicians and policies giving preferential lengths of obligatory service in rural areas, in order to improve the proximity of outer-island residents to medical care, to achieve equality in health care, and care for vulnerable groups. Retaining physicians that meet the region’s needs allow outer-island hospitals to reduce patient referral rates and increase patient satisfaction, which ultimately enhances overall revenues. Therefore, retaining physicians is an important issue for outer-island hospitals. With the increase of tourism on the outer islands, transportation has improved, tourists come from both sides of the strait, economic development has flourished, and under government policies of “localized medical care”, outer-island hospitals have continuously purchased medical hardware, there is relative security of benefit payment points (values) from the National Health Insurance, and there is great growth potential for the medical industry; by contrast, hospitals on the island of Taiwan are dealing with issues of physician saturation and competition, promotion is difficult for physicians, and compensation received for the amount of work done is declining annually, a situation which is conducive to physicians’ willingness to continue practicing in the outer islands. Since its transition to an Executive Yuan, Department of Health hospital in 2005, Kinmen Hospital has relied heavily on government-sponsored physicians as its source of physicians. In recent years its physicians have generated substantial revenue growth; therefore, in order to sustain the management and development of Kinmen Hospital, there is a necessity to investigate the willingness of physicians to continue practicing at outer-island hospitals and thus form a retention strategy for the hospital. This a qualitative study conducted using in-depth interviews with government-sponsored physicians. The results of the study indicated that traditional individual factors such as personal attributes, career plans, organizational factors (for example, management systems, empowerment in management, promotional and compensatory policies), social support factors, and especially familial support and job satisfaction all affected the willingness of government-sponsored physicians to continue practicing on the outer islands; other than that, the “localized experience” of the outer islands was also an important disturbance variable, which could resolve the problems or obstacles of the aforementioned traditional factors, and by itself provide positive effects on physicians’ willingness to stay on the outer islands.