教學醫院醫師生產力之預測模型

The Model for Predicting Physician Productivity in the Teaching Hospitals

在整個醫療體系內，醫師為主要的醫療服務提供者之一，以教學醫院而言，醫師的任務更為多元，其績效的衡量需包含服務、教學與研究。本研究分析台灣北部某教學醫學中心於1996年1月至1998年12月期間，包括內外科共126位主治醫師之產出及個人資料，分析方法除從橫斷及縱貫資料來探討影響主治醫師生產力的因素外，並發展主治醫師綜合生產力指標，以形成預測模式作為醫務管理決策者提高醫師生產力的參考依據。而研究結果發現： 1.主治醫師生產力顯著與個人背景特性有關，如年齡、主治醫師年資、畢業醫學院、現在行政職務。 2.在職進修程度及參與研究計畫與獲取研究經費對主治醫師之研究產出與綜合生產力有正面助益。 3.本研究所發展出之主治醫師生產力預測模型為適用於外科醫師之不偏估計模組。

Physicians play as one of the key important roles in the entire health care system. Especially in teaching hospitals, the tasks of an attending physician are far more diversified and demanded than those in non-teaching hospitals. The performance of an attending physician in teaching hospitals is usually defined by three parts such as service, teaching, and research. However, it is still not clear and under developed on how to construct a persuasive indicator by combining these three parts so as to evaluate the work performance of an attending physician. This study has collected data from 126 attending physicians in a tertiary medical center during 1996-1998. The variables covered various performance measures of clinical services, teaching loads, and publications. The present study has demonstrated that a quantitative combined indicator can reflect the performance of an attending physician both with cross-sectional methods and with longitudinal analyses in teaching hospitals. The predictive models for physician's performance were also valuable for decision makers in health care settings. Significant findings of this study were also summarized as follows. 1. Physicians' productivity was significantly associated with their baseline information such as age, seniority of an attending physician, undergraduate studies, and current professional accreditations and administrative position in the host hospital. 2. on-job trainings and research grants were factors which positively improved the subsequent productivity of an attending physician. 3. The quantitative model constructed for productivity of surgeon in teaching hospitals was less biased to true measures than that of physicians in internal medicine.