兒科醫生過勞

Burnout among Pediatricians

兒科專科醫療在歐美於19世紀逐漸成熟，＂Pediatrics＂一詞在1858年由Abraham Jacobi提出，歷經兩世紀，已是成熟的專科醫療。台灣的兒科專科醫療起步相當早。於1906年台大醫院成立了台灣第一個小兒科。經許多兒科前輩開拓了兒科醫療的領域，大幅降低了我國兒童死亡率，改善了我國兒童的健康。2013年我國嬰兒死亡率已降到3.9/1000新生兒，但在排序於OECD國家中仍不甚理想。要突破到聯合國千禧年目標（在2015年兒童死亡率降到1995兒童死亡率的三分之一，亦即2.5/1000新生兒），仍有努力之空間。台灣少子化的問題由西元2000年開始浮現，目前已逢底，但反彈仍不明顯，因已在谷底達十多年，若預估兒童人口群（18歲內人口）應已穩定，大約在450萬左右。兒童人口群雖較少，但兒童醫療需求不減反增，主要理由可能與兒童期疾病複雜度增加，兒童期疾病治療成功後慢性醫療照護需求增加，兒童醫療的精緻度及家長的期待高等有關。少子化問題嚴重，全國又是單一醫療保險制度。在這樣的大環境下，兒童專科醫療的確有其困境，醫院的兒科醫師已出現人才流失的負面循環。醫院的兒科醫師比率由1990年的45%到2014年下降到36%。而醫院兒科醫療尤其在住院與急診醫療，是全天候24小時全心守候醫療。因此在落入人力不足的關鍵點時，極容易落入骨牌效應之負面循環。繁鎖之醫療行政也可能蠶食教學甚或醫療專業的時間。如何在這特殊的年代，讓兒科醫師能不過勞，的確需要許多的努力與併有配套措施之政策方能奏效，例如，改變兒科醫療之經濟弱勢，讓醫院願意讓兒料之經管有彈性；修改相關醫療法規，減少醫病爭議，創造醫病雙贏；簡化醫院評鑑及改善兒童醫療的軟硬體。我們也應改變兒童疾病治療的概念變成積極的兒童健康促進觀念。兒科醫師過勞是兒童醫療危機，大家都知道兒童是我們的未來。為了更好的未來，我們還不能說累，但政策真的要出來！

The pediatric specialty of modern medicine is established around 200 years ago. In Taiwan, the pediatric specialty started in 1906 when the first Department of Pediatrics was established in National Taiwan University Hospital. In 1988, the specialty certification, including the pediatricians, policy was initiated Taiwan. By 2014, we have already 3,964 certified pediatricians in Taiwan. However, the recent decades in Taiwan are in an era of low birth rate and with limited medical resources from national health insurance. The pediatric population decreased, but the medical needs still increased. Various accreditation programs to prompt the quality of medical care in children were launched. The demanding workload from both advanced medical care and the administrative duty from medical care and various accreditation result in a shift in the pediatric workforce between hospital and primary clinic. At the initial enrollment of pediatric residents, a big decline was also noted in 2000s. A report in 2013 indicated low career satisfaction in hospital pediatricians in Taiwan, particularly in the self-care, financial benefits and working environment. They are likely to ＂burnout＂ and choose career shift, which possibly lead to ＂domino effect＂ in the hospital pediatric workforce. The proportion of hospital pediatrician to total pediatrician ratio decreased from 45% in 1990 to 36% in 2014. As set in the Millennium Goal 4 from United Nation, we expect that the infant mortality shall decrease from 7.5/1000 to 2.5/1000 in 2015 in Taiwan. Though the data is not available yet, a recent international research report deduced a recent negative trend for Taiwan. Pediatric workforce is definitely a key factor to prompt the child health care. To break such viscous cycle of pediatric workforce, particularly in the hospitals, a more flexible manpower plan to meet individual work-life balance, lowered risk of malpractice suit, simplified accreditation process and increased financial incentives for dealing with demanding children health care are recommended.