中醫師人力現況與規劃

CURRENT STATUS AND PROPOSED MANPOWER PLANNING FOR THE PRACTICE OF TRADITIONAL CHINESE MEDICINE IN TAIWAN, R.O.C.

目前台灣中醫師檢定考試、中醫師檢覈考試、專門技術人員高等考試及特種考試中醫師考試每年產生許多中醫師，中醫師人力成長情形必須有所控制以免造成問題。根據衛生署之規劃，理想中醫師數為每十萬人口22 名，但近年來實際中醫師人數已迅速增加，且根據中醫師人力研究結果顯示，中醫師成長情形已比預期時間超前。中醫於89 年7 月1 日正式試辦總額支付制度，若中醫師人力過剩，將對健保總額支付費用產生稀釋作用；中醫師多分布於中部地區，造成人力分布不均；國內中醫師「教」、「考」、「訓」、「用」無法配合；中醫課程教材及考試科目不符時代需求；臨床教學醫院明顯不足；醫政法規嚴格限制中醫師使用現代化醫療設備，並限制中西醫擇一執業，影響中西醫療之結合。針對未來中醫師規劃方面，必須重新評估中醫師人力之供給與需求、推動增設中醫臨床見習、實習教學醫院場所、准予中西醫雙登錄執業、開辦中醫健保住院給付，積極推動中醫臨床療效評估、醫政法規應開放中醫師使用現代化醫療設備、應加強管理民俗醫療及其他易與中醫師角色混淆之人員、將中醫師人力培養回歸正規教育體系，加強教（教育部）、考（考選部）、用（衛生署）單位之結合，以共同規劃人力。Traditional Chinese Medicine (TCM) has deep roots among the Chinese population with much proven success. However, years of unregulated practice had created much varied qualities of practice. To ensure high standards of practice in TCM both for the benefits of prospective patients and imparting of credibility and respectability to the profession as well as its practitioners the government of Taiwan, ROC in recent years strictly regulates the standards by administering various qualification examinations. These include the Qualifying/Recognition Examination for Chinese Medicine Practitioners, National Examination for Senior Specialists and National Board Examination for Chinese Medicinal Specialists. The first of these was designed to accommodate practitioners who had acquired or committed to acquiring their skills through diverse and informal channels and is in the process of being phased out. However, such multiple qualifying channels have produced a surplus of TCM practitioners, far exceeding the projected growth and threatening the projected ideal ratio of 22 practitioners per hundred thousand citizens. Unbalanced demographic distribution, with singular concentration of practitioners in the central part of Taiwan, has contributed to the uneven availability of TCM services. Foresight in planning must be exercised to prevent an undesirable cycle. On July 1, 2000 the National Health Insurance Bureau implemented, on a trial basis, the “total amount paid” program in which undue regional concentrations of practitioners would result in reduced compensation for the individual physicians. Along with manpower regulation, outdated training system and laws should be overhauled. At present TCM practice suffers from the incompatibility between ‘teaching’, ‘examination’, ‘training’ and ‘application’. Teaching materials and major course foci are not in conformity with the requirements of modern times. Clinical instruction is inadequate. Outdated health practice laws limit the use of modern medical equipment. The restrictive choice of practicing either TCM or Western medicine hinders the union of the two practices. Focal points for future planning of TCM practice must include the demand and supply, promotion and establishment TCM clinical training and facilities, permission of dual TCM and Western medical practices, governmental coverage of TCM hospitalization expenses, positive promotion of the evaluation of clinical effectiveness of TCM, legal revamping to allow the use of modern equipment, effective regulation and distinction (from TCM) of unsubstantiated folk medicine and other quasi medical practices, reversion of the training of TCM to formal educational systems, strengthen the working relationships among education (Ministry of Education), examination (Ministry of Examination) and practice (Department of Health) to forge a comprehensive TCM developmental plan.