運用系統動態觀點探討國軍醫院醫師人力供需之研究

Application of System Dynamics on Supply-Demand of Military Physician Manpower in R.O.C.

目的：醫師人力的供需對於國軍醫院的營運有重要的影響，但國軍醫院的醫師聘任、養成與升遷制度有其特殊的複雜與動態結構，要妥善規劃相關的人力政策，需要有適合的評估模式與方法。本研究嘗試針對國軍醫院複雜的人力供需體系建立模式，並進行情境政策模擬。方法：針對軍醫院結合軍職與外聘醫師的聘用體系，運用系統動態學之系統思考觀點，建構系統動態分析模式，並針對軍職醫師服役年限及聘任醫師補充比例改變對人力供需之影響進行模擬。結果：結果顯示適當延長軍職醫師服役年限以及調整聘任醫師補充比例，可以改善國軍醫院醫師人力供需失衡問題。模擬結果發現延長服役年限4年以上，以及聘任醫師補充比例調整為25％時，能增加留任高專業技術的資深醫師人力，供需比到西元2018年時仍可維持在2011年0.7之供需水準。結論：軍職醫師服役年限以及聘任醫師補充比例此二項政策，有助於縮減國軍醫院醫師人力供需差距，本研究之結果與發展之系統動態模式可作為相關決策單位制訂國軍醫院醫師人力政策之參考與運用。

Objective: The demand and supply of physician manpower in military hospitals are more complex and dynamic, which requires proper models and methodologies to make related policies. This study investigated this issue and developed a dynamics model for scenario simulation. Methods: This study used systems approach to analyze the supply and demand system of physician manpower in military hospitals, and built a system dynamics model. The proposed model was simulated and analyzed based on two policy variables: extending length of service of military physicians, and determining appropriate physicians replenishment rate. Results: The results show that the supply-demand ratio of physician manpower could be improved if the service length was extended to four years or more, and the physician replenishment rate is suggested to set on 25%. Based on the simulation results, the policies proposed by this study can increase the retention of senior physicians with high proficiency and techniques, and thus balance the discrepancy between the supply and demand of the military hospital physician manpower. Conclusions: This two policy variables suggested in this study demonstrated good potential to improve the unbalanced supply and demand of physician manpower in military hospitals. The model proposed by this study may also be a good reference to decision making in related issues of similar organizations.