我国医师多点执业研究综述

  目的  了解陕西省医师多点执业现状及其障碍因素，为推动陕西省医师多点执业提供参考依据。  方法  于2015年7月 — 2016年5月采用分层整群随机抽样方法在陕西省关中、陕南和陕北地区6家三级甲等医院抽取366名医师进行问卷调查，并应用文献分析法提炼障碍因素。  结果  陕西省366名医师中，有12.6 %的医师非常了解多点执业政策，有80.6 %的医师赞成多点执业政策，在条件允许的情况下有78.4 %的医师愿意多点执业；有多点执业行为的医师152人，占41.5 %，不同性别、年龄、职称、工作年限医师多点执业行为比例均不同，差异均有统计学意义（均P < 0.05）；医师多点执业的障碍因素主要涉及法律法规（包括多点执业制度未立法、配套法律法规不完善、执业管理办法地域差异大），第一执业机构（医院反对、人事管理制度限制、薪酬待遇有差异、未来发展受限），第二和第三执业机构（病人少、科研弱、硬件差、团队协调弱）；医生个人（时间受限、身份受限、影响薪酬和晋升、担心医疗风险大），医疗责任险（赔偿额度少、赔付范围窄、责任主体划分不明确、险种可选择性小）等5个方面。  结论  陕西省医师多点执业比例较低，加快医师多点执业制度的法律化、确立医师和执业机构的劳动（劳务）合同关系、完善医疗责任险，可更好的推进医师多点执业。

Licensed doctors practicing at multiple sites in Shaanxi province: analysis on status quo and obstacle factors

  Objective  To examine the status quo and obstacle factors of licensed doctors practicing at multiple sites in Shaanxi province and to provide evidences for promoting the practice of the doctors.  Methods  We conducted a self-administered questionnaire survey among 366 doctors selected using stratified cluster sampling in 6 grade A tertiary hospitals locating at central, southern and northern Shaanxi province between September 2015 and May 2016. We explored obstacle factors for multi-site practice of licensed doctors with documentary analysis.  Results  Of the participants, only 12.6% reported very understanding on the multi-site practice policy; 80.6% declared for the policy; 78.4% expressed the willing to conducted multi-site medical practice under favorable conditions; and 41.5% (152) reported having been carried out multi-site practice. The proportion of carrying out multi-site practice differed significantly by gender, age, professional title, and working years among the participants (all P < 0.05). The study identified 5 domain obstacles for licensed doctors practicing at multiple sites as following: gaps in related laws and regulations (lack of relevant legislation, imperfection in related laws and regulations, and great regional difference in administration management), adverse conditions attributed to practitioners′ full-time employer (managers′ negative attitude towards the multi-site practice, limitation of personnel management system, potential variation in salary, and possible career limitation in future), adverse conditions attributed to practitioners′ part-time employer (fewer patients, poor institutional capability for scientific research, backward instrument and equipment, and inefficient team collaboration), practitioners′ considerations (time limitation, professional role limitation, possible influences on salary or career promotion, and being worried about risk of medical practice), and medical liability insurance (less compensation, narrow insurance coverage, indistinctness of responsibility subject, and restricted insurance type selection).  Conclusion  The proportion of doctors conducting multiple site medical practice is low in Shaanxi province, and effective measures are needed to promote licensed doctors practicing at multiple sites.