医生视角下医师多点执业问题及对策研究——基于扎根理论

目的:应用扎根理论的方法,从医生视角探讨贵州省遵义市医师多点执业的问题并提出相应对策。方法:于2017年1—7月按照目的抽样并结合扎根理论研究方法对贵州省遵义市9家医疗机构可多点执业的43名医生进行半结构化访谈,经开放式编码、主轴编码、选择性编码对医师多点执业问题进行整合。结果:经过三级编码,最终梳理出与医师多点执业相关的105个概念,17个范畴,7个主范畴和5个核心范畴,形成医师多点执业的5条脉络:发展前景及医师意愿、发展促进因素、发展困境、相关配套政策、服务需求及执业条件。结论:绝大多数医生愿意开展多点执业,相关法律法规、具体实施细则、薪酬分配体系和医疗事故处理方案的完善、医疗机构管理者的支持、医疗机构管理模式的转变、第二执业点提供必要的医疗条件并充分考虑第二执业点的距离、交通条件和相应的团队协作支持是顺利实施医师多点执业的必要条件。

Problems and countermeasures of physician multi-sited license based on the Grounded Theory: A perspective of the doctors

Objective:Based on Grounded Theory, the objective of this study is to explore the problems of Physician multi-sited license in Zunyi, Guizhou Province from the perspective of doctors and putting forward the corresponding countermeasures. Methods:From January to July, 2017, based on purposive sampling and Grounded Theory, 43 doctors from nine medical institutions in Zunyi of Guizhou Province were interviewed using semi-structural interview syllabus. With the help of open coding, axial coding, selective coding, multi-sited licensed Physician were integrated to explore existing problems, and putting forward corresponding countermeasures. Results:After three-grade coding, 105 concepts, 17 categories, 7 main categories and 5 core categories of multi-sited licensed Physicians were concluded. Then, 5 lines of Physician multi-sited license were formed, including development prospect and doctors aspiration, the factors that could stimulate development, development difficulties, relative supporting policies, service needs and practice condition. Conclusion:The majority of doctors are willing to carry out multi-sited practice, the relevant laws and regulations, the specific implementation details, salary distribution system and the improvement of treatment scheme of medical negligence, the support of medical institutions, the transformation of medical institutions management, the necessary medical conditions that the second place of practice should provide, the distance of second place of practice which should be fully considered, the convenience of traffic conditions and corresponding teamwork support are necessary requirements to be taken into consideration to carry out physician multi-sited license.