卷首语

随着医药卫生体制改革的不断深入,医生多地点执业又一次成为社会各界热议的话题,此次热议的焦点已不再是医生能否多地点执业,而是医生多地点执业的效果为什么不好。有资料显示,部分实行医生多地点执业的省市,     

内江市执业医生法定传染病报告知识的调查

目的 :了解内江市执业医生掌握法定传染病报告知识的情况。方法 :对收回的执业机构中 10 0名执业医生调查表进行统计分析。结果 :对报告病种、类型的回答正确率为 5 7% ,对报告时限的回答正确率为 36 % ,对义务报告人的回答正确率为 2 9% ,对报告疫情机关的回答正确率为 89% ;服务于不同的医疗机构、不同的学历、不同技术职称的执业医生间 ,对法定传染病报告知识的掌握差异有显著性 ,不同服务年限的执业医生间无差异。结论 :提高疫情报告质量的重要环节是 :不断开展对执业医生专门培训 ,进一步强化依法管理和监督。     

湖北省通山县乡村医生执业现状调查分析

目的探讨如何提高乡村医生队伍的整体素质和水平。方法以通山县354名乡村医生的全样本为研究对象,采用半结构式问卷对其进行问卷调查。结果通山县乡村医生的学历水平以中专及以下学历为主;整体执业水平还较低,仍有相当一部分乡村医生不具备执业资质,而已取得执业资格证书的以乡村医生执业证书为主;培训需求方面,乡村医生对培训时间、培训内容等方面有不同程度的需求。结论加强教育培训和准入管理,提高乡村医生执业水平;明确政府投入责任,确保乡村医生基本待遇;完善乡村医生保障体系,促进乡医人才队伍建设。     

乡村医生执业证书再注册工作即将开始

9月29日卫生部办公厅发布《关于做好乡村医生执业证书有效期满再注册有关工作的通知》,凡获得乡村医生执业证书满5年且拟继续在村医疗卫生：机构从业的乡村医生,不包括在村卫生室从业的执业医师和执业助理医师。执业再注册要与乡村医生业务考评和职业道德评定相结合。     

自由与不逾矩

两会期间，医生自由执业再次成为一个热点话题，随着张强、朱岩等医生走出体制外的选择以及医改对社会资本办医的鼓励，自由执业的春天似乎要来了，而国内是否适合自由执业、自由执业有哪些困难和问题，成为了众多医疗卫生界人士探讨的中心内容。孔子曾说过“随心所欲不逾矩”，讲的是适度的自由。自由执业中自由的程度与执业的落实究竟如何契合，应成为一个慎重思考的课题。     

医生独立执业的可行性和必要性分析

医务人员掌握大量的隐性高科技知识资本,本文从医生的自然属性和国际通行做法角度提出医生应该具有独立执业的权利和义务,本文从医生独立执业有利于解决“看病难、看病贵”的问题、有利于医生个人品牌的建立和医生人力资本价值的实现、有利于医学走出“唯科学主义”的死胡同化解医患冲突等角度论证了我国医生独立执业的必要性;本文也进一步分析了我国医生独立执业受阻的原因.     

医学教育对促进乡村医生向执业医师转化作用的研究

目的:探讨医学教育对促进乡村医生向执业(助理)医师转化的作用.方法:采用分层抽样现况(问卷)调查方法,对乡村医生医学教育和取得执业(助理)医师资格等情况进行分析.结果:乡村医生中专以上学历教育不足和执业(助理)医师转化率较低,医学教育与执业(助理)医师转化有直接关系,现行继续医学教育与执业医师资格准入制度存在不相适应之处.结论:调整和制定相关政策,积极发展乡村医生医学学历教育,以促进乡村医生向执业(助理)医师转化.     

国家卫计委：医生多点执业有望入法

8月15日，在中国医院论坛上，国家卫生计生委法制司处长王玲透露，医生多点执业将成为执业医师法修订当中重点研究的问题。现行执业医师法对医生多点执业的问题，并没有做出明确的规定。     

彭双发：医生自由执业的趋势挡不住

网络上一项关于“是否赞同及参与自由执业”的医生调查显示，70％的医生们都愿意自由执业。您认为当前医生追求自由执业的原因在哪里？     

国家卫生计生委部署乡村医生执业证书有效期满再注册工作

<正>近日,国家卫生计生委办公厅印发《关于做好乡村医生执业证书有效期满再注册有关工作的通知》,主要内容:一是明确了乡村医生执业证书有效期满5年进行再注册(执业再注册)的对象:按照《条例》规定获得乡村医生执业证书满5年且拟继续在村医疗卫生机构从业的乡村医生,不包括在村卫生室从业的执业医师和执业助理医师。二是对省级和县级卫生计生行政部门提出了工作要求。三是提出执业再注册与乡村医生业务考评和职业道德评定相结合。四是要求县级卫生计生行政部门将执业再注册     

军队医院后勤训练等级考评的组织与实施

根据后勤训练等级评定标准和实施办法,成立考评专家指导组,制定考评千分制标准,采取＂听、看、查、考、演＂等方法,全面考评医院训练的组织领导、训练成绩、训练能力、训练管理、训练条件等。为提高后勤训练质量,还需进一步抓按纲施训工作落实,提高科学组训能力,规范战时卫勤支援保障勤务流程,推进医院卫勤指挥信息系统建设。     

加强感染管理 提高医疗质量

医院感染管理是评价医院综合医疗质量的重要内容。通过将医院感染管理纳入全面质量管理,以健全的医院感染管理体系为保证,强化医务人员感染知识的教育与培训,严格落实规章制度,注重诊疗环节的过程管理等措施,降低了感染发病率,促进了整体医疗质量的提高。     

Who is a generalist? An analysis of whether physicians trained as generalists practice as generalists

Accurate data on the number of generalist physicians are needed to monitor the physician workforce and to plan for future requirements in the changing health care system. This study assessed the relationship between two frequently used definitions of a generalist physician: completion of graduate medical education (GME) in only a generalist discipline and physician's self-report of practicing as a generalist. Data for 4,808 physician graduates from six Pennsylvania medical schools from 1986 to 1991 were analyzed using information from the GME tracking census of the Association of American Medical Colleges and the Physician Masterfile of the American Medical Association. Of 1,291 physicians trained in a generalist discipline, 1,205 (93%) reported practicing as generalists. Conversely, of the 3,517 not trained in a generalist discipline, 3,358 (95%) were not practicing as generalists. These results indicate GME training is a valid predictor of self-reported practice and provide baseline data to monitor future changes.     

论增设乡村全科执业助理医师资格考试的必要性及可行性

乡村全科执业助理医师资格考试的增设符合乡村医生合法行医的需要,有利于加快乡村医生队伍执业医师化的进程,并提高其素质,同时在规范乡村医生队伍管理和稳定乡村医生队伍方面具有重要意义。乡镇执业助理医师资格考试的增设、现行相关法律政策提供的法律依据以及政策实施的客体——乡村医生群体的强烈诉求和居民支持使得乡村全科执业助理医师资格考试的增设具备了可行性。为保障乡村医生的执业医师化进程,还需完善现行法律法规和政策、加强针对乡村医生参加执业医师资格考试的医学专业培训及全科医师培训、建立合理的乡村全科执业助理医师补偿、养老等社会保障机制。     

基本药物制度下基层医疗卫生机构补偿方式研究与实践进展

通过对我国实施基本药物制度基层医疗卫生机构补偿方式的理论研究与实践进展的分析、总结比较的基础上,提出对我国基本药物制度下基层医疗卫生机构补偿方式研究的展望,为政府决策提供相应的决策参考。     

Medical community involvement in a breast cancer screening promotional project.

The analysis, mobilization, and involvement of medical communities in two counties targeted for intervention by the Washington State Community Breast Cancer Screening Project is described. Principles of community organization were applied to the health care sectors in the counties, and the PRECEDE-PROCEED model was used as a conceptual framework for considering individual physician behavior. Quantitative and qualitative medical community assessment methods included a demographic study, a survey of primary care physicians, personal interviews with physicians, and medical office staff focus groups. In both intervention areas, physician planning groups selected, developed, and helped implement intervention activities targeting the health care sectors. These activities included informational mailings to physicians, training of medical office staff members and clinical mammographers, and support for a reminder system. The experience demonstrated that physicians practicing in medium-sized cities are willing to be active in community disease prevention programs.     

The Rural Physician Workforce in Florida: A Survey of US- and Foreign-Born Primary Care Physicians

CONTEXT: To meet the challenge of primary care needs in rural areas, continuing assessment of the demographics, training, and future work plans of practicing primary care physicians is needed. PURPOSE: This study's goal was to assess key characteristics of primary care physicians practicing in rural, suburban, and urban communities in Florida. METHODS: Surveys were mailed to all of Florida's rural primary care physicians (n = 399) and a 10% sampling (n = 1236) of urban and suburban primary care physicians. FINDINGS: Responses from 1000 physicians (272 rural, 385 urban, 343 suburban) showed that rural physicians were more likely to have been raised in a rural area, foreign-born and trained, a National Health Service Corps member, or a J-1 visa waiver program participant. Rural physicians were more likely to have been exposed to rural medical practice or living in a rural environment during their medical school and residency training. Factors such as rural upbringing and medical school training did not predict future rural practice with foreign-born physicians. Overall, future plans for practice did not seem to differ between rural, urban, and suburban physicians. CONCLUSIONS: Recruiting and retaining doctors in rural areas can be best supported through a mission-driven selection of medical students with subsequent training in medical school and residency in rural health issues. National programs such as the National Health Service Corps and the J-1 visa waiver program also play important roles in rural physician selection and should be taken into account when planning for future rural health care needs.     

国内外医生助理岗位对比分析及启示

医生助理有利于缓解医疗资源短缺问题,提高患者就医满意度,是使用现有资源创造价值的一种方式。文章从医生助理定义、岗位职责、准入条件、培养方式和管理等方面结合现有文献,对国内外医生助理概况进行了总结和分析,指出了其发展过程中的不足,启示我国应拓展医生助理服务范围,形成系统培养体系,制定相关政策法规,以优化医生助理执业环境,推动我国医生助理岗位工作向前发展。     

实施医师定期考核制度的政策环境分析

从宏观、微观两个层面分析了医师定期考核制度实施所遇到的政策环境,着重探讨了各种阻力的现状及其影响。认为在宏观层面的阻力主要包括医师协会的法律地位和作用尚未确立、部分执业规则对于医师执业行为产生束缚、医疗事故责任界定与医师考核结果之间衔接有待理顺,在微观层面的阻力主要包括医师准入标准各地尚未统一、职业道德评价机制尚不完善、制度运行经费出处并未明确。     

值班和交接班制度问题分析与改进建议

值班和交接班制度是诊疗过程连续性的重要保障。若落实不到位,可能发生患者伤害的不良后果。采用案例分析结合问卷调查方式,阐述值班和交接班制度存在问题,包括值班人员不在岗,值班人员资质不符,医院总值班能力不足,交接班记录不完整等。提出针对性改进建议:加强医务人员依法执业培训;严格管理值班医师资质;健全医疗值班体系;规范记录交接班内容等。