抚州市村级卫生机构调查分析

采用分层随机抽样的方法对抚州市76个村级卫生机构基本情况进行调查。结果显示：县级每千农业人口拥有乡村医生和卫生员1．61名．具有执业助理医师以上资格的占乡村医生总数的0．99％；业务用房平均面积为30．83m^2、1．69间；药品收入占业务收入的62．62％．规范处方率为56．91％；Logistic回归分析，机构性质、药品收入两因子被引入。表明：政府对村级卫生机构投入乏力，部门关心不够；乡村医生人数不少，整体素质不高；基础设施简陋，服务功能不全；医疗设备简单，药品收入高：监管不力．医疗行为不规范．     

国际视角下对我国医师多点执业政策的思考

在很多国家,医师多点执业是比较通行的做法;公立医院医生特别是高年资医生,既可以院外行医,也可以在院内诊治私人病人,以获得额外收入。国外公立医院医生多点执业制度的主要目的在于增加医生收入,帮助公立医院与其他医院竞争、吸引优秀或短缺的医生。我国实行医师多点执业政策是与国际通行做法相接轨的,不过也应加强管控,并且对其作用有恰当认识。推行医师多点执业制度并不一定必须把公立医院医师转变为自由职业者,但应加快公立医院薪酬制度改革。     

乡镇卫生院临床医生向执业(助理)医师过渡问题与对策研究

目的：研究乡镇卫生院临床医生执业现状，找出乡镇卫生院临床医生向执业（助理）医师过渡过程中存在的主要问题并提出对策建议．方法：采用典型抽样．对全国共6个省的12个县进行全面调查。每县按照经济发展的高、中、低水平选择3个乡镇对乡镇卫生院院长及部分临床医生进行重点调查。以问卷调查和现场观察的形式进行。结果：（1）乡镇卫生院临床医生的素质较低。年龄、学历和职称结构不合理。保障水平低是农村卫生队伍年龄老化的重要原因。（2）无证执业现象仍然存在，主要是由于考试资格门槛过高、考试方式与内容不切合农村实际；（3）超范围执业现象普遍。结论：（1）制定全国统一的医师资格准入标准；（2）对新选人员严把准入关，对现在在职但不具备执业（助理）医师资格的人员采取不同策略；（3）修改《执业医师法》中有关执业医师全国统一考试的规定：（4）设立农村全科医学专业；（5）逐步改善乡镇卫生院医生工资待遇，制定培训经费保障和减免专项政策。     

对两省医生收入满意度和期望收入的分析

为了了解医生对收入的意向，我们对山东和四川两省的三级公立医院各1所的所有临床医生的收入满意度和期望的收入、提高收入的途径进行了问卷调查，结果表明：公立医院的医生对目前收入不满意；医生目前的收入距离期望值还有很大差距；大多数医生希望通过调整收入政策和增发奖金来提高收入，33．3％的医生希望通过业余医疗服务兼职提高收入。因此，建议医院做好医疗服务价格和分配制度改革的工作，制定出相应的分配政策、医生兼职政策，同时也要给医生工作营造一个良好的人文环境。     

多点执业，医生从“单位人”走向“自由人”——医疗服务行政化的突破口公家人与自由职业的分界

对于医生来说，新医改方案最大的突破在于多点执业的合法化。医生多点执业合法化，可提高他们的收入；中小城市甚至是农村地区的患者，有望在居住地附近的医院接受大城市大医院专家的诊疗服务。然而，多点执业合法化的意义绝不止这些。更为深远的意义在于，医生的身份性质将发生重大变革。在不远的将来，他们将不再是国家干部，而成为自由职业者，回归其本性。由此，公立医院行政化的事业单位体制将出现一个缺口，计划体制时代遗留下来的人事制度将发生重大变革，转型为市场化的人力资源管理体系。唯有如此，医生的价值才能得到恰当的发现、充分的保障。     

不能用违法方式维权——从患者家属的感谢信看依法维权

常常看到患及其家属到医院吵闹，常常听到医生被打骂的情况，甚至发生医生被杀的惨案。本来，如果医生违法执业、医院违法经营侵犯了您的权益，您可依照《执业医师法》向法院或卫生行政部门申诉；若认为构成了医疗事故，可依照《医疗事故处理条例》申请鉴定；如果卫生单位或部门侵犯了您的合法权益，您可依照《行政诉讼法》向法院起诉或依照《信访条例》向其上级行政部门申诉……1990年10月1日起实施的《中华人民共和国行政诉讼法》，1999年5月1日起实施的《中华人民共和国执业医师法》，2002年9月1日起实施的《医疗事故处理条例》，2005年5月1日起实施的《信访条例》等法律法规都为各种矛盾与纠纷的解决指明了道路。但是，为什么仍然发生上述不明甚至不法行为？说明上述法律法规的贯彻落实还很不到位，人们还没有学会拿起法律武器，维护自己的权益；而往往用错误甚至违法的手段进行维权，这种维权方式是错误的，情节严重的还将受到法律的制裁，由有理变成了无理。这种现象与和谐社会是极不相称的，应当尽快予以纠正。本从患家属、医生、卫生行政部门对上述法律法规的执法实践探讨依法执业与维权的关系，希望能给读以启示。[编按]     

医师多点执业影响因素调查与研究

目的：通过对江苏省医师多点执业影响因素的调查与分析，提出进一步推进医师多点执业的建议。方法：选取南京市和泰州市共14所医疗机构作为抽样单位，从中随机选取552名已取得执业资格的医师为调查对象进行问卷调查，通过SPSS20.0软件对结果进行统计学分析。结果：（1）医师学历、年龄、职称、科室对医师多点执业意愿存在显著影响；医师性别、所在医疗机构等级、从业年限和月收入对医师多点执业意愿无显著影响。（2）政策因素、组织因素和个人因素都与医师多点执业意愿呈显著正相关，按照影响程度由高到低排序依次是政策因素、个人因素和组织因素。结论：为进一步推进医师多点执业，相关部门需要站在立法高度上完善医师多点执业激励、风险、准入、财政和监管等规定；二、三级公立医院和基层医疗机构管理者也要及时转变观念，积极鼓励、支持医师多点执业，完善人事制度；医师自身也要重新定位角色，以更好的状态积极参与多点执业。     

医改之谏·网友

王哲：有限资金要花在刀刃上 医改不能只看医保覆盖了多大范围，如果医生的待遇不能够改善，工资很低，都靠提成回扣，即使全民医保了，但是大处方及大检查仍会满天飞，不仅败坏了社会风气，还会大大增加医疗成本，使国家的投入无法满足支出，还不如国家提高医生的待遇，使医生拿到心安理得的收入，并对受贿的医生严惩，这才是根本的方法，     

从一则网帖谈医生的社会地位

为医生提供一个良好的行医氛围，给医生一个更加宽容的执业空间，让社会重视医学、尊重医生，要采取措施逐步提高医生的地位和待遇，使医生成为光荣而神圣的职业，让其担负起国家的公共卫生责任。[编按]     

上海市乡村医生现状调查与分析

目的 从乡村医生现状入手,分析乡村医生数量、年龄、职称、学历、收入及可能存在的问题,为完善上海市乡村医生队伍建设提供科学依据.方法 采用分层整群随机抽样的原则.调查并分析上海市8个郊区(县)24个乡镇72个村137名乡村医生的基本情况.结果 与讨论与现行人们日益增长的卫生服务需求相比,上海市乡村医生人力数量呈现相对不足;平均年龄48.6岁,50～60岁年龄段者高达46.7%,老龄化趋势严重;职称构成中,没有任何资质的村医占13.5%,乡村医生占19.9%;与<中共中央国务院关于农村卫生改革与发展的指导意见>"到2010年,在大部分农村地区完成乡村医生向执业助理医师的转化"要求还有一定差距;学历构成中,中专以上学历者占49.6%,与<中共中央国务院关于卫生改革与发展的决定>"到2000年使全国80%乡村医生达到中专水平"要求差距较大;被调查乡村医生平均年收入14 400.0元,72.8%的农村卫生服务组织者和管理者认为,与其劳动的强度和投入相比,该收入是偏低的.     

医疗职业风险防范与化解机制研究

医疗的特殊性决定医疗职业具有其他职业所没有的高风险性，基于对医疗职业高科技、高风险性的充分认识，应当考虑建立相应的风险防范和化解机制，以维护医生的合法权利。医疗职业风险的防范和化解是一个系统化的制度体系和法律安排，具体由医疗职业风险分散机制、医疗责任分担机制和医疗社会保障制度三个层面构成。     

Alcoholism in Doctors

Problem drinking among medical practitioners is an importanthealth hazard and has been much ignored in the past. There isconsiderable evidence to suggest that doctors constitute a highrisk group in respect of drinking problems. Follow-up studiesof alcoholic doctors have given variable results but on thewhole there is room for a reasonable degree of optimism. Scottish and Irish practitioners would appear to be particularlyvulnerable and the writer's study in Glasgow suggests the possibilityof a higher degree of risk among general practitioners. The general issue of the sick doctor is now receiving attentionfrom the newly constituted General Medical Council and the newprocedures should be observed with interest. The causal factors of problem drinking among doctors are multiple. Early recognition of the problem among doctors can lead to worthwhiletreatment. There is, however, a need for preventive and healtheducation measures among the medical profession.     

医改方案之初步设计——以破解医疗市场信息不对称为切入点

医改的主要矛盾在于医患双方信息不对称。笔者试图通过医疗保险费用支付方式的设计,将现有的医疗卫生机构划分为社区与专业两种,并将社区医疗机构作为参保者的健康代理人,以医疗机构监督医疗机构的方式破解信息不对称的矛盾;并以此为切入点,设计了一个相对简单易行、成本可控、效率较高的覆盖全民的医保体系。     

Television documentary in New Zealand and the construction of doctors by lower socio-economic groups

The medical profession remains central to the provision of health care and the treatment of illness within contemporary society. However, the image of doctors and the relationship of the profession with the public is contested. The public persona of doctors has been subjected to re-negotiation in recent years as a result of factors such as health care reforms, the increased autonomy of other health professionals, the rise of the health consumer, and well-publicised cases of medical misadventure. We argue that television viewing is one influential way through which images of medical doctors are socially negotiated. This paper explores the construction of doctors through an analysis of television health documentary coverage and the accounts of lower SES participants in New Zealand. It demonstrates how televised depictions of doctors are integrated into the lifeworlds of viewers. We show that multiple and often contradictory representations of doctors, within both television health coverage and the accounts of our participants, conflate the traditional characterization of the caring professional with more recently established characterizations such as the medical entrepreneur and the bungling quack. The result is a complex and contextually variable image of doctors that embodies tensions surrounding public anxiety over health care reform. Recourse to this more pluralistic image of doctors provides a way for participants to work through the dilemmas posed by reduced access to medical care and the uncertainties of medical treatment, while still maintaining support for universal access to medical care.     

Discrimination against women in the South African medical profession

The paper examines discrimination against women in the medical profession in the South African context. To measure the extent of the problem data was obtained from the records of one of the largest South African medical schools--the University of the Witwatersrand Medical School. This medical school is one of the most liberal in South Africa and does not discriminate against women in its admission policies and the number of women graduated as doctors has increased steadily. Despite this, women take a secondary place in the South African medical profession. Evidence for this was collected from official records and supplemented with guided interviews with 15 women doctors. Special attention is given to the serious under-representation of Black women doctors in South Africa.     

Remaining in or leaving the profession: the view of medical students

The circumstances under which medicine is practised have changed considerably in the past few decades and this together with the alternative prospects available for doctors on the labour market, has resulted in ever more of them leaving the profession. Aim: The aim of our complex study was an analysis of the professional socialisation. In this study is medical students' views regarding their staying in a medical career or leaving it and the relationship with other elements of becoming a doctor are described. Methods: The study was carried out with a self-administered questionnaire with 503 general medical students randomly selected from two Hungarian medical schools. Depending on their opinions regarding the advantages of staying in the profession or leaving it, the medical students were divided into two groups (career stayers)--57,5% of the students feel sure that, they will stay in the profession; (possible career leavers)--42,5% represented those students who were not sure if they wanted to work as doctors in the future. We analysed the similarities and differences between the two groups regarding their career socialisation. Results: A significant difference was revealed between the two groups regarding the strength of their dedication to the profession. The medical students indicated that their decision as of leaving or staying with medicine is not conditioned by objective factors (for example: origin, financial status), but it is conditioned by subjective factors, like sense of vocation. Conclusions: Our results can contribute to shaping of a better professional identity during training, as well as to a better understanding of job abandoners.     

A short history of the General Medical Council

INTRODUCTION: The General Medical Council (GMC) regulates British doctors through the Medical Act. The Council comprises doctors (who predominate) and laypeople. It registers doctors for UK practice, sets professional standards, regulates basic medical education, and manages doctors' fitness to practise. The GMC sits uneasily at the interface between the medical profession, the public, Parliament and the National Health Service. Herein lie the seeds of inertia and conflict. A TRADITIONAL REGULATOR: The early GMC mainly managed serious complaints against doctors. Reactive, passive and distant from doctors, it was reconstituted in 1979 after it lost their confidence. At this point the public became increasingly impatient with the GMC because it appeared to be too protective of doctors and unwilling to tackle poor practice. When it did respond, its actions were perceived as too little, too late. Public pressure accelerated radical change following the 1990s crisis in paediatric cardiac surgery at Bristol Royal Infirmary. NEW PROFESSIONALISM: In the 1990s, the GMC itself set a new direction. There was more public involvement. A statement of professional standards -Good Medical Practice- was agreed between profession and public. The standards are tied to licensure, medical education and workplace clinical governance, and are to be observed by all doctors. The biggest change is the plan to evaluate doctors' practice regularly through revalidation in the form of relicensure. CONCLUSION: All patients are entitled to a good doctor. The challenge to the profession and the GMC is to ensure they fulfil this entitlement by implementing professional regulation effectively.     

‘You're just a locum’: professional identity and temporary workers in the medical profession

Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi‐structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory‐driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety.     

论医疗过失诉讼的基本特征与缺陷——兼评我国医疗损害责任制度的改革

医疗过失诉讼具有过失认定的专业性和不确定性、医疗损害的基础性和自然进展性、因果关系判断的复杂性与多元性等基本特征,并存在诉讼结果的非预测性、证明责任的医患两难性以及诉讼导致医患对立的缺陷。这些基本特征与缺陷是基于医疗服务和法律的专业性以及医学与法学的局限性而产生的,与一个国家的法律制度与医疗服务模式没有关系。我国当前的医疗损害责任制度改革并没有充分认识到这些因素．以至采取了开放性的医疗过失诉讼制度,并在某些方面基本上视医疗损害责任为一般人身损害责任。这种改革趋势加剧了医疗服务的非医学化,有违医学规律,在某种程度也违背了法律的公平原则。     

More women enter medicine: young doctors' family origin and career choice

Summary. This study is part of the Finnish Junior Physicians 88 Study, the purpose of which was to shed light on the life situation, career choice and future plans of young doctors and their views on medical education. The survey population included all the medical doctors registered during the years 1977-1986 in Finland (n = 5208 ). A postal questionnaire was sent to a sample of 2632 doctors born on odd-numbered days. After a reminder letter, 1745 questionnaires (66%) were returned. Forty-nine per cent of the respondents were women. Typically both men and women doctors had a father who was an upper-level white-collar worker and a mother who was a housewife. More men than women had a father who was a doctor or other health professional. More women than men mentioned that a lifelong calling (42% vs 30%), success at school (58% vs 47%) and an interest in helping people (78% vs 71%) had considerable influence on their decision to become a doctor. Men more often than women emphasized the medical profession being regarded as a highly paid (56% vs 47%) and a high status profession (64% vs 56%) and also that a family member was a doctor (15% vs 11%).