醫師職場結構特質之研究：以生涯發展路徑與執業異動的關係為例

Abstract

本研究目的藉由醫師生涯發展路徑與醫師執業異動的回溯性歷史，探討職場 之結構特質。研究者從醫師訓練背景、醫師同儕支持度、醫師專業社會網絡及其 人脈關係、醫師離職意向與執業異動原因等面向，探討醫師職場結構的特質。 研究者針對66 位受訪醫師，同時進行結構式問卷與半結構式問卷的深入訪 談，由研究結果可歸納出以下的結論：在醫師訓練背景對其日後執業場址的選擇 方面，若在愈高層級的醫院完成住院醫師訓練，日後轉任於愈高層級的醫院升任 主治醫師的可能性愈高。故此，若未能在較高層級的醫院完成住院醫師訓練，將 來轉任於較高層級的醫院執業會較為困難。另外，就醫師職場結構特質的分析 中，當主治醫師晉升為科主任時，排除需要具備良好的醫療能力與醫務行政能力 的前提條件外，具有良好的關係能力，對於主治醫師是否能夠晉升為科主任，相 當重要。進而，於晉升過程中，以該院的院長與副院長最能夠發揮其影響力。再 者，醫師專業社會網絡及其人脈關係，對於醫師事業的拓展、轉換工作、增加病 人數量，均有正面的影響。最後，影響醫師離職意向與執業異動原因，主要為轉 到他院高昇與外界挖角。受訪者表示如果「有好的機會」，考慮離職的重要原因 為尋求較好的工作機會，以提升醫療能力。整體而言，醫師訓練背景、專業社會 網絡與人脈關係、職場結構特質均是影響執業異動的重要因素。同時，對於這些 問題的瞭解亦將有助於我們掌握醫師人力未來可能的發展趨勢。

The purpose of this study was to investigate the manpower mobility and change of physicians by using the retrospective history of physicians' career mobility from the aspects of physicians' training backgrounds, colleges' support, professional and social networks and characteristics of vocational structure. Based on the questionnaires (both structural and semi-structural) from 56 physicians, this study finds some important results: first, in regards to training backgrounds, it seems that the level of residential hospital has effect on a physician's future transference. A physician completing his resident at a high level hospital is more likely to be promoted to be a visiting surgeon at high level hospitals afterwards. Second, in addition to professional and administrative ability, a sound relationship is crucial for a visiting surgeon to be promoted to be a chief of visiting surgeon, specifically the president and sub-president in the hospital play an important role in this aspect. Third, physicians' professional and social networks have positive effect on physicians' career extant, transference and patients' number. Finally, the main reason of transference is recruitment and promotion from the outsides. As a whole, the results show that training background, physicians' professional and social networks and characteristics of vocational structure are all important factors of physicians' transference. The examination of those related factors will help us supervise the trend of manpower mobility of physicians in the future.