The Policy Analysis of Manpower Shortages in Internal Medicine, Surgery, Obstetrics and Gynecology, and Pediatrics in Taiwan

The structure of medical specialists in Taiwan has changed along with social development in the past two decades. The investigation report of the Control Yuan in 2010 indicated the manpower shortage of the 4 major specialties, i.e. internal medicine, surgery, obstetrics and gynecology, and pediatrics, which might lead to a crisis in health care system. However, there was no agreement among stakeholders on the manpower shortage issue. The aims of this thesis were to clarify the situation and causes of the manpower shortage problem, and provide policy suggestions.
This research applied policy analysis methods and collected information and evidence from literature review, questionnaire survey, official statistics, NHI claims data, and expert meetings. We found that the problem of manpower shortage in internist, surgeon, obstetrics and gynecology, and pediatrician were obvious in resident recruitment rather than healthcare services to patients in general practice settings in Taiwan. However, we were worried that the influence might emerge in the near future and the government should take actions to prevent future decline in the inflow of manpower in the 4 major specialties.
Possible reasons associated with the shortage of resident recruitment included 3 market factors: too many training quota, below-expected payment, and declining birthrate. The other 3 non-market factors were increasing medical disputes, higher expectation on quality of life and too much paper works for accreditation. We suggested that reducing resident training quota and established new measures to lessen medical disputes can be done in the short term. In the long term, the health authority should modify NHI payment rates to balance the effort and risk among specialties, revise hospital accreditation criteria and evaluate the feasibility of introducing physician assistant in Taiwan.