臺灣博碩士論文加值系統

健保制度實施以及美容醫學的興起，使得台灣整形外科醫師在選擇執業場所時有了不同的考慮。所謂執業場所即衛生部定義的醫療機構，包括大型醫院、中型醫院、大型診所、中型診所、小型診所、及單人診所。這些醫療機構都希望能夠找到好的人才並留任之。要達成這個目標首先我們必須了解整形外科醫師對他們執業的滿意度，然後找出影響滿意度的變數有那些，這樣才能夠改善自身的缺點並放大優點來吸引人才。首先我們設計一份有20個問題的問卷，包括受訪者的基本資料、服務的醫療機構、滿意度、是否曾經換過醫療機構、如果有的話原因為何、專長的手術項目與比例、專長的美容醫學項目、嚮往的醫療機構、以及留任原職的原因。由整形外科醫學會協助發放問卷，從2022年8月30日開始通知會員填寫，至2022年10月31日截止共收到148份有效問卷，回覆率為19%。統計的方法包含單項變數與滿意度之間使用單因子變異數；留任原職的原因以及嚮往的醫療機構是用卡方檢定；最後使用多元邏輯斯回歸計算各個變數與滿意度的關聯，統計顯著性差異的閾值為p < .05。結果發現年齡和服務的醫療機構是影響滿意度最重要的因素，而性別、執業地點、和手術專長則沒有顯著影響。留任原職位的原因在不同醫療機構間有顯著性差異。而醫師最嚮往的醫療機構則是2～5位醫師所組成的小型診所。

After the implementation of the National Health Insurance system and the rise of aesthetic medicine, plastic surgeons in Taiwan have different considerations when choosing their workplace. The term "workplace" refers to medical institutions defined by the Ministry of Health and Welfare, including large hospitals, medium-sized hospitals, large clinics, medium-sized clinics, small clinics, and solo clinics. All these medical institutions hope to find and retain talented individuals. To achieve this goal, we must first understand the satisfaction of plastic surgeons with their work and then identify the variables that affect their satisfaction, so that we can improve our own shortcomings and amplify existing strengths to attract them. We designed a questionnaire consisting of 20 questions, including respondents' basic information, the medical institution they serve, satisfaction level, whether they have changed medical institutions, reasons for changing if applicable, proportion of specialized surgeries, areas of expertise in aesthetic medicine, desired medical institutions, and reasons for staying in their current positions. The Taiwan Society of Plastic Surgery (TSPS) notified its members that they had to complete the questionnaire from August 30, 2022 to October 31, 2022. A total of 148 valid questionnaires were received, resulting in a response rate of 19%. Statistical methods used included one-way ANOVA to analyze single variables and satisfaction, chi-square test for reasons for staying in current positions and desired medical institutions, and finally, multivariate logistic regression to assess the association between various variables and satisfaction, with a significance threshold of p < .05. The results revealed that age and the medical institution served were the most significant factors affecting satisfaction level, while gender, practice location, and surgical specialization had no significant impact. The reasons for staying in current positions varied significantly among different practice institutions, and the most desired medical institution was a small clinic composed of 2-5 physicians.

第壹章 緒論 1
第一節 前言 1
第二節 研究目的 2
第三節 研究問題 3
第四節 研究範圍與限制 4
第五節 研究重要性 4

第貳章 文獻探討 7
第一節 整形外科醫師的工作量滿意度與過勞調查 7
第二節 整形外科醫師性別與滿意度 8
第三節 執業地點與滿意度 9
第四節 整形外科醫師選擇醫療機構的變化 12
第五節 手術專長與滿意度 14

第參章 研究方法 16
第一節 研究對象 16
第二節 研究材料 16
第三節 研究流程 18
第四節 資料處理與分析 18

第肆章 結果 20
第一節 描述性統計數據 20
第二節 執業城市與滿意度 20
第三節 年齡與滿意度 21
第四節 首任與現任醫療機構的任職時間與滿意度 23
第五節 現任醫療機構與滿意度 25
第六節 年齡和醫療機構與滿意度 28
第七節 留任的原因 30
第八節 對未來的選擇 33
第九節 其它 34
第十節 滿意度的多元邏輯斯回歸 36

第伍章 討論 38
第一節 年齡與滿意度 40
第二節 性別與滿意度 41
第三節 醫療機構與滿意度 43
第四節 手術專長與滿意度 44

第陸章 結論 47
第一節 研究限制與未來建議 47

引用文獻 49
附錄 52
附錄一 問卷 52

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天地人文創 (2020)。[跨產業]從藍海到紅海，醫美產業如何殺出一條血路。取自天地人文創產業報導。https://blog.tiandiren.tw/archives/10453
行政院性別平等會 (2023)。重要性別統計資料庫。取自衛生福利部各類醫事人員性別統計。https://www.gender.ey.gov.tw/GecDB/Common/FileDownload.ashx?sn=LhVF5PF8Nh9qATd20ZCc9w%40%40&ext=.pdf
林昌誠、柯賢忠、錢慶文 (1992)。醫師工作滿意度相關因素與離職意願之研究：以執業於臺北市之醫師為例。國立陽明大學，臺北市。
國立臺灣大學醫學院 (2023)。國立臺灣大學醫學院臨床教師聘任及升等辦理細則。取自台大醫學院人事組。https://www.mc.ntu.edu.tw/person/files/med5.pdf
許淑群 (2008)。西醫基層總額支付制度對執業醫師健保收入的影響。臺北醫學大學，臺北市。
陳秀敏、林宜靜、蔡宗珍 (2017)。全民健康保險全球預算支付制度之回顧與前瞻。台灣衛誌，36(6)，487-498。
楊馬利、徐仁權 (2011)。台灣最有勇氣的歐吉桑。遠見 301。https://www.gvm.com.tw/article/15640
臺北榮民總醫院 (2012)。住院醫師勞動權益保障參考指引。取自臺北榮民總醫院教學部。https://wd.vghtpe.gov.tw/medu/files/102年5月住院醫師勞動權益保障參考指引.pdf
蔡偉德 (2005)。健保十年醫療服務產業的演化。公平交易委員會。https://www.ftc.gov.tw/upload/seminar/14-08.pdf
衛生福利部醫事司 (2013)。發揮各層級醫院角色功能重振五大科。取自衛生福利部醫事司。https://www.mohw.gov.tw/dl-2829-a686eeda-76be-4cbf-84ed-5eb3b378d8f0.html
衛生福利部醫事司 (2017)。降低住院醫師工時，保障醫療品質與安全。取自衛生福利部，焦點新聞/106年衛生福利部新聞/7月新聞。https://www.mohw.gov.tw/cp-3539-36950-1.html
衛生福利部醫事司 (2020)。住院醫師勞動權益保障及工作時間指引。取自衛生福利部，衛生福利法規檢索系統。https://mohwlaw.mohw.gov.tw/FLAW/FLAWDAT0202.aspx?lsid=FL085553
賴品瑀 (2022)。異鄉變故鄉。衛福季刊，35，34-37。
American Society of Plastic Surgeons (2020). Plastic Surgery Statistics Report 2020. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
Capek, L., Edwards, D. E., & Mackinnon, S. E. (1997). Plastic surgeons: a gender comparison. Plastic and Reconstructive Surgery, 99(2), 289-299.
Coombs, D. M., Kwiecien, G. J., Sinclair, N. R., & Zins, J. E. (2022). Supply and demand: Resident applications to program positions in plastic surgery and our sister specialties. Plastic and Reconstructive Surgery, 151(1), 158e-166e.
Davis J. S. (1941). Address of the president: The history of plastic surgery. Annals of Surgery, 113(5), 641–656.
Dyrbye, L. N., Varkey, P., Boone, S. L., Satele, D. V., Sloan, J. A., & Shanafelt, T. D. (2013). Physician satisfaction and burnout at different career stages. Mayo Clinic Proceedings, 88(12), 1358-1367.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149-1160.
Mortada, H., Mustafa, N., Bamakhrama, B., Alshateb, M., Gelidan, A. G., & Arab, K. (2021). Employment and career choice satisfaction among Saudi plastic surgeons: a cross-sectional, questionnaire-based study. Plastic and Reconstructive Surgery Global Open, 9(10).
Scheurer, D., McKean, S., Miller, J., & Wetterneck, T. (2009). US physician satisfaction: A systematic review. Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine, 4(9), 560-568.
Schloss, E. P., Flanagan, D. M., Culler, C. L., & Wright, A. L. (2009). Some hidden costs of faculty turnover in clinical departments in one academic medical center. Academic Medicine, 84(1), 32-36.
Shanafelt, T. D., Balch, C. M., Bechamps, G., Russell, T., Dyrbye, L., Satele, D., ... & Freischlag, J. (2010). Burnout and medical errors among American surgeons. Annals of Surgery, 251(6),995-1000.
Silver, M. P., Hamilton, A. D., Biswas, A., & Warrick, N. I. (2016). A systematic review of physician retirement planning. Human Resources for Health, 14(1), 1-16.
Streu, R., Hansen, J., Abrahamse, P., & Alderman, A. K. (2014). Professional burnout among US plastic surgeons: results of a national survey. Annals of Plastic Surgery, 72(3), 346-350.
Streu, R., Hawley, S., Gay, A., Salem, B., Abrahamse, P., & Alderman, A. K. (2010). Satisfaction with career choice among US plastic surgeons: Results from a national survey. Plastic and Reconstructive Surgery, 126(2), 636-642.
Streu, R., McGrath, M. H., Gay, A., Salem, B., Abrahamse, P., & Alderman, A. K. (2011). Plastic surgeons' satisfaction with work–life balance: Results from a national survey. Plastic and Reconstructive Surgery, 127(4), 1713-1719.