Green Michael E, Van Iersel Rebecca I
Department of Family Medicine & Community Health and Epidemiology, Centre for Health Services & Policy Research, Queen's University, Kingston, ON.
Can J Rural Med. 2007 Winter;12(1):10-5.
The Weeneebayko Health Ahtuskaywin (WHA) is an Aboriginal regional health authority serving a large remote region on the west coast of James Bay. The physicians are all paid on a non-fee-for-service basis. There are periods of acute shortage, periods of relative stability and periods when much of the care is provided by locum physicians. As a closed system, it is ideal for the investigation of physician response to periods of acute increases in demand for service.
This study investigated the relationships between staffing levels and service provision to describe the response of physicians to increased demand due to an acute shortage of physicians. It also looked at whether payment options affected these relationships.
Using an existing administrative database from WHA for the period 1999 to 2002, relationships between staffing levels and service provision were investigated. We looked at the relationship between total physician levels and the number of patients seen per family medicine clinic. We also studied the relationships between total physician staffing levels and the number of patients seen in clinic, in the emergency department (ED), and per ED shift. We also looked at some proxy measures for the level of intensity of the work, including the number of hospital inpatients, the number of medevacs per ED shift and the number of ED shifts per physician. Exploratory graphical analysis was conducted and was followed by linear regression for associations of interest.
During periods of decreased staffing, physicians saw more patients per clinic and ED shift, despite the lack of financial incentives. The study also clearly demonstrates the increased intensity of the workloads carried by rural physicians in times of staffing shortages as noted by increased numbers of ED shifts, increased numbers of medevacs per ED shift and the lack of a decline in inpatient numbers. This highlights the need for ongoing recruitment and retention efforts in rural and remote locations to ensure adequate physician staffing levels, if burnout is to be avoided.
韦内贝伊科健康机构（WHA）是一个原住民地区卫生当局，服务于詹姆斯湾西海岸的一个广大偏远地区。医生均按非服务收费制领取薪酬。存在医生严重短缺时期、相对稳定时期以及大部分护理由临时代理医生提供的时期。作为一个封闭系统，它非常适合研究医生对服务需求急剧增加时期的反应。
本研究调查人员配备水平与服务提供之间的关系，以描述医生对因医生严重短缺导致的需求增加的反应。研究还探讨了薪酬选择是否会影响这些关系。
利用WHA 1999年至2002年现有的行政数据库，调查人员配备水平与服务提供之间的关系。我们研究了医生总数与每个家庭医疗诊所就诊患者数量之间的关系。我们还研究了医生总配备水平与诊所、急诊科就诊患者数量以及每个急诊科班次就诊患者数量之间的关系。我们还考察了一些工作强度水平的替代指标，包括住院患者数量、每个急诊科班次的空中医疗转运次数以及每位医生的急诊科班次数量。进行了探索性图形分析，随后对感兴趣的关联进行线性回归分析。
在人员配备减少期间，尽管缺乏经济激励，医生在每个诊所和急诊科班次仍接待了更多患者。该研究还清楚地表明，在人员短缺时期，农村医生的工作量强度增加，表现为急诊科班次增加、每个急诊科班次的空中医疗转运次数增加以及住院患者数量没有下降。这突出表明，如果要避免职业倦怠，就需要在农村和偏远地区持续开展招聘和留用工作，以确保有足够的医生配备水平。
