Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
World J Surg. 2010 Aug;34(8):1748-55. doi: 10.1007/s00268-010-0562-9.
A surgical workforce is essential for providing surgical services to the community. However, little is known about surgeons' career changes in circumstances where physicians can freely choose their specialty. Differing career transitions among surgical specialties were hypothesized.
Longitudinal data were obtained for all physicians in Japan, giving a total of 4,302,844 items of data (for 390,368 physicians) from 1972 to 2006. Descriptive statistics for all physicians and surgeons were calculated in 1976, 1986, 1996, and 2006. "Active surgeons" (working at hospitals), "primary care surgeons" (working at clinics), and "retired surgeons" were analyzed among physicians licensed in 1972, 1982, and 1992 for the subspecialties of general surgery, orthopedic surgery, neurosurgery, urology, and "other" surgeries. Survival analysis and Cox's proportional hazard analysis were conducted to examine factors affecting career changes.
During the study period, the greatest change was observed in the increased number of surgeons per 100,000 physicians. The percentage of female surgeons and surgeons registered in a surgical subspecialty also increased greatly. Significant differences, by sex, age, and subspecialty, were shown in survival analyses for surgeons' career changes in the transition from active surgeons to primary care surgeons or retired surgeons. Surgical specialty was still a significant factor for predicting career transition, even after adjustment for the surgeons' characteristics.
The current study elucidated the differences in career transitions among surgical specialties. Given the observed findings, policy makers should consider more detailed and effective measures for retaining surgeons in active practice.
外科医生队伍对于向社区提供外科服务至关重要。然而，在医生可以自由选择专业的情况下，人们对外科医生的职业变化知之甚少。本研究假设不同的外科专业会有不同的职业转变。
从 1972 年至 2006 年，共获取了日本所有医生的纵向数据，总计 4302844 项数据（涉及 390368 名医生）。1976 年、1986 年、1996 年和 2006 年对所有医生和外科医生进行了描述性统计分析。在 1972 年、1982 年和 1992 年获得行医资格的普通外科、骨科、神经外科、泌尿科和“其他”外科医生中，分析了“在职外科医生”（在医院工作）、“初级保健外科医生”（在诊所工作）和“退休外科医生”。采用生存分析和 Cox 比例风险分析来研究影响职业变化的因素。
在研究期间，外科医生的数量每 10 万医生中增加最多。女外科医生和注册外科专科医生的比例也大幅增加。外科医生的职业从在职医生转变为初级保健医生或退休医生的生存分析显示，性别、年龄和专科之间存在显著差异。即使调整了外科医生的特征，外科专业仍然是预测职业转变的重要因素。
本研究阐明了外科专业之间职业转变的差异。鉴于观察到的结果，政策制定者应考虑采取更详细和有效的措施来保留在职外科医生。
