Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2010 Aug;73(8):425-30. doi: 10.1016/S1726-4901(10)70091-5.
Since the fee-for-service reimbursement mechanism has been under the global budget of the National Health Insurance program, physicians' workloads have been increasing. Attending physicians in medical centers usually have long working hours because of their clinical work as well as teaching, research, and other administrative responsibilities. Many studies regarding reasonable work hours for physicians have been undertaken globally, but few have been conducted in Taiwan. In this study, we focused on the difference in working hours among physicians in different departments.
Using attending physicians from a major teaching hospital as the study population, we adopted self-administered questionnaires to investigate physicians' time allocations for 4 major categories: clinical work, teaching, research, and administrative work. We distributed 432 questionnaires and received 380 filled-out questionnaires, yielding a response rate of 88%. After eliminating questionnaires with incomplete responses, the valid sample size was 376. We used t test and 1-way ANOVA to analyze the association between physicians' characteristics and workload and used multiple linear regression to examine factors influencing physicians' work hours.
The average weekly work time among attending physicians was 65.6 hours; physicians under the age of 40 worked an average of 69.8 hours. Males worked an average of 66.2 hours weekly and females an average of 62.7 hours. Total work hours and hours of clinical work, teaching, research, and administrative work all reached significant differences among departments. Physicians who were under 40 years old, those with a doctoral degree, those with a teaching position as associate professor or above, and those working in anesthesiology had longer total work hours.
This study found that work hours among departments differed significantly and that physicians in surgical departments spend the longest hours in clinical work. Those in administrative positions are most involved in clinical work. However, work hours do not definitely represent work intensity, and to define the workload by working hours may be inappropriate for some departments. This possible difference between work hours and work intensity merits further consideration.
自按服务项目付费的报销机制纳入国家健康保险计划的总预算以来，医生的工作量一直在增加。由于临床工作、教学、研究和其他行政职责，医学中心的主治医生通常工作时间较长。全球范围内已经进行了许多关于医生合理工作时间的研究，但在台湾进行的研究很少。在这项研究中，我们专注于不同科室医生工作时间的差异。
我们以一家主要教学医院的主治医生为研究人群，采用自填式问卷调查医生在 4 个主要类别中的时间分配：临床工作、教学、研究和行政工作。我们发放了 432 份问卷，收到 380 份填写完整的问卷，应答率为 88%。剔除回答不完整的问卷后，有效样本量为 376 份。我们使用 t 检验和单因素方差分析来分析医生特征与工作量之间的关联，使用多元线性回归来检验影响医生工作时间的因素。
主治医生的平均每周工作时间为 65.6 小时；40 岁以下的医生平均每周工作 69.8 小时。男性每周平均工作 66.2 小时，女性平均每周工作 62.7 小时。各科室的总工作时间以及临床工作、教学、研究和行政工作时间均存在显著差异。40 岁以下、具有博士学位、担任副教授及以上教学职务、从事麻醉科工作的医生总工作时间较长。
本研究发现科室之间的工作时间差异显著，外科科室的医生在临床工作中花费的时间最长。行政岗位的医生最投入临床工作。然而，工作时间并不一定代表工作强度，用工作时间来定义工作量可能不适合某些科室。这种工作时间和工作强度之间的差异值得进一步考虑。
