Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Switzerland / Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
Swiss Med Wkly. 2019 Sep 2;149:w20116. doi: 10.4414/smw.2019.20116. eCollection 2019 Aug 26.
Physician shortage is problematic, but the percentage of physicians who left patient care in Switzerland is unclear. We set out to describe this percentage and determine whether gender or language region was associated with leaving patient care.
We analysed the National Registry (Medreg) of all physicians who graduated between 1980 and 2009 in Switzerland. Based on the last known working status noted in Medreg, physicians were classified as “probably involved in patient care” or “potentially left patient care”. We drew an unrestricted random sample of 250 from each category. We searched professional directories / social media to classify each sample. Those with undetermined status received a questionnaire that asked their working status. We quantified the percentage of physicians who left patient care and used Poisson and Cox regression to determine rates and the association of leaving patient care with gender, language region, and year of graduation.
We identified 23,112 living physicians in Medreg in 2015. Of these, 18,406 (79.6%) were probably involved in patient care and 4706 (20.4%) had potentially left patient care. In the random sample of 250 physicians probably involved in patient care, 237 were involved in patient care, 11 had left and the status of 2 was undetermined (0.8%). In the random sample of 250 physicians who had potentially left patient care, 109 were involved in patient care, 109 had left, and the status of 32 was undetermined (12.8%). We estimated that 13.6% of physicians had left patient care (95% confidence interval [CI] 11.1–16.1%). According to the most realistic scenario, the rate of physicians who had left patient care was 1.2 per 100 physicians/year (95% CI 0.9–1.6) for those who had graduated between 1980 and 1994, and 1.8 per 100 physicians/year (95% CI 1.4–2.3) for those who graduated between 1995 and 2009 (adjusted hazard ratio 1.74, 95% CI 1.12–2.71). There was no evidence that the risk of leaving patient care was associated with gender or language region.
Approximately one in seven physicians in Switzerland who graduated between 1980 and 2009 left patient care. Leaving patient care was not associated with gender, but the probability of leaving patient care was increased considerably in physicians who graduated more recently. Interventions that aim at keeping physicians in the work force and encourage their return to practice are sorely needed.
医生短缺是一个问题，但瑞士离开患者护理的医生的比例尚不清楚。我们旨在描述这一比例，并确定性别或语言区是否与离开患者护理有关。
我们分析了瑞士所有 1980 年至 2009 年毕业的医生的国家登记处（Medreg）。根据 Medreg 中记录的最后已知工作状态，医生被归类为“可能参与患者护理”或“可能离开患者护理”。我们从每个类别中抽取了 250 个不受限制的随机样本。我们搜索专业名录/社交媒体来对每个样本进行分类。那些状态不确定的人收到了一份问卷，询问他们的工作状态。我们量化了离开患者护理的医生比例，并使用泊松和 Cox 回归来确定离开患者护理的比率以及与性别、语言区和毕业年份的关联。
我们在 2015 年的 Medreg 中确定了 23112 名在世医生。其中，18406 名（79.6%）可能参与了患者护理，4706 名（20.4%）可能已经离开患者护理。在随机抽取的 250 名可能参与患者护理的医生中，有 237 名参与了患者护理，11 名已经离开，2 名的状态不确定（0.8%）。在随机抽取的 250 名可能已经离开患者护理的医生中，有 109 名仍在从事患者护理，109 名已经离开，32 名的状态不确定（12.8%）。我们估计有 13.6%的医生已经离开患者护理（95%置信区间[CI]11.1%至 16.1%）。根据最现实的情况，对于 1980 年至 1994 年毕业的医生，离开患者护理的医生人数为每 100 名医生/年 1.2 人（95%CI0.9 至 1.6），对于 1995 年至 2009 年毕业的医生，离开患者护理的医生人数为每 100 名医生/年 1.8 人（95%CI1.4 至 2.3）（调整后的危害比 1.74，95%CI1.12 至 2.71）。没有证据表明离开患者护理的风险与性别或语言区有关。
瑞士大约有 1/7 的医生在 1980 年至 2009 年期间毕业，已经离开患者护理。离开患者护理与性别无关，但最近毕业的医生离开患者护理的可能性大大增加。迫切需要采取措施保持医生在工作岗位上并鼓励他们恢复工作。
