Fossberg Bettina C, Frich Jan C
Tidsskr Nor Laegeforen. 2022 Jan 6;142(2). doi: 10.4045/tidsskr.21.0589. Print 2022 Feb 1.
All Norwegian municipalities have a statutory duty to employ a District Medical Officer as their medical advisor, but they are free to decide where this role should be placed in the municipal hierarchy. The position's contracted working hours, seniority and job content vary between municipalities. We conducted a survey to increase our understanding of how District Medical Officers see their own role.
Data were collected by conducting focus group interviews with fifteen District Medical Officers from various municipalities and counties. The data were subjected to thematic qualitative analysis involving systematic text condensation.
All the District Medical Officers had advisory roles and many reported limited access to formal decision-making arenas. They typically saw their role as poorly defined and felt a sense of invisibility, but this perception was combined with considerable autonomy. Most of the District Medical Officers reported that they felt caught between demands for advice at two different levels: clinical advice relating to individual cases and general public health advice to local authorities. This sense of being squeezed was more pronounced among District Medical Officers in large municipalities than in small municipalities. Organisational contexts and managerial expectations played a part in creating greater demand for clinical advice. This curbed the development of a public health identity and role.
District Medical Officers have a hybrid role as multi-level advisors, and this requires them to adopt several identities. In order to bolster the public health aspect, their role must be made clearer by introducing appropriate expectations and organisational contexts within the municipality.
所有挪威市政当局都有法定职责聘用一名地区医务官作为其医学顾问，但它们可自行决定该职位在市政层级中的归属。该职位的合同工作时长、资历和工作内容在不同市政当局之间存在差异。我们开展了一项调查，以加深对地区医务官如何看待自身角色的理解。
通过与来自不同市政当局和郡的15名地区医务官进行焦点小组访谈来收集数据。对数据进行了主题定性分析，包括系统的文本浓缩。
所有地区医务官都担任顾问角色，许多人表示在正式决策场合的参与机会有限。他们通常认为自己的角色定义不明确，有一种被忽视的感觉，但这种认知与相当大的自主权并存。大多数地区医务官报告称，他们感到在两个不同层面的咨询需求之间左右为难：与个别病例相关的临床咨询以及向地方当局提供的一般公共卫生咨询。在大城市的地区医务官中，这种被挤压的感觉比在小城市更为明显。组织环境和管理层期望在增加对临床咨询的需求方面起到了作用。这抑制了公共卫生身份和角色的发展。
地区医务官作为多层次顾问具有混合角色，这要求他们具备多种身份。为了加强公共卫生方面，必须通过在市政当局内部引入适当的期望和组织环境来使其角色更加明确。
