Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan.
Department of Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan.
Int J Health Policy Manag. 2022 Dec 19;11(12):2907-2916. doi: 10.34172/ijhpm.2022.6242. Epub 2022 Apr 25.
Long work hours for physicians not only harm the health of physicians, but also endanger patient safety. Compared with resident physicians, attending physicians-especially hospital-employed attending physicians-assume more responsibilities but has not gotten enough attention. The purpose of this study was to explore whether a hospital's geographic location and emergency care responsibility might influence the number of hours worked.
The respondents of 2365 attending physicians from 152 hospitals in the 2018 survey of Taiwan physician work hours were used as the data source. The total work hour per week and its components, the regular scheduled shift and three types of on-call shifts, were used as outcome variables. Hospital geographic location and emergency care responsibility were the independent variables. The multilevel random effect model was employed to examine the study objective after adjusting for clinical specialty, hospital teaching status, and ownership.
The average number of total working hours was 69.09 hours per week; the regular scheduled shift was account for 75% of total work hours. The results showed the total work hours were only varied by the level of hospital's emergency care responsibility. However, the results also demonstrated the hours of duty shifts were varied by hospital's geographic location and emergency care responsibility. The results of the multilevel random effect model revealed that the hospital's emergency care responsibility was the factor consistently associated with attending physician's work hour, no matter the total work hours or its composition.
In this study, we explored how a hospital's location and its level of emergency care responsibility were associated with physicians' work hours for each type of shift. Our findings offer an opportunity to review the rationality of physician workforce allocation, and financial incentives and administrative measures could be the next steps for balancing the work hours of attending physicians.
医生工作时间长不仅危害医生的健康，还危及患者安全。相较于住院医师，主治医生——尤其是医院聘用的主治医生——承担了更多的责任，但却没有得到足够的关注。本研究旨在探讨医院地理位置和急诊责任是否会影响工作时间。
本研究使用了来自台湾 2018 年医师工作时间调查中 152 家医院的 2365 名主治医生的调查数据。每周总工作时间及其构成部分、常规班次和三种值班班次被用作因变量。医院地理位置和急诊责任是自变量。在调整临床专业、医院教学状况和所有权后，采用多水平随机效应模型来检验研究目的。
每周总工作时间的平均值为 69.09 小时；常规班次占总工作时间的 75%。结果表明，总工作时间仅因医院急诊责任水平而异。然而，结果还表明值班班次的工作时间因医院地理位置和急诊责任而异。多水平随机效应模型的结果表明，医院的急诊责任是与主治医生工作时间相关的因素，无论是总工作时间还是其构成部分。
在这项研究中，我们探讨了医院的位置和急诊责任水平如何与每种班次的医生工作时间相关。我们的发现为审查医师劳动力配置的合理性提供了机会，经济激励和行政措施可能是平衡主治医生工作时间的下一步。
