Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan.
Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1 Asahikawa, 078-8510, Hokkaido, Japan.
BMC Health Serv Res. 2023 Oct 24;23(1):1143. doi: 10.1186/s12913-023-10085-7.
Physicians in public health administration agencies (public health physicians: PHP) play important roles in public health; however, there are not enough such physicians in Japan. This study aimed to elucidate the factors related to the resignation and migration of PHPs using nationwide survey data.
Data from the Survey of Physicians, Dentists, and Pharmacists (2010, 2012, 2014, and 2016) were analyzed. The outcome was the resignation of PHPs or migration to public health administration agencies. The explanatory variables in the resignation analysis were age, sex, workplace, and board certification status. The type of work was added as an explanatory variable in the migration analysis, and clinical specialty was added to the clinical doctor-restricted analysis. The odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations.
In the resignation analysis among PHPs, women had a significantly lower OR, whereas younger PHPs and those with board certifications had significantly higher ORs. In the migration to public health administration agencies analysis among medical doctors, women and those aged between 35 and 39 years had significantly higher ORs, but those with board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff and 'others/not working' had significantly higher ORs. In the migration to public health administration agencies analysis among clinical physicians, those aged between 35 and 39 years had significantly higher ORs. Still, those with two or more board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff had significantly higher ORs. Clinical doctors specializing in surgery and other specialties had significantly lower ORs, but those specializing in pediatrics and psychiatry/psychosomatic medicine had significantly higher ORs.
Having board certifications were significantly related to the resignation of PHPs and migration to public health administration agencies. Women migrated to public health administration agencies more than men and younger PHPs were more likely to resign. However, medical doctors aged between 35 and 39 years were more likely to migrate to public health administration agencies. Similarly, clinic staff, non-clinical physicians, and those whose specialties were pediatrics and psychiatry/psychosomatic medicine were more likely to migrate to public health administration agencies.
公共卫生管理机构中的医师（公共卫生医师：PHP）在公共卫生领域发挥着重要作用；然而，在日本，此类医师的数量还不够。本研究旨在利用全国性调查数据阐明与 PHP 辞职和迁移相关的因素。
对医师、牙医和药剂师调查（2010 年、2012 年、2014 年和 2016 年）的数据进行了分析。结果是 PHP 的辞职或迁移到公共卫生管理机构。辞职分析中的解释变量为年龄、性别、工作场所和委员会认证状况。在迁移分析中添加了工作类型，在临床医生受限分析中添加了临床专业。使用广义估计方程计算解释变量的优势比（OR）。
在 PHP 的辞职分析中，女性的 OR 显著降低，而年轻的 PHP 和具有委员会认证的人 OR 显著升高。在医生向公共卫生管理机构的迁移分析中，女性和 35 至 39 岁的人 OR 显著升高，但具有委员会认证的人 OR 显著降低。医院/诊所的创始人或主任的 OR 显著降低，但诊所工作人员和“其他/不工作”的 OR 显著升高。在临床医生向公共卫生管理机构的迁移分析中，35 至 39 岁的人 OR 显著升高。然而，具有两个或更多委员会认证的人的 OR 显著降低。医院/诊所的创始人或主任的 OR 显著降低，但诊所工作人员的 OR 显著升高。外科和其他专业的临床医生的 OR 显著降低，但儿科和精神病学/身心医学专业的 OR 显著升高。
具有委员会认证与 PHP 的辞职和向公共卫生管理机构的迁移显著相关。女性比男性更有可能迁移到公共卫生管理机构，年轻的 PHP 更有可能辞职。然而，35 至 39 岁的医生更有可能迁移到公共卫生管理机构。同样，诊所工作人员、非临床医生以及儿科和精神病学/身心医学专业的医生更有可能迁移到公共卫生管理机构。
