在整個醫療體系內，醫師為主要的醫療服務提供者之一，以教學醫院而 言，醫師的任務更為多元，其績效的衡量需包含服務、教學與研究。本研究分 析台灣北部某教學醫學中心於1996年1月至1998年12月期間，包括內外科共126 位主治醫師之產出及個人資料，分析方法除從橫斷及縱貫資料來探討影響主治 醫師生產力的因素外，並發展主治醫師綜合生產力指標，以形成預測模式作為 醫務管理決策者提高醫師生產力的參考依據。而研究結果發現： 1.主治醫師生產力顯著與個人背景特性有關，如年齡、主治醫師年資、畢業醫 教學醫院醫陃生產力之預測模型 ～10～ 學院、現在行政職務。 2.在職進修程度及參與研究計畫與獲取研究經費對主治醫師之研究產出與綜 合生產力有正面助益。 3.本研究所發展出之主治醫師生產力預測模型為適用於外科醫師之不偏估計 模組。

Physicians play as one of the key important roles in the entire health care system. Especially in teaching hospitals, the tasks of an attending physician are far more diversified and demanded than those in non-teaching hospitals. The performance of an attending physician in teaching hospitals is usually defined by three parts such as service, teaching, and research. However, it is still not clear and under developed on how to construct a persuasive indicator by combining these three parts so as to evaluate the work performance of an attending physician. This study has collected data from 126 attending physicians in a tertiary medical center during 1996-1998. The variables covered various performance measures of clinical services, teaching loads, and publications. The present study has demonstrated that a quantitative combined indicator can reflect the performance of an attending physician both with cross-sectional methods and with longitudinal analyses in teaching hospitals. The predictive models for physician’s performance were also valuable for decision makers in health care settings. Significant findings of this study were also summarized as follows. 1.Physicians’ productivity was significantly associated with their baseline information such as age, seniority of an attending physician, undergraduate studies, and current professional accreditations and administrative position in the host hospital. 2.On-job trainings and research grants were factors which positively improved the subsequent productivity of an attending physician. 3.The quantitative model constructed for productivity of surgeon in teaching hospitals was less biased to true measures than that of physicians in internal medicine.

優秀人力是企業創造、生產、永續經營的基本要件，人力資源管理已成為企業創造競爭優勢的關鍵，優秀的員工更是企業內重要的資源，而醫療體系內，主導資源利用且最不可或缺的角色就是醫師，醫師掌控重要的醫療活動，對醫療產出的數量與品質有決定性的影響，而在有關醫師行為的研究中，醫師績效評估乃為一個很重要的議題，因為其關係到醫療機構整體表現，且與病人照護品質有極大相關。但評估醫師績效的決定因素範圍極其廣泛，甚至包含許多過去專業訓練特質與現有的機構因素，此外，對醫院管理者而言，醫師的生產力代表著醫院的資源使用效率是否達到要求、醫師是否為病患提供最適切的服務及醫院的人力資源規劃是否恰當等。因此在考慮確保醫療品質的前提下，欲提升醫院的營運績效，亦必須由增加醫師的生產力著手；再者，以教學醫院而言，醫師須肩負研究與教學的學術任務，因此教學醫院內醫師的工作性質比起非教學醫院內的醫師顯得更為多元。如何正確衡量教學醫院內醫師的各項工作產出，以達到醫師個人在教學、研究、服務的貢獻平衡，以資評量公平的報償，並進而提高其個別生產力，乃具有醫院人力資源管理上的重要意涵。 綜言之，透過對醫師醫療行為之相關因素研究，可進一步瞭解其與醫療供給品質的影響性，亦即從供給面來探討醫療服務體系，利用控制或改善供給面的因素，來提升整體的醫療服務水準，以創造更完善的醫療環境與體系。