| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 95 === In the medical profession, physicians (surgeons) are the main leaders of medical teams. Their manpower and its distributions directly affect the medical resources as well as the medical environment. Practice of medicine transferred from general physician to professional specialist is a trend of medical care and its quality, fees and convenience will be greatly influenced by the physician manpower structure. Therefore, planning of manpower should be set up so as to provide appropriate service and to ensure the health of people. Taiwanese Orthopedic Association has been established in 1977. Up to now, it has already developed to 1,618 orthopedists, and 1,472 were practicing in 2005, while each of them serves 15.6 thousand people on average. Comparing the American orthopedist manpower demand is one per 15 thousand populations. It seems that the demand for Taiwan orthopedist has been saturated. Yet, the Taiwanese medical system and environment are different from the U.S. It is unknown whether future advancement for orthopedists is already saturated. Moreover, in recent years, the yearly increasing amount of orthopedists is declining. The age structure among orthopedists also tends to be older. In order to balance the future supply and demand of orthopedic surgeons to maintain healthcare quality, it is crucial to estimate the demand for the future manpower.
This research is for the study of orthopedists manpower in hospitals. Base on the health insurance databases, using hospital care orders to represent the medical care consumption. In addition, this study analyzes orthopedics treatment and care demand of people by using the data of population and its structure from the Executive Yuan and Interior Department. The hypothesis is that if the productivity of orthopedist and the service demands of people remain the same, then the estimate orthopedics treatment and care demand of expected years divided by surgeon’s productivity of base years, results in the manpower demand of the expected years. In addition, we can find out the possible recruiting totals for doctors by analyzing the age structure for present practicing doctors and the future-retiring doctors. On the other hand, to use Miller’s Law as reference, we can find out the natural manpower consumption, and further revise the manpower demand by investigating doctors’ working status and future planning from the questionnaires. In addition, there is a retrospective study about the developmental trends in each orthopedic subspecialty according to the amounts of orthopedics subspecialty surgeries and their executive surgeons. Different kinds of surgery are divided into each subspecialty to allow analysis of the changes in surgery amount with health insurance data. Executed surgeons of these surgeries are analyzed to estimate the quantity change in surgeons of different subspecialty. The relative quantity changes of surgeries and surgeons of each subspecialty from1998 to 2005 are compared for valid developing trends.
The year 2005 is set as the base year, the estimated quantity of hospital care orders is going to rise approximately 1.34 times by year 2020 and obviously will be an increase for patients over 50 years old. While retrospective analysis from 2000 to 2005, orthopedics medical consumption has been growing at an average rate of 1.026833 per year. In 2005, there were 1472 orthopedists licensed and 879 (59.71%) working in hospitals. If the current status remains, there should be 1178 hospital orthopedists demanded in 2020. Thus, during 2005 and projected for 2020, the basic demand is to add 299 orthopedists that equal to increase 20 in average every year. As for substitution of the retiring doctors, we anticipate average 17 (retire age of 65) to 27 (retire age of 60) of each year should be added to the basic demand. Refer to Miller’s Law: to recruit new doctors at the current rate, there will have to be 30 more in each year; which is 879 in 2005 and 1195 (36% increase) in 2020. In total, there will be 316 more, which means 21 more in each year to complement the needs of hospital care consumption. Due to the average working load for practicing is still in a feasible range so it will not be adjusted. Yet, the aspiration to be orthopedist of graduated medical student is declining. Therefore, an average hospital needs 37 to 47 more orthopedists each year, which is a huge difference when comparing average increase 22 per year from 1998 to 2005. It will result in a serious shortage of hospital orthopedist manpower demand by 2020. As for the development of each orthopedic subspecialty, although the ultimate result is growing by observing changes in surgical services, the total of surgeons of each subspecialty do not match-up in every way. Those subspecialty that the amount (in percentage) of growth in surgery are more than that of the executive surgeons are foot surgery, bone tumor, spine surgery, and bone fracture. On the centrally, those subspecialty that the amount (in percentage) of growth in surgery are less than that of the executive surgeons are hand surgery, joint reconstruction, sports medicine, and shoulder elbow. It shows that each orthopedist subspecialty has a different developmental trend.
An unexpected discovery from reviewing the data between 1998 and 2005 is that hospital orthopedics manpower are stable in medical centers, while there is an increase in district hospitals and decline in area hospitals. Also, the changing point is all in 2000. This situation of manpower transposition must have been related to the Taiwanese health insurance system and hospital ecology. Medical doctor manpower demands influences medical ecology and quality tremendously. It is essential and crucial to establish a system of orthopedics database. Through this database, the observation, analysis and publicity can be continuous, which can also provide references for further sanitation policies, medical insurance, association adjustment, hospital functions, and also doctors’ personal career and life scheme.
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