| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Excessive workloads for doctors not only encroach upon the health of doctors themselves, they may potentially affect the health of the people under those doctors’ care. Thus the question of excessive hours has become an issue of attention for Taiwanese society. Taiwan’s Ministry of Health and Welfare announced in September 2016 that doctors would be brought under the purview of the Labor Standards Act; the order would be issued by September 1, 2018, and would go into effect one year after that, on September 1, 2019. The public has universally acknowledged the social justice aspect of this issue. However, due to the unique characteristics of medical care practitioners and doctors, a restriction of working hours may lead to a general shortage of doctors, influence the finances of these doctors, and place limits on people seeking medical attention. These problems are especially pertinent when the working hours of doctors are not clearly stipulated. Thus it remains uncertain just how large the shortage of doctors will be.
This study uses National Taiwan University’s Plan to Evaluate the Financial Influence Resulting from Incorporation of Doctors in the Labor Standards Act, which was commissioned by the Ministry of Health and Welfare. Seminars were held at various locations around Taiwan. Working hours for doctors in Taiwan were defined by reference to the five categories of working hours in German labor law. By use of questionnaires, working-hour data were collected from doctors per specialty in district hospitals throughout Taiwan. A total of 64 hospitals responded and supplied a total of 451 valid individual responses. If 80 hours per week is assumed to be the ceiling for working hours for doctors, as is provided in the Guidelines Governing the Working Hours of Resident Doctors, analysis of the data from the district hospitals surveyed revealed that, with the exception of neurology departments, there is a shortage of 2 attending physicians. In non-urban hospitals that are required to undertake intermediate emergency responsibilities, there is a shortage of 65 attending physicians. There are no shortages of attending physicians for any of the other factors considered. Assuming the limit of 40 working hours per week as defined in the Labor Standards Act, it may be estimated that there will be an overall shortage of 2,562 attending physicians in district hospitals throughout Taiwan after the act is applied to doctors. That shortage becomes 2,575 attending physicians if the hospital emergency capacity accreditation by level is taken into consideration. Considering urban and non-urban areas, the shortage will be approximately 2,541 attending physicians. And when the hospital emergency capacity accreditation by level is added into the calculation, that shortage becomes 2,676 attending physicians. The shortage for non-urban hospitals that are required to undertake intermediate emergency responsibilities will be the largest, at 712 attending physicians. If we assume a limit of 100 acute care hospital beds and consider the hospital emergency capacity accreditation by level, the shortage will be 2,637 attending physicians. For hospitals with more than 100 beds that are required to undertake intermediate emergency responsibilities, the shortage will be approximately 710 attending physicians. Lastly, basing the estimate on the 23 medical specialties stipulated by the Ministry of Health and Welfare, the overall shortage for district hospitals will be 2,284 attending physicians.
It was discovered in this study that there will be a shortage of approximately 2,284 to 2,676 attending physicians in district hospitals after working hours for doctors are limited to 40 hours per week by the Labor Standards Act. Hospitals with the most serious shortages will be those hospitals in non-urban areas that are required to undertake emergency responsibilities, or those hospitals with more than 100 acute care hospital beds that are required to undertake emergency responsibilities.
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