CAJ | 학술논문

目的：分析新医改前后基层医生职业心理的变化。方法采用本课题组2007、2011、2013年对来自山东省济南、潍坊、德州三市基层医疗机构（乡镇卫生院、社区卫生服务机构）的基层医生进行的问卷调查和访谈资料，分析基层医生对总体工作满意度、疲劳度、工作稳定性、职业承诺变化情况。结果3次调查中基层医生对总体工作满意度比较，差异有统计学意义（χ2=27.700，P<0.05）。3次调查中基层医生的心理疲劳、身体疲劳、情感疲劳度比较，差异均有统计学意义（χ2=140.800、45.795、177.540，P<0.05）；其中2011年和2013年的心理疲劳同意率高于2007年，2011年和2013年的情感疲劳同意率低于2007年，差异有统计学意义（ P<0.05）。3次调查中基层医生工作稳定性比较，差异有统计学意义（ P<0.05）；其中2011年和2013年“我经常想离开所在的医院”“我经常想换一下工作，不做医生了”“明年我很有可能会找一份新工作”的同意率均低于2007年，差异有统计学意义（ P<0.05）。2011年和2013年调查中基层医生职业承诺调查项目中仅“做医生是很好的职业选择”同意率间差异有统计学意义（P<0.05）。结论新医改前后，基层医生职业承诺变化不明显；心理疲劳度增加，但情感疲劳度得到改善；同时工作稳定性改善，离职意向减弱。显示新医改稳定了基层队伍，但仍存在激励效果有限的问题；政府需强化对基层卫生人力资源的投资，完善激励机制。
목적：분석신의개전후기층의생직업심리적변화。방법채용본과제조2007、2011、2013년대래자산동성제남、유방、덕주삼시기층의료궤구（향진위생원、사구위생복무궤구）적기층의생진행적문권조사화방담자료，분석기층의생대총체공작만의도、피로도、공작은정성、직업승낙변화정황。결과3차조사중기층의생대총체공작만의도비교，차이유통계학의의（χ2=27.700，P<0.05）。3차조사중기층의생적심리피로、신체피로、정감피로도비교，차이균유통계학의의（χ2=140.800、45.795、177.540，P<0.05）；기중2011년화2013년적심리피로동의솔고우2007년，2011년화2013년적정감피로동의솔저우2007년，차이유통계학의의（ P<0.05）。3차조사중기층의생공작은정성비교，차이유통계학의의（ P<0.05）；기중2011년화2013년“아경상상리개소재적의원”“아경상상환일하공작，불주의생료”“명년아흔유가능회조일빈신공작”적동의솔균저우2007년，차이유통계학의의（ P<0.05）。2011년화2013년조사중기층의생직업승낙조사항목중부“주의생시흔호적직업선택”동의솔간차이유통계학의의（P<0.05）。결론신의개전후，기층의생직업승낙변화불명현；심리피로도증가，단정감피로도득도개선；동시공작은정성개선，리직의향감약。현시신의개은정료기층대오，단잉존재격려효과유한적문제；정부수강화대기층위생인력자원적투자，완선격려궤제。
Objective To analyze the changes of occupational psychology of primary healthcare doctors after new health care reform. Methods We reviewed the data from questionnaire surveys and interviews on primary healthcare doctors ( rural health centers and community health service settings)and analyzed the changes of general job satisfaction,fatigue degree, job stability and occupational commitment of primary healthcare doctors. Results The three surveys were significantly different in the general job satisfaction of primary healthcare doctors(χ2 =27. 700,P <0. 05). The three surveys were significantly different in psychological fatigue,physical fatigue and emotional fatigue(χ2 =140. 800,45. 795,177. 540,P <0. 05);psychological fatigue rates in 2011 and 2013 were higher(P<0. 05)than that in 2007;emotional fatigue rates in 2011 and 2013 were lower(P<0. 05)than that in 2007. The three surveys were significantly different(P<0. 05)in job satisfaction;for the items of ″ I often think about leaving the hospital I am working in″,″ I often think about changing my job″,″ I don′like being a doctor″ and″ I will probably find a new job next year″ in the surveys,the choosing rates in 2011 and 2013 were lower( P<0. 05)than those in 2007. Among the items about occupational commitment,the 2011 survey and 2013 survey were only significantly different(P<0. 05)in the choosing rate of ″ doctor is a good occupational choice″. Conclusion After the new health care reform,the change in occupational commitment of primary healthcare doctors is not evident,and the psychological fatigue increase,while we see relieved emotional fatigue,improved job stability and weaker willingness for demission. New health care reform has stabilized the grass - root workforce, while the incentive effect is deficient. The government should increase the investment in the human resources of primary health care and improve the incentive mechanism.