影響醫師專業化程度與組織-專業人員間衝突之相關因素探討

Abstract

本研究的目的在探討影響醫師專業化程度與組織與專業衝突的相關因素。研究中訪問了53位任職於北部六家醫學中心的醫師 (主治醫師18人，住院暨實習醫師35人) 。研究結果顯示，醫師的專業化程度隨著工作歷練而上升，顯示專業化的養成需要大量的實際醫療經驗。隨著專業化程度提高，醫師也越偏向內控取向，而組織與專業與衝突的程度則隨之下降，顯示資深醫師較有能力化解組織與專業間的衝突。由集群分析結果顯示，這53位醫師可依其在Spranger的六個價值觀的價值偏好、內外控取向、專業化程度、與組織-專業人員間衝突程度區分成三群。其中，醫學中心的高專業程度醫師的價值觀偏向理論型，專業程度較低且較年輕的兩群醫師則一群屬於宗教與審美型價值觀，另一群屬於經濟型的價值觀。由此推論，理論型價值觀可能是醫師專業化過程中相當重要的一個因素。由於醫師的組織-專業衝突程度是隨著年資而下降，且組織-專業人員間衝突程度較高的醫師偏外控取向與具有較高的社會價值觀，顯示組織-專業人員間衝突一部分反映出醫師的個人特質，一部分反映出專業程度。

The purpose of this study was to examine factors associated with medical professionalism and organizational-professional conflict. Eighteen attending physicians and 35 resident physicians and interns from six medical centers in the northern Taiwan were interviewed. Results showed that a physician’s medical professionalism increased with the working experiences, suggesting that extensive clinical experiences are required for acquisition of medical professionalism. As medical professionalism increased, physicians’ perceived organizational-professional conflict decreased. This finding suggests that senior physicians, with their increased medical professionalism and perhaps positional power in a hospital, have more resources to resolve their organizational-professional conflicts. Results of cluster analysis showed that these 53 physicians could be divided into three groups by their internal-external locus of control, six value scores from Spranger’s Value Scale, level of professionalism and level of organizational-professional conflict. One group was characterized by longer tenure, more internal control, higher medical professionalism, lower organizational-professional conflict, and higher disposition for theoretical value. The other two groups of younger physicians were similar to each other in terms of tenure, professionalism, organizational-professional conflict, and locus of control. But one group was characterized by higher disposition for esthetic and religious values while the other group was characterized by higher economic value. These findings together suggest that theoretical value is an important element in medical professionalism. The finding that organizational-professional conflict decreases with tenure and professionalism and findings that physician’s level of organization-professional conflict is associated with lower internal locus of control and a higher disposition toward social value suggest that a physician’s organization-professional conflict reflect in part his/her personality and in part his/her level of medical professionalism.