由於以上的問題，凸顯出：目前外科後繼無人的實際原因，也道出了外科
醫 師的壓力和困難。加上因健保對外科醫師剝削似的過低給
付；及社會上高醫療糾紛， 以刑罰論醫療過失及高額賠償，致使原本
執刀高風險之外科，有更高醫療風險之危機 意識。此等原因，使外科
新進人員裹足不前。反應在目前的就是： 外科
住院醫師的缺額、以及既有外科醫師的流失。我們的政府、社會若不再改
善此種缺失，不出數年，民眾將面臨生病找不到外科醫師開刀之困境。
關鍵字：外科醫師、執業、健康保險、問卷調查。 In order to better understand factors influencing surgical
practice in central Taiwan, asurvey of surgeons in
the city and county of Taichung was carried out. Various
levels of medical institutions were represented,including the
medical center,the district hospital,the local hospital,and the
basic private clinic. Of 521 questionnaires sent out,113 were
completedandreturned.
The results of the survey revealed that 78.3 %(72/92) of
surgeons work in the surgical department of a hospital whereas
49.6 %(56/113) work in basic private clinic. Eighty-three
percent of surgeons practice more than one subspecialty. More
than half of the surgeons surveyed run a combined medical-
surgical practice. Most surgeons register their practice as
surgical(79.4 %) whereas the remainder (20.6 %) register as
general or family practice. Surgical patients comprise less
than 10 % of all patients seen in practice for 30.2 % of
surgeons and more than 50 % of all patients seen for 29.3 % of
surgeons. Eighteen percent of surgeons do notengage in any
surgical activity on a daily basis due to lack of patients.
Average working hours are 56.2 +/- 9.4 SD hours per week.
Most surgeons(95.5 %) have contracted with the NationalHealth
Insurance (NHI) program but most(92.3 %) feel that NHI
reimbursement is too low. Sixty percent of surgeons,citing high
risk and low payment,say they limint the number of opertions
performed. In general,the main factors
influencing surgicalpractice in central Taiwan are NHI
reimbursement,availability of patients,andoperative risk.
