[[alternative]]A study of the cognitive influences to doctors and proprietors regarding the application of labor standard law to doctors

碩士[[abstract]]「醫師」是醫療產業當中，具有主導醫院發展特色的關鍵人物，因此醫師在醫療產業中角色的重要性，自當不言可喻。由於醫師職責基於濟世救人，以延續人類生命長度與廣度價值作為行醫的目標，所以一直以來「醫師」在傳統社會中，即具有崇高的地位與專業的技能。本研究旨在探討醫師適用勞基法，對於醫師及經營者認知影響之研究。本研究採用文獻回顧法和調查訪談法之方式，並且依據研究目的、研究流程、研究範圍，發展出研究架構，以工作時間影響、工資影響、勞資關係影響、醫師流動影響、財務影響、品質影響等六個研究基礎構面，針對醫師及經營者進行質性訪談，範圍包括醫療行為的影響、與醫療法之間適法性、醫師薪資制度、醫療團隊紀律、組織承諾、病人權益、醫療品質、生活品質等，最後歸納彙總整理訪談的認知，建構發展命題的內容，期望能夠促進醫療產業中，醫師與經營者間和諧勞資關係，並且在法律適用之前，提供勞工、衛生主管機關、醫師團體、醫療機構管理者，在實際經營管理上的參考。 本研究結果顯示，醫師在適用勞基法時，醫師與經營者一致認為，對於醫療品質仍然會繼續維持一定的水準，不會受到醫師成為勞基法適用對象的關係，而造成負面影響，此點重要的研究結論，其代表的意義與價值，顯示國內醫療機構對醫療品質的重視，亦是對病人安全的重要落實關鍵。 勞基法賦予勞動條件的保障，對醫師生活品質提升，具有顯著的正向關係，基本上研究的結果也顯示，有助於促進醫師適用勞基法的意願。但即使如此，醫師適用勞基法，仍然會認為對醫療工作及病人就醫權益，受到影響，同時會造成醫師薪資減少的顧慮，此點研究結論與研究價值，可提供行政院勞委會、衛生署及醫院經營者在策略管理上的參考。[[abstract]]Doctor is a key person to shape and develop a hospital’s characters in the medical industry. Therefore, doctor plays an important role in the industry without question. Due to the fact that doctors are striving to save and broaden the value of human lives, , they are traditionally pretty much respected by the society. This study is mainly aimed at exploring the application of Labor Standard Law to doctors, concerning about the cognitive effect between doctors and proprietors through literature review and qualitative interview based on the objectives of the study.The flow and scope of this study includes the development of the structure of this research and the execution of qualitative interview with doctors and proprietors in six basic scenarios such as the impact on working time, salary, labor relations, mobility of doctor, financing, and quality. The scopes of this interview include the impact on medical behaviors, the compatibility with Medical Law, salary system of practitioners, the discipline of medical teams, the organizational commitment, the patience’s rights, the quality of remedy, and the quality of life. We herein induce and summarize the cognition of all interviewees to develop propositions and expect to urge a harmonic labor relations between doctors and proprietors in the medical industry, and to provide these conclusions for reference to labors, hygienics authorities, doctor groups and the administrators of medical institutions in practical management. The final conclusion of this study shows that doctors and proprietors have an agreement to continue maintaining a specific level of medical quality, and it will not be affected negatively by Labor Standard Law being applied to doctors. It is important in its implication that medical quality is still highly valued by our local medical institutions, and it also is a critical achievement of patient’s safety. Labor Standard Law incorporates an insurance of working conditions, which gives apparent positive relations to raising the living quality of doctors. The results of this study also reveal that, basically, the positive aspect is helpful to boost up the willingness of doctors to be applicable for Labor Standard Law. Nevertheless, doctors being applicable for Labor Standard Law will still be influenced by their cognizance on medical jobs and the rights of patient’s medical treatment; it will also result in doctor’s concerns regarding their salary reductions. The conclusion and valuation of this study may provide the Council of Labor Affairs, the Department of Health, Executive Yuan and hospital proprietors for their reference on management strategy.[[tableofcontents]]目 錄 誌謝詞 Ⅰ 中文摘要 Ⅱ 英文摘要 Ⅲ 第一章 緒論 第一節 研究背景 1 第二節 研究動機 7 第三節 研究目的 8 第二章 文獻探討 第一節 醫師的職業結構特質 12 第二節 醫師的職能範疇 20 第三節 醫師的勞動權益與滿意度 34 第四節 醫師的薪資報酬制度 38 第三章 研究設計 第一節 研究架構 48 第二節 研究流程 49 第三節 研究範圍 50 第四節 研究方法 53 第四章 個案研究綜合討論 第一節 訪談醫師個案分析 55 第二節 訪談經營者個案分析 73 第三節 命題發展 97 第五章 結論與建議 第一節 研究結論 105 第二節 研究限制與對後續研究者之建議 106 參考文獻 108 表目錄 表1-1-1各產業適用勞基法時間及對象 2 表2-1-1歷年醫療院所家數-按權屬別分 14 表2-2-1醫師法部分條文 21 表2-2-2歷年醫療院所醫事人員數 23 表2-2-3新制醫院評鑑摘要 27 表2-4-1各家醫院醫師薪資制度 44 表3-3-1受訪醫師個人資歷介紹 50 表3-3-2受訪醫院經營者個人資歷介紹 51 表4-1-1 D1醫師服務醫院介紹 55 表4-1-2 D2、D3醫師服務醫院介紹 59 表4-1-3 D4、D5醫師服務醫院介紹 64 表4-1-4 D6醫師服務醫院介紹 69 表4-1-5訪談醫師的認知影響彙整 71 表4-2-1 M1經營者醫院介紹 73 表4-2-2 M2經營者醫院介紹 76 表4-2-3 M3經營者醫院介紹 79 表4-2-4 M4經營者醫院介紹 83 表4-2-5 M5經營者醫院介紹 86 表4-2-6 M6經營者醫院介紹 92 表4-2-7 訪談經營者的認知影響彙整 94 圖目錄 圖2-1-1馬斯洛需求層次理論 19 圖2-4-1醫師費制度的形成概念與影響架構 43 圖3-1-1研究架構 48 圖3-2-1研究流程 49[[note]]學號: 795620383, 學年度: 9