Factors affecting specialty and location of practice of government-sponsored physicians in Taiwan.
Geographic and specialty maldistribution have created problems of physician supply in Taiwan. Previous small-scale government-sponsored physician (GSP) programs in Taiwan have had only limited effects. To solve this problem, the National Yang-Ming Medical College was established in 1975; it supplied its first government-sponsored physician graduates in 1982. Obligatory service in different specialties and geographic areas were assigned to graduates according to their personal preference and school performance. In this study, we evaluated the factors affecting the choice of specialty and location for these GSPs during the 6-year obligatory service period. Data on Department of Health-regulated GSPs who finished obligatory service prior to 1991 were obtained from the GSP files, medical student files, and the National Medical Manpower Information System for the years 1982 to 1985. Logistic regression was used to assess the effect of year of entry, age, gender, rank in class, and hometown of the GSPs on specialty choice upon entry into the obligatory service period. Both logistic regression and generalized estimating equations were used to analyze the effects of these parameters and location experiences during obligatory service on location selection after the obligatory service period. We found that rural experience during obligatory service was strongly associated with the choice of rural practice after the completion of the obligatory service. Male gender, a later year of entry to the program, and having a rural hometown were only moderately associated with the choice of rural practice. A more comprehensive evaluation and review of the effect of the GSP program on overall specialty and location distribution of physicians is needed to provide guidelines for improvement of current GSP program policies.
Chie
W C
WC
Department of Public Health, College of Public Health, National Taiwan University, Taipei, ROC.
Chang
S H
SH
Yang
H F
HF
D000328:Adult; D005260:Female; D005380:Financing, Government; D006280:Health Workforce; D006801:Humans; D008297:Male; D010820:Physicians / Q000600:supply & distribution*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D013038:Specialization; D013624:Taiwan; D014146:Training Support