探討單獨開業牙醫師參與聯合執業之意願及其影響 因素

探討單獨開業牙醫師參與聯合執業之意願及其影響 因素

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因為牙醫聯合執業在國內尚屬新興的觀念，並且成功的案例不多，再加上台灣研究聯合執業的專家學者極為有限，以 致無法提供具體有效的成功經驗，導致一般牙醫師對聯合執業的參與裹足不前。

因此本研究的目的，在於探討單獨開業牙醫師對聯合執業的認知程度，並瞭解單獨開業牙醫師喜好的聯合執業模式，

最後更希望得知影響單獨開業牙醫師參與聯合執業意願之因素。

本研究方法是以 2001 年於中華民國牙醫師公會全國聯合會登錄之會員名單中，針對單獨開業之牙醫師 4210 人，以地 區別排序後，再以每隔 3 人抽取 1 人的等距系統抽樣法，共抽樣出 1403 名，採取郵寄問卷的方式來蒐集所需的資料。

有效回收樣本為 358 份，回收率為 25.9% 。

本研究結果發現：對於牙醫聯合執業的優缺點及相關法規之瞭解程度，有 65.3% 表示非常不瞭解和不太瞭解， 21.1%

表示普通瞭解，只有約 13.5% 表示非常瞭解和瞭解。在參與聯合執業的意願方面，則有 26.5% 的單獨開業牙醫師表 示非常願意及願意， 23.9% 表示非常不願意及不願意，而表達不一定的卻高達 43.4% 。

以邏輯式迴歸分析得知，有顯著影響單獨開業牙醫師參與聯合執業意願的相關因素有四，分別為： (1) 對聯合執業之 瞭解程度。亦即對聯合執業瞭解程度越高的單獨開業牙醫師有較高的參與聯合執業的意願； (2) 是否能降低營運成本。

亦即較同意參與聯合執業後「儀器及材料的使用率高，可降低營運成本」的單獨開業牙醫師有較高的參與意願； (3) 缺乏自主權的重視程度。亦即比較不在乎是否因「參加聯合執業後牙醫師會缺乏部分自主權」的單獨開業牙醫師，有 較高的機率願意參與聯合執業；以及 (4) 可提高生活品質。亦即較同意參與聯合執業後，「可提高生活品質，自我充 實」的單獨開業牙醫師有較高的參與意願。

至於有意願參與聯合執業的獨執業牙醫師其較喜好的聯合執業模式為： 1. 在法律型態 ( 所有權 ) 方面，約有 50.4% 的 獨執業牙醫師偏好合夥模式； 2. 在期待的牙醫師數目方面，有 62.7% 的獨執業牙醫師期待 2~3 位牙醫師聯合執業； 3 . 在期待的聯合執業科別方面，排名前三項為牙周病科、齒顎矯正科、人工植牙科； 4. 在管理方式方面 ; 排名前二項 為，聘用專職管理人才負責、由合夥人自組董事會管理； 5. 在收入分配方式方面，最受歡迎的是協商固定薪水加上 績效 ( 按抽成或分紅 ) 來分配。

結論：為提高獨執業牙醫師參與聯合執業的意願，本研究對衛生主管機關的建議為對牙醫師進行聯合執業的宣導、修 改聯合執業之相關法規、現行稅法明確化。

Exploring the Determining Factors of the Willingne ss of Solo Practice Dentists to Join Group Practice

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The solo practice has been a major operation model for the majority of dental clinics for a long time. Lately the operation of solo practice by dentist ha s become difficult because of the prosperous development of dental departments of hospital, tightness of public health insurance financing, demand of high quality and efficiency of dental treatment by consumers, and the aggravation of dentist-patient relationship. “Group dental practice” relative to sol o practice is another operation model for dentists. Group practice, which started in the late nineteen century in western countries, has become major pr actice type in America, Canada and England. Group practice indeed has positive impacts on patients and dentists based on the literature review. It does not only improve quality of dental treatment and services, but also increases dental access and reduces dental costs. Moreover, group practice elevates the level of dental treatments and improves quality of dentist’s life.

Because dental group practice in Taiwan is still a newly developed concept, successful cases are few, and researchers in this field are limited, it is impo ssible to provide realistic and effective successful experience for dentists. These all stop dentists from joining the group practice. Therefore, the purpos es of this research were to understand solo dentist’s level of recognitions toward group practice, to realize the types of group practice dentists prefer, a nd to explore the factors affecting the willingness of solo practitioners to join group practices.

The research population of this study was 4210 solo practice dentists who registered in National Chinese Dental Association in 2001. The systematic s ampling was used to randomly select 1403 subjects from the research population. A mailing survey was performed to collect information. A total of 35 8 questionnaires were returned and yielded a response rate of 25.9%.

As to the understanding level of advantage-disadvantage and related laws of group dental practice, 65.3% of respondents expressed extremely not und erstanding and not understanding, 21.1% express average understanding, and only 13.5% express understanding very much and understanding. For par ticipating aspects, 26.5% express extremely willing and willing, 23.9% express extremely unwilling and unwilling, and 43.4% express “not sure”.

According to multiple logistic regression analysis, the four factors influencing will of solo dental practitioners participating in group practice are: (1) le vel of understanding, namely, the higher understanding of solo practitioners, the higher of their will to participate; (2) whether it could reduce operatio n cost, namely, solo practitioners whoever agree that group practice “increase using rate of apparatus and material and keep operation cost down” have higher participating will.; (3) the extent of care of lack of autonomy ,namely, solo practitioners whoever are careless about “after participating in group practice , lack of partial autonomy could happen” have higher participating will. And (4) improving life quality of dentists, namely, solo practitioners whoever agree that group practice “can enhance life quality and fulfill themselves” have higher participating will.

For the group practice models which solo dental practitioners interested about are: 1. Legal type (ownership). About 50.4% solo practitioners prefer pa rtnership; 2. The numbers of expected dentists: 62.7% solo practitioners expect 2-3 dentists in group practice; 3.Specialty (practice) type anticipated: t he first three specialties are periodontics, orthodontics and implant dentistry. 4. Management type: the first two are hiring full time manager to manage and organizing board to manage by partners; 5.Income distribution aspects: the most welcome one is negotiation─fixed salary plus work performance (by percentage or bonus) to distribute.

Conclusion: To promote will of participating in group practices by solo practitioners, the suggestions provided by this study for related health service

will be propaganda for solo practitioners, modification of related laws of group practice, and clarification of modern tax laws.