本文選題：現(xiàn)狀調(diào)查 + 鄉(xiāng)村醫(yī)生�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2011年碩士論文

【摘要】：背景 改革開放30年來,我國經(jīng)濟飛速發(fā)展,人民生活水平得到了很大的提高,農(nóng)村居民對醫(yī)療保健的需求逐年增長。據(jù)統(tǒng)計,農(nóng)村居民家庭平均每人醫(yī)療保健支出占生活消費總支出的比例從1990年的3.25%上升至2007年的6.25%。中國農(nóng)村人口眾多,對健康的需求逐年增長,中國廣大農(nóng)村有限的健康資源與健康需求之間的矛盾日益增長。如何解決這個矛盾將是一個長期存在的問題�？梢灶A(yù)見中國農(nóng)村最基層的醫(yī)療衛(wèi)生人員——鄉(xiāng)村醫(yī)生,將在相當(dāng)長的時間里在國家醫(yī)療衛(wèi)生服務(wù)體系中承擔(dān)重要任務(wù)。鄉(xiāng)村醫(yī)生素質(zhì)的高低關(guān)系到農(nóng)村基層醫(yī)療服務(wù)網(wǎng)絡(luò)功能能否發(fā)揮作用,關(guān)系到國家農(nóng)村衛(wèi)生政策的落實,關(guān)系到農(nóng)村健康保障制度的建立,關(guān)系到對突發(fā)性公共衛(wèi)生事件的應(yīng)對效果,影響著億萬農(nóng)村居民的健康水平。 最近幾年,國家在農(nóng)村開始推行新醫(yī)改和新農(nóng)合制度,在這個形勢下,2004年全國開始實行的《鄉(xiāng)村醫(yī)生從業(yè)管理條例》對全國鄉(xiāng)村醫(yī)生提出了更高的要求,對鄉(xiāng)村醫(yī)生準入、培訓(xùn)和考核有了明確、嚴格的規(guī)定,希望能逐步解決多年來鄉(xiāng)村醫(yī)生執(zhí)業(yè)無法可依的問題,是鄉(xiāng)村醫(yī)生走向規(guī)范化、科學(xué)化和法制化道路的里程碑。在這樣的背景下,開展一個全國性、多省份、大樣本量、調(diào)查內(nèi)容全面、調(diào)查方法多樣的鄉(xiāng)村醫(yī)生現(xiàn)狀調(diào)查,系統(tǒng)了解中國鄉(xiāng)村醫(yī)生的基本情況,分析我國鄉(xiāng)村醫(yī)生教育的現(xiàn)狀和培訓(xùn)中存在的問題,可為制定鄉(xiāng)村醫(yī)生政策、加強鄉(xiāng)村醫(yī)生隊伍建設(shè)提供詳實可靠的基線資料。目的 一、系統(tǒng)了解我國鄉(xiāng)村醫(yī)生的基本情況(性別、年齡、文化程度等) 二、系統(tǒng)了解我國鄉(xiāng)村醫(yī)生受教育程度、培訓(xùn)情況 三、系統(tǒng)了解我國鄉(xiāng)村醫(yī)生收入情況 四、系統(tǒng)了解我國鄉(xiāng)村醫(yī)生面臨的問題和發(fā)展的需求 五、為中國農(nóng)村衛(wèi)生事業(yè)的發(fā)展提供基于事實的現(xiàn)狀報告和政策建議方法 本研究采用流行病學(xué)橫斷面調(diào)查的研究方法。在文獻綜述和專家咨詢的基礎(chǔ)上開發(fā)《中國鄉(xiāng)村醫(yī)生現(xiàn)狀調(diào)查問卷》,對全國十個省/直轄市/自治區(qū)(北京市、浙江省、江蘇省、江西省、廣西壯族自治區(qū)、海南省、山西省、貴州省、云南省和甘肅省)部分鄉(xiāng)村醫(yī)生的工作基本情況、教育培訓(xùn)情況、收入相關(guān)情況等進行問卷調(diào)查和小組訪談,系統(tǒng)分析調(diào)查和訪談資料,在此基礎(chǔ)上提出政策建議。結(jié)果 一、本研究總共調(diào)查了18,259名鄉(xiāng)村醫(yī)生。鄉(xiāng)村醫(yī)生的平均年齡為44.3±11.2歲,最大年齡為87歲,最小年齡為19歲。其中,36-45歲年齡段的鄉(xiāng)村醫(yī)生數(shù)量,占調(diào)查總體的32.8%。男性鄉(xiāng)村醫(yī)生占調(diào)查總體的70.2%。66.9%的鄉(xiāng)村醫(yī)生認為家庭條件與同村的其他居民相近；25.1%的鄉(xiāng)村醫(yī)生認為家庭條件與其他村民相比較差。在鄉(xiāng)村醫(yī)生的健康狀況方面,87.2%的鄉(xiāng)村醫(yī)生對自己的健康狀況評價良好。 二、67.1%的鄉(xiāng)村醫(yī)生所學(xué)專業(yè)為臨床醫(yī)學(xué)。鄉(xiāng)村醫(yī)生平均從醫(yī)年限為21.5±11.9年,最小從醫(yī)年限為1年,最大從醫(yī)年限為65年。在鄉(xiāng)村醫(yī)生的日常工作方面,臨床常見病治療占總工作量的60%。54.9%的鄉(xiāng)村醫(yī)生還從事除鄉(xiāng)村醫(yī)生工作以外的其他工作,平均每月從事其他工作的時間比例為20%。鄉(xiāng)村醫(yī)生每日進行衛(wèi)生服務(wù)的平均時間為8.5個小時,高于《中華人民共和國勞動法》規(guī)定的每天工作時間。71.4%的鄉(xiāng)村醫(yī)生為村民開展體檢服務(wù),平均每年提供體檢服務(wù)3次。其中,測血壓占體檢服務(wù)工作量的50.5%。59.4%的鄉(xiāng)村醫(yī)生為村民建立了健康檔案,服務(wù)人口健康檔案的平均建檔率為65.38%。83.6%的鄉(xiāng)村醫(yī)生在日常工作中幫助慢性病患者改善生活方式。其中,96.4%的鄉(xiāng)村醫(yī)生采用的方法為飲食指導(dǎo)。鄉(xiāng)村醫(yī)生平均每周服務(wù)人次數(shù)為58.5,與2009年的全國社區(qū)衛(wèi)生服務(wù)站的數(shù)據(jù)(68.5人次/周)相比較低。鄉(xiāng)村醫(yī)生平均每周服務(wù)人次數(shù)具有東中西部地區(qū)的差異性,東部地區(qū)平均每周服務(wù)140(及以上)人次的鄉(xiāng)村醫(yī)生占調(diào)查總數(shù)的10.7%,中部和西部地區(qū)這一比例分別為3.0%和9.7%。鄉(xiāng)村醫(yī)生每次診治病人的平均收費為17.4元/人。診治病人平均收費呈東部到西部遞減的趨勢。鄉(xiāng)村醫(yī)生平均每周轉(zhuǎn)診病人在7次/周以下的占總數(shù)的80.0%；92.2%鄉(xiāng)村醫(yī)生提供出診服務(wù),每周出診少于5次/周的鄉(xiāng)村醫(yī)生占總數(shù)的63.0%。61.4%的鄉(xiāng)村醫(yī)生不收取出診費。收取出診費用的鄉(xiāng)村醫(yī)生平均每次收取出診費用為4元/次。73.0%的鄉(xiāng)村醫(yī)生收取出診費用少于5元/次。92.9%的出診原因為“病人出門不便”。53.4%的鄉(xiāng)村醫(yī)生采用“口服給藥”作為處置發(fā)熱病人的首選方法。調(diào)查地區(qū)鄉(xiāng)村醫(yī)生在日常工作中處理最常見的五種疾病/癥狀為上呼吸道感染、消化道感染、高血壓、外傷中毒和皮膚病性病。69.5%的鄉(xiāng)村醫(yī)生對自己的本職工作不滿意。不滿意的三個主要原因為“收入低”(83.6%)、“工作量大”(38.8%)和“工作條件差”(37.9%)。 三、63.0%的鄉(xiāng)村醫(yī)生文化程度為中專學(xué)歷。大專及以上學(xué)歷的鄉(xiāng)村醫(yī)生占總數(shù)的13.3%。執(zhí)業(yè)資格方面,12.8%的鄉(xiāng)村醫(yī)生具有執(zhí)業(yè)(助理)醫(yī)師資格證書,比2006年全國的數(shù)據(jù)高(11.5%)。93.9%的鄉(xiāng)村醫(yī)生在近一年接受過培訓(xùn),平均每年接受培訓(xùn)次數(shù)在2次及以下的人數(shù)占調(diào)查總體的29.7%。48.8%的鄉(xiāng)村醫(yī)生平均每年培訓(xùn)天數(shù)在12天以下,平均每年培訓(xùn)天數(shù)在12-24天的鄉(xiāng)村醫(yī)生占總數(shù)的27.5%,平均每年培訓(xùn)天數(shù)在24天及以上的占總數(shù)的23.7%。東部地區(qū)有2,024人培訓(xùn)天數(shù)在24天及以上,占東部地區(qū)調(diào)查總數(shù)的37.6%；中部和西部地區(qū)這一比例分別為12.5%和27.6%。在培訓(xùn)天數(shù)需求方面,74.7%的鄉(xiāng)村醫(yī)生認為培訓(xùn)天數(shù)在12天及以下比較合適,9.1%的鄉(xiāng)村醫(yī)生認為培訓(xùn)天數(shù)在24天及以上比較合適。因此,無論是培訓(xùn)天數(shù)的現(xiàn)狀還是需求,“12天及以下”的比例是最高的。鄉(xiāng)村醫(yī)生平均培訓(xùn)費用支出為300元/次。其中,培訓(xùn)費用最高為4,000元/次,最低為0元。66.0%的鄉(xiāng)村醫(yī)生平均每年培訓(xùn)費用支出在500元及以下。東部地區(qū)鄉(xiāng)村醫(yī)生培訓(xùn)支出在1.000元及以上的人數(shù)占總數(shù)的20.5%,中部和西部地區(qū)這一比例分別為8.8%和8.9%。75.9%的鄉(xiāng)村醫(yī)生培訓(xùn)目的為“知識更新”。在培訓(xùn)方式現(xiàn)狀的調(diào)查中,較常見的前三種培訓(xùn)方式分別為“會議講座”(56.6%)、“上級醫(yī)生現(xiàn)場指導(dǎo)”(45.0%)和“遠程/視頻教育”(31.4%)。在培訓(xùn)方式需求的調(diào)查中,鄉(xiāng)村醫(yī)生需求較大的前三種培訓(xùn)方式分別為“上級醫(yī)生現(xiàn)場指導(dǎo)”(56.2%)、“臨床進修”(53.3%)和“學(xué)校培訓(xùn)”(29.3%)。因此,培訓(xùn)方式的現(xiàn)狀與需求分布不一致。在培訓(xùn)內(nèi)容現(xiàn)狀的調(diào)查中,較常見的前三種培訓(xùn)內(nèi)容為“臨床技能”(80.6%)、“用藥知識”(65.8%)和“預(yù)防保健知識”(65.5%)。在培訓(xùn)內(nèi)容需求的調(diào)查中,鄉(xiāng)村醫(yī)生需求較大的前三種培訓(xùn)內(nèi)容分別為“臨床技能”(93.2%)、“用藥知識”(74.5%)和“預(yù)防保健知識”(72.0%)。因此,培訓(xùn)內(nèi)容的現(xiàn)狀與需求分布一致。在培訓(xùn)地點現(xiàn)狀的調(diào)查中,92.8%的鄉(xiāng)村醫(yī)生在鄉(xiāng)鎮(zhèn)衛(wèi)生機構(gòu)接受培訓(xùn),“鄉(xiāng)鎮(zhèn)衛(wèi)生機構(gòu)”是鄉(xiāng)村醫(yī)生目前接受培訓(xùn)最多的地點。在培訓(xùn)地點需求的調(diào)查中,53.0%的鄉(xiāng)村醫(yī)生希望到“縣級衛(wèi)生機構(gòu)”接受培訓(xùn),“縣級衛(wèi)生機構(gòu)”是鄉(xiāng)村醫(yī)生最希望接受培訓(xùn)的地點。68.4%的鄉(xiāng)村醫(yī)生認為培訓(xùn)后有一定的提高,0.9%的鄉(xiāng)村醫(yī)生認為培訓(xùn)之后業(yè)務(wù)水平無變化。 四、年總收入的平均值為14,591.16元,最高年收入為500,000元,最低年收入為10,000。年總收入為10,000-50,000元的鄉(xiāng)村醫(yī)生占總數(shù)的61.6%,東部、中部和西部這一比例分別為77.6%、58.9%和45.9%。藥品收入占年總收入的50.0%。鄉(xiāng)村醫(yī)生年總收入的構(gòu)成為衛(wèi)生服務(wù)收入、農(nóng)副業(yè)收入、預(yù)防保健補貼和政府的其他補助,衛(wèi)生服務(wù)收入所占比例為60%；鄉(xiāng)村醫(yī)生期望收入為10,000-50,000元/年的占總數(shù)的82.4%,東部、中部和西部這一比例為79.8%、84.0%和82.8%,期望年總收入在100.000元及以上的鄉(xiāng)村醫(yī)生占總數(shù)的4.5%。其中,東部、中部和西部這一比例分別為5.9%、4.0%和3.7%。8.8%的鄉(xiāng)村醫(yī)生對現(xiàn)有收入滿意,41.8%的鄉(xiāng)村醫(yī)生不滿意現(xiàn)有的收入。 五、在調(diào)查總體中,86.5%的鄉(xiāng)村醫(yī)生所在村衛(wèi)生室實行了新型農(nóng)村合作醫(yī)療制度。實行和未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生平均每周服務(wù)人次數(shù)均為40人次/周,沒有統(tǒng)計學(xué)差異。實行和未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生對每個病人平均收費分別為14元/人次和13元/人次,沒有統(tǒng)計學(xué)差異。實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生每周轉(zhuǎn)診人次數(shù)(4人次/周)高于未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生(3人次/周)。實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生出診率(91.5%)高于未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生(91.1%)。實行和未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生每周出診人次數(shù)分別為5人次/周和4人次/周,沒有統(tǒng)計學(xué)差異。實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生“口服給藥”的比例(51.5%)低于未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生(53.8%)；實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生“靜脈滴注”(42.2%)高于未實行新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生(40.4%)。結(jié)論 一、對鄉(xiāng)村醫(yī)生發(fā)展的歷史回顧和相關(guān)政策研究表明,政府重視、政策支持、社會關(guān)注是鄉(xiāng)村醫(yī)生隊伍建設(shè)和發(fā)展的關(guān)鍵。 二、鄉(xiāng)村醫(yī)生工作基本狀況調(diào)查的結(jié)果顯示,其年齡結(jié)構(gòu)老化,從醫(yī)年限普遍較長,工作內(nèi)容以臨床常見病為主,公共衛(wèi)生工作開展的較少,日常工作量大,對工作的滿意度較低。 三、鄉(xiāng)村醫(yī)生教育培訓(xùn)調(diào)查的結(jié)果顯示,鄉(xiāng)村醫(yī)生的學(xué)歷以中專水平為主,缺少規(guī)范化的學(xué)校教育。培訓(xùn)的現(xiàn)狀具有以下特點：短期培訓(xùn)為主、主要集中在鄉(xiāng)鎮(zhèn)衛(wèi)生院進行培訓(xùn)、培訓(xùn)內(nèi)容以臨床技能為主、培訓(xùn)方式以會議講座為主。鄉(xiāng)村醫(yī)生希望在縣級衛(wèi)生機構(gòu)接受短期培訓(xùn),培訓(xùn)內(nèi)容以臨床技能為主,也要增加預(yù)防保健知識的學(xué)習(xí),培訓(xùn)方式最好為上級醫(yī)生現(xiàn)場指導(dǎo)和臨床進修。培訓(xùn)的現(xiàn)狀與需求存在一定的差距,建議在今后的工作中,政府相關(guān)部門應(yīng)當(dāng)將鄉(xiāng)村醫(yī)生教育培訓(xùn)的目標(biāo)真正定位于鄉(xiāng)村醫(yī)生的需求,將社區(qū)和全科醫(yī)學(xué)的概念逐步引入到鄉(xiāng)村醫(yī)生教育培訓(xùn)中來。 四、鄉(xiāng)村醫(yī)生收入調(diào)查的結(jié)果顯示,其收入較低,工作量大,“以藥養(yǎng)醫(yī)”的現(xiàn)象仍舊存在。鄉(xiāng)村醫(yī)生對收入的滿意度普遍較低。 五、鄉(xiāng)村醫(yī)生的工作情況、教育培訓(xùn)情況和收入情況大多數(shù)呈現(xiàn)地域差異。東部地區(qū)的鄉(xiāng)村醫(yī)生逐漸向執(zhí)業(yè)(助理)醫(yī)師過渡,村衛(wèi)生室逐漸消亡,逐漸由社區(qū)衛(wèi)生服務(wù)中心取代。中部和西部地區(qū)的鄉(xiāng)村醫(yī)生的工作模式仍舊以傳統(tǒng)的村衛(wèi)生室為主。因此,政府相關(guān)部分應(yīng)當(dāng)因地制宜制定鄉(xiāng)村醫(yī)生相關(guān)政策。 六、新型農(nóng)村合作醫(yī)療制度的實施對鄉(xiāng)村醫(yī)生提供衛(wèi)生服務(wù)情況和使用藥物情況產(chǎn)生了影響。實施新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生轉(zhuǎn)診人次數(shù)、出診率、使用“靜脈滴注”率和藥品收入占年總收入的比例均高于未實施新型農(nóng)村合作醫(yī)療制度地區(qū)的鄉(xiāng)村醫(yī)生。說明實施新型農(nóng)村合作醫(yī)療制度后,農(nóng)村地區(qū)居民衛(wèi)生服務(wù)利用率有所提高,但是,鄉(xiāng)村醫(yī)生不合理用藥的現(xiàn)象有加劇的趨勢。 七、黨和政府高度重視鄉(xiāng)村醫(yī)生隊伍建設(shè)。鄉(xiāng)村醫(yī)生管理走上規(guī)范化、法制化階段,其能力素質(zhì)不斷提高。長期以來,他們?yōu)槲覈r(nóng)村衛(wèi)生和廣大農(nóng)民的健康做出了重要的貢獻,他們提供的服務(wù)是公益性服務(wù),他們的待遇問題應(yīng)該得到重視。
[Abstract]:background
In the past 30 years of reform and opening up, China's economy has developed rapidly, the living standard of the people has been greatly improved, and the demand for health care for rural residents is increasing year by year. According to statistics, the proportion of health care expenditure per person per person in rural households has risen from 3.25% in 1990 to 6.25%. in 2007. The demand for health is growing year by year. The contradiction between the limited health resources and the health needs of China's vast rural areas is growing. How to solve this problem will be a long-term problem. It can be foreseen that the rural medical staff, the rural doctors, will be in the national health service for a long time. The quality of rural doctors is related to the role of rural medical service network function, the implementation of the country's rural health policy, the establishment of rural health protection system, the response to the emergency public health events and the healthy water of hundreds of millions of rural residents. Flat.
In recent years, the country began to carry out the new medical reform and new rural cooperative system in rural areas. Under this situation, the regulations of rural doctors' employment management started in the country in 2004 have put forward higher requirements to rural doctors in the country. There are clear and strict regulations on the access, training and assessment of rural doctors. It is hoped that rural doctors can be solved gradually for years. The problem that the student practice cannot be dependent on is a milestone in the road of standardization, science and legalization of rural doctors. Under this background, a national, multi Province, large sample, comprehensive survey and various survey methods of rural doctors are carried out to understand the basic situation of Chinese rural doctors and analyze the rural areas in China. The current situation of doctors' education and the problems in training can provide detailed and reliable baseline information for formulating rural doctors' policies and strengthening the construction of village doctors.
First, systematically understand the basic situation of rural doctors in China (gender, age, education level, etc.).
Two, we should systematically understand the education level and training situation of rural doctors in China.
Three, a systematic understanding of the income of rural doctors in China
Four, we should systematically understand the problems and development needs of rural doctors in China.
Five, provide a factual report and policy recommendations for the development of rural health in China.
On the basis of literature review and expert consultation, this study developed a questionnaire on the status of Chinese rural doctors on the basis of literature review and expert consultation. It was used in ten provinces / municipalities / autonomous regions (Beijing, Zhejiang, Jiangsu, Jiangxi, the Guangxi Zhuang Autonomous Region, Hainan, Shanxi, Guizhou, Yunnan province and Gansu). The basic situation of the work of some rural doctors, the situation of education and training, the related situation of income and so on were conducted by questionnaire survey and group interview, and the survey and interview data were systematically analyzed. On this basis, the policy suggestions were put forward.
A total of 18259 rural doctors. The average age of rural doctors was 44.3 + 11.2 years old, the maximum age was 87, and the minimum age was 19. Among them, the number of rural doctors in the 36-45 year old age group, which accounted for the overall survey of 32.8%. male rural doctors, accounted for the family conditions and the same village. Other residents were similar; 25.1% of rural doctors considered family conditions to be worse than other villagers. 87.2% of rural doctors rated their health well in the health of rural doctors.
Two, 67.1% of the rural doctors studied for clinical medicine. The average age of rural doctors was 21.5 + 11.9 years, the minimum number of medical years was 1 years, and the maximum number of medical years was 65 years. In the daily work of rural doctors, the rural doctors with the 60%.54.9% of the clinical common diseases, which accounted for the total workload, were also engaged in other than the work of the rural doctors. On average, the average time per month for other work is 8.5 hours per day for 20%. rural doctors, which is higher than that of rural doctors of.71.4% per day stipulated in the People's Republic of China labor law. The average medical service for villagers is carried out for villagers. The average medical service is provided 3 times per year. Rural doctors with 50.5%.59.4% for service work set up health records for villagers, and rural doctors with an average archival rate of 65.38%.83.6% to help chronic patients improve their lifestyles in their daily work. Of these, 96.4% of rural doctors use dietary guidance. Rural doctors have an average weekly service. The number of times is 58.5, which is lower than the data of the national community health service station (68.5 person / week) in 2009. The average weekly service number of rural doctors is different in the eastern and western regions. The average number of rural doctors serving 140 (and above) per week in the eastern region accounts for 10.7% of the total, and the proportion in the central and western regions is respectively The average charge of 3% and 9.7%. rural doctors for each patient was 17.4 yuan per person. The average fee for diagnosis and treatment of patients was declining in the east to the West. Rural doctors averaged 80% of the total number of patients per week below 7 times per week; 92.2% rural doctors provided medical services, and fewer than 5 visits per week of rural doctors accounted for 63 of the total. Rural doctors of%.61.4%, who charge 4 yuan per time per visit, charge less than 5 yuan per time per visit for the cost of medical treatment, and the reason for the visit of 5 yuan /.92.9% is the "oral administration" of "oral administration" as the first choice for the treatment of fever patients. Method. Rural doctors in the area of rural areas treated the five most common diseases / symptoms of upper respiratory tract infection, digestive tract infection, hypertension, trauma poisoning and dermatosis.69.5%. Rural doctors were not satisfied with their own work. The three main reasons for dissatisfaction were "low income" (83.6%) and "heavy workload" (38.8%). And "poor working conditions" (37.9%).
Three, 63% of rural doctors have secondary school education. Rural doctors with junior college or above qualifications account for the total number of 13.3%. qualifications, 12.8% of rural doctors have certified (Assistant) physician qualification certificates, which are higher than the national data of 2006 (11.5%).93.9% for rural doctors who have been trained in the last year, and the average number of training times per year is accepted. The average annual training days for the total number of rural doctors with 2 and below the total number of 29.7%.48.8% were less than 12 days, and the average number of training days per year was 27.5% of the total number of rural doctors in 12-24 days. The average number of training days in the eastern region of the east of 23.7%., the average number of training days for 24 days or more, was 24 days and more, accounting for the East. The total number of surveys in the Department is 37.6%; the proportion of the central and western regions is 12.5% and 27.6%. in the training day demand. 74.7% of the rural doctors believe that the number of training days is suitable for 12 days and below, and 9.1% of the rural doctors believe that the number of training days is more suitable for 24 days and above. The ratio of "12 days and below" is the highest. The average training cost of rural doctors is 300 yuan per time. The maximum training cost is 4000 yuan per time, and the average training expenses of rural doctors with the minimum of 0 yuan.66.0% are 500 yuan per year. The number of training expenditure of rural doctors in the eastern region is 20 of the total of 1 yuan and above. .5%, rural doctors in the central and western regions of the central and western regions were 8.8% and 8.9%.75.9% for the purpose of "knowledge renewal". In the survey of the status of the training methods, the most common three kinds of training methods were "conference lecture" (56.6%), "site guidance of superior doctors" (45%) and "distance / video education" (31.4%). In the survey of type demand, the first three training methods for rural doctors were "field guidance of higher level doctors" (56.2%), "clinical learning" (53.3%) and "school training" (29.3%). Therefore, the status of training methods was not consistent with the distribution of demand. In the survey of the status quo of the training capacity, the first three kinds of training contents were common. "Clinical skills" (80.6%), "medication knowledge" (65.8%) and "knowledge of preventive health care" (65.5%). In the survey of the requirements for training content, the first three training contents of rural doctors are "clinical skills" (93.2%), "medicine knowledge" (74.5%) and "preventive health knowledge" (72%). Therefore, the status and needs of the training content In the survey of the status of the training sites, 92.8% of the rural doctors were trained in the township health institutions, and the township health institutions were the most trained places for rural doctors. In the survey of the needs of the training sites, 53% of the rural doctors wanted to be trained at the "county health institutions" and "county health institutions". Rural doctors, the country doctors who are most likely to receive training at.68.4%, think that after training, there are some improvements, and 0.9% of rural doctors believe that the training has no change after the training.
Four, the average annual total income is 14591.16 yuan, the highest annual income is 500000 yuan, and the rural doctors with the total income of 10000. years with the minimum annual income of 10000-50000 yuan are 61.6% of the total, and the proportion of the eastern, central and Western countries is 77.6%, 58.9% and 45.9%., which accounts for the total annual income of the annual income of 50.0%.. The income of health services, agricultural and sideline income, health care subsidies and other government subsidies accounted for 60% of the income of health services; rural doctors expected 82.4% of the total of 10000-50000 yuan per year, and 79.8%, 84% and 82.8% in the eastern, central and Western countries, and rural doctors with a total annual income of 100 yuan and above were expected. Of the total number of 4.5%., the eastern, central and Western countries were 5.9%, 4% and 3.7%.8.8% were satisfied with the current income, and 41.8% of the rural doctors were dissatisfied with the existing income.
Five, in the overall survey, 86.5% of the village doctors in the village clinics carried out a new rural cooperative medical system. The average number of rural doctors who did not implement the new rural cooperative medical system was 40 times per week, with no statistical difference. The average fee of village doctors to each patient was 14 yuan per person per person and 13 yuan per person. There was no statistical difference. The number of referrals per week (4 person / week) for rural doctors in the new rural cooperative medical system was higher than that of rural medical students (3 person person / week) without the new rural cooperative medical system. The new rural cooperative medical system was implemented. The rate of visiting rural doctors in the degree area (91.5%) was higher than that of the rural doctors (91.1%) who did not implement the new rural cooperative medical system. The number of rural doctors who did not implement the new rural cooperative medical system was 5 times per week and 4 times per week, respectively. The new rural cooperative medical system was implemented. The proportion of "oral administration" for rural doctors in the region (51.5%) was lower than that of rural doctors (53.8%) who did not implement the new rural cooperative medical system (53.8%); the rural doctors "intravenous drip" (42.2%) in the new rural cooperative medical system (42.2%) was higher than that of the rural doctors (40.4%) who did not implement the new rural cooperative medical system (40.4%).
First, a historical review of the development of rural doctors and related policy studies show that the government attaches great importance to the policy support and the social concern is the key to the construction and development of the rural doctors.
Two, the results of the survey on the basic situation of the work of rural doctors showed that the age structure was aging, the years of medical treatment were long, the work content was mainly clinical common diseases, the public health work was carried out less, the daily workload was large, and the satisfaction of the work was low.
Three, the results of the rural doctors' education and training survey show that the education of rural doctors is based on the level of secondary school and lack of standardized school education. The present situation of training is characterized by the following characteristics: the short-term training is mainly focused on the township and village guards.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R197.1

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