FACTORS AFFECTING SPECIALTY AND LOCATION OF PRACTICE OF GOVERNMENT-SPONSORED PHYSICIANS IN TAIWAN

Geographic and specialty maldistribution have created problems of phys ician supply in Taiwan. Previous small-scale government-sponsored phys ician (GSP) programs in Taiwan have had only limited effects. To solve this problem the National Yang-Ming Medical College was established i n 1975; it supplied its first government-sponsored physician graduates in 1982. Obligatory service in different specialties and geographic a reas were assigned to graduates according to their personal preference and school performance. In this study, we evaluated the factors affec ting the choice of specialty and location for these GSPs during the 6- year obligatory sen;ice 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 Manpow er Information System for the years 1982 to 1985. Logistic regression was used to assess the effect of year of entry, age, gender, rank in c lass, and hometown of the GSPs on specialty choice upon entry into the obligatory service period. Both logistic regression and generalized e stimating equations were used to analyze the effects of these paramete rs and location experiences during obligatory service on location sele ction after the obligatory service period. We found that rural experie nce 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 home town 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 i s needed to provide guidelines for improvement of current GSP program policies.