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< 読書感想『ミラーニューロンの発見』 | メイン | 逆紹介 >
2010.09.30 18:31 |  医療制度 / 行政  |  その他（医療関連）  |  おかだ  | 推薦数 : 1

医師不足の解消法

「医師不足：分娩医の不足深刻　現状の１．１５倍必要－－厚労省調査」（毎日）

　厚労省にどこから突っこもうか、と言いたくなるニュースですが、とりあえず二点。
１）これが「初めて」の調査、という点。
　これまでどおり「医師は不足していない」と言い張り続けるよりはマシな態度ではありますが、「足りないと言っている病院がある」とはまるで他人事のような態度ですな。それとも、「昨日までは足りていたけれど、今日から足りなくなった」とでも？（しかし、“あの毎日”でさえ「都市部さえ充足しておらず、医師不足が深刻な実態が改めて裏付けられた」と書かなくてはならないとはねえ。やっと改心したのか、あるいはよほど切羽詰まって惑乱しているのかな？）
２）「不足」の“実態”から目を逸らしている点。
　ここでの数字はあくまで「足りないと言っている病院」の“求人数”を総計しただけです。たとえば「財源がないから『足りない』と声を上げる気にもならない」「経営陣や病院事務は『足りている』と判断しているが、現場では『足りない』と判断している」病院は最初からこの統計では落ちている。ところが一度「数字」が出ると、この数字が一人歩きを始めるんですよねえ。たとえ実態から大きく解離した数字でも。だけどお役所が大好きなのは「この数字をどのように評価するか」「これからこの数字がどう変化するか」であって「実態はどうか」「実態がどう変わるか」ではありません。そのことはお忘れなく。

　そういえば、この調査は病院だけですが、開業医でも「人手不足」の所があるとは思いませんか？　　たとえば流行っているところや老人への訪問診療を手広くやっているところなど、夜間や休日や学会出張のためにたとえば「一人は要らないが、もう0.5人分医者がいたら」などと思っているところなどはけっこうあるように思うのですが。
　そうそう、“目くらまし”でしょうね、都道府県別の数字が上げられていて、思わず「わが県は」「よその県は」とそちらに注目したくなりますが、ことの本質は「日本の医療」であることをお忘れなく。大英帝国の分断統治よろしく、各地域がいがみあっても「解決」にはなりません。それで喜ぶのは厚労省とマスゴミだけ。
　ところで……ものすごく手っ取り早い「解決法」を思いつきました。来年また同じ調査をするとして、それまでの１年間の間に「人手不足だ〜」という数字を出した病院を数字の大きいところから重点的に潰してしまうのです。そうしたら、あ〜ら不思議、来年の調査では「人手不足」の数字は激減しますよ。書類上はめでたく一件（一見）落着〜ぅ。

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>せんせい
　オイシャって不足してるんですかね？
　うちのオクサマは産科医と同じく不足が叫ばれている小児科医ですが。サラリーマンの私より帰宅はよっぽど早いし、当直もそんなにこなしていません（今は産休中。元もとは月4回くらいかな。関東圏某大学病院）。

　話に聞くのは「人件費が十分払えないから医師が配置できない」そうで。本勤務先の大学病院の当直料は一泊数千円です。本勤務先からの年収はサラリーマン（非医師）の小職より下です。にもかかわらず病院は赤字だそうで。

　医師の数はそれなりにいるけれども、責任の重さと勤務の過酷さに見合うだけの報酬が無い、だからより過酷な診療科からは人がいなくなる（産科小児科救命などなど）。

　今、医学部を新設しようという動きがあるようですが、そうして医師免許保有者数を増やしたところで不足の診療科に人が増えるのかなぁ。法曹職みたいに頭数を増やして過当競争を生みだし、「薄給激務責任過重でも仕事があるだけありがたい」なんて状況を作りたいのかしら？

　だったら給料そこそこ、仕事量そこそこ、責任そこそこでサラリーマンやってるほうがナンボかましですね。


　なお、医療機関の負担を減らす（医師不足を解消する）ためには、年寄りの診療負担を増やすべきではないかと。暇な連中はサロン代わりに病院を利用します。医療費の無駄遣い、本当に医療サービスを必要とする人の利用の妨げです（尤も本当に医療の必要な年寄りを否定するつもりはありませんが）。
written by リーマン / 2010.10.04 08:15

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