Abstract: Objective　To investigate the intention and awareness level of the strengths of practicing at multiple institutions among healthcare providers in China during the construction of the medical association，identifying methods for guiding doctors' multi-site practice reasonably.Methods　From March to April 2017，we recruited some clinicians，medical technicians，nurses，medical researchers and hospital managers from 4 tertiary hospitals in Shanghai and surveyed them for collecting the sociodemographic characteristics，awareness level of the strengths of practicing at multiple institutions，and effects of practicing at multiple institutions on personal and hospital's development.Results　Of the 500 healthcare providers，422（including 256 clinicians） returned responsive questionnaires，with a response rate of 84.4%.According to the survey results，only 11（4.3%） clinicians practiced at two or more medical institutions，and 30（7.1%） clinicians did not approve of practicing at multiple institutions.With regard to the strengths of practicing at multiple institutions，the majority of respondents believed that it could promote the reasonable flow of health talents〔72.0%（304/422）〕，reduce the excessive workload of healthcare providers from tertiary hospitals 〔64.7%（273/422）〕，improve the accessibility of medical services 〔69.7%（294/422）〕，improve the level of patient satisfaction with medical services〔52.6%（222/422）〕，was promising in China 〔59.5%（251/422）〕，could improve the income of doctors 〔76.3%（322/422）〕，raise the working enthusiasm of doctors 〔74.2%（313/422）〕，and promote the professional level of doctors〔54.0%（228/422）〕.However，46.2%（195/422） thought that practicing at multiple institutions could increase the doctors' workload，20.4%（86/422） considered that it could hinder the promotion or professional development of doctors，and 23.5%（99/422） believed that it would lead to increased probabilities and risks of making malpractice.In addition，76.8%（324/422）of them believed that practicing at multiple institutions would be more favorable to primary- or second-level hospitals，56.2%（237/422） thought it would narrow the gap of professional level between private and public hospitals，but 45.0%（190/422），50.9%（215/422） of them considered that it would not bring adverse effects on the development of tertiary hospitals，weakening the brand characteristics.Conclusion　Most respondents believed that practicing at multiple institutions could promote the reasonable flow of health talents，reduce the excessive workload of healthcare providers from tertiary hospitals，improve the accessibility of medical services，improve the level of patient satisfaction with medical services，and some intended to practice at multiple institutions.During the construction of the medical association，using incentive mechanism and protecting doctors' legal rights and interests are of great significance in reasonably guiding doctors' practicing at multiple institutions and promoting the reasonable allocation of health resources between the members of the medical association.

Key words: Health manpower, Multi-site physician practice, Medical alliance, Allocation of medical resource, Flow of medical talents

摘要： 目的　探索在医联体背景下，医务人员对多点执业的意向及优势的认识，分析合理引导医生开展多点执业的路径。方法　2017年3—4月，以上海市4家三级医院的临床医生、医技人员、护理人员、科研人员、医院管理人员等为调查对象。调查内容包括调查对象基本情况，以及对开展多点执业的优势、对医生和医院的相关影响的认识。结果　本次研究共发放500份问卷，回收有效问卷422份（其中临床医生256名），有效率为84.4%。当前，仅11名（4.3%）临床医生已在两个及以上的医疗机构开展多点执业，30名（7.1%）调查对象不赞成多点执业。多数调查对象认为，开展多点执业具有促进医疗人力资源合理流动〔72.0%（304/422）〕、缓解三级医院就医拥挤的现状〔64.7%（273/422）〕、提高医疗服务可及性〔69.7%（294/422）〕、提高患者满意度〔52.6%（222/422）〕的优势，并认为多点执业在我国具有广阔的前景〔59.5%（251/422）〕。多数调查对象认为，开展多点执业能提高医生收入〔76.3%（322/422）〕、工作积极性〔74.2%（313/422）〕、医术水平〔54.0%（228/422）〕和增加医生工作负担〔46.2%（195/422）〕，分别有20.4%（86/422）、23.5%（99/422）的调查对象认为开展多点执业会对医生晋升或职业发展造成阻碍、分散医生精力导致医疗差错和风险。多数调查对象认为，开展多点执业对一级或二级医院更有利〔76.8%（324/422）〕、会缩小民营医院与公立医院的差距〔56.2%（237/422）〕，分别有45.0%（190/422）、50.9%（215/422）的调查对象并不认为开展多点执业对三级医院不利、会削弱医院的品牌特色。结论　多数调查对象认为多点执业具有促进医疗人力资源合理流动、缓解三级医院就医拥挤的现状、提高医疗服务可及性、提高患者满意度等实际的社会价值，并且具有一定的动机开展多点执业。如果在医联体平台上运用激励机制、权益保障等举措合理引导医生开展多点执业，有助于医联体内医疗卫生资源的合理配置，具有较为显著的社会意义。

关键词: 卫生人力, 多点执业, 医疗联合体, 医疗资源配置, 医疗人才流动