本研究旨在探討醫師執業生涯路徑類型，以及醫師由醫院受雇身份轉為診所自雇所涉風險程度及其決定因素。本文探討在考慮專科別的自我選擇效應後，醫師職場在長期政經勢力影響下形成的階層化結構，如何透過醫師生涯初期的「地位取得」變項，影響醫師在中、後期由醫院受雇轉為診所自雇的生涯轉換。以行政院衛生署所提供2002年全國醫事人員執業異動資料檔，選取進場時間(初次執業證照核發時間)為1988年至1995年的內、外、婦、兒、骨科專科醫共6,111位醫師為分析對象，檢視其於自1988年至2002年間的工作異動歷程，並利用對比涉險COX迴歸模式分析醫師由醫院受雇轉為診所自雇自雇所需時間及所涉風險的決定因素。結果指出，醫師平均在醫院工作5.3年後(標準差為2.43年)即會選擇診所自雇。醫師的生涯異動型態主要分為四種類型：一、穩定型；二、流動型；三、轉換型；四、零亂型，其中以流動型為主要型態。醫師生涯初期的地位取得對中、後期生涯路徑轉換有一定的解釋力，反映出醫師專業職場以學校派系、學制與組織位階化所鑲嵌的階層化結構，影響醫師中、後期的生涯路徑選擇。

Physician career path types and hazard factors related to changing from hospital employment to self-employment in clinics are explored. The main study question is how the stratified structure of the medical job market formed by the long-term development of a political economy affects physicians' mid- and late-period career moves from hospitals to clinics; the effects of specialty choices are also considered. In addition to examining the effects of early status attainment on late career moves, we analyze physician job change data provided by Taiwan's Department of Health between 1988 and 2002. The data indicate that 6,111 physicians (internal medicine, surgery, obstetric and gynecologic, pediatric, and orthopedic specialists) started their practices between 1988 and 1995. Results from a COX proportional hazards model show that 1,293 of these physicians (21.2%) chose self-employment in office-based clinics after an average of 5.3 years (SD=2.43) of hospital employment. Four types of job change patterns were identified: stable, mobile, transformative and chaotic, with mobile being the most prevalent. Early status attainment variables were found to affect mid- and late-career moves, with the long-standing structure of stratification inthis specific labor market also affecting physician career choices. Stratification is manifested in the form of school schisms, hospital stratification, and separate medical education tracks.