Shenzhen issued new rules to clarify that doctors do not need the approval of the original unit to ＂go to the acupuncture point＂
As the first city in the province to pilot doctors to practice freely, Shenzhen has recently made a lot of moves. The newly issued Detailed Rules for the Implementation of Multi-point Free Practice of Doctors in Shenzhen (hereinafter referred to as the "new rules") clearly points out that doctors only need to file online for multi-point practice without the approval of their affiliated hospitals, and it has been reported to the Provincial Health Department for approval.
Over the years, every step of doctors’ income, promotion and pension in public hospitals in China is inseparable from the system, and the voice of "liberating doctors" has been rising. In December 2009, the Health Department issued the Trial Management Measures for Doctors’ Multi-point Practice. From January 1, 2010, doctors’ Multi-point Practice was tried out. Any practicing doctor who has the title of associate senior and has worked in this technical position for more than two years can apply for multiple practice places, but he must go through the procedures of reporting and approval at the original unit.
Due to the application, although many doctors are eager to try, not many of them finally managed to leave. According to the data, as of December last year, there were only 36 doctors who applied for multi-point practice from Shenzhen Wei Ren Wei Committee, of which 60% were doctors from private medical institutions. Most of the "going out" from public hospitals were old doctors who were about to retire or postpone their retirement.
Today, the new Shenzhen rules skip the approval process of the original unit. And this "shock wave" also radiated to Guangzhou-two days ago, a plastic surgeon in a large 3A hospital in Guangzhou put forward an application for "acupuncturing".
Once the new rules are implemented, can doctors really be set free? How many doors do doctors need to break through to "liberate"?
Yizhong door
How can doctors have the energy to "walk the hole" when they are overworked?
Every day, I spend almost all the available time in rounds, operations and outpatient clinics, and I have to teach and research, and I don’t even have time to spend with my family. Even if you don’t need to apply to the hospital for acupuncture, you are willing but unable to do so.
Two days ago, in the conference room of a large 3A hospital in the old city of Guangzhou, members of the hospital team held a special meeting on the application of a plastic surgeon for "acupuncturing".
"In the end, we tend to let him concentrate on his work in the hospital. With so many things, how can I have more energy to practice? " The person in charge of the hospital admits that the hospital is overcrowded every day. "This person can’t be released. After all, it can’t affect the hospital’s diagnosis and treatment order and medical level."
There are many patients in big hospitals, and it is no longer news that doctors are overwhelmed. Take the First Affiliated Hospital of Sun Yat-sen University as an example. Last year, the number of outpatients received exceeded 4.6 million, and the average number of outpatients per day exceeded 10,000. Experts had to see more than 40 patients every day, and the time was full.
The same is true of Shenzhen. According to media reports, the designed outpatient service of Shenzhen Children’s Hospital is 2,000 person-times per day, and the actual daily consultation often reaches 5,000 to 6,000 person-times, and the medical staff are overloaded. Liao Qingwei, director of the Medical Affairs Department of the Shenzhen Municipal People’s Health Commission, bluntly said in an interview with the media that although there are many changes in the new policy, it is not expected that there will be a blowout in the number of doctors applying for multi-point practice. After all, the old system will affect the implementation of the new policy, especially in public hospitals, where staff work overtime every day, and doctors will carefully consider going out to practice more.
When it comes to multi-point practice, many doctors in public hospitals first nodded and said "looking forward to liberation", then shook their heads and said, "If you want to leave, you have to overcome all difficulties."
"Every day, I spend almost all my time on rounds, operations and outpatient clinics. In addition, I need teaching and research, and I don’t even have time to spend with my family." Dr. Zeng is the deputy chief physician of a large 3A hospital in Guangzhou. She admits that even if there is no need to apply to the hospital for "going to the acupuncture point", the doctor is willing but unable to do so, and it is better to be content with the status quo.
Double gate
Who should be responsible in case of medical accident?
A hospital in Haizhu District of Guangzhou staged a "farce" in which patients and their families collectively jumped off the building. The hospital was "shot while lying down" because this operation was done by doctors in other hospitals, and the "mother’s family" lost money to avoid trouble.
In recent years, the doctor-patient relationship has almost fallen to the "freezing point". If a doctor goes out to go to the acupuncture point and there is a medical accident or medical dispute, who should be held accountable?
The reporter learned that a hospital in Haizhu District of Guangzhou staged a "farce" in which patients and their families collectively jumped off the building. However, the hospital was shot while lying down, because the failed operation was done by doctors in other hospitals, and the "mother’s family" hospital was inexplicably taken as a "big head" and finally lost money to avoid trouble.
"In today’s environment, once patients and doctors have conflicts, it is easy to go to the hospital." Zeng Qiyi, Dean of zhujiang hospital, Southern Medical University, said that one of the advantages of freelance practice is to return this complicated relationship linked to the organization to a simple relationship between doctors and patients. "The ideal situation is that once a medical dispute arises between the two parties, it can be resolved through lawyers or insurance companies. If it proves to be the responsibility of the doctor, his qualification for practice can be revoked. "
The reporter learned that this is the way to operate in the United States. If a doctor has a medical accident in the course of treatment, the patient can seek help from an insurance company or a lawyer instead of solving the problem through medical trouble. Once the doctor’s improper operation is verified, his file will have bad records.
"Therefore, if we really want to realize multi-point practice, not only should the patient’s concept be changed, but doctors and medicine need to understand that they are not omnipotent, and doctors should also respond well and take relevant legal issues seriously." Zeng Qiyi said.
At present, in view of the medical disputes that may occur during doctors’ free practice, Shenzhen has given a new solution, or launched a compulsory insurance system for medical practice liability ("medical insurance") within this year to provide a protective barrier for doctors’ practice risks. Insurance companies will bear a certain amount of compensation for medical damage caused by doctors’ improper diagnosis and treatment, which is the first time that individual medical practitioners have been included in the insured in China.
In addition, Shenzhen will learn from Hong Kong’s experience, and the doctors’ association will be responsible for online filing, so that professional doctors’ associations can judge and supervise doctors and realize real industry autonomy and professional autonomy.
Triple Door
Who will pay for the benefits of working in multiple hospitals?
Under the current system, public hospitals, as institutions, have concentrated high-quality resources for teaching and scientific research, and doctors are responsible for all kinds of insurance and welfare benefits. If they choose to practice freely, it is equivalent to giving up their identity as institutions.
In a private hospital in Guangzhou, which focuses on obstetrics and gynecology, there are more than 20 experts with the title of deputy high school or above. The reporter learned that six or seven of them are multi-point doctors. However, they don’t want the "mother’s family" hospital to know that they are "part-time" outside, because they are afraid that welfare, security and promotion will be affected.
The 2011 China Health Statistics Yearbook shows that there are about 2.41 million medical practitioners (including assistant doctors) in medical institutions nationwide, of which 1.73 million are affiliated to public hospitals, accounting for 71.8%. While enjoying the stable welfare of public institutions, more than 70% of these doctors are also bound by their own choices.
Under the current system, public hospitals, as institutions, concentrate high-quality resources for teaching and scientific research, and hospitals are responsible for all kinds of insurance and welfare benefits for doctors. "To some extent, if you choose to practice freely, it is equivalent to giving up the identity of a public institution." In the opinion of many doctors, the reason for taking this step is to think carefully, because we can’t help but care about this identity. "Stay in the hospital for one day and enjoy the corresponding protection and welfare of the hospital. If you go out, once the hospital does not provide complete insurance and welfare benefits, the relevant promotion evaluation will be difficult to achieve. "
Therefore, many doctors who have "left" still believe that the current multi-point practice has not made doctors truly free, and doctors have always been attached to the identity management and corresponding benefits of the public medical system and cannot get rid of the constraints of "units".
However, from the standpoint of the hospital, there are also views that if the hospital allows experts to practice more, the salary bonus can be reduced accordingly. At the same time, in order to ensure that the welfare of doctors is not weakened, we only need to negotiate with third-party practice institutions to form a win-win situation.
Zeng Qiyi provided a specific idea: if a unit is responsible for various benefits of doctors, such as social insurance and housing accumulation fund, the bonus can be deducted accordingly; Another unit is responsible for the rest of the salary bonus. Through this tripartite bond, healthy competition between hospitals is formed.
■ Expert advice
Doctors’ multi-point practice should be managed by doctors’ association
Facing the possible problems caused by doctors practicing more, Liao Xinbo, deputy director of the Provincial Health Department, thinks that this reform in Shenzhen has certain significance, at least it has taken a step, but the step is not big enough. He believes that the operation steps are still too complicated. Whether a doctor has the ability to practice more should be managed by the medical association, and professional autonomy will be better.
"I think that a more meaningful approach is contractual management and contractual management. I work here according to the service contract I signed with the hospital, and I don’t need to report to the hospital where the rest of the time is. This is market-oriented, which can force the society to respect the value of doctors. As long as doctors flow, the market value of doctors will naturally form. " Liao Xinbo said.
Zeng Qiyi believes that doctors should practice regionally and establish a regional qualification system certification. Regional, that is, doctors have obtained the qualification of practicing in the whole country, but they need to be registered in the local area to facilitate management.