They all have the heart to save lives and help the wounded, but survival is still the first
"If I had the opportunity to start over, I wouldn't have chosen the path of care."
Liu Jun is a senior nurse at a public hospital in Shenzhen, and the Spring Festival holiday is only on the second day of the Chinese New Year. After three days of rest, it is back to the rhythm of black and white work. Working the night shift has an impact on the body, but Liu Jun said: "Take advantage of your youth, want to earn more money, and now you can still carry it."
In public hospitals in the first-tier city of Shenzhen, nurses have limited income from normal work. Liu Jun said frankly: When the hospital's efficiency was not good, he almost did not repay the mortgage. If you want your child to live in a better school district, it is also difficult to achieve because of practical problems.
The doctor may be slightly better, but the stress is also greater. On January 19, Niu Xueqiang, an orthopedic surgeon at the Third Affiliated Hospital of Zhengzhou University, died suddenly; on January 14, Peng Hanming, a gastroenterologist at Wuhan Children's Hospital, was slashed. The hospital is overcrowded all year round, and it is impossible to see it, and in addition to the huge risk of doctor-patient disputes, the income is also unsatisfactory.
"The older the doctor, the more popular it is", but not all doctors are like this. An internist at a public hospital in Shijingshan, Beijing, told the Health Bureau that his job was at most a "drought and flood guarantee", and the work pressure would be greater before and after the end of the year.
This is because in the past two years, many people have celebrated the New Year locally because of the epidemic, and the workload of doctors on duty during the Spring Festival holiday has increased significantly. Young doctors have little experience, and they can't let young people rush ahead, so senior experts are also receiving more referrals.
Although some doctors believe that the work intensity of doctors today is not as great as the outside world thinks, they are not busy enough to do scientific research and write papers. But the other side also admitted that it was indeed a little harder than in previous years.
The pressure of work is getting bigger and bigger, and Zhang Wenhong also has to go to the clinic for 10 hours continuously
"The more the merrier" is still the core logic of most hospital operations. Although "all the money in the operating room" has been scolded to the dog blood sprinkler, but recruiting one more patient will add an extra income, and the hospital really thinks so, and it does this.
A doctor told the Health Bureau: "Sometimes there are too many patients, and going to the toilet is a luxury."
The rising pressure of hospital visits is not just a doctor's intuitive feeling. According to the China Health Statistics Yearbook of the National Health Commission, in 2019, the number of medical and health institutions in various regions reached 8.719 billion person-times, an increase of 4.94% over 2018 and an increase of 13.36% over 2015, when the new medical reform was launched.
Source: National Health Commission China Health Statistical Yearbook
According to the outpatient volume data of the national large hospitals in the "Medical Circle", only 20 outpatients exceeded 4 million in 2016, and by 2020, the number has increased to 34. Even during the epidemic, the outpatient volume of some hospitals in many parts of the country has maintained steady growth. The outpatient volume of Huashan Hospital affiliated to Fudan University exceeded 4.8 million in 2020, an increase of 30.08% over 2019.
The Health Bureau learned that seeing a doctor late at night is the norm for doctors at Huashan Hospital. According to the surging news, at the end of 2021, Zhang Wenhong, director of the National Infectious Diseases Medical Center, will see a doctor for more than 10 hours in a row on the day of the visit, and basically cannot take care of rest and eating. Chen Lianjun, deputy chief physician of the Department of Dermatology, even 365 days a year.
Obviously, they were flesh and blood, and they all turned out to be steel warriors. In addition to daily medical treatment, doctors also write papers.
At the two sessions last year, Liang Yijian, a deputy to the National People's Congress and director of the Department of Orthopedics of the Third People's Hospital of Chengdu, Sichuan Province, came out of the circle: "There is no need for all doctors to do scientific research, and doctors in grass-roots hospitals should concentrate on taking good care of the disease." However, the evaluation of titles and income are inseparable from the paper.
Some doctors do not have the ability and time to force themselves into "writers", so they take the shortcut of "falsification".
In the second half of 2021, the Department of Science and Technology Education of the National Health Commission announced the results of 13 batches of medical research fraud treatment, involving more than 300 doctors in 150 hospitals. Most of these doctors were stripped of their titles, demoted, and missed awards and promotions. "Scientific research and counterfeiting" will be more fierce in 2022, the management of doctors' scientific research will become more and more stringent, the pressure of medical treatment will become greater and greater, and doctors can only comfort themselves that they can "bear it".
Doctors are tired and nurses are busier. The Health Bureau learned that the number of infected patients during the epidemic has increased sharply, and after the basic diagnosis and treatment, the doctors will also go to the ward to inspect it, and most of the workload is borne by nurses. In addition, there are also patients who do not cooperate, and nurses also have words of suffering.
Increasing pressure at work is already the norm for healthcare workers.
Income growth is slow and the "gray area" is too risky
What makes medical staff more psychologically unbalanced is the unmatched income.
Before the Chinese New Year, there was a detailed income of high-level orthopedic doctors in the top three hospitals circulating on the Internet: basic salary, quarterly bonus, year-end bonus, flying knife, lecture, conference and other projects added together, with an annual income of about 2 million yuan. However, lectures, conferences, and projects account for most of the income, and the income in the real hospital is not much.
For most general doctors, the money is something they can't earn and can only get paid from the hospital.
Calls for salary increases for health care workers are increasing year by year, but the actual implementation is relatively slow. According to the results of a commissioned survey by the Medical Administration Bureau of the National Health commission, the actual annual after-tax median income of more than 20,000 front-line clinicians in 136 hospitals across the country was 150,000 yuan, an increase of only 30,000 yuan over 2018, and the proportion of dissatisfied with their income exceeded 70%.
Even the grassroots group of general practitioners whose state demands salary increases is far below their expectations. A study on the current situation of community general practitioners' work pressure and its influencing factors published in July 2021 shows that of the 3244 community general practitioners sampled nationwide, more than 76% of doctors believe that their salaries are too low, and there is great financial pressure, especially for home purchase and children's education.
In the public hospitals of the first-tier cities in the north, Shanghai and Guangzhou, the income of ordinary medical staff is lower in comparison, an ophthalmologist in Shanghai said to the Health Bureau: Shanghai's cost of living is high, he is tight, he just recently bought a house, there is no money left in his hand, "Although the doctor takes saving lives and helping the injured as his duty, but the doctor is also a person, and he also has to live to eat." ”
Sunshine income is not high, some doctors began to wander in the gray area. Liu Jun told the Health Bureau: "Although the quality of imported consumables is better than that in China, some patients do not necessarily need to use imports. The orthopedic surgeon of the hospital will recommend that patients use imports, with many kickbacks, and can earn at least 60,000 yuan a month. ”
However, since 2018, the wind of medical anti-corruption has become more and more fierce, and the "good days" are gone. Liu Jun said: "Some colleagues were suspended for three years because they were found to have retracted the buckle, and now many doctors dare not take this risk." ”
Moreover, the national collection of consumables extends from coronary stents to orthopedic trauma and spine, and the price diving means that the rebates are significantly reduced. Even if medical anti-corruption is not carried out, the most profitable departments no longer have the same scenery as before.
Of course, the doctor's gray income cannot disappear all at once, and the Health Bureau understands that kickbacks still exist inevitably, "only private transactions are more hidden.".
With the strengthening of anti-corruption and hospital management, another important source of doctors' income, "scientific research funds", will also be strictly managed accordingly.
In January 2021, Lian Hongxin and others of Shenzhen People's Hospital said in an article entitled "Analysis and Countermeasure Suggestions on the Management Status of Scientific Research Funds in Public Hospitals from the Perspective of Discipline Inspection and Supervision": The scientific research funds of a hospital in the past three years have reached 221 million yuan, and there are problems such as lack of control supervision in the approval of fund applications, non-public bidding and procurement in accordance with regulations, no competition constraints in procurement, and even reimbursement invoices before the project is established.
The official scientific research funding "cliff-like" decline, the national health commission disclosed in March 2021 public budget, the ministry of more than 40 public hospitals in 2021 budget of 3.840 billion yuan, 72.92% less than the number of implementation in 2020.
The whole country is beginning to "live too tightly", and the doctor's life will not be too loose.
An uncertain future
"It's not as easy to recruit people in hospitals now as it used to be."
The Health Bureau learned that some hospitals do have recruitment difficulties, and in April 2021, Anhui Wuwei Municipal People's Hospital recruited a number of doctor positions, because no one applied for the examination and the number of applicants was insufficient. 388 people registered for the written test, but nearly 200 missed the test.
A similar situation has occurred in the first-tier cities of Beijing, Shanghai and Guangzhou. A doctor at a hospital in Shenzhen said: Now that the Internet is very developed, these graduates also know what the situation is now. Today's children are very realistic, desperately trying for many years and not making money, what do you let your children do? I know that some medical schools have lowered their scores to enroll.
Not only that, but cities such as Shenzhen are also in full swing to abolish the doctor staffing. "The newly recruited doctors are not staffed, those who have been appointed are struggling, and those who are not recruited are difficult to retain after they are recruited."
While there is a saying that abolishing the doctor establishment is conducive to the free movement of doctors, it is also possible to develop a doctor group. However, some insiders told the Health Bureau that only a few specialties of the doctor group can develop successfully, and most general doctors are still very dependent on the platform of public hospitals.
In December 2021, the Hebei Provincial Health Commission issued the "Work Plan for Promoting the Experience of Medical Reform in Sanming City, Fujian Province", which clearly used the resources to include qualified non-staff personnel in the establishment management; on January 24, 2022, the Guangdong Health Commission also issued a similar policy, in the "Guangdong Xue Sanming" medical reform document, it was clearly stated that non-staff personnel were selected for inclusion.
Whether the future of doctors will be strengthened or abolished is not yet known. However, doctors are out of the system, and the probability of development opportunities is not easy to be too good.
According to the 2020 China Health Statistics Yearbook, the loss of non-public medical institutions reached 130 billion yuan, and the data of Tianyancha also showed that the number of domestic private hospitals written off in 2020 was 685, nearly double that of 2019.
There is no way to go before, and there are soldiers chasing after it, which may be the most embarrassing reality for Chinese medical staff at present.
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