According to the Lancet study, the mainland is the country with the greatest need for rehabilitation, with about 460 million people in need of different forms of rehabilitation services.
As one of the four branches of modern medicine, rehabilitation medicine has only developed in the mainland for more than 30 years, and there is still a large talent gap. At the same time, a series of issues such as professional qualification identification, education standards, and career prospects also need to be further solved.
At 3 p.m. on March 4, the Fifth Session of the 13th National Committee of the Chinese People's Political Consultative Conference opened. Ling Feng, a member of the National Committee of the Chinese People's Political Consultative Conference and chief expert of the Department of Neurosurgery at Xuanwu Hospital of Capital Medical University, told "Occasional Cure" that this year she plans to submit a proposal to establish a long-term mechanism for standardized training of rehabilitation therapists.
Decades of work as a neurosurgeon have given Ling Feng a deep understanding of the importance of rehabilitation. Last year, her proposal to launch "rehabilitation and health huts" to village clinics was recognized by the National Health Commission. To date, 100 huts have landed in 12 provinces across the country. Combined with the existing experience, this year Ling Feng will also submit a proposal to popularize the "rehabilitation and health hut" nationwide.
In response to these two proposals, as well as the development status and future direction of rehabilitation in the mainland, "Occasional Cure" held a dialogue with Ling Feng.
The gap in rehabilitation talents is huge,
Rehabilitation therapists should not continue to be classified as technicians
Occasional Cures: Has the need for rehabilitation become more prominent in recent years?
Ling Feng: Rehabilitation is the need of all ages. As far as children are concerned, congenital disabilities, autism, etc. need long-term rehabilitation; in the intervening decades, a variety of diseases may cause limb disability and loss of function; in old age, even if there is no serious disease, functional decline will need help in this regard.
In the past, we paid more attention to clinical medicine, the so-called life-saving and injury-saving, in some cases, it is already amazing to be able to save people, as for how to function, there may not be so much energy, economic conditions, etc., to pay attention to for a long time. Now the people's living standards are improving, and the yearning for a better life is also constantly improving, not only to live, but also to live well and live with dignity, which requires rehabilitation medicine to play a role.
Rehabilitation medicine in the mainland began to develop in the 1980s, started relatively late, and is still in short supply of talents, so it is necessary to speed up the pace.
On March 1, Ling Feng shared his prepared proposal with the media.
Image source: Photo by Chen Yihan
Occasional cure: As just mentioned, there is a shortage of talents in this area on the mainland, how big is the current gap?
Ling Feng: In the past two years, there is no more authoritative statistics, and in 2015, the proportion of rehabilitation physicians in the mainland accounted for about 0.4:100,000.
According to the "Notice on Printing and Distributing Opinions on Accelerating the Development of Rehabilitation Medical Work" jointly issued by 8 departments last year, "Strive to gradually establish a reasonable number and quality rehabilitation medical professional team by 2022, with 6 rehabilitation physicians and 10 rehabilitation therapists per 100,000 population." By 2025, there will be 8 rehabilitation physicians and 12 rehabilitation therapists per 100,000 population," which means we haven't reached that level yet.
This is the goal for the coming years. Ideally, the ratio of the number of rehabilitation physicians, therapists, and clinical care is at least 1:1. (Note: According to the 2020 China Health Statistics Yearbook, there are more than 3.21 million practicing physicians and more than 4.44 million registered nurses in mainland China.) And some frontier areas, such as brain-computer interfaces and mechanical exoskeletons, also need more rehabilitation talent to participate.
Occasional Cures: You first mentioned in your proposal that rehabilitation therapists should be classified as part of a health technology role in the hope of changing the professional status of rehabilitation therapists. What is the current situation of rehabilitation therapists in the health care system?
Ling Feng: The "Trial Regulations on the Duties of Health Technicians" was implemented in 1986, which divided the health technology positions into four categories: "medicine, medicine, nursing, and technology", when rehabilitation medicine in the mainland was still in its infancy, and rehabilitation therapists were not listed as one category.
Later, rehabilitation therapists have been classified as technicians, but in fact, it is different from the nature of the technician's work. Therefore, we should keep pace with the times, revise relevant regulations in a timely manner, and form five types of positions of "medicine, medicine, nursing, technology, and health" to fundamentally promote the development of rehabilitation medicine.
There are many people now, including doctors, who believe in surgery and medication, and do not realize how important rehabilitation is to a person's health. In those countries where the development of rehabilitation medicine is relatively early, such as the stent of the heart today, tomorrow the rehabilitation therapist will begin targeted training, in our place, whether it is a doctor or a family, many times still think that it is necessary to rest for a period of time.
If you look at everyone's health as a flying aircraft, preventive medicine may be the nose, clinical medicine, rehabilitation medicine is the two wings of the aircraft, the wing is large and small, the aircraft can not fly smoothly.
Ling Feng was free-standing in Jiangxi.
Image source: Courtesy of respondents
Occasional cures: From "medicine, medicine, care, technique" to "medicine, medicine, care, technology, health", in addition to helping to increase the awareness of patients and medical care for rehabilitation therapists, can it also bring benefits in other aspects, such as prescription rights?
Ling Feng: Rehabilitation does not involve the right to prescribe drugs as we routinely understand them, but the right to prescribe non-drugs. The rehabilitator should not be a mechanical performer, but only to follow the doctor's arrangement, because in the process of rehabilitation training, the doctor is not the one who interacts with the patient the most every day.
The question is not only about awareness, but also about whether there is enough ability. Rehabilitation therapists need a lot of knowledge, not only medicine, but also some ergonomics, linguistics, psychology and other aspects.
If a therapist has good knowledge and can use it well in patients, why can't he prescribe non-drug prescriptions? We can set different barriers to entry, what subject background you want, which exams you pass, to reach a higher threshold, there is a higher approval and treatment, you can have non-drug prescription rights. But don't block this door completely, if there is no professional certification, no relatively clear career prospects, how many people will be willing to do it?
For rehabilitation therapists,
Uniform education and training standards are needed
Occasional Cure: Just mentioned the knowledge reserve of rehabilitation therapists, which involves another point in your proposal, that is, the issue of educational standards, what do you think about this issue?
Ling Feng: According to the professional catalog released by the Ministry of Education, there are 534 rehabilitation treatment professional points enrolled in 2022, including undergraduate, specialist and higher vocational, plus sports rehabilitation and Traditional Chinese medicine rehabilitation, a total of 682.
However, the training programs of various colleges and universities are very different, some have been subdivided into physiotherapists, speech therapists, occupational therapists and other directions, some are learning acupuncture and massage in traditional Chinese medicine, and some sports universities will add a little bit of sports rehabilitation content.
This really needs a professional team to give advice, such as the rehabilitation association of our disabled federation, or the Chinese Rehabilitation Medicine Association of the Science association, which is the only two first-level associations and societies in rehabilitation in the mainland. I am now promoting this matter as the chairman of the rehabilitation association, and we have set up a federation called the China Rehabilitation Therapist Certification Training Joint Working Committee, which is to bring together the top experts of these two associations and societies, hoping that they will jointly formulate a plan.
In 2015, the Disabled Persons' Federation proposed to build a national rehabilitation university, which was also written into the "13th Five-Year Plan" and "14th Five-Year Plan" plan, and the construction has entered the final stage, and it is expected to start enrolling students this year. We can first implement the program developed by the experts here and use it as a model for the reference of institutions.
Occasional cures: on the one hand, higher education and vocational education, from scratch to cultivate talents in this area, on the other hand, a considerable number of therapists are currently transferred from other directions after short-term training, how to view the effect of this training?
Ling Feng: In 2014, the "Notice of the Medical Administration Bureau of the National Health and Family Planning Commission on Doing a Good Job in the Training of Rehabilitation Treatment Professionals" put forward the training requirements and outline. After 8 years, according to incomplete statistics, only 5 provinces and cities in the country have held training courses for two or three months, a total of 14 000 people, the Disabled Persons' Federation has trained 1900 short-term training in 2018, and 6 affiliated hospitals of universities have organized 1-year training, a total of 535 people.
To some extent, it fills the talent gap faster, but not forever. At present, the content and time of training are inconsistent, we need to explore and refine in practice, and now it is time to establish a unified standardized training system.
The level of rehabilitation therapists in the mainland is uneven, in this case, our newly trained people should refer to the national unified education standards (Note: referring to the above-mentioned programs to be formulated by experts), and the training of the transfer population is actually a temporary supplement. As a cause, it is still necessary to have a long-term planning and direction. Slowly, more rehabilitation therapists are trained, these two parts of the people converge, the whole team will gradually grow, will become more and more standardized.
In Tumen Town, Mao County, Sichuan Province, Ling Feng counsels patients to use rehabilitation equipment.
Occasional Cure: Financial support for standardized training for rehabilitationists is also part of the proposal, can it be talked about?
Ling Feng: In 2017, the Beijing Municipal Health Commission took the lead in organizing 8 training bases with reference to the national method of inpatient medical training, which was funded by the Beijing Municipal Finance and trained 268 rehabilitation therapists on a full-time basis at a standard of 30,000 yuan per person per year.
I think this experience is replicable, mainly depending on whether the local government attaches importance to it. The state may first entrust the first-level associations and societies in rehabilitation to carry out pilot projects in several provinces and cities.
Popularize the "Rehabilitation and Wellness Hut",
Improve access to rehabilitation services
Occasional Cure: Another of your proposals is about the Rehabilitation and Wellness Hut, which is also a pro bono project you have been promoting since 2020, how did the idea for this project come about in the first place?
Ling Feng: Since 2017, I have been deeply involved in the medical and health action of poverty alleviation, at first we thought that the county-level hospital was the bottom, and we put a lot of energy into helping the county-level hospital, including free clinics, training, and building workstations.
Later, I found that when the county-level hospital was freely consulted, the rate of real illness among the people consulted was not high, and when we went down to the countryside, the positive rate became significantly higher, and 70% of the villagers who came to the consultation were really sick.
In October 2020, I was in a county hospital in Nujiang, Yunnan Province, a 24-year-old boy in a wheelchair, the medical history said that he encountered a collapse when digging coal 8 years ago, but I watched his film, there is no such transverse damage, if there is a good recovery after the operation, it should be able to stand up, not complete paraplegia. The Disabled Persons' Federation took good care of him and changed his wheelchair every year, but he missed that point in time, and it was difficult to have an effect if he wanted to recover.
The village where he lives is more than a hundred kilometers away from the county seat, and it is also a mountainous area, so it is difficult to obtain rehabilitation services for a long time, so I was thinking that if there were corresponding equipment and people in the village to help him recover, the outcome might be different.
Later, we went to a village of more than a thousand people, where there were sixty or seventy disabled people, one of whom was a patient with hemiplegia caused by stroke, who could have stood up and recovered for a period of time, he should be able to walk, and self-care may be no problem. But after he returned to the village, there was no equipment and people in this regard, he could only lie at home, he could not even get out of the door, and his wife had to take care of him at home and could not go out to earn money, which could easily cause him to return to poverty due to illness.
There are many more such things. There was a data before that only 33.5% of the tens of millions of disabled people in the mainland actually received rehabilitation treatment, and one of the important reasons was the problem of accessibility. So I hope to be able to move the rehabilitation forward to the village so that more people can get help at their doorstep.
Occasional Cures: We learned that 100 "healing and wellness huts" were put into use last year, how can we make them more useful?
Ling Feng: We focus on several aspects, one is the material, we provide 16 kinds of equipment, including 10 kinds of rehabilitation equipment, 3 kinds of physiotherapy instruments, electrocardiogram machines, etc., to meet the basic needs.
The second is the staff, our configuration of each hut is 6 people, in addition to the village doctor, but also includes a volunteer doctor, as well as the volunteer service corps of the Central Medical University of the League, now there are more than two dozen medical universities have joined this work, each university has an undergraduate volunteer and graduate student volunteers, there is a counselor, and finally the coordinator of the local health commission, a total of 6 people to help the normal operation of the hut.
Except for the fact that the village doctor is resident, everyone else is paying attention in different ways. For example, the volunteer doctor signed a 3-year help agreement with the county government, called at least once a week, and went at least once a month to help the village doctor learn more knowledge. Some village doctors are older and have difficulties in learning online courses, and our university student volunteers will help.
The third is the network, each of our cottages has an online platform, it will give the village doctors 100 hours of courses, mainly the content of "two diseases in the kang" (hypertension, diabetes, traditional Chinese medicine appropriate technology, rehabilitation basic technology), others can help and counsel the village doctor through the platform.
Volunteer doctors counsel village doctors in the use of rehabilitation equipment.
Occasional cures: The training of village doctors has a corresponding policy, so how to increase their enthusiasm for participating in rehabilitation work?
Ling Feng: This goes back to a proposal I made last year on the grading of village doctors. The appointment and grading of village doctors can be done by the county health commission, so why should we have the coordinators of the health commission to participate, they should also pay attention to the learning results and work ability of these village doctors in the cottage, our 100 hours of courses, each lesson has an assessment after each lesson, these can also be transmitted to the Internet, feedback to the county health commission, they can be based on these to grade the village doctors.
At the end of last year, the grass-roots departments of the National Health Commission have made a formal reply to this proposal - "Our committee is actively coordinating the policies of relevant departments to improve the construction of the rural doctor team and promote the solution of problems affecting the enthusiasm of rural doctors." On this basis, by grading rural doctors and giving different standards of medical fees to rural doctors at all levels, it will be a good attempt to promote the active progress of rural doctors." "Support and encourage village clinics with appropriate capacity conditions to carry out various forms of rehabilitation services and include them in the scope of medical insurance reimbursement."
In this way, the village doctor in the cottage has a certain incentive mechanism, some of which are financial incentives, or within the scope of medical insurance reimbursement, according to your rating, the corresponding diagnosis and treatment costs are formulated, and some are more opportunities for further education. These are all groping, and I believe that this system will be established and improved step by step in the future.
Author: Chen Yihan
Producer: Li Chen
Source: Courtesy of respondents