Two years ago, Zhang Hui, who was the director of the department in the third-class hospital in the mainland, set off from her hometown in the northwest to Shanghai, thousands of miles away, and became the head of the department in a second-class hospital in the rising stage. In her opinion, this is a great opportunity to get in touch with new things and rekindle the passion for medicine.
In March 2022, this experience of joining a new unit for nearly 18 months surprised Zhang Hui. Nearly half a hundred years old, she tried to gain a foothold in this first-tier city, but it was only the beginning of a long period of cultivation.
"I feel like I'm sitting idle and useless. Many of the hospital's promises at the time had not been fulfilled, and I didn't know what to do, and I was a little breathless..." On the other end of the phone, her tone could hear the obvious anxiety.
In the circle of doctors, it is not a new thing to jump to the north, Shanghai, Guangzhou, and Shenzhen, where medical resources are more abundant.
Over the past many years, generations of young medical students have poured into first-tier cities, spilling their blood on the vast hot land, some rejoicing, some lost, and some people suffering day after day, quite a bit of "fresh clothes and angry horses, waving fangs" flavor.
However, when those middle-aged doctors who have experienced decades of hard work in their hometowns are not willing to be confined to a small world for a lifetime and open the second half of their "Shanghai Drift" and "North Drift", they obviously have to bear more pressure than the younger generation.
Leave your hometown and start over
Like Zhang Hui, there are not a few doctors who are still eager to move towards the big city in middle age.
According to the data of Lilac Talents, in the three years from 2019 to 2021, the total number of resumes submitted through Lilac Talents to the North, Shanghai, Guangzhou, and Shenzhen is about 4.44 million times, 4.87 million times, 5.09 million times, and 4.71 million times, all of which exceed 4 million levels.
From the perspective of the number of resumes submitted, taking the data of Beijing and Shanghai in 2021 as an example, the number of resumes invested in the two cities in one year is: 139,000 and 154,000 respectively - of which the number of resumes from other places accounts for more than 65%, the proportion of people who have worked for more than 10 years is about 23%-25%, and the total proportion of intermediate and senior titles is more than 26% (the following figure has excluded ungraded data).
Schematic diagram of incoming resumes
Source: Lilac talent
That is to say, the number of medical workers with long-term work experience in the field and the intention of job hopping to lock in first-tier cities is still huge, including many senior candidates at the level of director and deputy director.
In 2019, on his 43rd birthday, Li Feng decided to leave Yichang, Hubei Province, a city where he had lived for many years, to embark on a job search in the coastal areas.
Although he was already the director of the provincial key specialty of the top three hospitals in the original unit, he still felt that the overall medical resources in the local area were relatively limited and his thinking was relatively conservative, and he hoped to change to a larger platform.
After comparing the job opportunities in Shanghai, Hangzhou, Yiwu and other cities, he found a district-level comprehensive hospital affiliated to a university in Shanghai, and made full exchanges with the leaders of the personnel department and the hospital, and found that the other party's discipline construction concept and cultural values were consistent with his own ideas, so he was ready to join the company.
More medical resources, more room for development, and higher salaries in first-tier cities seem to be the main reasons for attracting thousands of doctors every year. In their view, choosing a big city is equivalent to choosing a more avant-garde lifestyle and a better network of contacts.
At least, when she first stepped into Shanghai, where "ten miles of ocean fields, colorful sounds", Zhang Hui thought so.
Disappointment: Waiting and searching
Zhang Hui still clearly remembers the scene of the first interview at Shanghai Hospital: "The hospital took me to see their treatment room, the space is very large, and the future development scale is very impressive. I am also confident in my ability to work, and I should be able to develop the department."
However, as the new work unfolds, reality reveals its true face of "bone feeling".
As a registered rehabilitation physician, Zhang Hui originally thought that she had accumulated many years of clinical experience in rehabilitation and pain science, and it was also good to choose a specialized hospital with outstanding regional strength in Shanghai, and it would be better to serve patients more accurately.
But what she did not expect was that the department planning arranged by the hospital for her had not yet landed, "Seeing that the next department can open two floors at once to admit patients, my department has not even allocated beds, and the patients she received can only be temporarily placed in wards in other departments." Gradually, the young people on the team went to work in other departments, and I became the commander of the light rod."
The hot blood that was originally planned to roll up his sleeves and do a big job was poured with cold water and slowly froze in his heart.
The chaos of internal management and the coldness of interpersonal relationships stung Zhang Hui's self-esteem. More importantly, she believes that the current income situation is not directly proportional to the consumption level of first-tier cities. At the time of entry, the issue of the introduction fee was not discussed with the hospital.
"In the past, working in the mainland, it was still very easy to add up to tens of thousands of yuan per month. After coming to Shanghai, the department has not yet been created and perfected, and more than 20,000 are in hand every month, living in the unit dormitory, and life is still tense." Zhang Hui frankly said that she has been in Shanghai for two years and dare not go shopping.
Also impacted by the pressure of first-tier cities is Li Feng. In 2019, on the eve of successfully passing the interview and preparing to sign a contract, he decided to abandon Shanghai and turn around and go to the Pearl River Delta for a simple reason: the salary competitiveness was not enough.
Later, he chose to enter a third-class hospital in Dongguan and worked for three years. Li Feng is satisfied with his current working status: the positions promised by the hospital, the salary and the introduction fee are clearly in place.
Compared with the treatment given by Shanghai, Li Feng calculated an account: "The director of the section here has a fixed salary of 10,000 per month, plus performance, allowances, year-end bonuses and other income, and the current annual salary is about 500,000-600,000; the Shanghai side is estimated to be 20,000-30,000 per month, plus the talent introduction fee of 1 million, but considering that it is still very difficult to settle a family, it is still very difficult to buy a house." Overall, Dongguan is more appropriate."
According to the "2021 China Hospital Salary Survey Report" of Lilac Talents, the average annual salary of hospitals nationwide is 197,000 yuan. Among them, the salary of hospitals in Shanghai is 78% higher than the national average, the average annual salary is 351,000 yuan, and the annual salary of doctors at all professional title levels is significantly higher than the national average, and the difference between different grades is obvious.
Source: Station Cool Helo
Li Feng's income is not too competitive among the shanghai Zhenggao doctors. Instead, his current annual income in Dongguan is higher than the average for the Shanghai physician population.
Of course, in addition to the "cost performance" of salary and treatment, Li Feng also found the added value after coming to Dongguan: "The academic exchange atmosphere here is very strong, the hospital is also very influential in the local area, I have gone up to a higher level as a department management post here, the team is young, and I feel that my mentality has also opened up a lot."
"Maybe one day when the time comes, I'll be back in Shanghai, if I can afford a house." He smiled, probably unable to tell whether this was relief or embarrassment.
Whirlpool: North to Guangzhou, deep, where to go
Zhang Hui and Li Feng, who were affected by the vortex of "Shanghai Drift", are only a small microcosm of the doctor group in the context of the big era.
In contemporary China, which is full of change, for many people, the hometown is only the hometown. Their footsteps may because they obey the arrangement of fate, or because they chase the ideals in their hearts, they rush to the super city where "all people are hidden like the sea".
Leaving aside the factors of geographical proximity, the flow of talents in first-tier cities shows two characteristics: first, the inflow of population in first-tier cities continues to increase, and second, the proportion of population flows from non-first-tier cities to first-tier cities is increasing year by year.
Ding Xiang talents analyzed the flow trend of medical talents in the four first-tier cities of north, shanghai, Guangzhou and Shenzhen from 2019 to 2021. The data shows that in three years, the total number of resumes flowing to first-tier cities has increased year by year.
Judging from the number of foreign resumes in each city, the number of foreign resumes in first-tier cities in 2021 will exceed 100,000 / year except for Beijing, and the vast majority of resumes submitted from non-first-tier cities (more than 90% in Beijing and Shanghai, more than 80% in Guangzhou and Shenzhen).
Source: Station Cool Helo
The bustling siege attracted countless people to flock to the city, some people got their wishes, and some people lost their way.
Comparing the resume data flowing out of four first-tier cities in 2019-2021, it is not difficult to find that this set of numbers is much smaller than the number of resumes flowing in. Taking Beijing and Shanghai as an example, the average number of resumes invested in foreign countries each year is around 10,000, which is less than one-tenth of the inflow of resumes. However, once job-hoppers choose to "flee the north, Shanghai and Guangzhou", they will be more inclined to go to non-first-tier cities.
Schematic diagram of outgoing data comparison
Source: Lilac talent
Another point worthy of attention is that the proportion of fresh medical students in the north, Shanghai, Guangzhou, and Shenzhen is very high, and many young people will regard first-tier cities as the first stop of work, but whether they can stabilize will be affected by multiple factors such as personal career planning, job matching, and urban living costs. The data shows that in the past three years, among the medical personnel who have flowed into and out of first-tier cities, the highest proportion of the population is still fresh graduates (40%-50%).
Compared with budding medical students, people who have worked for 5, 10 or even more years are obviously more cautious when faced with the choice of switching cities.
We surveyed the group of senior doctors who have worked in first-tier cities and found that the main factors they are most concerned about and most likely to cause anxiety include: hospital competitiveness and influence, introduction policies (such as hukou issues, salary and treatment, fixed posts), hospital culture, personal development space and urban living costs.
Medical resources: The north, Shanghai, Guangzhou, and Guangzhou are gathering, and Shenzhen is struggling to catch up
The strength of a city's medical resources comes from long-term accumulation, and is inextricably linked to political, economic, residents' cultural and educational resources.
Among the top 100 hospitals released by the "2020 China Hospital Rankings", Beijing, Shanghai and Guangzhou have won 51, and secondly, strong provincial capitals and municipalities directly under the central government have also become the winners of the top 100 hospitals. On the contrary, the number of hospitals in the top 100 list of economic stars shenzhen is "at the bottom of the hate" - the Third People's Hospital of Shenzhen has become the first local pioneer to enter the top 100 list.
The root cause is not difficult to find: medical care is a highly integrated industry, high-quality medical schools can not only provide scientific research support for hospitals, but also play an important role in cultivating medical talents.
As a highland of national educational resources, Beijing and Shanghai not only have famous schools such as Qingbei Fujiao, but also many top three hospitals with a history of hundreds of years. At the administrative level, especially in Beijing, there are many large hospitals under the central government, such as hospitals directly under the National Health Commission, hospitals directly under the Ministry of Education, military hospitals, and even large state-owned hospitals.
On the other hand, Guangzhou, as the medical center of the whole of South China, has the eight old schools of medicine "Sun Yat-sen Medical", Southern Medical University and Guangzhou Medical University, and the foundation of medical talents, education and scientific research is also quite profound.
It is conceivable that a new middle-aged doctor, when he migrates from another country to the north, Shanghai and Guangzhou, where the top three are gathered and the masters are lined up, will face extremely fierce competition and self-doubt.
According to Lilac talent data, the number of jobs publicly released by Beijing Hospital in 2021 is 13541, while the total number of resumes submitted by medical talents flowing to Beijing in the same year is 1684014, and the ratio of the two is about 1:124 (that is, an average of 124 people competing for a job opportunity).
Only Shenzhen, as the largest city in Guangdong Province with the highest GDP and the third largest city in the country, has a very weak medical school and medical foundation. It is reported that before 2020, only Shenzhen University and Southern University of Science and Technology in Shenzhen have opened clinical medicine majors in the local area, and many universities here are as young as Shenzhen.
As a hot land of reform and opening up, the rapid influx of population has put forward higher requirements for medical resources. The number of medical care and beds per capita in Shenzhen is at a low level. This situation has prompted the government to increase investment in the introduction of medical talents and medical infrastructure: Shenzhen proposed in the 2021 government work report that 20,000 new beds and 30 tertiary hospitals should be added during the "14th Five-Year Plan" period. At the end of 2020, there were only 18 top three hospitals in Shenzhen, but as of the first half of 2021, this number has increased to 23.
Talent introduction policy: The threshold of beijing, Shanghai and Guangzhou is higher, and Shenzhen is more open
The gathering of high-quality medical resources is bound to have a huge "siphon effect" on talents. In the past decade, the mainland population has further concentrated in first-tier cities, with the total population of the four first-tier cities exceeding 83 million, accounting for 5.8% of the total population of the mainland. In the field of doctor job hunting, the number of resumes submitted to the north, Shanghai, Guangzhou, and Shenzhen in the past three years is still rising.
At the same time, we also pay attention to the introduction policies of beijing and Shanghai, which are known for their "difficulty in settling down", and the introduction policies of graduates of the corresponding years are still relatively friendly.
From July to September 2021, Beijing and Shanghai successively issued the "Beijing Municipal Measures for the Administration of the Introduction of Graduates" and the "2020 Measures for the Classification of Household Registration of Non-Shanghai Fresh Graduates of Ordinary Colleges and Universities entering Shanghai for Employment", both emphasizing that fresh graduates of double-first-class universities can directly settle down.
In contrast, for medical staff with work experience, the relevant social recruitment introduction policies are more intricate and complex, and the approval process is more cumbersome.
A headhunter of a clove talent said: "In the past 10 years of third-party recruitment in the medical industry, I have often felt that the threshold for the introduction of senior talents in Beijing and Shanghai is too high, and the corresponding settlement fees and introduction fees should be approved according to the layers of each district-level unit. Each subsidy policy will be linked to very specific prerequisites, such as scientific research topics, release time, project approval, etc., and need to have detailed materials to apply for. If there is a problem with the materials submitted by the candidate, it may not be able to get the corresponding money."
It is true that behind the "high threshold" is also related to the population control policies that Beijing and Shanghai have been implementing in recent years.
Looking at the 2020 Statistical Communiqué on National Economic and Social Development, evaluating the annual household proportion of the permanent population, it is not difficult to find that Shenzhen has the highest proportion of settlement, and the difficulty of settlement is significantly lower than that of Beijing and Shanghai.
Under the favorable background of macro policies, Shenzhen has spared no effort in building hospitals and recruiting talents in recent years. According to the official micro-news of the Shenzhen Health Commission, Shenzhen is recruiting doctors around the country, and the intensity is getting stronger and stronger year by year, and the number of recruitments for the whole country in 2021 will reach 7734 people. A private hospital in Shenzhen released more than 400 positions at one time in 2021: from clinical frontline, nurses, office administrators, to discipline leaders, all kinds of vacant positions are not incomplete.
In addition, Guangzhou, which has 38 top-three hospitals, has also become a target city for many senior doctors because of the relatively loose talent introduction policy, faster development speed and lowest cost of living in first-tier cities.
However, in the fiercely competitive first-tier cities, most of the social recruitment of the head of the veteran top three hospitals requires a doctorate or above, and candidates with master's and undergraduate degrees can only go to the district level or new hospitals to find opportunities.
Salary: Shanghai continues to lead the way, and Shenzhen has become a dark horse
According to the "2021 China Hospital Salary Survey Report" of Lilac Talents, the higher the city level, the higher the annual average salary. Among the first-tier cities, Shanghai has the highest total salary and Guangzhou has the lowest salary (excluding the sample size of Shenzhen).
At the same time, the fixed salary ratio in first-tier cities is lower than that in second- and third-tier cities, and incentive factors such as performance and bonuses are more important for doctors in the north, Shanghai, Guangzhou, and Shenzhen. From the average monthly fixed salary, it is still Shanghai (9100 yuan) > Beijing (6000 yuan) > Guangzhou (4500 yuan).
Statistical diagram of average annual salary in different cities
Source: Lilac talent
As a "dark horse" player in the robbery war, Shenzhen's sincerity has always been sufficient. The policy is also clear: give treatment.
In recent years, medical talents have come to Shenzhen, and hospitals will arrange special personnel to assist in applying for government public housing. Taking Shenzhen Bao'an District as an example, those who meet the high-level talent standards of Bao'an District and are certified (such as: full-time doctors under the age of 40) can enjoy a living subsidy of 200,000 yuan and rent-free accommodation for 90 square meters of talent housing. After recruiting a group of discipline leaders, more and more backbone forces have begun to flow to Shenzhen.
According to Li Feng, Shenzhen is now digging people "at any cost" .
He was impressed by the shenzhen hospital's grand gesture: "In the past two years, the efforts to recruit people from the western region (especially Xinjiang) have been too great. For a while, the state directly issued a strict policy, and people from the west to Shenzhen had to re-evaluate their titles. At that time, I also considered going to Shenzhen, and there was a unit that interviewed and said that it would give 3 million talent introduction fees, and the benefits were very good. But I still think that the hospital platform is a little smaller, and there is no compilation, so I gave up."
Of course, regarding salary levels, we must not only consider the city. Medical technology level, title, department, hospital level... Every factor will become an intervention item for doctors' income. Under these passive or active "interventions", the income gap between the doctor groups will reach several times to even more than a dozen times.
Drought death, waterlogging death, this is a true portrayal of the income of doctors in first-tier cities.
Hospital culture: such as people drinking water, cold and warm self-knowledge
Compared with the salary package in black and white, hospital culture is more like an invisible hand, which determines the professional happiness and personal development space of doctors.
The culture of a hospital bears the cultural imprint of the city in which it is located. On this point, Xiang Yang, an oncologist who has been practicing medicine in Beijing for 10 years, will have a deep understanding.
In his view, Beijing's hospitals pay more attention to academic factions: Xiehe, Beijing Medicine, and Shouyi all have a more far-reaching historical background, just like the city's long-term precipitated sense of heaviness. However, the gradient between hospitals is very large, and the head effect of Concord is too obvious, including affiliated hospitals directly under the Northern Medicine and the First Doctor, and it is also very difficult for foreign talents to enter.
"I've interviewed other local hospitals in the past two years. For example, Concordia once recruited a person in a department, many competitors, four of whom were still foreign - the United Kingdom, the United States, the University of Tokyo in Japan, and also attached great importance to who the job seeker's mentor was, school background, etc., so it was difficult to find the right opportunity for himself." Xiang Yang obviously felt that when people reached middle age, the development of the city also encountered a bottleneck period.
Like Xiangyang, Li Feng, who is in Dongguan, also has the feeling of "although he can't go to Shanghai, his heart yearns for it". He believes that the atmosphere of Shanghai is more open and fair, the system is more standardized, while Dongguan is more like a humane society in a small city, and many things in the working atmosphere must "look at the relationship" and "rely on connections".
An HR Han Li, who has been engaged in human resources work in the hospital for many years, believes that the medical concepts of patients in the north and south are different, forming a phenomenon of "patients in the north see the hospital, and patients in the south see doctors". As a result, some doctors who want to build a personal brand may be more inclined to stay and work in southern cities.
"Of course, for the current crazy talent situation in Shenzhen, I think we must calm down and wait and see its sustainability, after all, without the accumulation of the hospital's humanistic heritage, doctors are still easy to lose."
Han Li particularly emphasized her views on hospital culture. She believes that the construction of culture and disciplines is not made up of money, and it is better to attract good managers than to attract experts.
Hold on: For the life you want
Almost all middle-aged doctors who have experienced hardship in first-tier cities have had the idea of fleeing. They are in the same state as people in other industries who are experiencing a midlife crisis: they are not satisfied with their current lives and dare not give up easily.
The relationship between the city and the people is often: you choose the city at the same time, the city chooses you. Human character has long been integrated into the character of the city.
Xiangyang always knew exactly what he wanted.
"After graduating from Shanghai Jiaotong University School of Medicine in 2010, I stayed in Ruijin, many of my mentors and colleagues are locals, and I am very good, but I feel that it is difficult for me to have a sense of belonging as a Hebei person, and I consider that I want to be closer to home to take care of my parents, so I came to Beijing in 2012, and this stay is ten years."
Today, Xiangyang is already the deputy chief physician and the backbone of the department. He began to think about changing platforms and shaping more personal influence.
In his bones, he loved his family and set his sights on a branch of capital medical university in the suburbs. Although the commuting distance is farther, Xiang Yang feels that the personnel above the deputy high school there are not yet saturated, have a more suitable soil for their own development, and will spend more time with their relatives.
There are also some people, who are not as lucky as Xiangyang, and are still struggling to find the world that their hearts really desire.
Going to the top three hospitals in the north, Shanghai, Guangzhou, and Shenzhen to become the "king of the rolls" may have to endure the gap of "high jobs and low employment"; going to small hospitals is afraid of small development space and few platform opportunities.
In addition, in terms of daily commute time, due to the higher housing prices near the unit, many doctors choose to live in an area 40 minutes away from the unit, which means that it takes nearly 2 hours to commute every day........ Just like this, the soul and body are the choice of choice in the first-tier cities, losing their original intentions.
When people reach middle age, it is difficult to live only for themselves. I also understand that unsatisfactory things are "nine times out of ten" .
If you can finally lower your expectations, you will give up if you are willing to "take three thousand weak waters, and only take one scoop to drink". Otherwise, you may wish to try to let yourself go, try to change the track to place life and ideals, and anchor the new first-tier and second-tier cities with higher comprehensive cost performance.
For middle-aged doctors eager to break through the bottleneck of their profession, the changes brought about by each city choice seem to be different, but the problems behind them are similar.
Whether it is the cheerfulness of Beijing, the fashion of Shanghai, or the warmth and livability of Guangzhou and Shenzhen, any post-70s and post-80s who are "old on the top and small on the bottom" are difficult to bypass the three mountains of real estate, pension and education. The high cost of living has also made many doctors who are not financially weak feel anxious.
Zhang Hui, 48, has been in Shanghai for more than a year and still lives in the dormitory provided by the hospital, and she wants to wait for her son's college entrance examination to finish before considering buying a house.
"I may go back to my hometown after I retire, but I don't plan to leave Shanghai now." The hospital has already helped me solve the hukou, and I think my son can come to Shanghai to study next year." Zhang Hui's voice disappeared on the other end of the phone, drowned out by the roar of the subway that whistled past.
(Thanks to Xiaoying, Feige, Mary, Panda, Qi Fei, etc. for their contributions to this article.) At the request of the interviewees, Zhang Hui, Li Feng, Xiangyang and Han Li are pseudonyms)
Author: Still
Curator: Still
Literature: Bourne still
First image source: Stand Cool Helo
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