Recently, the topic of salary cuts for medical staff has attracted widespread attention in society. Various headlines such as "The Wave of Healthcare Cuts is Coming" and "Collective Salary Cuts!" "Clinical reduction of 8000, administrative reduction of 3000" and so on frequently appear in media reports. According to a non-real-name voting survey conducted by a doctor's community forum, more than 66% of the 2,630 users who participated in the online survey said that their hospitals had reduced their salaries, 19% had their salaries the same as before, and 6% had increased their salaries.
However, are salary cuts in hospitals widespread? Why is this happening? Are there rules for hospitals and doctors who suffer salary cuts? From doctors in some tertiary public hospitals in North, East, South and Southwest China, we can learn that salary cuts do exist, but the situation is different.
The prevalence and causes of wage cuts
Starting in 2023, some doctors' earnings returned to 2019 levels, but the additional workload did not lead to a corresponding increase in revenue. Respondents said that hospitals are reducing expenses to varying degrees, saving consumption, and sending a signal of "cost reduction". This phenomenon may be related to the impact of the pandemic, the reform of functional payments, and the common pressure of multiple performance appraisals, and hospitals often choose to work on open source and reduce costs in order to cope with these challenges, which will affect the income of medical staff.
The relationship between hospital income and department characteristics
The survey found that whether and how much medical staff cut their salaries are closely related to factors such as the medical level and department group of their hospitals. In first-tier cities or large public hospitals, the level of medical care is high, the number of patients is relatively stable, and therefore the income is relatively stable. However, hospitals in some areas have experienced a decline in the number of visits to medical staff, which has affected the income of medical staff. In addition, when hospitals introduce new medical payment policies (such as DRG/DIP), it will also affect doctors' performance pay.
Impact of DRG/DIP policies on physician income
The implementation of the DRG/DIP policy has allowed doctors to pay more attention to cost control when treating patients, so some doctors' income has been deducted. Although some policies require that the salary of medical staff should not be directly linked to the income of departments and individuals, in reality, many hospitals still link the profits and losses caused by DRG/DIP payment to the business of departments and medical staff, resulting in doctors having to consider how to control costs when working, which affects the treatment effect of patients.
Challenges and solutions
The interviewed medical staff said that factors such as hospital management level, medical level, and payment policy will affect the income of doctors. Some hospitals have responded to the challenge by adopting an open source approach to reduce costs and increase efficiency. Some observers suggest that different incentives can be used to guide physicians' medical behavior within hospitals to balance efficiency and fairness.
The recently hotly debated "annual salary system" is considered to be a possible solution, but its promotion and operation are still difficult. Experts pointed out that different levels of hospitals can adopt different annual salary systems to promote graded diagnosis and treatment while ensuring the stability of doctors' income. However, how to balance the income of good doctors and the economic pressure of hospitals is still a complex issue that needs to be considered by many factors.
In short, the phenomenon of salary cuts for medical staff varies from region to region and hospital to hospital, and the reasons are complex and diverse. In solving this problem, it is necessary for the government, hospital management, doctors and other parties to work together from the financial management, policy formulation, medical level improvement and other aspects of the hospital, so as to achieve reasonable income of medical staff and high quality of medical services.