Anyone who has had a fever understands that it is no exaggeration to describe this winter as a respiratory disease "a group of demons dancing".
Influenza A and B, new crown two yang, mycoplasma pneumonia...... You sing and I'll appear. Adults can still rely on immunity to fight against it, while children with lower immunity are not immune.
The child always had a fever in the middle of the night, and his body temperature was over 39 degrees Celsius. Anxious parents hurried to the fever clinic of the hospital, but what they saw was that some had been waiting for more than seven hours and had not yet been called; some had held up their infusion bags and could only find a place to stay in the corridor; and some had brought their own folding beds and small maza, ready to fight for a long time.
Why is it so difficult for children to see a doctor due to the "pandemic" of respiratory diseases?
The number of pediatricians has increased, but it is far from enough
In fact, there is a chronic shortage of pediatricians. Especially during the flu season, there is a surge in children's emergency rooms, and pediatricians are eager to grow three doppelgangers to share their work.
The reason for the "pediatric shortage" can be traced back to 1998, when the department no longer set up pediatrics separately, but merged it into clinical medicine. After graduation, medical students can develop into pediatricians through pediatric training as a resident or through postgraduate education [1].
However, medical schools have always circulated the saying that "pediatric work is heavy, occupational risks are high, and pay is low", and many medical students are reluctant to step into this "fire pit".
This policy has been influencing for nearly two decades. In 2015, for example, there were 118,500 pediatricians [2], and the number of children aged 0-14 was as high as 228 million [3], which is equivalent to 2,000 children having one pediatrician.
While this figure is a significant increase from a decade ago, in 2005, when there were 0.29 physicians per 1,000 children [3][4], it is still clearly not enough.
The turning point came in 2016, when the implementation of the "comprehensive two-child" policy and the resumption of enrollment of pediatric undergraduates in order to rewrite the fate of "congenital deficiencies and acquired malformations" in the training of pediatricians [5].
In addition, the hospital also encouraged professional doctors from other departments to transfer after training, and guided pediatricians who were transferred to other positions to return to pediatrics [5].
After a set of combination punches, the number of pediatricians has increased significantly. In 2021, the number of pediatric practitioners (assistants) in the country reached 206,000 [6], and the number of practicing (assistant) physicians per 1,000 children rose to 0.78 [7].
But if it is said that it has become easier to see a doctor in pediatrics since then, then parents who have queued up thousands of numbers to see a doctor this winter will definitely not agree.
Compared with the overall medical situation, the allocation of pediatric medical resources is still seriously unbalanced. According to the 2021 Statistical Communiqué on the Development of Health Undertakings in China, the number of physicians per 1,000 people in China in 2021 was 3.04, nearly four times that of pediatricians [8].
Similarly, in the eyes of pediatricians, outpatient and emergency departments have long been overwhelmed.
Even excluding special periods such as the flu season, paediatrics saw 504 million outpatient and emergency visits in 2021, second only to internal medicine and general practice, equivalent to an average of 2,449 patients per pediatrician per year [6].
The actual number of patients will only be higher. In a study comparing the differences in the work of pediatricians in China and the United States, Chinese pediatricians worked more than 50 hours per week and saw an average of 80 to 100 children a day [9].
It can be said that pediatric busyness is not accidental, but daily. In the face of the huge demand for consultations, some hospitals are still overcrowded even if they have arranged for pediatricians to arrive early and leave late without taking lunch breaks, ensuring that there are doctors available 24 hours a day to provide diagnosis and treatment services [10].
It was so difficult that the pediatricians left one after another
Although the older generation often says that doctors are more popular the older they get, there has long been such a saying in the medical world - "golden ophthalmology, silver surgery, don't kill pediatrics", and advise medical students not to choose pediatrics.
Why? Because of the workload. Pediatricians often work in a state that before they have even drunk a sip of water, the next parent on the waiting list has already pushed the door in a hurry, and they can only hold it first if they want to go to the toilet.
If a job with a lot of work but good pay can still be jokingly called "good fortune", then the pediatrician can be called "generating electricity for love".
According to a 2020 study published in China Public Health, a monthly income of 10,000 yuan or more is the threshold for job satisfaction among pediatricians, but only 17.77% of the 4,198 pediatricians surveyed nationwide earned more than 10,000 yuan per month [11].
If you are constantly rotating and paying income that is not proportional, you may be able to comfort yourself with "just get used to it", but if you are often beaten and threatened by your parents, you really can't make the pediatrician pretend that "I'm fine".
If the collapse index for parents taking their children to the doctor is 10, then the collapse index for pediatricians must be at least 100. In many cases, children and parents are unable to express their symptoms clearly, which is a great test of the pediatrician's "baby language" ability and clinical experience.
When you encounter a little patient who is regarded as "the meat of the heart" by the whole family, and there are two or three anxious parents standing on the side, the pediatrician is very likely to say the wrong thing and receive a complaint.
Sometimes when the child cries, the parents' business and emotions go up, and the simple dissatisfaction will escalate into "medical trouble":
In the outpatient clinic, I saw a baby with a cold being checked by the outpatient doctor with a tongue depressor on his tongue to check his throat, crying nonstop, and the parents went up to punch him, scolding the doctor for being too heavy......
For this reason, some pediatricians always keep steel helmets in their drawers, and some never dare to post photos of their babies in the circle of friends, for fear of retaliation.
Other pediatricians are torn between going and staying. According to a study of pediatricians in tertiary hospitals in Guangdong Province, 35% of pediatricians had a significant intention of leaving their jobs [12]. It is said that there is a spring in pediatrics, but the spring of the profession is more like "Schrödinger's cat", I have never heard of it.
In fact, there are many pediatricians who have actually put the idea of leaving their jobs into action. According to the "Healthcare Industry Talent Development Report Collection", pediatrics is the department with the highest turnover rate among the 15 departments of medical institutions [13].
Some people have concluded that King Kong's incorruptible body and steely heart are essential for pediatricians.
Many medical students who want to become pediatricians do so out of their love for children and their pursuit of professional value.
But when they see their predecessors tired and aggrieved to the point of unbearable state, they will also think of themselves one day. When the day is cold, pediatrics will become a place that no one wants to go to, let alone dare to go.
Graded diagnosis and treatment for many years,
Parents are still clustered in big hospitals
In fact, pediatricians don't have to work so hard, and the pressure shouldn't be so great.
This is because the National Health Commission has been advocating graded diagnosis and treatment of children, such as children's fever, cold, gastrointestinal discomfort and other common diseases, which are handed over to primary medical and health institutions, and difficult and miscellaneous diseases are left to children's specialized hospitals and general hospital pediatrics [14][15].
However, the current situation is that parents are flocking to the pediatric and children's specialized hospitals of general hospitals. A pediatrician bluntly said: "After so many years of hierarchical diagnosis and treatment, I feel that I have returned to the pre-liberation period." ”
It is undoubtedly most convenient for children with fever in the middle of the night to go to the nearest community hospital, but some community hospitals have pediatric outpatient clinics that are only open two and a half days a week, and it is impossible to expect to see a doctor in the middle of the night [16]. Other community hospitals may impose restrictions on the age of the child and whether the child is stable, such as:
Children over the age of 6 can be treated. On-site vascular assessment is required to determine whether infusions can be given [16].
However, compared with "inconvenience", parents do not choose community hospitals, and the core is "distrust".
A study of 934 parents of children in Fuzhou City, Fujian Province, showed that 68.06% of parents would visit provincial and municipal medical institutions when their children suffered from common diseases.
Among the reasons for not preferring community health institutions, 73.75% of the reasons were that parents believed that the capacity of community hospitals to diagnose and treat children was insufficient [17].
Parents in a first-tier city shared on social media that their children had a high fever, and in the face of the same film, the community doctor diagnosed that there was no problem with the lungs, and only let them take cephalosporin and antiviral drugs. However, pediatricians in tertiary hospitals diagnosed pneumonia at first glance, and follow-up examinations did so [18].
In the face of the enemy of disease, in addition to the lack of good "generals" to command the operation, the community hospitals also lagged behind in the equipment for rear support. In reality, community hospitals with complete facilities for children's medicine and filming can be said to be rare.
Some parents said that when they took their children to a community hospital to see a doctor during the flu period, the doctor prescribed azithromycin and nebulization based on experience, but they advised: "This hospital does not have antiviral drugs, and I am also a halfway monk to see pediatrics, if the child is not well in three days, I will change hospitals." ”[19]
The ideal is very plump, the reality is very skinny, and the "superstition of big hospitals" of parents is naturally not difficult to understand. After all, if there is no community hospital near your home that has passed the test, going directly to a big hospital to queue up has undoubtedly become the safest and most reassuring choice.
In this way, it is undoubtedly the pediatricians who are suffering - they are overwhelmed with consultations, busy as spinning tops; they always have to be cautious and careful in the face of strong parents; at the end of the month, when they look at the amount of their salary cards, they can't help but want to ask themselves, "Do you want to escape?"