Rural doctors, as the "bottom of the network" of medical and health services in the vast rural areas of the mainland, are the guardians of the health of hundreds of millions of farmers. Banyuetan reporters found in Guizhou that there are more than 20,000 rural doctors in the local area, and some of them are facing heavy work tasks, weak treatment guarantees, and a shortage of talents. The grassroots call for a practical solution to the treatment and identity of rural doctors, improve the talent training mechanism, and steadily deliver young forces to rural areas, so that the village medical group can be more energetic.
Public health services are pressed, and daily diagnosis and treatment are mixed
Health management of patients with chronic diseases, reporting and handling of infectious diseases, and health check-ups for the elderly...... There are as many as 14 basic public health service projects involving the peasant masses.
"As doctors, our vocation is to heal the sick and save lives." Walking into the Duoding Community Health Room in Yonghe Town, Weng'an County, Guizhou Province, Lei Zhaojin, a village doctor, talked with Banyuetan reporters about her beloved village doctor career while treating the sick people.
Lei Zhaojin, 48 years old, has been working as a village doctor in his hometown since graduating in 1998. In 2023, she will receive about 10,000 villagers, from morning to night, receiving consultations, infusions, and massage, and she is so busy that she often can't take care of eating. Keeping a few candies in the pocket of his jacket is a habit that Lei Zhaojin has maintained for many years. When she was too busy to eat, she would stuff a candy into her mouth to relieve her hunger.
Lei Zhaojin's home is two to three hundred meters away from the village clinic, and there is an LED display in front of her house with her contact information. "On call, I am 24 hours a day to serve the villagers, and I can't shirk when I call in the middle of the night." Lei Zhaojin said.
There are more than 1,600 people in the whole village of Wugu Village, Yunwu Town, Guiding County, Guizhou Province, and Luo Haixiang, a deputy to the Guizhou Provincial People's Congress and a village doctor, has been here for 38 years. At present, there are more than 140 people with high blood pressure in Luo Haixiang's village, and their blood pressure needs to be monitored regularly. In addition, there are 9 diabetics in the village, and more than 200 elderly people need to have a health check-up once a year. "Over the course of a year, the busiest work is to carry out public health, and if I go today, I may not be there, but I will go again tomorrow, and the remote mountainous areas are far away from each other." Luo Haixiang said.
Luo Haixiang visited the patient's home three times in February this year to check on the medication and whether there was any abnormality in his body. "Patients walk around all day, talk gibberish, don't have a cell phone, and don't necessarily come across it when they go to their homes. We have to serve well, or it's very risky. Luo Haixiang said.
The treatment guarantee is worried, and the successors are worried
Affected by factors such as the number of people served and the county's medical and health policies, some local rural doctors are paid a higher salary, with an income of seven or eight thousand yuan per month, but generally speaking, the income of rural doctors is low, and the pension problem after exceeding the service age is worth paying attention to.
A rural doctor in southern Guizhou told Banyuetan reporters that her basic salary is more than 1,100 yuan per month, and the average monthly subsidy for public health work is 3,000 yuan, which is her monthly income. The fuel consumption of mountain roads is relatively large, and the basic salary of one month is only enough for fuel costs.
On August 16, 2023, in Zhongzhong Zhendinglong Village, Rongjiang County, Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou Province, Wu Changxi, a village doctor, measured the blood pressure of villagers. Photo by Xinhua News Agency reporter Liu Xu
Zhang Wen (pseudonym), 25, is a rural doctor in Guizhou Province who worked as a rural doctor in Qiandongnan Prefecture after graduating from Zunyi Medical College in 2021 with a major in clinical medicine. He said that at the beginning, he only received more than 3,000 yuan a month. In February 2024, he was transferred to another village as a village doctor, serving more villagers than in his previous village, and now earns about 4,000 yuan a month. "If you get married in the future, you will definitely not be able to keep this treatment." He said.
Some rural doctors are worried about their livelihood after retirement and are very concerned about paying social security. A rural doctor in Guiding County has been paying social security at his own expense for 14 years so far, and the local government has promised that the government will be responsible for paying it from this year.
Aging age and lack of successors are common problems among village doctors. The person in charge of the health bureau of a county in Guizhou introduced the age structure of village doctors in the county: there are 159 village doctors on duty, 7 of whom are over 60 years old, accounting for 4.40%; 41 were aged 50 to 60, accounting for 25.79%; 70 between the ages of 40 and 50, accounting for 44.02%. In terms of academic qualifications, there were 149 students with technical secondary school degrees, accounting for 93.71%.
A village doctor who graduated from Qiannan Nationalities Medical College in 2019 told Banyuetan reporters: "It is definitely unrealistic to say that you have been a village doctor for a long time, and this step can only be said to be a buffer." In the future, there are two plans, one is to upgrade to a bachelor's degree, and the other is to take the qualification certificate of assistant physician and licensed physician. Another village doctor who graduated from a junior college in 2021 also said: "If I have a medical practitioner qualification certificate and some clinical experience, then I will definitely still consider a better job and go to a better platform to realize value." ”
Steadily deliver new forces, so that village doctors have more headway
In recent years, some counties and cities have been exploring measures to improve the treatment of rural doctors to stimulate their endogenous motivation. For example, Majiang County, Guizhou Province, has increased the basic salary part of the village doctor's treatment from 1,117 yuan/month in 2016 to 2,000 yuan/month now, and in villages with small populations, the monthly subsidy for village doctors is stable at 3,500~4,000 yuan.
Huang Linmei, deputy director of the Guiding County Health Bureau, and others believe that the county-level finance can consider investing a certain proportion of funds to pay for rural doctors' pension insurance, medical liability insurance, accident insurance, medical insurance, and other expenses. For example, refer to the pension insurance policy for enterprise employees to purchase endowment insurance for on-the-job village doctors; Help village clinics to purchase medical liability insurance, and effectively solve the concerns of rural doctors who are afraid of taking risks and are reluctant to carry out medical services.
In response to the aging of village doctors, in 2023, Guizhou launched the "Special Program for College Students and Rural Doctors", providing more than 1,000 village clinic jobs to recruit medical college students from the society.
If you can recruit people, you have to be able to keep people. Zhang Song, vice president of Yunwu Town Health Center, and Tan Jinqian, head of primary health care of Majiang County Health Bureau, suggested: On the one hand, township health centers should set aside a certain number of positions to openly recruit qualified outstanding college students to enrich the team of rural doctors, so that they can be part of township health centers and serve as extended services of township health centers, rather than fighting alone; On the other hand, it is necessary to improve the comprehensive medical ability and practical skills of rural doctors through training and advanced study, so as to create conditions for them to obtain the qualification of practicing (assistant) physicians.
In addition to the introduction of university graduates, Luo Haixiang proposed that some rural people with technical secondary school or high school education can also be tapped to medical colleges and universities for special training, and spend one to two years off work for theoretical and practical study, and finally return to the village for resettlement to serve the rural medical and health undertakings.
On August 16, 2023, Luo Haixiang (first from left) learned about the health of a villager's child on the way to the clinic. Photo by Xinhua News Agency reporter Yang Wenbin
It has been learned that the Qiannan Buyi and Miao Autonomous Prefecture in Guizhou Province has made useful explorations in this regard. The local government recruits young people under the age of 35 who are willing to contribute to the rural medical and health undertakings in rural areas to study at Qiannan National Medical College for three years, and then return to the countryside to become rural doctors after graduation.
"Most of the village doctors are natives of rural areas, and they are not afraid of hardship and tiredness, and if there is a staff, many problems will be solved." When Banyuetan reporters are interviewing at the grassroots level, they often hear similar voices. In April 2023, five departments, including the National Health Commission and the Office of the Central Organization Establishment Commission, jointly issued the Notice on the Implementation of the Special Program for Rural Doctors for College Students.
At present, in the vast rural areas, most of the rural doctors are still "half-doctors and half-farmers", and the status of "temporary workers" has not been resolved. A rural doctor reflected: "Now is the time to ask us to go to the meeting, and we will go when we are dispensing medicine, and the rest basically has nothing to do with the township health center, but in fact, our village doctor should be a member of the township health center, although the establishment cannot be solved for the time being." ”
A person in charge of a township health center in Guizhou said that the "family doctor" contracted service implemented in rural areas has actually built a rural medical and health service system that links counties and villages, but in the actual operation process, the specific work is often transferred to rural doctors.
Many village doctors have called for strengthening the relationship between regional medical centers and township health centers and rural doctors, so as to avoid becoming "temporary workers". Luo Haixiang suggested that the identity of rural doctors should be further clarified, and the team of rural doctors should be optimized and integrated.
(Source: Banyuetan WeChat public account)