A brief history of Chinese doctors flying knives: Are doctors free or unit people?

At the end of the last century, in the countryside of Jiangsu and Zhejiang, a black Buick, carrying Hu Hai, a gallstone surgeon known in the industry as "Hu Yi-knife", and his laparoscopy, galloped along dusty roads all year-year-old.
hospitals that were accessed by vehicles were able to perform laparoscopic gallbladder surgery, a minimally invasactic operation that was rarely performed at the time in triple-A hospitals.
then, Hu Hai left Shanghai Sanjia Hospital, to Zhangjiagang, Jiangsu Province, a township health hospital work less than two years, carried out more than 1500 cases of laparoscopic gallbladder surgery, the market demand is evident.
a memorable "free" time for doctors.
The Law of the People's Republic of China on Medical Practitioners has not yet been implemented, and only the professional title and medical qualification certificate are marked, there is no license, and there are no restrictions on the place of practice.
that is, doctors can practise anywhere.
Hu Hai may be China's first batch of "flying knife" doctors, and later also out of the system, become a free practitioner of the famous vascular surgeon Zhang Qiang, said Hu Hai is "the first group of free practitioners since the founding of New China."
2004, the "early practitioner of free practice" returned to Sanjia Hospital, where he was invited to Shanghai Oriental Hospital to set up a gallstone center.
interview with the Shanghai News, Hu Hai claimed to have been "recruited" and although he never felt there was anything wrong with flying knives, he "couldn't risk his career any more".
because the 1999 Law on Medical Practitioners established the registration system of physicians in China, and also tied doctors to public hospitals.
doctors can only obtain the qualification of practising by passing the national unified examination, and institutions that are unable to freely choose to practice medicine can only register in a medical institution, and it is illegal to practise medicine more than half a step from Leichi.
Hu hai changed from "free man" to "unit man", but under the huge economic benefits brought about by the serious imbalance of medical resources, the "flying knife" wind has become more and more serious.
a survey by Lilac Garden, the country's largest doctors' forum, 55 percent of the doctors surveyed said that flying knives were common among doctors in hospitals, and nearly 30 percent said they had.
over the next 20 years, surgeons, as well as hospital chiefs and policymakers, have been engaged in a long tug-of-war.
from consultation to catacombs: the doctors' golden age began with flying knives, not flying knives, called consultations - an elegant word at the time.
can go out to consult are famous doctors, can enjoy the consultation of famous doctors is a specific class of society.
1995, Zhang Qiang was a attending physician in vascular surgery at Yifu Hospital in Zhejiang Province.
been working for a few years, because of one of Asia's first intravenous surgery techniques, he shot and received invitations to surgery across the country.
these surgical invitations are first in the form of "consultation slips" from hospitals.
the history of medical consultations after the founding of the People's Republic of China, the exchange of doctors between hospitals for medical assistance and cooperation has been regarded as a fine tradition in the domestic medical community.
Zhang Qiang's first consultation list came from a primary hospital in Taizhou, Zhejiang Province, "I had just become the attending doctor at that time, and the head of the department did not agree with me because he felt that my qualifications were not enough, and then the dean approved it."
, in the eyes of many doctors, to be able to go out for consultation is a great recognition of their professional ability.
big hospital well-known doctors for remote or poor medical conditions to solve the problem of "difficult to see a doctor", behind the subtext of support and help, different from the later emergence of the "flying knife hole", because of the "earn extra fast" business atmosphere, not decent enough, rarely taken to the table to talk about.
After 1997, because of their own "extinence", Zhang Qiang received a lot of "consultations", but these "consultations", is not exactly the usual sense of hospital business collaboration, mostly through peers or acquaintances, "visits" are often more than a thousand yuan, far higher than the market price at that time, some "consultation" hospitals do not know, pay the cost of the doctor and patient private cash settlement.
under the market supply and demand control mechanism, "elegant" consultation in the 90's has slowly evolved into a slightly derogatory "walking hole" in people's mouths.
the term "cave", which was first described as "an actor going out to perform in private in order to get away with it", was later derived from other professions, including teachers, lawyers and doctors.
among them, doctors "walking holes" received the most attention and controversy, doctors use their spare time to privately outside the hospital to provide medical services, and pay for labor, it does not seem to be in line with the doctor's "angel in white", selfless dedication image.
but the four interest groups behind the "cave" - patients, cave doctors, cave doctors for medical institutions, cave medical institutions, but can benefit from it.
the implementation of the Medical Practitioners Act in 1999, the doctor's "cave" can be said to be a market for the optimal allocation of medical resources, multi-win behavior.
, the distribution of medical and health resources in China has been very uneven.
think of Shanghai's Sanjia Hospital in hospital, sometimes it can take months to queue up.
patients from other cities go to Shanghai to see a doctor, transportation, accommodation, work stopping escort costs are huge, many families are difficult to pay.
then, Shanghai's Sanjia Hospital near the bomb shelter, because the price is relatively cheap, many parents with their children in order to see a doctor, live in it, a stay is more than half a year.
if doctors can go to the local clinic to treat difficult diseases, it is undoubtedly very popular for patients.
difficult for patients, but the workload of doctors is limited by the size and capacity of the hospital and is not completely saturated.
(ad., a doctor at an oncology hospital in Henan province) also went out to "walk" in the late 1990s.
he recalls at eight o'clock, "At that time, our whole hospital had only two inpatient buildings, old-fashioned barrel buildings, and only more than 30 beds on the first floor."
"In Li Zhi's department, basically only the morning surgery, " a core only one operation, basically 1 pm to end, we are all right.
" But as a specialist in head and neck tumors, the incidence of tumors gradually increased, the patient's medical needs are growing, he used the time outside of work, through acquaintance introduction, word-of-mouth, began to the surrounding hospitals "consultation" "walking hole", and a dry is more than twenty years.
market demand also determines the market price of doctors.
Zhang Qiang's first "consultation" object is Taizhou, a local aquaculture import and export company boss's father, at that time only consulted did not operate, but ran to get a "consultation" fee, more than his full salary for the month.
is issued between the hospital consultation forms, but Zhang Qiang received the "consultation fee" directly paid by the patient's family in cash, not through the hospital.
, the hospital, knowingly, did not interfere with the payment of such consultations.
the "Medical Practitioners Act" was introduced, there was no law that made it illegal for doctors to practice medicine outside the hospital.
, if a doctor receives invitations from all over the country to go to the hospital for surgery, it is a very decent and honorable thing for the hospital.
" Zhang Qiang explained, "shows that the strength of the hospital is very strong, the dean will even encourage everyone to go out."
"The first time Chinese doctors choose the flow of doctors' resources, from the hospital between the introduction letter, the appointment of consultation forms, to the hospital without knowledge, the hospital is not audited and the doctors go out "walking hole", is the first choice made by Chinese doctors with their feet.
is the "flying knife" market really big? At the time, some in the industry had joked that many familiar faces in the industry could be seen 100 per cent if they waited an hour at the capital's airport on a Friday night.
also estimated that doctors in Beijing would have to count in triple digits among the passengers who were out of Hong Kong on that day.
they're either a person, or they're in a group, or they're carrying some of the necessary medical equipment, and they're going to do all kinds of surgery outside of Beijing for patients they've never been exposed to for two days and 48 hours on weekends.
According to reports at the time, in the staff dormitory area of a major hospital in Shanghai, every Friday and Sunday afternoon, there will be many cars with the license plates of neighboring provinces and cities coming and going in a hurry, most of these cars are to pick up well-known doctors to "walk the hole", the vast majority of them are knife surgeons.
Baoding, Hebei Province, 130 kilometers from Beijing, local newspapers often have Beijing experts to Baoding "consultation" content, please Beijing experts have gradually become the local atmosphere.
Although the advertisements are played out in beijing doctor's name, but they are not in accordance with the prescribed procedures to go out to consult, mostly acquaintances introduced, or human relations trust, "consultation" pay is naturally closed in private.
Zhang Qiang also admitted that around 2000, in the high-level doctor and when the head of the department between this time, he "flying knife" very frequent, basically every weekend in the field.
" a weekend, there are always a few doctors on a plane, either a knife, or a meeting.
", such as Nanjing, the provincial capital of the doctor's appearance fee of about a thousand yuan, well-known experts higher.
and the appearance fee of experts in Beijing and Shanghai is 56,000 yuan.
a famous hospital in Beijing, the most earned, even reached 10,000 to 20,000 yuan at a time.
many doctors who live, the weekend "walking hole" once often earns more than a month's hospital income.
, out-of-the-brain, chest, hepatocholine surgery, cardiovascular surgery, orthopaedic and interventional therapists, as well as orthodontic, dental, cosmetic and other doctors who have their own life, the most popular.
these departments involved in the disease, but also precisely at that time the hospital patients queue the longest, the most strong demand for medical treatment.
some of them became the first in the group of doctors to get rich", "big brother".
' Santana was the first car among hospital staff.
to buy a car, is to facilitate the "walking hole."
graduated with a master's degree, Zhang Qiang also bought a mobile phone to make it easier for patients to find him.
, there were only five people in the hospital with cell phones, including four deans.
Zhang Qiang's monthly salary of about 300 yuan, Siemens "big brother" to 8000 yuan.
doctors have accumulated wealth through "flying knives".
As early as 2009, the Yangcheng Evening News reported on the topic of "walking hole" out of a million bodies" as a doctor who had made a huge career - Liu Baosong, who was previously an ophthalmologist at the first hospital affiliated with Guangzhou Medical College, and later founded wuhan Aeg Eye Hospital, which covers an area of 6,000 square meters, with a total investment of 20 million yuan, as director and chief cataract specialist.
Liu Baosong stressed that every time he went to the field surgery went through a formal procedure.
, a doctor who is the director of orthopaedics at a Sanjia hospital in Beijing mentioned in a blog post that an excellent surgical director, his son talked about a girlfriend of his own, and that the woman's request for marriage was to have a wedding room.
the doctor turned on the flying knife mode for each double-day off.
had been flying knives for years, until the flight attendants on the flight knew him.
only earned enough money to buy his son a wedding house, he immediately stopped flying knives.
the "siege" and "game" of doctors, the hospital's attitude towards doctors going out for consultation was generally supportive.
the introduction of the Law on Medical Practitioners, "Flying Knife" has officially become an illegal practice, and the dean's attitude has undergone a subtle change.
The Medical Practitioners Act requires physicians to practise at the place of registration.
doctors who go to other hospitals for consultations and operations must get a consultation form.
if the doctor "flying knife", the resulting medical responsibility, the doctor's hospital to bear, hospital chiefs became cautious.
more important factor driving the change of dean's attitude is the appraisal mechanism of public hospitals, the number of outpatients, the number of operations, revenue and other indicators, which often determine the career prospects of hospital deans.
the implementation of the "two lines of income and expenditure" and "self-financing" policy in public hospitals, the proportion of total revenue in hospitals is generally very low, public hospitals must be through business income to ensure the operation.
doctors out of the "flying knife", will undoubtedly affect the work of the hospital, or even take away some patients, affecting the hospital's revenue.
"flying knife" has become a headache for deans, doctors and deans began a long "siege" and "game."
"s "containment" measures include increasing the workload of doctors in the hospital, extending working hours on Fridays and meetings on two days off.
there are hospitals that set the rules, doctors have to be on call 24 hours a day, once found out to go out to run private work, either on-the-spot dismissal, or demotion treatment.
addition to this, but also to withhold the penalty bonus, disqualification, etc.
the dean of a famous big hospital in Beijing even sent doctors to the airport to "block" the weekend out of the "flying knife".
hospital meeting, there is a dean is to a group of surgeons straight, "one weekend, you so many doctors are at the airport, why go, in addition to the meeting, not all are 'flying knife' to go?" "For some of the big experts "flying knife", the deans are trying to block also can not block.
Jianmin, director of orthopaedics at Wangjing Hospital of the Chinese Academy of Traditional Chinese Medicine, has been calling for doctors to be "sunshine" when they go out to practice.
, a dean euphemistically said to Wen Jianmin, "Be careful."
"Wen Jianmin fire, " my expert number, in line to want.
those patients dragged their homes to Beijing to find me, in order to do a 'thumb-over' surgery, may have to queue for half a year.
what's wrong with me bringing the technology down there? ""It's no big deal, this section director, you look at it.
," Wen Jianmin said.
, the hospital didn't deal with him.
In 2003, Professor Wan Feng, then director of cardiac surgery at Peking University People's Hospital and known as "the first person in China to keep jumping on a heart bridge", said in an interview that he had at least two operations a day at the People's Hospital;
"I know I can do more, why."