Liao Xinbo: the key way to let doctors flow

Source: how doctors flow from June 9, 2015 in Nanfang Daily totally depends on the system Is the American medical system the goal of China's medical reform? I don't think the United States should be an example for us to follow, but many ideas in the American system are worth learning We have learned about the medical system of many countries, and we all think that others are good But the common "feeling" is that the system is different, and we can't learn In fact, "learning" and "copying" are different concepts Why can't we learn the concept of government run medicine? Why can't we refer to or improve some good systems? With more examples from the United States, let's talk about the British In the UK, 90% of patients are first diagnosed by general practitioners, and only 10% need to be referred The vast majority of patients are treated by general practitioners The purpose of the hospital is to set up fewer outpatient clinics What about China? In 2012, the total number of patients in Beijing was 192 million, of which only 21.3% were in the community center, while 42.1% were in the tertiary hospitals Moreover, the difference between the price of doctor services in Concord and in the community was no more than 2 yuan In the past, we criticized the idea of "seeking foreign countries for a large amount of money" Now, the idea of "seeking foreign countries for a large amount of money" is very popular in the medical industry Large hospitals are accompanied by large outpatient service, large medical treatment, large equipment and large hospitalization, and people's medical concept is also: there is a large hospital, why don't I go to a large hospital? Now, we propose to control the blind expansion of public hospitals and to divert patients from large hospitals, but it has not been effective In principle, a system like China's has more advantages than other countries in rectifying the phenomenon of large hospitals in large numbers Why can't it be done? The key point is that the local government has no way to "support" the hospital In fact, it has "released" the hospital However, under the very narrow management thinking, the hospital has "captive" the doctor, treating the doctor as the private property of each hospital Some people even worry about it“ Let the doctors out How can so many specialists live? How hard is it to train them! " This kind of doubt just tells the malady of the current system! It's really necessary to reflect on the cultivation and training of Chinese doctors Why are there so many differences between them? Is the hospital not big enough? If we think that only in large hospitals can we have specialists, and only in large hospitals can specialists live, what is the medical system? If a specialist in a big hospital can't live without a big hospital, who is to blame? In the market-oriented United States, the training of doctors is the task of the country The trained doctors serve the public no matter in profit-making hospitals or non-profit hospitals If doctors are social and their services are for the people rather than for hospitals, what will happen? For example, although Massachusetts General Hospital is called "general hospital", it has less than 1000 beds; Cleveland Clinic is the largest medical institution in the United States, but the hospital headquarters has only 1400 beds, and the whole system has more than 4000 beds People call it "clinic"! But it has cardiovascular, Urology, pathology and several of the best specialty in the United States The clinic has 50000 doctors Are they all in hospital? The people's daily focuses on the last kilometer of doctor flow, which seems to be the obstacle of the president, but not all of them It's a real fact that hospital directors don't agree with the free access of doctors they cultivate, but they have two important problems: one is to retain useful people and eliminate useless people At present, it is difficult for some people to play a role in the hospital, but in other hospitals, they may be able to play their strengths better For these people, some hospitals want to fry but can't, some doctors want to leave but can't, and it's hard for people to flow Second, the knot of "I am the president" and "I am not the president" I once asked the Dean directly in some seminars: if you are not the Dean, do you support doctors to practice more? "Of course," the dean said frankly Obviously, the president's heart also wants to practice more, so this is a management problem of buttock command head In the final analysis, the formation of these knots is caused by the system If the president's term of office is no longer than 10 years, then he will not forget his future According to a global public opinion survey conducted by global times, most people hold a positive attitude towards the impact of multi-point practice of doctors on public hospitals, of which 52.6% believe that it will "increase the legal income of practicing doctors, improve job satisfaction", 48.2% believe that it will "improve the horizontal communication and cooperation between large hospitals", 47.5% Of the people think it will "promote the promotion and development of new medical technology" At the same time, 42.9% of the people have a negative impact on doctors' multi-point practice, and they will feel that "doctors are distracted and the medical quality of the hospital is difficult to guarantee" Let's imagine that with the deepening of the reform, the time for doctors to become social people is becoming more and more mature The result of the imprisonment of doctors is doctors' escape, because other hospitals offer more relaxed employment conditions to attract doctors If other policy barriers are also opened, the establishment is cancelled, welfare is socialized, doctors no longer set salary and bonus by "thesis" and "title", payment system is reformed, and an open medical market is formed, then doctors don't care about the grade of hospital, so they will flow naturally At this time, the way of thinking of the Dean may change, from the doctor asking me to the doctor, because the doctor chooses the hospital platform suitable for his own development (original title: let doctors flow reasonably)