Doctors are about to lose their “establishment status”? Interpretation of the New Medical Policy

Any positive attempts should be respected.

On August 30, the General Office of the Hainan Provincial People’s Government issued a notice on the “Implementation Plan for Promoting the High-Quality Development of Public Hospitals in Hainan Province” (hereinafter referred to as the “Implementation Plan”).

In Hainan’s “Implementation Plan”, it is about canceling the administrative establishment of public hospitals, promoting the de-administrative reform of public hospitals, gradually canceling general outpatient clinics in tertiary public hospitals, and strictly controlling tertiary public hospitals. Measures such as the number and scale of hospitals have aroused widespread concern in the industry.

After the author posted the original text of the policy to the group, a senior attending physician in a tertiary-grade hospital raised a question: “If Hainan’s new plan is fully promoted, it will affect Chinese medical care and Chinese doctors. What’s the impact?”

In response to her doubts, the group had a heated discussion, mainly focusing on the following aspects:

The stability of the profession of a doctor;

Developability of physician treatment;

Profit issues of tertiary public hospitals;

The fairness of the employment system in the context of the New Deal.

The above issues need to be viewed in conjunction with the latest Hainan release documents. As the medical reform gradually enters the deep water area, the existing living environment of Chinese hospitals and Chinese doctors is bound to face new challenges.

“Implementation Plan” clearly pointed out that it is necessary to improve the mechanism and promote the establishment and improvement of the modern hospital management system. Specific measures include: strengthening the party building of public hospitals, improving the governance system of public hospitals, improving the management system of public hospitals, improving the operating mechanism of public hospitals, and strengthening the responsibility of government investment.

The reform of Hainan’s new policy in two aspects: “improving the public hospital governance system” and “improving the public hospital management system” has aroused widespread concern in the medical community.

The new “Implementation Plan” proposes to promote the de-administrative reform of public hospitals, cancel the administrative level of public hospitals, and gradually implement the professionalization of directors and Appointment system, fully implement the operation and management autonomy of public hospitals, and implement full-staff employment management.

This means that doctors may lose their “establishment status”.

In the communication between the author and my friends, everyone expressed their anxiety about the stability of the doctor’s occupation after administrativeization.

In recent years, perhaps because of the slowdown in economic growth, or as a catalyst for the outbreak of the new crown epidemic, there has been a wave of pursuit of “organization” among young people in China. Doctors have strong technical attributes and relatively considerable income in public institutions, and their social status has been significantly improved.

Because of this, Hainan’s de-administrative documents have aroused anxiety among many doctors, worrying that they will also face an “unemployment crisis”.

I don’t see much need for this concern.

First of all, doctors are not “youthful” jobs, and experience and skills are absolutely positively related. And the industry barriers are high, and it is impossible for foreign competitors to appear. In addition, the training of doctors is highly dependent on schools and hospitals. Coupled with a clear professional title promotion system, it is difficult to overtake in a corner.

To sum up, even if the “organizational identity” is lost, at most quack doctors who fish in troubled waters will have no place to stand. At the same time, many constraints and restrictions have been lost, and those who are truly capable can gain more choices.

In addition, the implementation of the professionalization and appointment system of deans is also a major benefit for most general doctors. Professionalization can significantly improve the past situation of “laymen leading experts”; the appointment system can weaken the deep-rooted “circle culture” and create more opportunities for young doctors without background.

Some people think that Hainan’s new policy is equivalent to promoting the marketization of hospitals, which is a commonplace and has no new ideas.

I disagree with this statement. Although the “Implementation Plan” has loosened public hospitals in many places, for example, public hospitals can independently formulate post setting (adjustment) plans within the total number of staff or the total number of personnel approved by the institutional establishment department; management; improve the employment mechanism based on contract management, and fully implement the system of competitive recruitment; support public hospitals to independently carry out talent introduction and recruitment.

But there are also detailed regulations on the regulatory side.

Leadership: Fully implement and implement the dean responsibility system under the leadership of the party committee, and complete the division of the party committee secretary and dean as required. If the secretary of the party committee and the president are separated, the secretary of the party committee generally does not hold the administrative leadership position concurrently, and the president is a member of the Communist Party of China and serves as the deputy secretary of the party committee. Improve the decision-making system of the hospital party committee and the president’s office, collectively study and decide on major issues, establish a regular communication between the secretary and the president, and a reporting system for the implementation of the president’s responsibility system under the leadership of the party committee.

Budget management: establish and improve the budget management organization system and system of public hospitals, promote comprehensive budget management to cover all resources such as human, financial and material resources, and run through the budget preparationStrengthen budget analysis reports and performance appraisals, strengthen informatization construction and budget information disclosure, and improve hospital budget transparency.

In terms of talent evaluation: set evaluation standards, put medical ethics and medical style first in talent evaluation, pay attention to clinical practice ability performance orientation, and fully apply information such as the hospital case mix index (CMI). The tertiary public hospitals highlight performance achievements such as the clinical diagnosis and treatment ability of difficult and miscellaneous diseases, grass-roots service performance and scientific research level, and support qualified tertiary public hospitals to carry out independent evaluation and employment of senior professional titles in health. Explore the self-assessment of professional titles in urban medical groups and county medical communities.

It is worth noting that all of the above schemes clearly define the responsible unit, which shows their determination.

To sum up, the author believes that the Hainan New Deal is an active attempt to get public hospitals out of the constraints of the traditional model to the greatest extent possible under the premise of reasonable government supervision, so as to achieve Real high-quality development.

In the “Implementation Plan”, there is another part worthy of in-depth discussion, that is, Hainan will gradually cancel general outpatient clinics in tertiary public hospitals.

It is not difficult to see that the core appeal of the program is to promote the implementation of “graded diagnosis and treatment”. However, the specific approach is more radical than the previous policy, so it has received wider attention.

As we all know, my country’s medical resources are insufficient and unbalanced. However, in this context, the medical resources of top hospitals are diluted by a large number of conventional diseases. Hospitals such as Xiehe, Huaxi, and Qilu are filled with all kinds of local residents who have a cold and fever every day, which is obviously a huge waste.

Therefore, it will be a long-term trend for tertiary hospitals to cancel general outpatient clinics. Up to now, many places in my country have made similar attempts, but the effect is not obvious. In addition to the deep-rooted habit of seeing a doctor, the finances of tertiary hospitals are also very dependent on general outpatient clinics, and they are reluctant to let go easily.

This time, it is still unknown whether the Hainan New Deal can break this situation, but any positive attempts should be respected.

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