Doctors are a career in life-saving. A qualified doctor not only needs a wealth of medical knowledge and noble medical ethics, but also needs comprehensive clinical skills. The education and training of general practitioners is the guarantee for the sustainable development of general medicine. In our country, there is a huge shortage of general practitioners in primary hospitals. Why are general practitioners so scarce? Recently, the Shanghai Economic Review conducted an exclusive interview with Cai Jiangnan, director of the China-Europe International Business School's Health Policy and Management Research Center, on issues related to general practitioners.
Reporter: One of the major reasons why community hospitals are not doing well is the lack of qualified doctors. We have so many medical schools. Why is there such a big gap?
Cai Jiangnan: There are many reasons. Doctors' resources can't flow freely. This may be a big reason. We have a lot of data showing that medical graduates are reluctant to be doctors because if they can't enter the top three hospitals to be doctors, he is not. What is the future? If they are allowed to go to a secondary hospital or a community hospital after graduation, he will feel that the doctor's career has come to an end and there is no hope. The existing doctors did not flow and were closed resources. All the places in the top-three hospitals had a pit of Roberts so that it could no longer absorb too many new born forces, thus blocking the growth path for new doctors. If this problem is to be resolved, it is necessary to consider how the medical resources are socialized, that is, how the resources of doctors become common resources of the society rather than belonging to a certain hospital. There are also some advanced equipment in the top three hospitals, but also try to make it social.
In the United States, the relationship between doctors and hospitals is open and flexible. Each hospital has a small number of doctors who are employees of their own, but the vast majority of doctors are independent of the hospital and are freelancers. He has his own clinic. Under such conditions, the relationship between doctors and hospitals is open. A doctor can sign up with a number of hospitals. The doctor can recommend the patient to a suitable hospital. At the same time, the doctor's level and the professionalism of the hospital are also in line with each other. Good doctors must sign contracts with good hospitals. Good hospitals also need to find good doctors. This way doctor resources will not be monopolized. There is a one-to-many relationship between doctors and hospitals. The pattern of this will integrate social resources. As a result, medical students have a lot of opportunities for growth. Unlike us, if we can't become Huashan, Ruijin, or Zhongshan doctors, the future will be lost. As long as you improve your business abroad, you can sign up with many good hospitals. You may go to Huashan Hospital today and go to the Ruijin Hospital tomorrow. This way, a new medical graduate will be willing to be a doctor. On the other hand, if your technology is not closed, no one will come to you and you will be eliminated.
Reporter: Family doctors are generally served by general practitioners. However, the general practitioner's skill level cannot be compared with that of specialist doctors in terms of professional design. It does not seem to be as effective as people in terms of traditional concepts. It should not be possible to obtain high incomes. How do foreign countries solve this problem? questionable?
Cai Jiangnan: General practitioners are not third-rate doctors in foreign countries, and they are not despised by people. However, in China, general practitioners are seen as a panacea, which is the group with the least technical content. Therefore, the focus of medical services can not be realized. All doctors are moving to the top three hospitals, so that an endless loop is formed. The top three hospitals are getting stronger and stronger, and no one in the community hospital is willing to go.
Although the country has invested a lot of money in the past few years, there are no good doctors at the grassroots level, so patients are still unwilling to go to community hospitals. In this way, we do not have the means to promote grassroots doctors to play the design of medical resource gatekeepers. According to our understanding, Shanghai is currently promoting family doctor programs. There are not many people signing contracts. Even if they sign contracts, not many people look at them. Most of them are elderly people or chronic patients. They take drugs because they already have mature treatments. The plan is, but the mainstream people are not going to see those places.
This is the core issue. Without solving the problem of talents, basic hospitals cannot grow up. Grass-roots doctors cannot flow to the top-three hospitals. The result is that the quality of the vast majority of doctors is very low. Less than half of the country’s 2 million doctors’ teams have undergraduate degrees, which is a very bad data. If you have not received medical undergraduate training abroad, you can't be considered a doctor. You must go to medical school outside these undergraduate programs in the U.S. countries, and then you will have to do a few years of internships to become a doctor. We cannot have such a low-level team of doctors. The patient is convinced.
I have found that some European countries even reverse the income of general practitioners and specialists. The income of general practitioners is even higher than that of specialists, and the most critical issue is income. I have done a statistic. In the United States, in 2003, the annual income of a general practitioner was about $170,000, and the specialist doctor was about $270,000. The income gap between the two is still very big, plus the technical expertise of specialists. Attractive, there will be more and more people to do specialists. However, in recent years, the income of general practitioners in the United States has begun to increase. The American medical reform has increased the income of general practitioners. The income of general practitioners in China cannot be compared with that of doctors in the top three hospitals, which is too different.
Reporter: If you want to design a family doctor system, how do you design it?
Cai Jiangnan: If I were to design a system of family doctors, we must break the monopoly of medical professionals in large hospitals. However, it is estimated that only incremental reforms can be made, and there will be too much resistance to changes in stocks. It is the new graduates who do not want to go to any hospital to set up a pure doctor organization, let it go to the hospital to negotiate and discuss how to cooperate. Choose a partner hospital to achieve free flow. Recently I heard about a hospital in Guiyang. The average annual income of all the medical workers and staff of their hospitals, including doctors and nurses, is about 140,000 yuan. Everyone in Guiyang knows that it is a city with a relatively underdeveloped economy. This is quite high. I asked him why he is so tall. He replied that if he does not do so, doctors will flow to big cities and other large hospitals. Only Mentioned so high to retain people. The hospital can make such a high salary. This shows that there is still a great demand in the medical market and there is also a large market. If doctors are freelancers, they are completely different. You can earn many times more income than Others, and you can attract a lot of people under that system. The current practice is that the income of general practitioners has been reduced and the workload has been increased. Therefore, many of our current policies are irresponsible and inconsistent with the reality. We do not consider incentive mechanisms, and the goals and methods adopted are far-fetched.
Reporter: How to increase the income and enthusiasm of community doctors?
Cai Jiangnan: To achieve a good doctor's access to high income through institutional design, the rules for the two lines of revenue and expenditure must be broken. This is a quasi-civilian practice and cannot be mobilized or attractive. The work of community doctors is increasing, but the income does not increase much. For good doctors, his income actually decreases. In the community, the original drug sales income was relatively high. Some hospitals earned 78% of their income from drug sales. After the zero difference was implemented, the government’s financial compensation did not make up for the loss of drug sales. This made the community The actual income of doctors in hospitals is further reduced.
Another job title is also a problem. As long as you get a doctor's qualification in foreign countries, there will be no other job evaluation. It is entirely up to the patient to determine the quality of his service. If there is an administrative rating, then it will distort many things. It is necessary to write a dissertation and issue an article. This is linked to the topic. The funding and opportunities for the project will generally only be allocated to large hospitals. There is no opportunity for community hospitals, and they do not have the strength to do research. . Recently, I saw community doctors also began to comment on what general practitioners and general practitioners refer to doctors, but there is still a difference between these and tertiary hospital titles, which still cannot improve the professional honor of community doctors. It is a very bad system.
At the grassroots level, there is still a very bad practice to allow them to open only essential medicines. Many patients need medicines that are not available in the primary hospitals. This way, he does not go to community hospitals. In order to dispense medicines, they flow to large hospitals. It is controlled by medical insurance abroad. Some new and expensive drug reimbursement rates will be lower, but they are not excluded from the doctor's prescription.
Reporter: One of the major reasons why community hospitals are not doing well is the lack of qualified doctors. We have so many medical schools. Why is there such a big gap?
Cai Jiangnan: There are many reasons. Doctors' resources can't flow freely. This may be a big reason. We have a lot of data showing that medical graduates are reluctant to be doctors because if they can't enter the top three hospitals to be doctors, he is not. What is the future? If they are allowed to go to a secondary hospital or a community hospital after graduation, he will feel that the doctor's career has come to an end and there is no hope. The existing doctors did not flow and were closed resources. All the places in the top-three hospitals had a pit of Roberts so that it could no longer absorb too many new born forces, thus blocking the growth path for new doctors. If this problem is to be resolved, it is necessary to consider how the medical resources are socialized, that is, how the resources of doctors become common resources of the society rather than belonging to a certain hospital. There are also some advanced equipment in the top three hospitals, but also try to make it social.
In the United States, the relationship between doctors and hospitals is open and flexible. Each hospital has a small number of doctors who are employees of their own, but the vast majority of doctors are independent of the hospital and are freelancers. He has his own clinic. Under such conditions, the relationship between doctors and hospitals is open. A doctor can sign up with a number of hospitals. The doctor can recommend the patient to a suitable hospital. At the same time, the doctor's level and the professionalism of the hospital are also in line with each other. Good doctors must sign contracts with good hospitals. Good hospitals also need to find good doctors. This way doctor resources will not be monopolized. There is a one-to-many relationship between doctors and hospitals. The pattern of this will integrate social resources. As a result, medical students have a lot of opportunities for growth. Unlike us, if we can't become Huashan, Ruijin, or Zhongshan doctors, the future will be lost. As long as you improve your business abroad, you can sign up with many good hospitals. You may go to Huashan Hospital today and go to the Ruijin Hospital tomorrow. This way, a new medical graduate will be willing to be a doctor. On the other hand, if your technology is not closed, no one will come to you and you will be eliminated.
Reporter: Family doctors are generally served by general practitioners. However, the general practitioner's skill level cannot be compared with that of specialist doctors in terms of professional design. It does not seem to be as effective as people in terms of traditional concepts. It should not be possible to obtain high incomes. How do foreign countries solve this problem? questionable?
Cai Jiangnan: General practitioners are not third-rate doctors in foreign countries, and they are not despised by people. However, in China, general practitioners are seen as a panacea, which is the group with the least technical content. Therefore, the focus of medical services can not be realized. All doctors are moving to the top three hospitals, so that an endless loop is formed. The top three hospitals are getting stronger and stronger, and no one in the community hospital is willing to go.
Although the country has invested a lot of money in the past few years, there are no good doctors at the grassroots level, so patients are still unwilling to go to community hospitals. In this way, we do not have the means to promote grassroots doctors to play the design of medical resource gatekeepers. According to our understanding, Shanghai is currently promoting family doctor programs. There are not many people signing contracts. Even if they sign contracts, not many people look at them. Most of them are elderly people or chronic patients. They take drugs because they already have mature treatments. The plan is, but the mainstream people are not going to see those places.
This is the core issue. Without solving the problem of talents, basic hospitals cannot grow up. Grass-roots doctors cannot flow to the top-three hospitals. The result is that the quality of the vast majority of doctors is very low. Less than half of the country’s 2 million doctors’ teams have undergraduate degrees, which is a very bad data. If you have not received medical undergraduate training abroad, you can't be considered a doctor. You must go to medical school outside these undergraduate programs in the U.S. countries, and then you will have to do a few years of internships to become a doctor. We cannot have such a low-level team of doctors. The patient is convinced.
I have found that some European countries even reverse the income of general practitioners and specialists. The income of general practitioners is even higher than that of specialists, and the most critical issue is income. I have done a statistic. In the United States, in 2003, the annual income of a general practitioner was about $170,000, and the specialist doctor was about $270,000. The income gap between the two is still very big, plus the technical expertise of specialists. Attractive, there will be more and more people to do specialists. However, in recent years, the income of general practitioners in the United States has begun to increase. The American medical reform has increased the income of general practitioners. The income of general practitioners in China cannot be compared with that of doctors in the top three hospitals, which is too different.
Reporter: If you want to design a family doctor system, how do you design it?
Cai Jiangnan: If I were to design a system of family doctors, we must break the monopoly of medical professionals in large hospitals. However, it is estimated that only incremental reforms can be made, and there will be too much resistance to changes in stocks. It is the new graduates who do not want to go to any hospital to set up a pure doctor organization, let it go to the hospital to negotiate and discuss how to cooperate. Choose a partner hospital to achieve free flow. Recently I heard about a hospital in Guiyang. The average annual income of all the medical workers and staff of their hospitals, including doctors and nurses, is about 140,000 yuan. Everyone in Guiyang knows that it is a city with a relatively underdeveloped economy. This is quite high. I asked him why he is so tall. He replied that if he does not do so, doctors will flow to big cities and other large hospitals. Only Mentioned so high to retain people. The hospital can make such a high salary. This shows that there is still a great demand in the medical market and there is also a large market. If doctors are freelancers, they are completely different. You can earn many times more income than Others, and you can attract a lot of people under that system. The current practice is that the income of general practitioners has been reduced and the workload has been increased. Therefore, many of our current policies are irresponsible and inconsistent with the reality. We do not consider incentive mechanisms, and the goals and methods adopted are far-fetched.
Reporter: How to increase the income and enthusiasm of community doctors?
Cai Jiangnan: To achieve a good doctor's access to high income through institutional design, the rules for the two lines of revenue and expenditure must be broken. This is a quasi-civilian practice and cannot be mobilized or attractive. The work of community doctors is increasing, but the income does not increase much. For good doctors, his income actually decreases. In the community, the original drug sales income was relatively high. Some hospitals earned 78% of their income from drug sales. After the zero difference was implemented, the government’s financial compensation did not make up for the loss of drug sales. This made the community The actual income of doctors in hospitals is further reduced.
Another job title is also a problem. As long as you get a doctor's qualification in foreign countries, there will be no other job evaluation. It is entirely up to the patient to determine the quality of his service. If there is an administrative rating, then it will distort many things. It is necessary to write a dissertation and issue an article. This is linked to the topic. The funding and opportunities for the project will generally only be allocated to large hospitals. There is no opportunity for community hospitals, and they do not have the strength to do research. . Recently, I saw community doctors also began to comment on what general practitioners and general practitioners refer to doctors, but there is still a difference between these and tertiary hospital titles, which still cannot improve the professional honor of community doctors. It is a very bad system.
At the grassroots level, there is still a very bad practice to allow them to open only essential medicines. Many patients need medicines that are not available in the primary hospitals. This way, he does not go to community hospitals. In order to dispense medicines, they flow to large hospitals. It is controlled by medical insurance abroad. Some new and expensive drug reimbursement rates will be lower, but they are not excluded from the doctor's prescription.
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