Unfortunately, in China, doctors are not a "high-paying profession" as some people think, but generally overworked and underpaid, which is especially obvious among doctors with lower qualifications.
▌ Long training time and low salary.
As a profession with strong professional and technical requirements, clinicians in all countries have relatively strict management and access systems. In recent years, China's medical education and training has gradually embarked on a standardized track.
At present, the basic situation is that after the five-year undergraduate education in medical college (the last year of which is clinical practice), it is divided into clinical (also called professional) and academic (also called scientific research) (master's degree) graduates, among whom clinical graduate students have the status of students (practitioners) in standardized training of residents, and there are similar differences in the doctoral stage after that, and professional doctoral students also have the status of students in specialized training, so we can draw a conclusion.
In addition, there are eight-year medical students who are studying for bachelor's and doctoral degrees, and medical students who have entered academic postgraduate education. After graduation, you still need to enter three years of standardized training for residents and two to four years of standardized training for specialists (specialist training). (According to the regulations of different regions, the standardized training time of doctoral students may be shortened accordingly, generally ranging from 1-3 years. )
Under the present situation of uneven distribution of medical resources, in order to get a position in a higher level hospital, there are very high entry thresholds for clinical, scientific research and teaching work, which requires graduate students to choose research-oriented graduate students (or directly join bachelor's and doctoral degrees in eight years), and then enter the training stage after graduation, which is usually 5-7 years. On the whole, it takes at least 15 years for a medical student to obtain the intermediate (attending physician) title in the hospital from the beginning of professional study to the end of a series of teaching and training, that is to say, it usually takes 33 years to obtain the intermediate (attending physician) title in the hospital. After that, the promotion of professional titles and the promotion of grades in the administrative system is still a long process that has to be faced, which can be seen from the long training time of doctors.
▲ 2065438+In May 2005, Guizhou Provincial People's Hospital held a clinical skills competition for young doctors and medical students.
Of course, the long training time is inseparable from the importance of the profession of doctors, and this phenomenon is not unique to China. In fact, standardized training and long-term education process are common phenomena in medical education in various countries. Doctors and medical students in China are quite dissatisfied with long-term education and training, mainly because there are serious problems of low salary and overwork in this process. Primary doctors account for the majority in medical institutions, and they are also the most direct undertakers of clinical frontline work. However, due to the allocation of medical resources and the cultivation of doctors' identity, junior doctors, as the main force of medical work, bear the common situation of overwork of basic salary.
Perhaps because of the administration and establishment of the hospital, or because of the traditional inheritance of the apprenticeship system in medicine and the high demand for technology, the hospital is actually a very strict workplace.
From the director to the deputy director, from the chief physician to the deputy director, to the attending physician, the resident, and even the interns who have just come into contact with clinical medicine, there are obvious barriers between levels, and the salary level of doctors also corresponds to the level. For primary attending physicians and residents, the low income level seems to be incompatible with their previous years of study investment and technical level.
An online survey of a medical website shows that the average annual income of doctors in China in 20 17 years is about 95,500 yuan, which is only 65,438+10,000 even in tertiary hospitals. Compared with the income of doctors in other countries and the long-term investment (including time and money) in education before becoming a doctor, it is extremely disproportionate.
For residents, they often "drag their feet" statistically. The average monthly salary of residents in many second-and third-tier cities is only 2000-3000 yuan or even lower. Even in the top three hospitals in first-tier cities such as Beijing and Shanghai, the monthly salary of trained (hospitalized) doctors is only 6000-8000 yuan. Although this salary is not low compared with peers in other cities, it is still only "low salary" compared with the cost of living in cities, especially compared with the salary level of people of the same age in other industries.
Working long hours is a health problem for doctors.
In addition to low wages, another major problem faced by doctors is widespread overwork, and long working hours have become a "daily" phenomenon. To some extent, the problem of salary can be slightly improved through the accumulation of time and promotion of professional titles, while overwork of doctors is a common problem from directors to interns.
According to the provisions of the labor law, the daily working hours of workers shall not exceed eight hours, and the average weekly working hours shall not exceed forty-four hours. Although the Labor Law itself makes an exception for industries that cannot implement this provision due to production characteristics, it is difficult for doctors to directly resort to the protection of the Labor Law, but this does not prevent this provision from being used as a comparison of working hours. After all, the eight-hour working system basically conforms to the general understanding of the public.
As far as my hospital is concerned, residents have at least four night shifts and one weekend shift in addition to completing five days of work every month, and some departments with heavy work tasks (such as surgery) still have work delays on weekdays. Even though these doctors can get to and from work strictly on time every day (in fact, they can't do this), the average working time per week has reached 58 hours. There are many departments that work more than 80 hours a week, which is equivalent to one doctor undertaking the workload of two doctors.
For experienced doctors, the working hours have not been reduced at all, and even the deputy director of the department still needs to rotate the night shift. The director of the department in my hospital even admitted that the average sleep time every day is no more than five hours, which is the general situation of colleagues all over the country.
For doctors on duty, this long working time can be said to be 365 days a year, which is not only the lack of normal holidays, but even legal holidays. Due to the relative reduction of holiday personnel, they also shoulder heavier work tasks than usual. At present, the situation of night shift in hospitals usually requires continuous work, that is, after going to work normally the day before, the night shift the next day is followed by heavy work. In this way, if the night shift is in the middle of a week, a doctor can work continuously for 33 hours, or even longer. Regardless of whether continuous fatigue work will adversely affect medical quality and patients, it is also a great consumption and challenge for doctors' own health.
▲ 20 16, a doctor is resting in the corner of a hospital in Hengyang, Hunan. "At least 1-2 night shift every week, on duty on weekends, plus outpatient service, ward round, surgery, writing medical records, and writing papers ... not only there are no weekends and holidays, but doctors working overtime is also a very serious problem." A deputy chief physician working in the First Affiliated Hospital of South China University said.
The responsibility of doctors is far more important than the consequences of mistakes. Serious overtime has led to the "overwork death" of doctors in recent years, and most of them are young doctors. What is even more puzzling is that some residents have worked overtime in the hospital for a long time, and after the casualty accident, they cannot be identified as work-related injuries or work-related deaths. The reason given by the hospital involved is that "residents are standardized in the hospital, and they have not signed labor contracts, nor have they been paid, and their status is still a student". This happened in a hospital in the east. It can be seen that residents in some hospitals are not only overworked, but also have low salaries, or even unpaid or negative salaries (they have to pay tuition fees from schools and cannot receive remuneration from hospitals).
It can be said that the occurrence of this kind of incident is a complete disrespect for doctors' knowledge and labor, and even does not regard doctors as workers with basic rights (especially the right to rest). For residents and interns who do not have formal employee qualifications, how to define their identity and protect their rights should be a problem worthy of attention and urgent solution.
The vicious circle of doctor shortage.
Low-paid doctors are generally overworked, which has a foreseeable impact on the whole industry. At present, the medical resources in China are still in short supply relative to the population. According to the report of the World Health Organization in 20 15, China has 14.9 doctors per 10,000 population, ranking 83rd in the world, not to mention the uneven distribution of doctors among hospitals in different regions and at different levels.
With the aggravation of aging and the improvement of medical demand, it seems that the shortage of doctors will only get worse. However, the long start-up stage of the medical industry, the widespread low salary and overwork, the public's distrust of doctors and even medical injuries have made many doctors choose to change careers or start sideline business. For young students who have not yet entered this industry, more people choose to stay away from it. In recent years, there have been difficulties in enrolling students in medical colleges to varying degrees, and the medical major has become the major with the lowest score in comprehensive universities, which is the result of the bad industry situation when entering the school.
For the current situation of low-paid and overloaded work, the result of intuitive thinking is to recruit more medical staff to share the excessive work pressure and improve the salary of medical staff. However, more medical staff and higher wages per unit time require more capital investment. However, under the background that hospitals are self-financing but the prices of medical services and related products are still strictly controlled, hospitals seem to have no more funds to support this idea.
As for the shortage of medical insurance funds in some provinces and cities, and it will be further short with the aging, it seems that it is not a realistic and feasible option to ask them to increase investment and raise doctors' salaries. If the doctor's demand for higher salary and treatment is passed on to the patient, it will lead to a lose-lose situation for both doctors and patients: the problem of difficult and expensive medical treatment does not exist, but the voice of medical staff has become louder and louder in recent years. If we only consider the interests of doctors and deny the interests of patients who are in a weak position in medical relations, it will bring a heavier burden to patients and will only further undermine the already fragile trust relationship between doctors and patients.
Although doctors' underpayment and overwork have become the norm, they even have a visible impact on the normal operation and sustainability of the medical system. However, in previous reports and discussions, it seems that the problem of low salary and overwork of medical staff is more about the doctor's moral sense. In other words, doctors are sympathized, recognized and positively evaluated in the moral sense when they are overworked with low pay. Words such as "selfless dedication" and "dedication" are added to doctors who work with low pay and overload.
▲ 2065438+In April 2008, students of Tianjin Medical University reviewed the Medical Student Oath. ?
Moral positive evaluation helps to find and spread problems to a certain extent, or slightly improves the tense doctor-patient relationship, but it does not touch on the reasons and mechanisms behind doctors' low pay and overwork, let alone how to improve or solve this situation. This positive moral evaluation is more like a means to avoid and delay the problem. It seems that the public begins to understand and understand the hard work of doctors, and overwork with low salary will not become a problem worthy of attention. Doctors' overwork is still not regarded as a problem, but the special needs of special occupations. What they should get is only "noble" moral recognition.
From this point of view, overwork with low salary seems to be in a dilemma in the medical field. If this phenomenon continues, it will lead to a shortage of personnel, and the shortage of personnel will further aggravate the vicious circle of overwork with low salary. As a change in the population structure of the whole society, aging will only pose an increasing challenge to the medical system.
It can be said that we don't have much time to hesitate or let this vicious circle continue. After all, medical care can be said to be a basic industry that society can operate. The low salary and overwork of doctors hurt not only the doctors themselves, but even the medical industry. Therefore, the situation of low pay and overwork faced by doctors in China needs to be seen by the society first, and it needs to be effectively solved before the whole system has a big problem.