(Health Times reporter Qiu Yue)He Lin, deputy to the National People’s Congress and deputy director of the Institute of Health Education of Guizhou Provincial Center for Disease Control and Prevention, suggested that the "place of practice" in the Law on Medical Practitioners should be deleted, and doctors should be allowed to practice more, so as to make up for the technical weakness of primary hospitals and improve the uneven distribution of medical resources.
"The ideal is full, and the reality is still quite skinny." Song Hui (a pseudonym), an attending physician in the Department of Orthopaedics of a 3A hospital in Nanchang City, Jiangxi Province, told the Health Times reporter that doctors have been practicing for many years, but in reality, doctors still have to meet the needs of patients by privately "flying knives". "Experts are flying all over the country, and they can’t register in all parts of the country. In addition, in the face of their doctors going out to practice more, although the hospital will not stop it, for doctors, this is still the’ secret’ that is best not to say. "
Information picture. Xie Xuejiao
There are 260,000 doctors practicing in many institutions in China, and these departments are common.
Li Xin (pseudonym) is an obstetrician in a third-class hospital in Beijing. According to her, it is common for doctors in obstetrics and gynecology, pediatrics and some departments that do not involve medical insurance to practice more. Doctors usually use weekends to visit other medical institutions, and many private hospitals will take the initiative to find experts from public hospitals to establish cooperation.
Multi-point practice of doctors refers to the behavior that qualified medical practitioners are employed to practice in more than two medical institutions after being registered by the health administrative department. The registration places of clinical practitioners are divided into provincial administrative regions. According to the existing regulations, clinical practitioners can apply for up to three majors in the same category as the scope of practice for registration.
In 2009, according to the Opinions of the State Council, the Central Committee of the Communist Party of China on Deepening the Reform of Medical and Health System, the former Ministry of Health issued the Notice on Issues Related to Doctors’ Multi-point Practice, which was piloted in some areas. In 2014, the former National Health and Family Planning Commission and other five ministries and commissions jointly issued "Several Opinions on Promoting and Standardizing Doctors’ Multi-point Practice". According to this regulation, doctors only need to apply to the administrative department that approved the practice of the institution to increase their registration, instead of applying to the health administrative department for registration through the original medical institution. Simply put, doctors have the initiative to start multi-point practice in their own hands, and they don’t need to ask for opinions from the unit as before.
On October 28th, 2020, Yu Xuejun, deputy director of National Health Commission, introduced that during the 13th Five-Year Plan period, the Measures for the Administration of Physician Practice Registration was revised and promulgated, and a regional registration system for physicians was established. The practice place was changed to "provincial or county-level administrative divisions", and doctors were "registered once, and the region was effective", so they could practice in multiple institutions. In addition to the main practice institutions need to be registered, doctors can practice in other institutions for the record.
According to the data released by National Health Commission, there are currently 260,000 doctors practicing in multiple institutions in China.
Doctors’ practice should break through geographical restrictions, and "flying knife" should be standardized management.
Information picture. Zhang yangshe
In recent years, the term "flying knife" has appeared in the surgical field, which refers to the behavior of doctors using their rest time to go to other medical institutions for surgery privately. To some extent, this method has alleviated the problem of lack and uneven distribution of medical resources in some grass-roots areas, but at the same time, it has become one of the reasons for medical disputes because of lack of norms.
"Although many people have high hopes for doctors to practice more, hoping to realize the flow of doctors and alleviate the uneven distribution of medical resources, there are not many doctors who actually put them into action in reality. First, the procedures are relatively complicated and may not meet the actual needs. Second, situations like’ flying knives’ cannot be included in the scope of multi-point practice, which is precisely the needs of many patients." Song Hui told the Health Times reporter.
In 2019, a video of "The Doctor Accepts the Patient’s 10,000 Yuan Red Packet Privately" once caused quite a stir. The incident originated from the fact that a family member of a cerebral infarction patient first agreed to accept "flying knife surgery", and then secretly recorded the video of the private payment transaction with the surgeon and reported that the doctor accepted the red packet.
"It is the fundamental problem that doctors need to solve to get better diagnosis and treatment for patients in areas with limited medical resources.’ Flying knife’ was originally a win-win thing, but it was often a good thing with good intentions." Song Hui said that according to the current method of selecting one or two fixed-point practitioners, it is not suitable for the demand of "flying knives". "There are only a few experts, but there are patients in need all over the country, and it is impossible to concentrate on medical institutions where several doctors practice at fixed points, and this demand is very common in surgery."
Li Xin also believes that "flying knife" can help patients avoid traveling and fatigue, and it also allows doctors to get a certain amount of labor remuneration in their spare time, which is a "win-win" thing. However, at present, management is indeed not standardized, and rules should be clearly formulated and the cost standard should be given reasonably, instead of letting doctors carry the pot of "receiving red envelopes".
He Lin said that doctors should use their spare time to "fly knives", which should be supported and protected, while getting reasonable remuneration and benefiting more patients. "We can drive all over the country with a driver’s license. After years of study and accumulation, the doctor has obtained a medical practitioner’s license. Why should he be confined to one area and one hospital? What we should think about now is how to manage the phenomenon like’ flying knife’ reasonably. "
Doctors’ resources should belong to the whole society, and multi-point practice should be liberalized to achieve "three wins"
According to the regulations, doctors who are willing to practice more need to file in the medical institutions that practice more, and then apply to the local health administrative department, and can practice more after approval.
"However, this method still has some difficulties in practical operation. Although it is not allowed to pass this unit for multi-point practice now, doctors will still worry about affecting their development in this unit." Song Hui said.
Li Xin told reporters that from the hospital’s benefits and management issues, although the hospital leaders do not oppose practicing more for their doctors, it is not realistic to want them to give a green light. "Some hospitals stipulate that the director of the department should not practice more on weekdays, and the director of the department does not necessarily agree that his doctors will go out and will use attendance to get a card. In addition, taking our obstetrics department as an example, the number of pregnant women has dropped significantly in the past two years, and the hospital ordered that doctors should not take patients to private hospitals. These are actually some invisible obstacles. "
He Lin pointed out that practicing in the registered practice place, that is, the medical institution, has been implemented for more than 20 years, which seriously does not adapt to the development of the current healthy China strategy and cannot satisfy people’s yearning for a healthy life. "As a high-quality and scarce resource of a country, doctors should not become the’ private property’ of a hospital, but should belong to society and the country, and should play a greater role in safeguarding people’s lives and health."
"Let go of multi-point practice, for primary hospitals, more experts can be invited to come to the clinic to improve the medical technology level of our hospital in on-site teaching; For ordinary people, they can hang up the expert number without going to the big hospital, which can solve the problems of difficult and expensive medical treatment; For doctors, reasonable mobility can encourage medical staff to study their business, improve their medical technology and get reasonable remuneration by virtue of their medical skills. Therefore, the effect of’ win-win-win’ can be achieved by amending the law on medical practitioners and liberalizing multi-point practice. " He Lin said.
