Two unavoidable topics doctor: drug rebate is an open secret. The reporter found that this doctor has 13 years of clinical experience. When it comes to drug kickbacks, he thinks it is a chronic and incurable disease. The following is an interview with him: I think the media has vilified the image of doctors in recent years. When we prescribe drugs, doctors usually consider which drugs are suitable for the patient's condition first. Of course, if several drugs have similar efficacy, doctors will choose according to the actual situation. Drug rebate is an open secret, and there are very few drugs without rebate now. Drugs that cost only seven or eight dollars can be sold to patients for more than 100 yuan. A little girl who is a medical representative, just graduated, earns more than 10 thousand a month, while most doctors with professional skills work hard for a month, which is about 3000. Of course, the doctor's income in the local area belongs to the upper-middle level, and we should be satisfied, but people are all material and want to live a decent life, and the board should not be all on us. As far as I know, at present, the chief physician earns 40,000 to 50,000 yuan a year, and the drug rebate income is far more than this. At present, the rebate of some drugs can be as high as 30%, which means that doctors can get 30 yuan with drugs of 100 yuan. The law is that the rebate accounts for about 10% of the drug price, and antibiotics are higher, reaching about 15%. Patient: Give a red envelope and feel at ease. Ms. Wang's mother is hospitalized with lung cancer. Ms. Wang has a "very useful" acquaintance in this hospital, so her mother was admitted to the hospital soon. As soon as the mother and daughter began to tidy up, they heard a family member of a patient who lived in at the same time hurriedly ask the people in the same ward how to give the doctor a red envelope and to whom. How much to send? How to send? Many details. The price given by the patient is: send 1000 yuan to 2000 yuan to the ward director in charge of the operation; Send more than 500 yuan to the anesthesiologist; Issued to the doctor in charge of the bed, not less than 1000 yuan. In a word, a red envelope costs about 3000 yuan for an operation. "In the process of sending red envelopes, the psychology of each patient and his family is quite complicated. The son of a patient in my mother's ward is a policeman. When giving the red envelope, the family discussed it for a long time and finally decided to give the director 2000 yuan. I heard from the patient's son that I will deliver it tomorrow, and I will put on my police uniform. If the Secretary thinks I am a policeman, he may not accept it. The next day, the police wore police uniforms to deliver red envelopes. Before long, I came back with my head drooping. I reluctantly said that the director received a red envelope and was not at all polite. " When the reporter asked her how she felt about giving a red envelope, she said, "If there is a way for me to give a red envelope and let my mother have an operation as soon as possible, I will be satisfied. How many patients are anxiously waiting in line outside the hospital because they can't find a way. " It is understood that from 1992, the health system began to grasp the bad phenomena such as taking red envelopes and kickbacks. The Ministry of Health issued a document on this topic five times, but the effect is not obvious now. Why? The existence of an ethos has its own soil, and it is not enough to treat the symptoms without changing the soil. According to the reporter's investigation, there are basically three kinds of mentality for patients to send red envelopes. First, if everyone sends me, I have to send it to buy peace; Second, save a little money, save a lot of money by early hospitalization and early surgery; Third, express gratitude and establish a long-term relationship. Doctors also have three basic mentality in accepting red envelopes: First, follow the crowd, others accept me, and the law does not blame the public; Second, find a balance. The subsidy for a few hours of surgery is only twenty or thirty yuan. What does it depend on to buy a car and a house? Third, I didn't ask for it. Make friends. A doctor surnamed Rong said that although the phenomenon of red envelopes occurred in a few people, it harmed the vital interests of patients and seriously tarnished the image of the health industry, so it must be treated with "fierce medicine". For those "hardest hit areas" that are easy to issue red envelopes, the management department should focus on education and monitoring. If the phenomenon of asking for accepting red envelopes is verified, severe punishment measures must be taken. Being a doctor is not nourishing. In many people's minds, the income of doctors seems to be extremely high. In this regard, when analyzing the composition of medical expenses, experts think: "The technical service fees charged by hospitals to pay doctors account for a small proportion of the total medical expenses, and the income of doctors is actually very low." Many readers question this. A reader said: "Is the doctor's income low? Arabian Nights! " Others said, "How to explain the red envelopes and kickbacks?" And so on. The sensitive issue of red envelope rebate certainly exists, but we have to admit that not every department in every hospital has this kind of "good thing", and of course not everyone in our province's 9065 doctors is so "nurturing". Then, apart from the interference of medical ethics, what is the current doctor's income? The reporter made a random survey of 10 doctors in three hospitals, from residents who just graduated with a master's degree to chief doctors: the average income of a graduate of a medical college during his seven-year residency was between 1000 yuan and 1500 yuan; The average income of attending doctors (equivalent to intermediate titles) is between 1500 yuan -2000 yuan; The deputy chief physician's income is between 2000 yuan and 3000 yuan; The average income of professors and chief physicians is between 3000 yuan and 3500 yuan. If consultation fees, bonuses and lecture fees are added, the income of deputy chief physicians in better hospitals and departments is roughly between 3,500 yuan and 4,000 yuan, and the income of professors and chief physicians is between 5,000 yuan and 6,000 yuan. When talking about her income, the director of a third-class first-class hospital said that after deducting taxes, insurance and other items, her salary was 1.7 million yuan, and her bonus was 1.000 yuan. The registration fee of 7 yuan, 2 yuan can be raised, and the monthly registration fee can be deducted by 300, which adds up to 3000. The year-end bonus is basically equivalent to one more month's salary, with an average of one month. In order to compare the income of doctors in related industries, the reporter made a random survey on the income of lawyers and university teachers who are also high-tech industries. A law firm has 23 lawyers. In the annual salary ranking, there are 3 people who earn more than 500,000 yuan, 3 people who earn about 300,000 yuan 1 person, 6 people who earn 1-200,000 yuan, and 3 people who earn less than110,000 yuan. As for the average annual salary between15-170,000 yuan, most lawyers agree. The income of university teachers usually consists of salary, post allowance, lecture fee and year-end bonus. Different schools and disciplines have greater flexibility. The monthly income of a lecturer (intermediate title) is about 2000 yuan, and that of an associate professor (deputy senior title) is about 4000 yuan. The low income of doctors is not just a judgment based on accidental comparison. The director of a hospital pointed out that doctors, as a risky profession, naturally need compensation, but there is no such compensation mechanism in China. In the era of planned economy, hospital services have the nature of welfare, and the policy of "supplementing doctors with medicines" that the state has been implementing has objectively formed the fact that hospitals "sell medicines to compensate for labor losses". Judging from the current proportion of income and expenditure in general hospitals, the income of hospitals in medical technical services is indeed at a loss. As far as occupation is concerned, doctors are engaged in high-tech and high-risk occupations, and their responsibilities and risks are more prominent than those in other industries, which can be explained by the fact that the training cycle of doctors is much longer than that in other industries. As we all know, undergraduate courses usually take four years, while medical schools need five or even six years. A medical college student who just graduated from a university needs to practice in the hospital for one year to become a resident, and then be promoted to an attending doctor after 5-6 years, and then he can manage patients independently. It will take another five years from the attending physician to the deputy chief physician-10 years. Once you become a doctor with a certain academic level and clinical experience, responsibilities and risks are almost accompanied. An old dean once told reporters that people who are engaged in other occupations can have a good sleep after work and can relax and take a vacation, but doctors are often nervous. You can't go to the hospital for surgery at 2: 30 in the middle of the night. Teachers should pay fees on time for extra-curricular tutoring, but a doctor often deals with his illness because of urgent matters, but most of them do their duty. Doctors are engaged in high-tech and high-risk occupations, but the treatment is very inconsistent with the profession. It is understood that at present, among the overall medical expenses of patients, the labor expenses of medical staff charged by hospitals are actually very small, accounting for a very small proportion of the total expenses. Generally speaking, the cost of a complicated congenital heart disease operation is about 40,000 ~ 50,000 yuan, but the operation cost charged by the hospital is only 2,000 yuan, which is only one twentieth of the total cost, or even less than this ratio. "According to this calculation, in the overall medical expenses, the technical service fees charged by hospitals account for about one tenth to one twentieth of the overall cost of patients, and these fees are not all paid to medical personnel. As we all know, medical staff get some remuneration from hospitals in the form of wages and bonuses. In this way, the final income of medical staff accounts for less than one tenth to one twentieth of the total medical expenses. Individual doctors can't say that there is no kickback at all, and no industry can guarantee complete purity, but even if there is, it will certainly not account for the main part. Wu Qiang (a pseudonym), the attending physician who will see us in the future, said that he was the only one of the five students who studied with him. Most doctors who switched careers became drug salesmen. A survey shows that 37.3% and 1 1. 1% people think that the practice environment is poor and extremely bad; Only 10.4% people are willing to enroll their children in medical schools, while 63.0% people are unwilling to enroll their children in medical schools. The survey also found that it is common for clinical professionals to switch to basic medicine when applying for graduate students, while departments with high risks and responsibilities, such as obstetrics and gynecology and pediatrics, are facing a shrinking situation. Judging from the possibility of doctors leaving their jobs, about 19% of doctors are "likely" to leave their jobs. In addition to the main reason of low income, the current bad practice environment is characterized by the tense relationship between doctors and patients, and doctors generally feel that personal safety and personal dignity cannot be guaranteed. During the SARS period, the relationship between doctors and patients was improved as never before, and medical staff were called "the cutest people in the new period". But after less than half a year, the doctor-patient relationship has changed so much, which shows that the root of this contradiction has not changed. From this point of view, there are different understandings of the sensitive topic of "doctor's income" in society: on the one hand, bad phenomena such as red envelope rebate make patients overestimate the actual income of doctors; On the other hand, doctors are very dissatisfied with their income. Therefore, it will take time for doctors to find a balance point that both doctors and patients are satisfied with. There are also a few doctors who call and write to Mr. Li (deputy chief physician of a hospital) to receive red envelopes. Generally speaking, red envelopes are mainly concentrated in large hospitals, especially specialized hospitals with more operations. However, in outpatient clinics and small and medium-sized hospitals, the phenomenon of red envelopes is not prominent, because the hospital itself has insufficient sources of disease, and there is no seller's market. There are also many doctors in big hospitals who don't accept red envelopes, or take them temporarily, and then give them to the medical department to offset the hospitalization expenses of patients when they leave the hospital. At the same time, the phenomenon of asking for money also exists In order to collect money, individual doctors delayed the operation and did not give red envelopes, and hinted in their speeches. Although this situation is rare, its influence is extremely bad. Mr. Gu (a doctor in the hospital) Our doctor is overworked every day. An orthopedic surgeon has to perform four or five operations a day, a ward has to take care of patients, and a clinic has to go out. Outpatients are waiting in line, and doctors can't even eat lunch. Doctors who have operated for more than 4 hours can only get 8 yuan for meals. Besides, you know, what is the cost of beds in our hospital? There is a bathroom, an air-conditioned ward, and a hospital bed costs 28 yuan every day. How much is the hotel fee? Besides, don't people in other industries accept red envelopes? No gray income? So I don't like talking about red envelopes very much. It is a fact that the remuneration paid to doctors by hospitals cannot reflect the value of doctors' labor. Attention in the next issue: Many doctors think that expensive medicine is the most important factor of expensive medical treatment, so let's take a look at the role played by medical representatives and the subtle relationship between drug dealers and doctors.