In the eyes of many people, being a doctor is a glamorous profession that often represents specialized skills, high social status and decent living standards. Particularly common in society is the idea that "doctors earn high salaries." On the one hand, in most developed countries, clinicians do belong to industries with relatively high salary levels; on the other hand, there are hearsay or news reports about the “grey income” of some doctors, which makes people think that they earn more in addition to their normal work. There is a "small treasury" with a large amount of money.
Unfortunately, in China, doctors are not a "high-paying profession" as some people imagine. Instead, they are generally in a situation of low salary and overwork, which is especially obvious among junior doctors.
▌Long training time, low salary level
As a profession with strong professional and technical requirements, clinicians have relatively strict management and access systems in various countries. In recent years, medical education and training in China have gradually embarked on a standardized track.
The current basic situation is that after the five-year undergraduate education in medical school (the last year of which is clinical internship), it is divided into clinical type (also called professional type) and academic type (also called Research-oriented) (master's) graduate students, among which clinical graduate students also have the status of trainees (employees) in the standardized training of residents. There are similar distinctions in the subsequent doctoral stage. Professional-type doctoral students also have the status of trainees in the specialist training. In summary This is the so-called "5+3+X" model.
In addition, there are medical students who study for an eight-year bachelor's degree and a Ph.D., as well as medical students who enter academic postgraduate education. After graduation, they still need to enter three years of standardized residency training, 2-4 Years of standardized training for specialist physicians (specialist training). (According to the regulations of different regions, the standardized training time for doctoral students may be shortened accordingly, generally ranging from 1 to 3 years.)
Under the current situation of uneven distribution of medical resources, it is necessary to study in higher-level hospitals. To obtain a position, clinical, scientific research and teaching work all have extremely high entry barriers, which requires graduate-level students to usually choose a scientific research-oriented graduate school (or directly study for an eight-year bachelor's degree with a Ph.D.). After graduating from the graduate school, Then enter the training stage, which usually lasts 5-7 years. Overall, it takes at least 15 years for a medical student to start from the professional study of medical school and end with a series of teaching and training. That is to say, it usually takes 33 years to get an intermediate (attending physician) in the hospital. professional title. The subsequent professional title promotion and level promotion in the administrative system are still a long but inevitable process, which can be seen from the long training time of doctors.
▲ In May 2015, 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 doctor profession, and this is not a phenomenon unique to China. In fact, standardized training and long education processes are common phenomena in medical education in various countries. The reason why Chinese doctors and medical students are dissatisfied with long-term education and training is mainly because of the serious problem of low pay and overwork in this process. Junior doctors make up the majority of medical institutions and are the most direct undertakers of front-line clinical work. However, due to issues such as the allocation of medical resources and the status of training doctors, junior doctors, who are the main force in the operation of medical work, bear the burden of basic salary. This is a common situation.
Perhaps due to the administrative and organizational structure of the hospital, or due to the traditional master-apprentice inheritance in medicine and the extremely high requirements for technology, the hospital is actually a very hierarchical workplace.
From the department director to the deputy director, from the chief physician to the deputy chief physician, to the attending physician, resident physician, and even the intern who is new to clinical medicine, the barriers between levels can be said to be clear, and the doctor's The salary level also corresponds to the grade. For junior attending physicians and resident physicians, the low income level does not seem to match their previous years of study investment and technical level.
According to an online survey by a medical website, the average annual income of Chinese doctors in 2017 was about 95,500 yuan, and even in tertiary hospitals it was only over 100,000 yuan. Whether it is compared with the income of doctors in other countries, or the long-term investment in education (including time and money) before becoming a doctor, it is extremely disproportionate.
As for resident doctors, they are often still a "laggard" group in statistics. The average monthly salary of many resident doctors in hospitals in second- and third-tier cities is only 2,000-3,000 yuan or even lower, even if It is a top-level hospital in first-tier cities such as Beijing and Shanghai, and the monthly salary of regular training (resident) doctors is only 6,000-8,000 yuan. Although this salary is not low compared to peers in other cities, compared with the cost of living in the city, especially compared with the salary levels of people of the same age in other industries, it can still only be regarded as a "low salary."
▌Excessive working hours, health concerns for doctors
In addition to low remuneration, another major problem faced by the physician group is the widespread overwork and extremely long working hours. Become an "everyday" phenomenon. To a certain extent, the problem of remuneration and benefits can be slightly improved through the accumulation of time and promotion of professional titles, but the overwork situation of doctors is a widespread problem ranging from directors to interns.
According to the provisions of the Labor Law, workers shall not work more than eight hours a day, and their average working time shall not exceed 44 hours a week. Although the "Labor Law" itself makes exceptions for industries that "cannot implement this provision due to production characteristics", so that it is difficult for doctors to directly appeal to the protection of the labor law for their overwork situation, this does not prevent this provision from being used as a measure of working hours. In contrast, after all, the eight-hour work system is basically in line with the public perception.
As far as my hospital is concerned, in addition to completing five days of work, residents have to work on average at least four night shifts and one weekend shift every month. Some departments with heavy workloads (such as surgical operations) ) There are also situations where work is delayed on weekdays. Even if these doctors can go to and from get off work strictly on time every day (which is actually impossible), the average working time per week reaches 58 hours. There are also many departments that work more than 80 hours a week, which is equivalent to one doctor taking on the workload of two doctors.
For senior doctors, there is no tendency for the working hours to be reduced at all. Even the deputy director of the department still needs to work night shifts. The director of the department at my hospital even admitted that the average sleep time per day is no more than five hours, and this is a common situation among colleagues across the country.
For doctors on duty, this kind of extremely long working hours can be said to last 365 days a year without interruption. Not only do they lack normal vacations, they cannot even rest on statutory holidays. Due to the relative reduction of staff during holidays, they are also responsible for heavier work tasks than on weekdays. The current situation of night shifts in hospitals usually requires continuous work, that is, they continue to work night shifts after going to work normally the day before, and then the night shift is followed by heavy work the next day. In this calculation, if the night shift is in the middle of the week, a doctor will continue to work continuously. Working hours can reach 33 hours or more. Regardless of whether continuous fatigue work will adversely affect the quality of medical care and patients, it is also a great consumption and challenge to the health of doctors themselves.
▲ In 2016, a doctor rested in a corner at a hospital in Hengyang, Hunan. “We have to work night shifts at least 1-2 times a week and weekend shifts, plus outpatient clinics, ward rounds, surgeries, writing medical records, and writing papers... Not only are there no weekends or holidays, but overtime working hours for doctors is also a serious problem. " said a deputy chief physician who works at the First Affiliated Hospital of University of South China.
The responsibilities borne by doctors and the consequences of mistakes are much heavier than ordinary work. In addition, serious overtime work has led to doctors' death from overwork in recent years, and many of them are concentrated. among young doctors. What is even more puzzling is that some resident doctors work overtime for a long time in the hospital and suffer casualties, but they cannot be recognized as work-related injuries or deaths. The reason given by the hospital is that "the resident doctor is working overtime." The hospital conducts standardized training without signing a labor contract or receiving compensation, and they are still students at the school." This incident occurred in a hospital in the east. It shows that residents in some hospitals are not only "low-paid and overworked", but are even "unpaid" or "negatively paid" (they do not get paid from the hospital and have to pay tuition to the school) ).
It can be said that the occurrence of this kind of incident shows a complete lack of respect for the knowledge and labor of doctors, and does not even treat doctors as workers with basic rights (especially the right to rest). How to define the status of residents and interns who do not have formal employee qualifications and how to protect their rights should be an issue that deserves attention and needs to be solved urgently.
▌A vicious circle of doctor shortage affects the whole body
The widespread low salary and overwork of doctors has had a foreseeable impact on the entire industry. At present, China's medical resources are still in short supply relative to its population. According to the World Health Organization's 2015 report, China has 14.9 doctors per 10,000 people, which ranks 83rd in the world, not to mention the distribution of doctors. There is no balance between regions and different levels of hospitals.
As the population ages and medical needs increase, the shortage of doctors appears to be only getting worse. The long initial stage of the medical industry, widespread low wages and overwork, public distrust of doctors and even medical injuries have caused many doctors to choose to change careers or start side jobs. For young students who have not yet entered this industry, , more people choose to stay away from it. In recent years, medical school admissions have experienced varying degrees of difficulty, and medical majors have become the lowest-scoring majors in comprehensive university admissions. This is the result of the poor conditions of the industry reflected at the entrance.
As for the current situation of low salary and overwork, the result of intuitive thinking is to recruit more medical staff to share the excessive work pressure, and at the same time improve the salary and benefits of medical staff. However, whether it is more medical staff or higher wages per unit time, more capital investment is required. However, in the context that hospitals are self-financing but the prices of medical services and related products are still strictly controlled, the hospital does not seem to have More funding to support such an idea.
As for the medical insurance funds that are already in short supply in some provinces and cities, and will be further shorted as the population ages, it does not seem to be a reality to require them to increase investment to improve doctors’ salaries. Viable options.
And if doctors' demands for increased remuneration are passed on to patients, 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 voices of medical staff have become louder in recent years. If we only consider the interests of the doctor group but deny the interests of patients who are in a weak position in the medical relationship, placing a heavier burden on patients will only further undermine the already fragile trust relationship between doctors and patients.
Although the situation of doctors being underpaid and overworked has become the norm, it has even had a visible impact on the normal operation and continuity of the medical system. However, in previous reports and discussions, the issue of low pay and overwork of medical staff seems to have been appealed more to the moral sense of doctors. In other words, doctors are sympathized with, recognized, and given a positive moral evaluation in the situation of low salary and overwork. Words such as "selfless dedication" and "dedication" are applied to low salary and overworked doctors. .
▲ In April 2018, students from Tianjin Medical University reviewed the “Medical Student Oath.” ?
Although positive moral evaluations may help to detect and disseminate problems to a certain extent, or slightly improve the current tense doctor-patient relationship, they do not touch on the reasons behind low wages and overwork of doctors. The reasons and mechanisms, not to mention the methods to improve or solve this situation. This kind of positive moral evaluation is more like a means of avoiding and delaying the problem, as if the public has begun to understand and appreciate the hard work of doctors, and low pay and overwork will no longer be a problem worthy of concern. Doctors' overwork is still not seen as a problem, but as a special need of a special profession, and should only receive "noble" moral praise.
From this point of view, low-wage overwork seems to be in a dilemma in the medical field where there is no way to start. The result of allowing this phenomenon to continue will be that low-wage overwork will lead to staff shortages and more staff shortages. Exacerbating the vicious cycle of low pay and overwork. Aging, as a change in the demographic structure of the entire society, will only pose greater challenges to the medical system.
It can be said that we do not have too much time to hesitate or allow this vicious cycle to continue. After all, medical care can be said to be a basic industry for the functioning of society. The low salary and overwork of doctors harms not only the doctors themselves, but also not just the medical industry. Therefore, the low salary and overwork situation faced by Chinese doctors needs to be seen by society first, and needs to be effectively solved before major problems arise in the entire system. .