Chinese doctors still unable to work at more than one location

by Zhang Pinghui
Doctors in China hope reforms outlined in Third Plenum will give them greater freedom to operate.
It is 6.30am, but Liu Yinglong’s waiting room is already packed with anxious parents expecting the top cardiac surgeon at Beijing’s Anzhen Hospital to check on their babies.
The demand for Liu’s expertise is so great he has to see about 30 patients before his official rounds start at 8am. Later in the day, his office is crowded once again with the sick and needy.
Liu, like many mainland doctors, has a huge workload, but his task has been made more even more complicated by the red tape restricting the work of medics on the mainland.
Liu said that only a fraction of the patients who ask for his help come from Beijing, but doctors are only allowed to register at one hospital or medical practice.
The result is that Liu spends his spare time treating patients in other parts of the country, but only as a ‘consultant’ as a way of getting round the regulations.

“Only 7 per cent of our patients come from Beijing, the rest come from all over the country,” said Liu, whose team of doctors perform 2,500 heart operations a year. At weekends he goes to other cities to carry out surgery. To date, he has operated in 140 cities around the country.
Liu has been campaigning for an overhaul of the system for 16 years and now it seems his labours have won the backing of the country’s leaders. Top Communist Party officials at the third plenum in Beijing last month promised they would lift some of the restrictions placed on medical practitioners.
Liu’s proposal to allow doctors to work officially in more than one location was included in a healthcare reform document released four years ago and provinces around the country have pilot schemes to introduce the reforms.
But so far the response to the tentative changes has been low key.
In Beijing, only about 1,000 doctors have been allowed to register to work in a second hospital while in Guangdong the figure is 3,800.
Doctors have to get approval from their own hospital to work at a second, but Liu said administrators were often wary of giving staff greater freedom.
“The situation cannot be improved right away because doctors are valuable assets of the hospital and a hospital president depends on them to see patients and make money,” he said. “How can the hospital president pay salaries and bonuses if [the] doctors all go away to practise elsewhere?”
Gong Xiaoming, a gynaecologist at the Shanghai First Maternity and Infant Hospital, said giving doctors greater freedom to operate was key to improving the quality of healthcare on the mainland.
Doctors in public hospitals lack motivation to improve the service because they are poorly paid, the workload is huge and they are unlikely to get decent pay from public hospitals already struggling with high costs and low government funding, he said. It is common for low-paid doctors to make money by prescribing unnecessary drugs in order to get kickbacks from pharmaceutical companies.
“If doctors are reasonably paid in their practice elsewhere and focus [on] their work in public hospitals on training young doctors, it will improve access to medical services and increase satisfaction among patients,” he said.
Gong left his previous job in Beijing in June and one of the conditions of taking his new role was to be allowed to practise at a second hospital.
“I think the evaluation mechanism in public hospitals has flaws. Doctors are assessed on how many patients they see and how many surgeries they perform, but never how many qualified doctors they train,” he said.
“Now you see many private hospitals built, but they are not popular among patients because patients don’t feel they’re reliable.
“I think by training more doctors in public hospitals it will provide the healthcare market with more trained staff and they can work at grassroots-level hospitals or private hospitals and patients will have access to more qualified health care,” he said.
Source: SCMP