Salary in grassroots hospital: 3,000 yuan monthly salary after 17 years of work
"We work with our lives, and we are overloaded every day. We cannot make any mistakes in the face of life, even so , they also have to suffer various speculations from the society, and even receive physical threats. "A doctor from a tertiary hospital said, "The gray income that society refers to does not belong to most doctors, but they are still working hard on the front line."
Long training cycle, high occupational risks, high work intensity, low wages... This is the current practice situation that doctors in my country generally face. In the 2014 "China Labor Statistics Yearbook", among the 20 industry categories in the country, the salary of personnel in the health, social security and welfare industry ranked 11th in the country. If they say their income is low, some people will question them. If they receive red envelopes and kickbacks, who would believe that their income is low? If they say their income is high, almost every medical staff is full of grievances.
In the whirlpool of public opinion and the tide of medical reform, medical and nursing groups have become the main force. How to make them feel the dividends of reform will be the key, and this dividend will benefit not only medical personnel, but also the public. of health.
In the "Notice on Issuing the Work Summary of Deepening the Reform of the Medical and Health System in 2014 and Key Work Tasks in 2015" (hereinafter referred to as the "Notice") issued by the State Council in May, it clearly requires the Ministry of Human Resources and Social Security and the Ministry of Finance to Take the lead to study and formulate the "Public Hospital Salary System Reform Pilot Plan" before the end of September this year.
“Reforming the salary system of medical personnel, improving the overall salary level, and standardizing the salary gap between positions have become a top priority. Some people are worried that increasing salaries in the medical industry may lead to other public institutions (such as education ). I believe that establishing a salary system that is consistent with the characteristics of the medical industry must be a decision made after rigorous scientific review. Some concerns are unnecessary and may even affect the reform process of public hospitals. "National Health and Family Planning Commission Health Development Research. Ying Yazhen, director of the Center's Health Finance and Performance Research Office, told China Business News that through system innovation, doctors can get decent sunshine income, get out of the shadow of the criticized "gray income", and return to "seeing doctors and saving people" Their professional nature tests the implementation of medical reform policies.
According to the 2014 data released by the National Bureau of Statistics, there are 7.7 million medical staff in my country, with a total salary of 439.78 billion yuan and an average annual salary income of 59,200 yuan. However, the salary income of 59,200 yuan still makes most medical staff feel that it is lagging behind the average.
“In first-level hospitals of primary medical institutions, clinicians earn 3,000 yuan per month, nursing staff earn around 2,700 yuan, and other staff earn around 2,200 yuan.” A doctor who has graduated from medical school for 17 years has been struggling A doctor from a township health center showed his salary slip to a reporter from China Business News, "My monthly salary is 826 yuan, with a bonus of 2,300 yuan and a bonus of 3,126 yuan. This bonus is not fixed and depends on the workload. If there is no other income, who would give red envelopes to doctors in township hospitals?”
Another doctor from a community service center who has also been on the job for 17 years said: “What’s even more frightening is that all we can do here is I can’t even get 60% of my salary. If the district finance department doesn’t allocate the salary, it’s impossible to receive 3,000 yuan. This figure is also a luxury.”
Looking at the pay slip in my hand. , it is not only the doctors who are fighting on the front line who are in trouble, but also their leaders. "All grassroots medical institutions have implemented two lines of income and expenditure. The total salary is fixed. I can only distribute it according to the only food. One person has more, the other person has less. The division is based on performance appraisal. , there are no additional expenses, and it is very difficult for the hospital itself to earn money and pay bonuses. "When it comes to salary distribution, the director of a township health center has a difficult time.
In secondary hospitals, the income situation of doctors is also not optimistic. According to the compilation of this reporter, the actual monthly salaries (excluding bonuses) of senior, intermediate and junior doctors in secondary hospitals are 3947.46 yuan, 3116.96 yuan and 2477.98 yuan respectively.
“General doctors’ incomes are not high. In secondary hospitals, the basic salary of mid-level doctors is mostly around 3,600 yuan, including various subsidies and bonuses of 5,000 to 6,000 yuan per month. However, If you get a bonus of 1,000 yuan to 2,000 yuan, you will be very busy. There is no annual leave, and it is very luxurious to take three consecutive days off a year." A clinician from a secondary hospital became emotional when talking about the salary, "There are red envelopes. But they were all refunded. ”
A doctor with an intermediate professional title further said: “The bonus is between 1,000 yuan and 2,000 yuan, but it does not exceed 2,000 yuan.”
And some. In top-level hospitals, there is even a phenomenon of "discounting" by doctors. "The bonus depends on the business volume. If the performance is not good, not to mention the bonus, the operating costs of the hospital will have to be subsidized from the salary." Another doctor from a secondary hospital said.
The nursing salary in secondary hospitals is even lower than that of clinicians. The actual salary of nurses with intermediate professional titles is only about 2,300 yuan per month.
In tertiary hospitals, there are indeed a group of people with high wages, but there are also differences between tertiary hospitals, especially between first-tier cities and other cities. "The salary of a doctor with an intermediate professional title is around 6,500 yuan, and the actual salary is only more than 4,800 yuan, which is much lower than that of people in tertiary hospitals in first-tier cities." A clinician from a tertiary hospital in a second-tier city said.
Our reporter learned that in a top-level hospital in the military system in Beijing, the actual monthly wages of bureau-level, division-level, department-level, and clerk-level staff were 12,002.8 yuan, 9,442.67 yuan, 7,432.67 yuan, and 5,388.67 yuan respectively. Yuan.
"We work overloaded every day and cannot make any mistakes when facing life. Even so, we are still subject to various speculations from society and even personal threats. Doctors cannot fight back when faced with attacks, even in legitimate defense None, the reward is not proportional to the effort," said a doctor from a tertiary hospital.
The low salaries of the medical and nursing staff are covered by red envelopes and kickbacks, and the salary system is distorted, which may bring consequences such as large prescriptions, large inspection orders, and excessive medical treatment. In the end, it is still the patients who suffer. In this wave of medical reform, how to mobilize their enthusiasm, the top priority is the reform of the salary system of medical staff.
Labor factor investment lags behind hardware
The sunshine income of medical staff across the country is not that high in various industries. In the 2014 "China Labor Statistics Yearbook", the 2013 Health and Social The salary of employees in the work industry is 57,979 yuan, ranking ninth in the country. At the same time, the result of revenue generation in the medical industry will directly lead to an increase in medical expenses, which is completely different from other industries that can achieve better results through sales.
Problems in the compensation system in the medical industry have also attracted great attention from decision-makers.
The "Notice" clearly states that my country has not yet established a personnel compensation system that conforms to the characteristics of the industry, so establishing a compensation system that conforms to the characteristics of the medical and health industry is listed as one of the key tasks of the medical reform in 2015.
The State Council requires relevant departments to formulate a salary system reform plan as soon as possible and select some regions or public hospitals to carry out pilot work on the salary system reform of public hospitals. Pilot cities and counties (cities) that are not included in the pilot scope of public hospital salary system reform can first explore and formulate methods for determining the total amount of performance pay for public hospitals. We will improve the performance-based salary system to embody more rewards for more work, better rewards for good performance, and reasonably widen the income gap. It is strictly prohibited to set income-generating targets for medical personnel, and medical personnel's salaries must not be linked to business income from medicines, consumables, medical examinations, etc.
However, how to establish a personnel compensation system that meets the characteristics of the medical industry is a difficult problem in the current reform of public hospitals.
Ying Yazhen said, "In the process of medical reform, if the enthusiasm of doctors to participate in the reform cannot be effectively mobilized, the reform will be difficult to advance smoothly, and the effectiveness of the reform will naturally be affected. Establish a new salary system to fully reflect the medical The value of personnel services and standardizing the incentive mechanism are the core measures to mobilize them to actively participate in the reform. ”
From the perspective of public hospitals, the overall level of industry remuneration deviates from the value of labor, and the remuneration and benefits of grassroots personnel are too low, and their job levels are too low. The lack of standardization of inter-professional income and the increasingly serious inversion of bonuses and basic wages in the income structure are all institutional causes that have weakened the attractiveness of the medical industry, made it difficult to solve the problem of grassroots health manpower, and distorted incentives within hospitals.
Ying Yazhen analyzed that “people” are the core of all systems and the basic premise for discussing issues. Only by establishing a scientific and reasonable salary system and attracting more outstanding talents to enter the medical and health industry can the problem of insufficient high-quality medical resources be fundamentally alleviated, and only then can we have the foundation to strengthen industry supervision, supervision of doctor service behavior, and establish a doctor professional evaluation system condition.
But what is puzzling is that in the construction of this service system, all parties seem to be more willing to invest in hardware, but they have been slow to make a decision on the investment in the more important productivity, that is, the labor factor. . Ying Yazhen believes that the key lies in the understanding and determination of reform, and the relationship between guarantees, incentives and constraints.
Find a good balance between public welfare and service efficiency
A salary system that conforms to the characteristics of the industry must be able to handle the following relationships: the relationship between current levels and long-term goals, public The relationship between the salary and benefits of medical staff between the hospital and grassroots institutions, and the distribution relationship between personnel at different levels within the hospital.
“Scientifically design the proportional relationship between basic salary and bonus, ensure the basic income and benefits of medical personnel, and properly handle the relationship between guarantee and incentive. At the same time, when establishing the performance appraisal and income distribution mechanism, it must be based on public welfare, Service efficiency and service quality should be goal-oriented, and effective incentives and constraints should be implemented. "Ying Yazhen said, "The complexity and uncertainty of medical services must be fully considered. It is necessary to mobilize service enthusiasm, implement effective incentives, and ensure that the total salary reaches the goal. At a certain level, we must also achieve a 'capping' of the total amount, set a 'ceiling', lock the interests in a 'cage', and achieve 'hard constraints' on interests, and resolutely avoid the situation where the higher the service income, the higher the personnel income level will be without limit. Practice. ”
In 2013, Sanming City, Fujian Province took the lead in implementing an annual salary system for doctors, raising the salary of medical staff to more than three times the average social salary.
At the same time, it is stipulated that in addition to the basic annual salary and annual performance salary, hospitals are not allowed to issue any form of subsidies, bonuses, etc. related to individual employees.
Data shows that after the comprehensive reform of 22 public hospitals in Sanming City, the proportion of medicines in the 22 hospitals dropped from 46.77% in 2011 to 27.36% in 2014, which is about 16 percentage points lower than the national average. ; The proportion of medical income increased from 39.92% in 2011 to 63.06% in 2014, and the per capita medical expenditure (calculated based on the city's population of 2.73 million) dropped from 289.51 yuan in 2011 to 204.50 yuan in 2014; the annual per capita income of employees Rapid growth, from 32,300 yuan in 2011 to 77,200 yuan in 2014, with an average annual growth of 46.3%.
The local government implements a cap on the total performance salary, uses performance indicators such as the proportion of medicines, health materials, and inspection and laboratory tests to control and guide hospital management and service behavior, and uses the hospital’s medical income as the basis for issuing performance wages. The foundation encourages hospitals to actively provide medical services and finds a better balance between public welfare and service efficiency. Sanming City's reform has better solved the problem of funding sources for medical staff's salary. By "reducing material consumption, optimizing the medical expense structure, and transforming the operating mechanism", it has ensured the improvement of medical staff's salary and benefits.
"Reform is advancing continuously, and the situation is different in different places. In some places with vast areas, sparse population, and insufficient demand for services, it is difficult to fully rely on the adjustment of medical service prices to fund increases in the salary and benefits of medical staff. Financial support is definitely needed. "Ying Yazhen believes, "If financial resources permit and the finance can guarantee the basic salary of medical staff in public hospitals, then the pressure to adjust the price of technical labor medical services will not be so great, and the growth rate of medical expenses will also keep pace. If the finance does not guarantee basic wages, the level of medical insurance financing will increase rapidly. When the medical insurance payment standards are determined, a certain level of labor costs will be included in the cost of medical services, which can also ensure the level of salary. To improve, this is actually a question of whether finance supports the 'supply side' or the 'demand side'.
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