Author: yxtl**i
The wind is sluggish and the water is cold, and the strong man will never return. 」
After seeing off batches of former classmates and colleagues, Zhenzhen (pseudonym) is also packing her travel bag, she is about to leave the Northeast Hospital where she has worked for many years and take her family to Fuzhou, Fujian. There, she thinks there will be more room for development.
No one wants to leave their hometown, but we seem to have been born to leave. As long as there is a hospital to dig the foot of the wall, one digging is accurate. Over the years, there are often colleagues around me who suddenly confess that they will go to Shenzhen, Guangzhou, and Hangzhou to work, and finally Zhenzhen has become one of them, and leaving has become the main theme of the department.
Is Northeast Medical really going to be gone?
The answer may be unknown. Because the departure coincides with the footsteps of the top hospitals into the black earth, they vow to keep the people who leave. On November 30, the signing ceremony of Jilin Hospital of Beijing Anzhen Hospital was held in Changchun City, and Hou Xiaotong, vice president of Beijing Anzhen Hospital, saidIt will build a national-level medical management team that cannot be taken away, and cultivate a group of high-level hospital management talents and high-level professional and technical talents for Jilin Province.
Scenery of the past
Contrary to the loss of doctors, no matter how you look at it, the medical resources and level of the Northeast are not bad, and even more abundant than some central provinces.
At the beginning of the founding of the People's Republic of China, the state concentrated its efforts on the layout and construction of a number of strategic industries and backbone enterprises in the northeast region, forming an independent and complete industrial system and national economic systemA number of medical colleges have been established in Northeast China, and well-known pharmaceutical companies such as Harbin Pharmaceutical Group, Northeast Pharmaceutical, and Sunflower Pharmaceutical have been born one after another. The scale of urbanization is the highest and the illiteracy rate per capita is the lowest, polishing the identity of the eldest son of the Republic, and the scale of hospitals and the flow of medical personnel are not inferior to other regions.
However, with the passage of time, various lists and data reflect the decline of the medical industry in Northeast China.
Some scholars analyzed the data of China's four major regional fiscal medical and health expenditures from 1996 to 2015, and found that from the perspective of total expenditure, the growth rate of Northeast China has been at the bottom for a long time. Among them, it is particularly obvious that the expenditure related to health human resources is at the bottom.
Source: Reference 1
The Northeast region was established by 31 in 19964.4 billion yuan, up from 801. in 20157.4 billion yuan, an increase of only 25 in 20 years5 times, which is the least growth multiple among the four regions, with an average annual growth rate of only 185. The growth rate is also the lowest among the four regions.
In 2023, a total of 6 hospitals in Northeast China will be listed in the TOP100 list of Fudan University Hospital Research Management Institute, ranking respectively (the 90th hospital was officially established in 2018). It is undeniable that several hospitals are declining in the rankings: in 2010, the five hospitals were ranked separately. On December 25, Ranking China released the 2023 China University Medical Strength Rating, and there are no Northeast universities in the top 20.
What touches the Northeast doctors the most is not only the continuous departure of colleagues around them, but also the injection of rare fresh blood. According to the data released by Lilac Talent,From 2018 to 2021, doctors in Northeast China submitted as many as 240,000 resumes, of which only 13% were willing to find jobs in the three northeastern provinces, and the other 87% were intended to be outside Northeast China.
Source: Lilac Talent.
A doctor from Northeast China said that the old acquaintances and classmates of the hospital are walking and flying. There are even jokes about fresh doctors being the leaders of the departments in some departments. He concluded that everyone's departure is nothing more than two words "money, front". When I came back, the department was almost empty. He said helplessly.
The Tohoku region is not turning a blind eye to the departure of doctors, and is taking measures such as policy support and technological revitalization. In 2021, the "14th Five-Year Plan for the Comprehensive Revitalization of Northeast China" was issued, emphasizing cohesion and joint efforts to seek the comprehensive revitalization and development of Northeast ChinaThe Medical Device Review Center of the State Food and Drug Administration carried out a training meeting on the development of the medical device industry in Northeast China, etc.
The deployment of Anzhen Hospital may also become a part of the revitalization.
Jilin Hospital, Beijing Anzhen Hospital Affiliated to Capital Medical University, is a national regional medical center construction project, which aims to strengthen medical quality management and specialty construction, increase the supply of high-quality services, and promote the downward shift of the focus of medical services and the sinking of resources through a series of measures.
This is not the first project in the Northeast, nor is it the first cooperation project of An Zhen. The news reached the ears of the local doctors. Chen Yuxi (pseudonym), a doctor who left a hospital in Jilin Province and went to Shanghai, saidIt's not an overnight thing, it's not a team, it's not a leader's thing, and it's hard to say whether even a hospital can do it on its own. In such a big environment, it is difficult to change the status quo in the real world. 」
Hometown can't accommodate the flesh
If you want to take them away, you have to talk about what they have taken away.
In 2019, some scholars conducted a survey on the willingness of clinicians in 4 tertiary hospitals in Heilongjiang Province to leave their jobs, and the results showed that 536% of physicians have the intention to leave the clinical frontline, of which 422% of doctors believe that it is due to low salaries. Further investigation showed that doctors with an annual income of more than $50,000 had a lower willingness to leave their jobs than clinicians with an annual income of $50,000 or less. [2]
Doctors' salaries vary greatly from region to region. According to the 2022 average wage data released by the National Bureau of Statistics, both in urban non-private units and private units,The wage level is the highest in the east and the lowest in the northeast, with an average wage ratio of 1:068。
2020 salary** calculation results Source: Lilac Talent.
Chen Yuxi, 29 years old this year, said that she graduated from graduate school a few years ago and wanted to stay in the Northeast, and finally chose a first-class hospital, but she was disappointed by the salary: she did not sign a contract during the probation period in the first year, the salary was 1,000 yuan, and 5 yuan of union fees were deducted. The actual amount is 995 yuan. 」
According to her educational background, she thought that she could successfully stay in the provincial capital, even if it was a second-level hospital, even if it was a tired department, I could accept it. The actual hiring situation was different from what she expected. Either there is no recruitment, or there is no establishment, or you need to find people to go through internal channels, and it is indispensable to play up and down, starting with 100,000. 」
In order to be able to accompany her family, Chen Yuxi took a monthly salary of 995 yuan for a year, but after getting married, she still chose to leave the Northeast. My identity is different and I have to think about it more. Chen Yuxi said.
Similarly, in order to attract doctors to enter the bureau, Shenzhen once put up a slogan of 300,000 yuan in annual salary, and gave a one-time living allowance of up to 350,000 yuan according to their academic qualifications to graduates who have obtained training certificates and work in community health centers.
Source: The hospital's official website.
From another dimension, also for the National Regional Medical Center project, the National Children's Medical Center Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine Fujian Hospital (Fujian Provincial Children's Hospital) and Fujian Provincial Maternal and Child Health Hospital (including Wusi North Campus) issued a recruitment notice for department heads, and also said that the salary is negotiable
100,300,000 yuan will be given as a settling-in allowance according to the hospital's talent standards at the corresponding level, housing subsidies or talent apartments will be provided, and problems such as children's schooling will be assistedEquipped with no less than 1 million yuan of scientific research start-up funds. 」
At present, the signing ceremony of Beijing Anzhen Hospital Jilin Hospital has not yet been completed, and the relevant recruitment notice has not yet been released.
Can the spring water flowing into the Tohoku quench your thirst?
At the signing ceremony of Beijing Anzhen Hospital and Jilin Hospital, it was also emphasized that it will work together with Changchun City to devote itself to three aspects, that is, to do a good job in management, technology and brand, and truly realize integrated management and homogeneous development.
Management has also been a major concern for doctors in the Northeast.
A doctor from Liaoning Province said that a few years ago, his brother had the opportunity to go to Beijing Medical University for further study, but he was forced to give up his place under the hospital's rules. Now, the doctor who replaced the senior brother has been given the title of vice president, and Chen Yuxi also mentioned that the hospital needs to be checked from top to bottom.
Similarly, Xu Hui (pseudonym), who works at a prefecture-level city hospital in northeastern China, said that he was shunted to the hospital's oncology department because of the lack of care, which is the last department that doctors in the hospital are willing to go to (the department is located in a mountainous area alone), and he was forced to accept it.
In the years that followed, he felt that his fate was in the hands of the head of the department. He said that he had no right to make decisions at all in scientific research, funding, and experimental applications, and often had to engage in scientific research when he was busy with clinical practice. Xu Hui said that although the population in the northeast is declining, there are more and more hospital jobs.
Data shows that after 2011, the proportion of population in the Northeast region declined, and in 2020, it was as low as 698%, below 1949 levels. But the rate of loss of doctors seems to be faster than the loss of population, for Xu Hui to stay up late and be on duty is commonplace, a large number of patients poured into the hospital, the hospital did not think of any adjustment measures, let the director arrange.
Eventually, as an oncologist, Xu Hui chose to quit his job and go to Shanghai to become a community doctor. I went to Shenzhen, Hangzhou, and Shanghai, and I felt that no matter where I went, I would definitely not be able to stay in the Northeast. I don't want to stay, and my hometown doesn't keep me, sad and helpless. Now he has a stable monthly salary, a fixed day off, and an environment to speak freely.
Studies have shown that if the hospital management system is biased, it will lead to the loss of core talents, including team integration, work autonomy, role clarity, formal communication, work specialization, job matching, internal mobility, distribution fairness, etc. [3]
According to a survey by a tertiary hospital in Shanghai, a total of 127 people left the hospital in 2017 and 2021, and the hospital tried to reform the management system in 2020, requiring a true understanding of the scientific research projects, talent plans, overseas study visits and other training of core talents, and understanding the degree of specialization of department management, and then the turnover rate of core talents increased from 6 in 20207% down to 23%, the effect is obvious. [3]
The study shows that some hospitals tend to focus more on attracting talent than retaining it, often only alerting doctors when they offer to resign. Therefore, for the management translation proposed by Beijing Anzhen Hospital and Jilin Hospital, Liang Lu (pseudonym), who graduated from a medical university in Northeast China and worked in a tertiary hospital in Zhejiang, saidIf we can really learn from the management system and technology of Anzhen Hospital, so that doctors can gain something from their hard work, they may be hopeful, but there are many difficulties that need to be overcome and many chronic diseases to be solved.
When I was in a hospital in Northeast China, everyone saw that gastric cancer was basically operated on, but not in Zhejiang. The Northeast may not be enough to renew its ideas. If you can learn the latest technology of Anzhen, it will be effective in attracting local talent. Liang Lu said.
In 2008 and 2016, through the merger of other hospitals and the establishment of new hospitals, the First Affiliated Hospital of Zhengzhou University attracted a large number of patients to go to the hospital and concentrate on doing great things.
However, Henan Province currently has a population of 98.72 million, and the number of disease sources brought by the demographic dividend cannot be underestimated, and the combined population of the three northeastern provinces is also less than that of Henan. Whether it is the Shenzhen model or the Zhengzhou model, it is very difficult for hospitals in Northeast China to walk. How the pace of Anzhen Hospital will be is also expected by doctors in the Northeast.
On the plane that took off from the Northeast to Fuzhou, Zhenzhen was not so happy. She said that she believes that the departure of her colleagues is more helpless, just like her current mood. She said that she had made a lot of efforts to break out of the world in the south, and she also had to do a good job of showing her local colleagues.
When asked what he thought about the layout of the well-known top three in the Northeast, Zhenzhen said, sincerely bless every doctor in the Northeast.
References: 1] Li Wenjun. Research on the evolution and convergence of regional fiscal medical and health expenditure: 1996-2015[J].Lanzhou Academic Journal,2018,0(4):121-133
2] Tao Siyi, Liu Wei, Hao Yanhua, Song Weijian, Xue Yuxin, Wang Jiahui, Chen Chaoyi, Liang Libo. Analysis on the current situation of clinicians' resignation intention in four tertiary hospitals in western Heilongjiang Province[J].Chinese Hospital, 2020, 24 (06): 35-37
3] Wang Qun, Zhou Jiong, Xue Yunyun, et al. Research on early warning model and intervention strategy of core brain drain in public hospitals[J].Chinese Journal of Hospital Management,2023,43(07):53-56