General practitioner: Why is the health "gatekeeper" absent?
In recent years, doctors in pediatrics, emergency department, anesthesiology department, psychiatry department and other professions have been in urgent need frequently, which has aroused widespread concern in society. On February 25th, at the first meeting of the Expert Committee on General Practitioner Education and Training of Chinese Medical Doctor Association, Academician Zeng Yixin, chairman of the Committee and president of Beijing Hospital, pointed out that the demand for general practitioners was in short supply and the level needed to be improved. If it is not solved, the people's dilemma of "difficult to see a doctor" cannot be broken!
The number is small and the level is generally not high, so it is difficult to retain patients.
General practice is a concept introduced from abroad in the late 1980s, and it is still unknown. Zeng Yixin explained that compared with specialists in large hospitals, general practitioners are also called family doctors, and they mainly undertake integrated services such as preventive health care at the grassroots level, diagnosis, treatment and referral of common diseases and frequently-occurring diseases, patient rehabilitation, chronic disease management and health management, so they are also called "gatekeepers" of residents' health.
At the grassroots level, people need this kind of "general practitioner" most, but it is extremely scarce at present. According to Qin, director of the Science and Education Department of the National Health and Family Planning Commission, by the end of 20 14, the number of general practitioners trained nationwide was only 6% of the total number of doctors, while that in developed countries such as Europe and America was about 30%. He pointed out that according to the goal of having 2 to 3 qualified general practitioners per 10,000 urban and rural residents by 2020, China needs about 280,000 to 420,000 general practitioners. "Even according to the goal of 300,000 people, there is still a shortage of130,000 people, and at least 26,000 people need to be trained every year."
At the meeting, more than 50 experts from the General Practitioner Education and Training Committee of the Chinese Medical Association were even more worried that general practitioners were still facing the problem of low general level. At present, about 40% clinicians in urban communities have college education; About 84% clinicians in township hospitals have college or technical secondary school education, and most of them become general practitioners through job-transfer training.
Ceng Yixin pointed out that among the current total number of general practitioners, there are very few doctors who have studied medicine for five years and passed the standardized training of general practitioners for three years, that is, the so-called "5+3" general practitioners, and their diagnosis and treatment level is higher than that of general practitioners who have been trained for job transfer.
It is urgent to improve the training system and improve the level of diagnosis and treatment.
How to keep patients in primary hospitals, let large hospitals return to academics, and diagnose and treat intractable diseases is also one of the key points of current medical reform. In Ceng Yixin's view, in addition to the current grading diagnosis and treatment policy, the "human" factor is very important. "The key is to train a team of high-quality general practitioners with formal medical education and general training as soon as possible to provide talent support for' strong grassroots'."
Ceng Yixin said that at present, China mainly trains general practitioners through job transfer training, "3+2" resident training, "5+3" resident training and rural order orientation, and there are more than 599 national general practitioner training bases. "The base mainly relies on experts from top three hospitals to train students. Specialist doctors generally lack the concept of general practice and will habitually train students with specialist thinking. " Ceng Yixin stressed that this training awareness needs to be changed.
At the same time, some bases do not pay enough attention to training, and the level of teaching teachers needs to be improved. "If you can't teach qualified students, how can you let the people go to the grassroots to see a doctor?" Ceng Yixin believes that the Committee should make efforts in this regard.
Yanling Zhang, president of Chinese Medical Doctor Association, thinks that the training system of general practitioners in China is not perfect, especially the teachers are weak. There are not only shortages of theoretical teachers, clinical teachers and community base teachers in colleges and universities, but also problems of insufficient teaching ability and low training quality. He stressed that the expert committee should take strengthening teacher training as the top priority to improve the quality of general practitioner training, formulate teacher standards and assessment standards as soon as possible, and promote the system of teacher access and certificates.
The lack of attractiveness of posts is the key to retaining talents.
Like pediatricians, general practitioners also face the problem of low treatment. "Not only that, general practitioners have to face many problems, such as difficult promotion of professional titles, unclear career development path and imperfect related supporting policies." Qin Xiang pointed out.
It is understood that the National Health and Family Planning Commission had planned to recruit 1000 general practitioners in 2065,438+05, but the registration was not enthusiastic. "The most important reason is that the job prospects of general practitioners are not optimistic." According to Ceng Yixin's analysis, job attraction can be divided into salary, career development, incentive mechanism, employment environment and social status.
Academicians and experts such as Ceng Yixin, who have been concerned about general practitioners for many years, suggested that 654.38 million general practice posts should be set up at the grassroots level, and two posts should be set up in township hospitals and social health service centers. The establishment of posts is specially determined by the state, and the county is responsible for rural use. In addition to normal income, the state grants personal special allowance of 654.38 million yuan every year.
There are more than 900,000 primary medical and health institutions in China's medical service system, and they need qualified general practitioners most. However, about 80% of general practitioners are located in communities in large and medium-sized cities, and the grassroots in the central and western regions only account for less than 20%.
Although the central government has given unprecedented support to the training of general practitioners, it has invested 9.5 billion yuan to build 599 clinical training bases for general practitioners; Invest 2.8 billion yuan in the capacity building project of general practitioner training base; Establish a regular subsidy mechanism for standardized training of residents, and the subsidy standard is 30 thousand yuan per person per year. However, in the opinion of experts, if the job attraction is not improved, the situation of not recruiting interns and not retaining general practitioners will still exist for a long time.
With the aging of population and urbanization of lifestyle in China, the spectrum of diseases has changed greatly, and chronic diseases have replaced infectious diseases as the main cause of death. Ceng Yixin pointed out that the change of disease spectrum requires that the focus of medicine must be shifted downwards, and attention must be paid to prevention and health management, and to the emotional and psychological needs of people. General practitioners can undertake such changes, and they can play a fundamental role in alleviating the difficulty of seeing a doctor in a big hospital. "It is urgent to strengthen the construction of general practitioners."