Chen Jing, a pediatrician in Hainan Maternal and Child Health Hospital, will go out early every time he comes to the clinic. She went to work one hour in advance in the morning, postponed one hour in the afternoon, and canceled her lunch break at noon. However, she was like a war when she came all the time.
In fact, the five pediatric doctors in the pediatric clinic of Hainan Maternal and Child Health Hospital are almost like Chen Jing. They are overloaded every day, and some even receive more than 100 patients a day. Behind the overload of pediatric doctors in Hainan is a national phenomenon facing the current medical system: the shortage of pediatric doctors.
According to the data of China Health Statistics Yearbook in 2015, in the past five years, the total number of pediatric doctors in China has dropped from 105000 to 100000, with an average of 0.43 pediatric doctors per 1,000 children. The shortage of Pediatrics doctors has become a pain point from the industry to ordinary people.
After the comprehensive two-child policy is released, the shortage of Pediatrics doctors will further intensify. In Hainan, this shortage situation is particularly obvious: there are 551 pediatric practitioners in Hainan, while the number of children aged 0 to 14 is 1.76 million, on average, every pediatrician has to bear the health of nearly 3200 children.
From 7 a.m. to 7 p.m., she saw 103 children.
At 7:30 in the morning, Chen Jing’s clinic was crowded with a long row of parents of children.
Although he is not yet a senior expert, Chen Jing still faces at least 50 or 60 parents of children from Haikou and other cities and counties every day.
“This period of time is quite good. In the winter of last year, Hainan Pediatrics was full of explosion, which directly forced the hospital to bear the limit.” She clearly remembered that in the winter of last year, Hainan was cold and hot, and it was cloudy and rainy days. The children who came to see the doctor were one after another. From 7 a.m. to 7 p.m. that day, she saw 103 children. “After work, you can’t drive at all. You are too nervous, too tired, and you have no strength to step on the accelerator.”
After working in pediatrics for 11 years, Chen Jing worked night shift for 9 years, once every four or five days, from 4:30 p.m. to 8:00 a.m. the next day. There was only one doctor on the night shift. At peak, she had to face 70 or 80 patients. “After the night shift, I didn’t want to move. I slept with my clothes in the duty room before I recovered.”
Such work intensity means that there is no concept of 8-hour work. According to the pediatric regulations of many hospitals, doctors on duty for 24 hours need to go out of the clinic the next morning and work continuously for more than 28 hours. “You can’t put down all your work to rest on weekends. Even if you are not on duty, you have to transfer to the ward.” Chen Jing smiled bitterly.
High pressure makes many people choose to escape. This makes the shortage of paediatricians worse. In 2016, two colleagues of Chen Jing resigned. But the recruitment of pediatric doctors has always been a difficult problem for the hospital. In recent years, Hainan Maternal and Child Health Hospital has been recruiting almost every year, and it is facing the whole country, but it often “returns without success”.
Unable to retain people, unable to recruit people, resulting in the extreme lack of Pediatrics doctors.
Lin Yunyan, human resources department of Hainan Maternal and Child Health Hospital, provided a set of data to reporters, reflecting the current shortage of Pediatrics doctors in Hainan province.
The shortage of paediatricians is a national problem, especially in Hainan. According to statistics, there are 4.063 million outpatient and emergency departments in hospitals in Hainan, accounting for 12.8 percent of outpatient and emergency departments in medical institutions in the whole province; 94900 pediatric inpatients, accounting for 9.8 percent of the total number of inpatients in the whole province, on the contrary, there are 551 pediatric medical practitioners, accounting for only about 4.56 percent of all doctors in the province.
“It is reasonable to say that in the top three hospitals in the city, medical students have to go in to sharpen their heads, but Pediatrics is an exception. This is the final choice of medical students-other departments can’t get in, and they can’t go to pediatrics until they can. Some people even prefer to go back to the county hospital to do other subjects rather than Pediatrics.” Lin Yunyan was helpless.
High pressure, more grievances and less income
At 10:50, Chen Jing, who had been working for nearly 4 hours, got up for the first time. She wanted to do laser treatment for several children. “The child still has classes later!” “The child needs a blood test and hasn’t eaten yet.” Why do you add so many numbers?” Parents waiting anxiously often complain.
Sometimes, in the corridor, parents’ complaints and children’s sharp and endless crying reached high scores, which made Pediatrics form a special landscape.
“At the end of the day, my mind is covered.” Some medical staff in the department said.
In fact, it is an open secret in the industry that the “scarcity” of Pediatrics doctors is caused by overload work, more grievances and less income.
Pediatrics is called dumb department. Children are not well expressed, their condition changes quickly, and they do not cooperate with treatment. In most cases, doctors need to judge their condition according to rich experience and children’s symptoms, and misdiagnosis is inevitable, the risks and pressures are extremely high.
Generally, children are at least accompanied by their parents when they get sick, and what’s more, parents and 4 elderly people come together. “Now a child is sick, and there are often six parents standing behind it. Doctors not only have to repeatedly answer all kinds of inquiries from grandparents and grandparents, but also the child’s condition changes slightly. Parents with impatient temper will be emotional and even punch and kick.” Chen Jing calculated roughly that one third of the medical staff in the department had been pushed and beaten.
Compared with doctors in other departments, the income and treatment are not high, which is also a real problem faced by Pediatrics doctors.
A pediatric doctor in a municipal hospital who did not want to be named said frankly that compared with other adult departments in the hospital, such as obstetrics and gynecology, general surgery, etc., doctors with the same qualifications as her, the monthly income is about 2000 or 3000 yuan more than that of her, and the income is totally not proportional to the payment.
The pressure, grievance and low income lead to the increasing “scarcity” of Pediatrics doctors “.
Xing Kaihui, a pediatric doctor of Hainan Maternal and Child Health Hospital, told the reporter that both her undergraduate and graduate students studied pediatrics. During her undergraduate course, there were 79 students in the two classes of Pediatrics. After graduation, all 30 boys were transferred to surgery and other fields. Many girls turn to gynecology and other fields. Finally, only about 20 students in the two classes were engaged in pediatrics, accounting for about 25%.
Doctors have low treatment, high work intensity, poor medical experience and prominent conflicts between doctors and patients. This vicious circle makes medical students discouraged from Pediatrics.
It is urgent to find a way to crack
At 01:10, the corridor of the pediatric clinic of the hospital was still crowded with parents. The nurse walked into the clinic, stopped the patients who were still waiting in line and said, “it’s been a whole morning, and the doctor is going to have dinner.” But 32 minutes later, Chen Jing finished the one-day visit.
She sat in the lounge less than 10 square meters next door, huddled with two medical staff and stuffed a mouthful of instant noodles into her mouth. At this time, the noodles could not be lifted, this was made for her by the nurse an hour ago, and it was also her lunch for many years.
“Pediatric doctors don’t need sympathy. Doctors in any department work hard, but with the arrival of the second child era, these problems really deserve the attention of relevant departments.” Chen Jing said.
In fact, the competent department in Hainan has obviously realized the severity of the “doctor shortage” in pediatrics, and has tried many measures to solve the urgent shortage of Pediatrics doctors.
“Targeted training may be a way to save the emergency.” The person in charge of the maternal and child department of Hainan Provincial Health and Family Planning Commission said.
In 2015, the first batch of 80 “rural orders” free medical students in Hainan province will graduate to work in township hospitals. At the same time, in order to strengthen the construction of rural doctors in Hainan and better meet the health needs of rural residents, the targeted free training project for rural doctors has been carried out since 2014.
The person in charge believes that, like training rural doctors, order-based training of pediatric doctors is currently the most feasible way.
“The shortage of Pediatrics doctors is a universal problem in the country. It is suggested that colleges and universities with conditions at the national level should set up pediatrics majors separately and train Pediatrics doctors in remote provinces such as Hainan. Increase the enrollment scale of pediatrics in the standardized training of resident doctors.” In Chen Jing’s view, while calling on medical colleges to resume the pediatric major, relevant experts also hope to respect and understand the pediatric doctors and tilt in salary distribution.
At the same time, due to the shrinkage of Pediatrics in these years, the existing Pediatrics doctors are concentrated in the top three hospitals, and the strength of community and level two hospitals needs to be developed.
“Children suffering from common diseases and frequently-occurring diseases can enjoy the same medical services in pediatric hospitals in the hospital at home, which can eliminate the pain of patients waiting for a long time in the big kids specialized hospitals, it can also alleviate the contradiction of shortage of Pediatrics doctors.” Chen Jing said.
In order to solve the “shortage of Pediatrics, previously, Hainan Maternal and Child Health Hospital had proposed strategic cooperation with Hainan Medical College. One of the important contents was to hope Hainan Medical College could set up the Department of Pediatrics and the Institute of maternal and child health. Relevant departments also guide and support social capital to give priority to investing and holding medical institutions related to pediatrics, allowing social forces and public hospitals to build new children’s hospitals through franchise entrusted management and other methods.
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Chen Jing, a pediatrician in Hainan Maternal and Child Health Hospital, will go out early every time he comes to the clinic. She went to work one hour in advance in the morning, postponed one hour in the afternoon, and canceled her lunch break at noon. However, she was like a war when she came all the time. In fact, Hainan province