Great leap facing general practitioners#Oriental Outlook#-Sino-US


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Great leap facing general practitioners

 

Lines are always long at the large hospitals, and people are eager to see a specialist at large hospitals, which has given opportunities to the scalpers who would earn some money for patients to get registered at specialists.

Generally, people who get mild diseases will go to the community hospitals, rather than large hospitals, but still lots of people flock to large hospitals even when they got a cough. One reason is that lack of medics at the primary level.

Following people’s living conditions improved, people have longer life and lots of them have chronic diseases. These patients need general practitioners by their side to provide necessary services, which will be cheap for them.

In the nineteenth issue of 2018, Oriental Outlook magazine under Xinhua News Agency ran a cover story on the general practitioners, pointing out their missions, problems they faced and that more efforts are needed to enlarge the group.

Below is an excerpt of the article.

In China, general practitioners are totally new for both patients and doctors. Only “barefoot” doctors in 1980s, who seemingly knew all kinds of diseases and walked to provide services, were close to the role of general practitioners.

Following the development of the country’s health care sector, the demands on the general practitioners who received formal education and training started to emerge.

General practice would provide basic medical services on common and frequent diseases, and it focused more on providing basic public health services including preventive health care and chronic diseases control.

Through promoting people’s health awareness and ability to prevent diseases, general practitioners will help people prevent the diseases from happening and worsening. From this angle, general practitioners are people’s heath gatekeepers.

From 2009, China has launched a new round of medical reform, the core is to improve the tiered medical services, providing medical services in order of priority. Medical institutions shoulder medical treatment on diseases at levels, fulfilling community first-treatment and two-way referral.

There is little doubt that the tiered medical services would help allocate medical resources adequately, promoting equal access to basic public health services for all, which is significant for improving people’s health, ensuring and improving the livelihood of the people.

If the system of tiered medical services will reach an ideal state, the core is the primary-level medical services. Community health centers currently shoulder the first-treatment at primary level, and general practitioners are the core strengths.

While the country’s medical system reform progressed, it has become an urgent need to establish a general practitioner system with Chinese characteristics, and China has quickened its pace in building teams of general practitioners.

In 2010, China has started training medical workers in large hospitals to work at community centers as general practitioners. From 2011, the State Council, the country’s cabinet, and top health authorities have issued series of policies for building a system of general practitioners.

In January this year, the State Council has published guidelines on an incentive system of fostering and using general practitioners, noting the importance of expanding the prospects of general practitioners to attract talents.

The team building of general practitioners has entered a fast lane.

Data from National Health Commission shows that by the end of 2012, China had 110,000 registered general practitioners, a ratio of 0.81 for every 10,000 people, and by the end of 2016, China had 209,000 registered general practitioners, a ratio of 1.51 for every 10,000 people.

In four years, the number of general practitioners has almost doubled. But it is still far away from the guidelines issued in January that says “by 2030, there will be 5 general practitioners for every 10,000 people,” which means half million more general practitioners will be needed.

The gap is just the great force to drive the development of general practitioners. Following the expansion of general practitioners, they will act as the footstone of China’s medical and health undertakings, and have a bright future.

Gatekeeper

The concept of general practitioners was brought into China in 1980s, but hospitals and colleges all did not have the independent departments.

“When students were sent to large hospitals, they would develop into a specialist in a field, and if they were sent to township hospitals, they would shoulder the work of general practitioners,” Ke Yang, former vice president of Peking University said.

In January 1997, the State Council issued the document on the medical reform and development, definitely putting forward the requirements on speeding up the development of general practice and training general practitioners.

“It is for the first time that general practitioners appeared in a government document, becoming a new development requirement,” Ke said.

Meanwhile, the government has made plans to establish basic health service institutions in communities to meet people’s demands on basic medial services in urban areas.

Hospitals run by sub-districts started to turn to community health service centers, and the doctors at these hospitals received trainings to become the country’s first batch of registered general practitioners.

Besides, many doctors at large hospitals have been encouraged to become a general practitioner at community hospitals.

Xu Gaojie, who used to work in Renji Hospital in Shanghai after graduation in 2006, is one of the doctors receiving trainings to become a general practitioner at community hospitals.

Xu said he made the decision to become a general practitioner when he worked at the emergency department. “Many patients there suffered diseases at middle and late stages, and it is not ideal to treat with such patients, even though Renji Hospital has good conditions,” he said.

He realized that many patients were in late stage of diseases because of the bad medical services at communities, and the chronic disease control was not good to cause the disease worse step by step.

In May 2011, after four-month trainings, Xu became a general practitioner at Dongming community health service center, Pudong New district in Shanghai. And now, he serves as the deputy head of the center.

The first batch of general practitioners, like Xu Gaojie, had to explore pairing services for residents, knowing their real demands. Different from doctors at large hospitals, they need to be more patient and in a slow pace.

Gradually, they realized that they are more like health keepers, and except for medical services, they will offer comprehensive services for families and communities. They set health files for patients and families, providing unique services for different people, especially for elderly people.

In June 2016, the central government issued guiding opinions on promoting family physicians to provide contracted services. The documents said that in 2017, contracted services should cover 30 percent of residents.

“Now, contracted services have become the major work mode in communities, more and more general practitioners play a role of ‘health gatekeeper’ through this mode,” Li Ruili, secretary general of Community Health Association of China.

Individual development

Since community health service center shoulders more and more basic public health services, such as health education, vaccinations and medical services for children and the elderly, general practitioners have less energy in specialty.

Hu Yurong, deputy head of Dashijie community health service center in Panyu district of Guangzhou, said that general practitioners became busier due to the added services, such as contracted services, and they had to produce files, formats and summaries. “The work is very tedious.”

A general practitioner who declined to be named said that having so much routine work to do, he did not feel he was a doctor still, and the tedious work has eroded professional honor as a doctor. “Doctors should inject more energy in improving their ability in diagnosis and medical treatment.”

More work does not mean more earnings, and in fact, the income of general practitioners did not increase and kept at a low level among doctors.

“A general practitioner in Beijing could earn about 80,000 yuan to 100,000 yuan a year. The low salary has become an important reason for the difficulty in expanding the team of general practitioners,” Li Ruili said.

Further, Li also said that different from doctors in other fields, the country does not have an advanced professional rank for general practitioners, and their promotion was also in a plight.

Some cities, such as Shanghai and Guangzhou, have started exploring incentive mechanism on general practitioners.

Xu Gaojie, born in 1983, said that Shanghai has set special appraisal plans for general practitioners, such as lowering the standards on English and papers, when they apply for professional ranks.

Great pressure still exists in building the team of general practitioners. Especially by 2030, half million new general practitioners needed to be added.

“It means 40,000 qualified general practitioners are needed every year, but 70 colleges with general practice department could foster less than 1,000 graduates a year,” Chi Chunhua, a professor at Peking University Health Science Center.

To meet the goal, China has provided programs of shortened learning time for general practice students from 5 plus 2 years to 3 plus 2 years, and training programs for medical workers at community health service centers.
 


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