Great changes have taken place in the practice system of Chinese physicians!

Author: Xu Yucai

On July 28, 2005, "China Youth Daily" disclosed the main content of the research report of the "China Medical and Health System Reform" research group

Since then, the prelude to a new round of medical reform has been opened

In September 2006, the country officially launched a new medical reform

In January 2009, the State Council executive meeting passed the "Opinions on Deepening the Reform of the Medical and Health System" and the "2009-2011 Implementation Plan for Deepening the Reform of the Medical and Health System", and a new round of medical reform was officially introduced

On March 17, the new medical reform plan was issued as Zhongfa No.

For more than 10 years, the new medical reform centered on solving the problem of people seeking medical treatment can be described as magnificent and turbulent

One of the new medical reform review series of "Seeing the Doctor": The doctor's practice system has undergone tremendous changes!

Regulations of "Practicing Doctors Law" on the practice of doctors

On June 26, 1998, the Third Meeting of the Standing Committee of the Ninth National People's Congress passed the Practicing Physician Law of the People's Republic of China (hereinafter referred to as the "Practicing Physician Law", which came into effect on May 1, 1999)

The "Practicing Physician Law" stipulates that the state implements a medical practitioner registration system

On July 16, 1999, the Ministry of Health promulgated the Interim Measures for Physician Practice Registration by Order No.

If a doctor changes the registration matters such as the place of practice, the type of practice, the scope of practice, etc.

Careful people may have noticed that the "Interim Measures" only clarifies the location and type of practice, but does not specify the scope of practice.

It was not until June 20, 2001 that the Ministry of Health and the State Administration of Traditional Chinese Medicine issued interim regulations on the scope of practice in physician practice registration

Taking into account the peculiarities of the practice of clinicians in medical institutions at and below the county (mainly township health centers and community health service institutions), the "Interim Measures" stipulate that the work of primary medical and health services is required by the county-level health administration.

At the same time, it is stipulated that emergency medical rescue is provided to patients; clinicians are transferred to clinical departments in accordance with the "Regulations on Standardized Training of Residents" and "Trial Measures for Standardized Training of General Practitioners"; in accordance with relevant national regulations, after medical treatment, prevention, and health care Health support for agriculture, consultations, advanced studies, academic exchanges, tasks assigned by the government, and free consultations approved by health administrative departments approved by the institution; other circumstances stipulated by health administrative departments at or above the provincial level are not considered to be out-of-scope practice

However, the "Interim Measures" put forward the separately formulated "Regulations on the Management of Physicians' Practice Places in Two or More", we have not seen it

Since the new medical reform, physicians have explored more practice

The new medical reform plan in 2009 did not forget this

Since then, the exploration of doctors' multi-point practice has not stopped
.

In September 2009, the "Notice of the Ministry of Health on Issues Concerning the Multi-point Practice of Physicians" (Weiyizhengfa [2009] No.
86) clarified that if a physician is hired to practice in two or more medical institutions, he shall obtain approval from his work unit and the relevant health administrative department.
Approved
.

In July 2011, the General Office of the Ministry of Health "Notice on Expanding the Pilot Scope of Multi-point Practice for Physicians" (Weiban Yizheng Fa [2011] No.
95) was issued, which listed four conditions for applying for multi-point practice, that is, having an intermediate level or above.
Technical qualifications, consent of the first place of practice, good health and ability to perform multi-point practice, other conditions stipulated by the health administrative department of the pilot area
.

In November 2014, the National Health and Family Planning Commission, the Development and Reform Commission, the Ministry of Human Resources and Social Security, the Bureau of Traditional Chinese Medicine, and the China Insurance Regulatory Commission jointly issued the "Several Opinions on Promoting and Regulating the Multi-point Practice of Physicians" (Guoweiyifa [2014] No.
86), The restriction on the number of practice locations has been cancelled, and the feasibility of implementing record management can be explored
.
Where conditions are ripe, you can explore the implementation of regional registration
.
However, for public hospitals who hold hospital-level leadership positions, it is stipulated that "generally not"
.
"Contract management" is implemented for doctors' multi-site practice, but it still needs to "consult and agree" with the medical institution of the first practice site
.

In July 2015, Shenzhen doctors' multi-point practice was released.
Starting from May 2016, Shenzhen registered doctors no longer need to go through the approval of the first practice site when they apply for multi-point practice
.
After the filing procedures are completed, the "Shenzhen Physician Practice Management System" will automatically feedback the multi-point practice situation to the medical institution in the first practice location
.

However, just as the policy was gradually liberalized, some large hospitals “slayed” doctors who practiced at multiple locations
.

In June 2016, two ophthalmology directors of well-known top three hospitals across the country were dismissed for multi-point practice because of "multipoint practice in many private hospitals in Beijing without the approval of the hospital, which violated work discipline and system
.
"

In March 2017, Hu Yiwen, director of the Department of Psychiatry at Tianyou Hospital Affiliated to Wuhan University of Science and Technology, became a victim again.
He was removed from the post of director of the Department of Psychiatry at Tianyou Hospital for "part-time" at Wuhan Wuzhong Psychiatric Hospital
.

Proposal of regional registration system for physicians

On February 28, 2017, the "Administrative Measures for Physician Practicing Registration" was revised, and the new measures came into effect on April 1, 2017
.

The method has three provisions that are very eye-catching: First, it has implemented a regional registration system for physicians
.
That is, a doctor’s practice location is no longer a certain medical institution, but a certain province or a certain county; the second is that doctors who plan to practice at multiple locations no longer need the consent of the first practice location, only the second, The third practice institution shall file with the health administrative department that approved the practice of the institution; third, the registration information of doctors shall be changed online
.

However, in the actual implementation process, there is still room for breakthroughs
.
One is that while the practice registration policy is being released, there is always a "first place of practice"; the other is that individual doctors are an obstacle to multi-point practice.
On the one hand, doctors are still in the work unit, not in society.
They have no "personal" freedom.
They are not equal to the work unit.
They need the consent of the hospital.
The real multi-point practice is still on the way
.

Because of this, in fact, the "Registration of Physicians" proposed in the "Administrative Measures for Physician Practicing Registration" is still restricted under actual conditions
.
In this regard, there are also "restrictive provisions" in some subsequent policies and regulations
.

The "Fourteenth Five-Year Plan for National Economic and Social Development and the Outline of Long-Term Goals for 2035" clearly stated that the regional registration of physicians will continue to be implemented and the practice of physicians in multiple institutions will be promoted
.

The "Physician Law" stipulates that if a practicing doctor practices in two or more medical and health institutions, one of the medical and health institutions shall be the main one, and the formalities such as change registration and filing shall be handled in accordance with relevant national regulations
.
It can be seen from this rule that multi-institution practice of doctors is legally permitted, but one institution must be identified as a "main practice institution", and procedures such as change registration and filing must be handled in accordance with the regulations
.

What needs more attention is that the "Physician Law" also stipulates that in violation of the provisions of this law, doctors who practice outside medical and health institutions permitted by law, or practice beyond the registered practice location, practice category, and practice scope, shall be administered by the people's government at or above the county level.
The health department or the Chinese medicine department shall order corrections, give warnings or order the suspension of practice activities for more than six months but less than one year, confiscating illegal gains, and imposing a fine of 10,000 yuan to 30,000 yuan; if the circumstances are serious, the physician’s practice shall be revoked Certificate
.

This provision is actually a severe punishment for failing to go through the multi-institution registration formalities as required, “practising outside a legally permitted medical and health institution” or “practising beyond the registered practice location”.
In severe cases, the physician can be revoked.
Practicing certificate"
.

Obviously, the "Physician Law"'s strict regulation of multi-institutional practice of doctors also reminds doctors that it is very dangerous to "go acupuncture points" without going through the procedures
.
If you really want to practice multi-institutions, you must go through the registration procedures in accordance with the regulations .

Looking at the new medical reform for more than 10 years, what we can see is that the physician practice system has undergone a fundamental change, although from the current situation, whether it is law or policy, it may be difficult to practice unlimited multi-institution practice
.
However, as more and more doctors are no longer nostalgic for the establishment and enter the market to become freelance doctors (not freelance doctors), open clinics, hospitals, or form doctor groups, the practice status of Chinese doctors is ushering in Great change
.