Young doctors under the impact of the price slash on supplies

This is a coffee shop opposite the hospital.
like other cafes, noon is its peak.
Not the same, in a full cafe, some callers talking about business point to the other side of the phone, referring to high-frequency words such as "bracket" and "surgery" to make people realize that the cafe is actually open across the street from the hospital.
(ad.m.) appeared, it was 11:02 p.m.
he was an orthopaedic doctor who had just come off the operating table, and he said sorry several times for being late for the next two minutes.
-to-minute view of time is the habit of his profession - two minutes, a time to brush a news line for ordinary people, a golden rescue period for doctors, probably a life-related one.
he was not wearing a white coat, black jacket, jeans, paired with a pair of sports shoes, looks like a college student.
also accompanied by his college classmates, are also doctors, one is the endocrinology department of Liu Yu (analyte), the other is the heart of the money Mu (analyte).
they worked at a triple-A hospital in the southern city, all in their 30s.
even if they are not wearing white coats, in the coffee shop leisurely crowd, you can feel that they are doctors, they always have a "hasty" temperament.
indeed, they are busier than ever towards the end of 2020, a busy half-year period.
In order to catch up with the "underdaught" workload of the outbreak, hospital chiefs are anxious to supplement the hospital to maintain the operation of the necessary "flowing water", the first half of the almost completely closed public hospitals, from the second half of the crazy high-speed operation.
their classmates in other cities, the clinic opened a two-day clinic and extended the registration deadline from 11:30 p.m. to 12 p.m.
they are not only college classmates, but in the past few years, even in the same hospital, their contacts are not much.
because busy, but also in different departments, 30 years old, also not always need to party to recall the age of youth.
But recently, they have a new common topic: national drug belt procurement (here is the drug collection) from last year and national high-value consumables belt collection since the beginning of this year, where they are located in the endocrinology, orthopaedics, which are the key departments involved in the reform.
the effects of drug collection and consumables collection may be only income compared to those of highly senior doctors.
and reduced income will not affect their lives or the future for 2000 people who have completed the highest level of career advancement and already have a sufficient and stable life.
But for Li Zhen, Liu Yu and Qian Mu, the young doctors who have just finished their busy and lowest-earning inpatient phases and have been promoted to the primary doctor for less than a few years, the reforms have affected not just the immediate life, but also the planning for the future, and the impact and re-establishing of values.
have a common life trajectory, this year seems to be particularly in need of communication.
they've been talking more in 2020 than they've talked about in the past few years.
Not a good year: busy, fine and patient complaints endocrinologist Liu Yu, when it comes to the past few months when the state collected drugs into the hospital, the hospital in order to complete the volume of procurement indicators, the computer system is always suddenly unable to open the original drug, still some anger.
"We are also very confused, also do not give us a notice, metformin's original research drug suddenly gone."
"he can't accept, is some patients do not understand.
In his outpatient experience, the better talk is the elderly, this part of the patients accounted for the majority of the entire medical population, most of them have one or several chronic diseases, the monthly income is not much, but the cost of medicine is quite a lot, when the price of the drug fell, especially when a box of twenty yuan of Bai Tangping (Acapo sugar original research drugs), replaced with a more money Acapo sugar belt procurement of the winning domestic capsules, they not only accept, but also happy.
for most elderly chronically ill patients, national harvesting is an obvious "good thing" for them.
But what affects doctors is always that part of the "difficult" patients, especially some young patients, directly to the hospital to ask only to open the original research drugs, never accept alternatives;
sometimes, a day to meet such a patient, the doctor a good mood of the day is gone, in the face of patients' doubts and scolding, Liu Yu has not been able to immediately calm their inner depression.
In fact, doctors do not know that the hospital "one size fits all" will collect the unseeded varieties of drugs suddenly stopped, some provinces and cities of health insurance, drug supervision and health care system has jointly issued a message, not only do not support, but also prohibit hospitals to do so.
but one-size-fits-all drug suspension is the simplest way for hospitals to complete the volume purchase target.
Even when the original medicine required by the common people appears in the hospital's prescribing system, doctors are afraid to prescribe more - because hospitals will have an average prescription assessment, if the doctor's average prescription exceeds the standard, still have to be fined.
Li Jin's orthopaedic clinic, the first half of the year because the average prescription exceeded the standard, was punished by the hospital once.
specific punishment is to withhold the performance of the entire department, if the outpatient ten doctors are over-charged, the hospital will withhold the entire department a sum of money.
department to see how much each person exceeds the standard, more than the deduction.
, the entire orthopaedic clinic was fined $200,000, and the largest number of people withheld $20,000 - almost the entire month's bonus.
first half of the year, the outbreak almost shut down hospitals.
Doctors only pay basic wages, the basic salary of the attending doctors fluctuates around 10,000 yuan, and the bonus, which accounts for more than half of their total income, stops directly until the second half of the epidemic subsides and the hospital enters a normal state before slowly recovering.
Doctors slowly recovering behind the payroll, there are still difficult to understand at their level of difficult to understand the dilemma: after the outbreak of public hospitals, in the outbreak led to a reduction in business volume, coronary stents, drug collection policy impact, most hospitals to maintain operations of the flow of water can not last for several months, the deans' anxiety, into some hospital medical behavior changes.
Li Zhen, Liu Yu and Qian Mu, suddenly found that the department's hospitalization time and examination rules have changed: the original to be hospitalized for 7 days of patients, now reduced the length of hospitalization to 5 days;
later, they learned that some patients were now discharged from hospital when they returned to 80 per cent, in order to increase the hospital's bed turnover and increase hospital revenue.
Of course, to improve the hospital turnover rate, shorten the average number of days in hospital behind, in addition to the hospital to improve income considerations, there are in the past health care, health insurance and other complex indicators of the assessment of the direction, but ultimately the hospital in the near future has produced such a big change, the main reason is still from income pressure.
more examinations, in the eyes of doctors, in order to hedge the decline in hospital business throughout the year, the decline in drug, consumables revenue, but also under special pressure of the hospital secretly an option.
" In the past tendonitis or gliocarditis these soft tissue diseases, even filming is not used, senior doctors know what is wrong with each other, but now, patients will have some more ultrasound;
even in this environment, Li really still feels a little insanity.
" before the hospital inspection has been more standardized, do not give patients more open examination will not open.
"He wants this to be temporary," and perhaps the anomaly will disappear when the outbreak is over.
" crown stent collection: the operating room's crown long stent, how disappeared? The first batch of crown bracket national collection boots, just landed on November 5th.
doctors in the department of internal surgery, the news that more than 10,000 coronary stents had dropped to more than 700 yuan, heatedly discussed for a few days, gradually restored calm.
but Qian Mu strangely discovered that the long stents available in the operating room, like human evaporation, disappeared from the hospital over the next month.
In the tens of thousands of bracket windfall period, compared to the short bracket, long bracket cost more than that point of material costs, whether manufacturers or agents are negligible, unified brand of long bracket and short bracket, the same price.
But into the era of 100 yuan bracket, the average price of 10,000 yuan bracket down to 700 yuan, and the lowest bid price is only 469 yuan, long bracket out of the material cost, in the eyes of manufacturers and agents become "sky price."
patient's blood vessels are stenosis, how long a stent is needed.
the length of the bracket is the same as the shoe size, whether it is 42 yards of feet, or 45 yards of feet, as long as the selection of a shoe, pricing is uniform.
but in the case of a sharp drop in profit margins, manufacturers prefer short brackets with small profits and multiple sales.
in their view, no matter how big the lesions, short stents are always useful, and long stents are not necessarily.
long stent disappeared, so that the original habit according to the length of the lesions to choose the bracket money Mu is very helpless.
" originally a lesions, to 38 mm stent, but a question, the hospital is gone, now can only give patients two short stents.
" only short stents, resulting in the original coronary lesions of patients, can only be treated by multiple stents, the difficulty of surgery for doctors will increase.
this episode in qian Mu's heart, in the patient side for the time being did not cause too many reactions.
price reduction of the crown stent, so that patients waiting for the stent after New Year's Day pile up, will also release some patients to install the crown stent needs.
there will be some complaints, he felt that the number of operations increased, the difficulty of the operation also increased, but the cost of surgery did not increase.
Sumable pre-harvest income, after the collection of income halved they some say not to export, but the real existence, and even once became the unrecosted existence of supplies "kickbacks", is a part of their income can not be ignored.
although the national volume procurement of orthopaedics has not yet been opened, Li Jin can anticipate the change of his income from the feeling of Qian Mu's experience of coronary stent collection.
In public hospitals, the composition of doctors' income is divided into two parts, one is the basic salary, the other part is the hospital to the department of a bonus, the department again according to the title and years of service, according to each doctor's outpatient workload, surgery, examination and inspection workload, to assess each person's bonus performance.
for surgeons like Li Jin, the basic salary of the attending doctor is about 5000-6000 yuan, with the cost of surgery and examination accounting for the majority of the bonus.
but doctors don't earn much from an operation, they tend to work a lot.
" a wrist fracture, if the patient has health insurance, the total cost to bear is about 20,000 to 30,000 yuan.
surgery costs only 2000 yuan, of which supplies accounted for the majority of the cost, accounting for 15,000 to 20,000 yuan, the rest is anaesthetic hospital expenses.
" in the 2000 yuan operating fee, Li Jin can only take 5% of it - about 100 yuan.
when his workload is greatest, it is hundreds of operations a month, an average of 7 or 8 operations a day, so that day and night work, the monthly bonus of about 20,000 to 30,000 yuan.
the remaining important income is the supplies.
orthopaedic departments, such as the Joint Spine, are among the most well-earned departments for orthopaedic physicians, where supplie rebates are an important part of their income.
medical representatives will be rebated to the head of the treatment group according to the amount of supplies used.
rebates are not given directly to the doctor.
"We have a separate treatment group, responsible for surgery on our own beds, and one group is relatively independently managed."
this part of the commission is based on the group, to the group leader, group leader redistribution.
distribution principle is different according to the doctor's seniority, some group leaders are a little more generous, a little more hair, some group leaders a little less hair.
" Li Jin said, like a group leader a month in the hands of 100,000 yuan supplies rebate, the group leader himself left about 350,000, sent to the deputy high 20,000, sent to the attending doctor 10,000, sent to the resident doctor 5000 yuan.
" group leader is similar to the contracted contractor forehead, divided into the following words, it is entirely to see his own mood.
" this part depends on the "group leader" mood of the supplies rebate, li Jin such a doctor, a month in about 20,000.
deputy director level bonus and mention Chengdu higher, deputy director doctor's average monthly bonus in 60,000 to 70,000, plus supplies rebates, the total income is about 1.56 million, is Li really eight times.
Li Jin graduated with a master's degree in medicine for six years and was promoted to the primary doctor for only two years, and his income from about 5,000 yuan in the resident period to between 20,000 and 40,000 yuan a month now, but two years.
This income in the first-tier cities, can pay the mortgage and children a month nearly 10,000 yuan of kindergarten fees, but also to allow themselves in overtime to miss the subway, have to take a bus, not as painful as before, which can maintain some dignity outside of a busy life.
In a rational way, Li Really felt that the country's high-value consumables with the volume of procurement, really conducive to the decline in patient costs, but the thought that he may shrink by half of the income, he felt that he still did not noble completely do not care.
hundreds of operations a month are nearly saturated in workload, and he doesn't know which way he's going to go, so he can keep his income a little longer.
to become a senior doctor through the promotion of importers and promotion channels, has been the direction of Li Jin's efforts.
highly skilled doctors, have strong experience and technical ability, and have many sources of income.
income from grey supplie rebates, senior doctors have a lot of opportunities to generate income through flying knives and lectures.
and supplies of income, almost become Li Jin these small doctors income of the main source, such income composition, it is inevitable that Li really some of the ripples.
business is an opportunity that young doctors value.
and domestic suppliers mainly give cash rebates is different, rebates than domestic supplies about 10% lower import supplies, every year, will invest a large amount of money to hold academic conferences, improve the level of doctors' business. <b。