Breathing new life into private healthcare

As China boosts Market-based sector, many doctors employed by public hospitals are taking advantage of changes in the rules to work part time in non-State-run establishments

Zhu Gang, a urologist at a public hospital in Beijing, initially sought part-time work at Beijing United Family Hospital in 2004 to maintain his English, given that many of the hospital's doctors and patients come from overseas.

Although he didn't know it at the time, Zhu was a trailblazer, and now the government is encouraging other doctors to follow his example.

The 48-year-old has worked full time at Beijing Hospital since 1990. In 2000, the hospital sent him overseas to study for a PhD and undertake post-doctoral research at King's College, London. It was on his return in 2003 that he decided to outsource his talents, even though he didn't obtain a license to practice at outside institutions until about two years ago.

During his time at Beijing United, a US-Sino healthcare joint venture, Zhu says his professional life has been deeply rewarding, and he's done far more than simply keep up his language skills and earn extra money. "Here I have learned lots of things I wouldn't learn at my main employer, such as a totally different management system that promotes greater efficiency," he says.

Policy changes

Now, changes to official policy are making it easy for other doctors to follow in his footsteps, but legally. "The policy changes of the past few years have made it much easier for doctors in public hospitals to apply for part-time jobs at private establishments," Zhu says.

In China, doctors in public hospitals are full-time employees, and aren't usually allowed to work elsewhere without the consent of their employers, who, in addition to paying their salaries, also handle matters such as social security contributions. Now though, many public hospitals are concerned about a potential talent drain if the number of employees choosing to work part time in other institutions rises.

In recent years, a number of measures have loosened the ties between doctors and hospitals. Earlier this month, the National Health and Family Planning Commission announced that some health authorities are planning moves to further assist doctors who want to offer their skills to a range of establishments. That includes simplifying the registration procedures so they won't need their employer's consent.

"Encouraging the flow of doctors and medical resources can provide better services to the people," the commission says.

Since 2011, doctors registered with the Beijing health authorities have been allowed to work for people other than their main employer, and a few places, such as Guangdong province, follow similar policies.

In August, doctors were given even greater autonomy when new rules were released allowing them to work at as many institutions as they wish, compared with the maximum of three stipulated under the previous rules.

More than 2,500 doctors in the Chinese capital have registered for multi-institute practice, according to the Beijing Commission of Health and Family Planning. However, many unregistered doctors also work several jobs, and in the past it was common for senior doctors at public hospitals to work part time at smaller institutions, says Han Xiaofang, director of the Beijing Medical Reform Office.

Loosening ties

"We are considering further loosening the ties between hospitals and doctors, so they can practice in different medical institutions," she says

Yu Ying, who set up a private clinic last year, says the changes have definitely made it easier for doctors to practice at different institutions. "Many doctors I knew before called me to apply for part-time work at my clinic," says Yu, who worked as an emergency room doctor at Peking Union Medical College Hospital for several years. "But a few years ago, many doctors had to do this secretly."

For Zhu Gang, working two days a week at Beijing United Family Hospital not only provides extra income, but, more important, also offers good opportunities to research and practice in a different environment, and that could be useful in his future research.

"The hospital's management system and diagnosis ideology are very different from those in public hospitals. I'm glad to have the opportunity to learn about international standards of care, which I wouldn't have learned if I'd stayed in a public hospital," he says.

Besides practitioners such as Zhu, who seek part-time work in private institutions to broaden their professional horizons, other doctors have turned away from public hospitals in the hope of better fulfilling their dream of being a doctor.

Jin Limin, who worked at the Capital Institute of Pediatrics Children's Hospital for nine years, joined Beijing United in 2013 because she wanted to be "a doctor in the truest sense".

She says: "A large part of my work was unrelated to treating patients, and I had to take many other things into account, such as the circulation of hospital beds, and the amount of time I should spend on each patient under the pressure of the evaluation system. I hope to find a place where all I need to consider is how to better serve my patients."

The excessive workload was also a reason for her move into private care, she adds.

Yu Ying has set up a clinic in partnership with the AmCare Group of the United States. The greatest incentive for starting her own business was to establish a model of service in harmony with her concept of "happiness and respect", she says.

Excessive workload

After working as an emergency doctor for 12 years, Yu found her "doctor dream" was far from the reality. "I felt miserable back then, and my patients were also unhappy," she recalls.

Like many of her colleagues at Peking Union Medical College Hospital, Yu's workload was heavy because of the large numbers of patients, some of whom had traveled as far as 1,600 kilometers to be treated.

In addition, she also had to handle a number of extra duties, such as appeasing angry relatives of patients who had to wait for treatment in the emergency surgical rooms, which were almost always full.

"After working for more than a decade in the emergency department I found I had to deal with all sorts of disputes between patients and doctors and nurses," Yu says. "I felt I would be no different from a community mediator if I stayed."

The official policies encouraging the development of private healthcare prompted Yu to start her own business. In June she applied for a license for the clinic, which is scheduled to open in February, after Chinese New Year. "It wasn't as difficult as I'd expected," she said. "I didn't go through too much bureaucracy. I think Beijing has done this much better than many other cities."

In recent years, the central government has issued a number of measures aimed at supporting the development of a private medical sector, such as facilitating the talent flow from public to private hospitals, and encouraging foreign investment in the private sector.

By the end of the first three quarters of 2014, there were 11,963 private hospitals in the country, an increase of 11 percent from the same period the previous year, reducing the gap with public hospitals, according to the National Health and Family Planning Commission.

Wang Hong, chairwoman of the private Beijing Huilan Hospital, says the government needs to provide a wider range of measures to regulate investment in the sector and ensure its healthy development.

"Many investors don't have the right concept. They just want quick profits," she says. "But in the health sector, that's simply not the case."

That may be true for some new arrivals, but for Yu, the move into the private sector is about professionalism, not profits. "I want to provide an environment where the doctors are happy treating the patients, and the patients are happy to consult the doctors. But in many public hospitals, that's hard to achieve."

wangxiaodong@chinadaily.com.cn