Should you run a public hospital or a private clinic in China?
There is a rising dema...
This article was originally published in the August issue of Healthcare Global magazine. To read additional features, click here.
There is a rising demand for health services as the population increases, and the industry has realized that to meet the public’s demand it is impossible to solely rely on hospitals. Of course, the discussion of expanding existing hospitals by adding beds and prolonging doctors’ hours has been held by many within the industry but that won’t resolve the issue at hand. What we need now is to further expand community medical services via private clinics.
Public hospitals in China have remained underdeveloped for years, according to Beijing Review, the reason being due to a shortage of doctors. With this in mind, how can private clinics rise? The answer: doctors.
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Doctors are the best medical resource as they are already supposed to operate in accordance with the rules of the market. To solve the issue of persuading patients who prefer large, public hospitals to attend community medical agencies, one must look to mobility.
If doctors from public hospitals are willing to open their own clinics, policy support should be offered to them, the source states.
“The reality is the country's best doctors and medical experts are serving in public hospitals in big cities, and as a result, patients from around the country rush to these hospitals for medical treatment,” Guo Changsheng told Beijing Review. To encourage on-the-job doctors to open clinics means medical resources will be distributed in accordance with market rules, which will mobilize current medical resources to the largest extent. The major objective for this policy is to cushion the conflicts between the public's huge demand for quality medical treatment and the limited medical resources, particularly excellent doctors.”
Conflicts may arise when doctors run their own clinics while keeping their posts in larger hospitals at the same time. They key to dissolving these conflicts is balance. An additional issue is that private clinics are unlikely to be covered by the country’s medical system.
“A major obstacle for the establishment of private clinics is the complicated and strict approval procedure. Compared to public hospitals, these clinics will bear heavy tax burdens and difficulty in purchasing medical equipment,” added Changsheng.
According to experts, most doctors feel they will not choose to operate a private clinic.
The fear of sacrificing personal time is one that has held doctors back from venturing into open waters. As a result, patients have also begun to fear whether their doctors are overworked, therefore hindering the quality of medical services provided.
Moving towards accessibility
In Beijing’s larger hospitals, it is reported that one doctor could receive an average of nearly 100 patients every day, sometimes even around 200. But, private clinics have their advantages.
Doctors have accumulated a lot of experience from big hospitals and are usually capable of communicating with patients. These clinics don't need medical inspection equipment, or other expensive hardware, as they can entrust a qualified third party to do the necessary physical examination for patients.
As with every industry, here are pros and cons to remaining solely in a public hospital setting:
Payment security: Both staff and physicians are assured of their incomes in a public hospital. Incomes are also sometimes higher.
Less administrative troubles: The hospital will worry less about issues such as human resources, billing and collecting, rent and overhead.
Compensation can be changed: Nearly all hospitals pay on some form of production-based compensation formula but that does not mean that can’t change.
You may be judged by new metrics: Hospitals are aggressively adopting quality and patient satisfaction measures that are part of the overall compensation plan.
“Although the policy grants individual doctors the freedom to run their own clinics, hospitals tend to hold on to their best doctors and prevent them from leaving,” said Lei Hongpei. “However, if doctors and hospitals can reach a balance in terms of economic interests and various other aspects, medical capacity will be improved, and this is beneficial to the public.”
“Private clinics are mostly operating in communities, where doctors are badly needed, Hongpei added. “Patients who usually find it difficult to see a doctor in big hospitals will now have easy access to quality doctors in community clinics. On the basis of doing well in hospitals, doctors can make extra money in their private clinics.”
Many physicians enjoy a hospital association and some simply don’t. The bottom line? Do what works best for your daily routine and how you believe you can best treat your patients.
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.