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Doctors quitting the public sector en masse shouldn't surprise anyone

June 21, 2022 | 06:38 pm PT
Nguyen Lan Hieu Doctor
Doctors, drugs and the medical field in general seem to be all over the news these days; and it's nothing to do with the novel coronavirus.

Instead, it's about medicine and equipment shortages, about health workers quitting en masse from public hospitals; what some people have called a brain drain.

I don't think it's accurate to call it a brain drain. Doctors aren't actually going anywhere out of the country by moving to the private sector, but the sudden shift might disrupt social security programs, especially for people who cannot afford private hospitals and clinics.

In the first quarter alone, around 400 health workers quit from public hospitals and medical stations in Ho Chi Minh City, equal to the average labor turnover in a single year in pre-Covid times. In 2021, an astounding 1,154 health workers in the city quit their jobs.

This is understandable, considering how little they are paid, how their salaries keep shrinking (vis a vis inflation), how they lack equipment to do their job and how bureaucratic and corrupt our public health system can be.

Those who haven't quit typically fall into two groups: those who are still passionate about their jobs and have stable incomes; and those who are new and cannot jump into the private sector yet.

The problem now is how to prevent the collapse of the healthcare system in the short-term and to build a modern, sustainable and compassionate system in the long run.

First, we need to deal with the drugs and equipment shortage. The simplest solution will be to let patients pay bills with medical insurance with specific time frames, which should ensure proper treatment as well as the maintenance of their insurance fund, while relieving burdens on hospitals and their workers.

We should revamp the bidding system for healthcare related products, as there are products of specific qualities that should be purchased differently. If they're purchased normally, we might stumble on to drugs and equipment that are cheap, but of inferior quality.

Next, we should give health workers a much-needed pay raise. But that's where another problem comes up: higher salaries for workers means hospitals must collect more money from somewhere else, especially public hospitals that have to manage their own finances. What else can they do but raise the price of services? But public hospitals cannot do this as they wish: their job is to provide affordable healthcare to all segments of the population.

Some developed countries have succeeded with hospital models that don't rely solely on their patients and medical insurance, but also benefactors, training fees and fees for pharmacological studies, among other sources of revenue.

Here in Vietnam, there are not enough benefactors for a non-profit hospital model to be practical, but there can be in the future.

For now, though, the benefactor should be the government itself.

There needs to be post-Covid stimulus packages for medical facilities, along with the introduction into law of non-profit public-private partnerships for public projects.

Amendments to the Law on Medical Examination and Treatment are one way to usher in needed changes. I'm sure that with the right direction and orientation, the medical field can get through several crises.

The most important thing, however, remains the development of human capital: how to help healthcare staff thrive and how to make them stay.

It is time for us to stop spouting slogans about "improving medical capabilities", because anyone who's been to a local medical station knows that changes to improve their quality and efficiency cannot be done overnight. They have virtually zero capacity for treatment. Doctors don't pick local medical stations as places to work; and even if they do, there might not be enough patients to make the choice worth it. If doctors don't get chances to garner valuable experience, learn more and improve themselves, all the knowledge and skills they've acquired over the years in school would gradually fade.

I have three suggestions on improving our public healthcare system for a better future:

First, hospitals at district levels should be the main focus of investments and improvements. Local medical stations can become clinics for such hospitals. Doctors can spend one day per week to work in medical stations and work in hospitals on other days.

Second, we should build areas with strong healthcare capabilities in every province, or at least in every region. Major hospitals should be grouped near one another, or maintain tight-knit communication. Facilities that find it difficult to stand on their own, for example those that deal with traditional medicines or rehabilitation, could be housed inside the complexes of major hospitals so they can benefit from available resources.

Third, there should be changes to the monitoring of administrative errors. There should be more focus on the monitoring of technical errors instead. I knew a patient who was recommended to have a 6mm kidney stone taken out with no symptoms, a recommendation that I'm sure few doctors would agree with. Medical profiles should be checked randomly for errors.

I believe such changes would contribute to more orderly operations at a hospital.

The role of expert groups could be enhanced by getting them involved in the approval process for new doctors, or by getting them to provide opinions on different medical cases. Such groups can also safeguard the rights of health workers.

"Don't hate the player, hate the game," they say. If the game gets much needed improvements, many players will stay on in the public healthcare sector, for sure.

*Nguyen Lan Hieu is the director of the Hanoi Medical University Hospital and a National Assembly delegate. The opinions expressed are his own.

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