For Doctors,What Matters Most?

Since 2001,Yu Ying practiced medicine in the emergency department of the prestigious Peking Union Medical College Hospital.Her candid and humorous stories about her work as a doctor won her a measure of fame in the microblog community as Emergency Department Superwoman,with 2 million followers.

However,she recently announced her resignation from the hospital,claiming that she could no longer conform to the current criteria for evaluating doctors based on the number of academic papers they have published;the additional pressure of publishing articles meant securing a promotion,which could only come at the expense of her clinical practice.

She said her dream is to become a general practitioner and provide health consultation to patients.Her resignation ignited controversy in the country’s medical community about emergent scientific evaluation systems for medical professionals.The following are excerpts of some opinions:

Liu Zhiyong (Health News):If not for Yu’s influence in cyberspace,this old topic would not trigger such widespread debate within hospitals,where so many doctors share almost the same feeling as Yu.The problem existed long before her resignation.

The number of papers published and research programs they have participated in are becoming increasingly decisive factors in professional evaluations of doctors.These assessments determine their job positions,so the system is urging doctors to write papers to earn promotions.As a result,some doctors game the system,to the detriment of both academic quality and clinical capacities.It is a truly worrying trend.

We don’t want to deny the important role of scientific research in assessing doctors.Without clinical and basic research,progress would be impossible,and evaluations based on academic papers seem more scientific and fair than a system hinging on public opinion.

However,the focus on papers published hinders doctors who excel at clinical treatment but lack time for research.Under such an unfair incentive system,few doctors will be encouraged to devote themselves to frontline treatment.

A diversified assessment system is badly needed.It should consider more than just a doctor’s achievements in publishing.Those doctors who spend the majority of their time on clinical treatment may not have enough time to do academic research.If they are assessed in other ways instead of the number of papers,these doctors may concentrate more on treating patients.

We are pleased to notice that some provinces have already started to reform the assessment system on doctors’ professional title evaluation.The proportion of a doctor’s clinical competence is expanded in the assessment while frontline doctors are required to finish much fewer academic papers in the process of being promoted to a higher professional title.This is good news for ordinary clinical doctors.

Many patients choose to go to big and well-equipped state-run hospitals.For doctors already struggling with daily clinical tasks,the requirement to author an academic paper could be the straw that breaks the camel’s back.

Tong Tong (morningpost.com.cn):It couldn’t have been easy for Yu to have stayed in her position and devote herself to her patients for so many years with the full knowledge of the impossibility of earning a promotion without a talent for writing papers.

According to China’s current criteria in state-run hospitals,there is no index that is to measure a doctor’s clinical capability.

It’s OK for hospitals to measure a clinical doctor’s professional capability with the number of academic papers,but when papers are taken too seriously,it seems unfair to them.Also,we’ll see a strange phenomenon resulting from the current assessment system.Doctors who participate in a highlevel research program will be more likely to be published in high-level publications.

The authors of these papers will find it easier to bid for certain medical programs.As a result,some doctors not only neglect their job of treating patients,but are enticed by easy money winning grants from the state.

According to an investigation by the China Association for Science and Technology,only 40 percent of state funding allocated for research and publishing are actually spent as designated.

Yu is an excellent clinical doctor.Her resignation is a loss to her hospital.However,the bigger loss to the Chinese medical circle is the decline of clinical quality and also corruption resulting from the current evaluation criteria.

Bai Jianfeng (www.china.com.cn):Doctors are at liberty to practice at a staterun hospital or to leave for a private hospital.The major reason that dragged Yu out of her hospital,however,is that she is fed up with the doctor assessment system based on the number of academic papers written.

For most doctors,if they work in a big state-run hospital,they’ll easily reach higher positions and harvest many resources that a doctor in a small hospital can never have access to.That’s why some people try to persuade Yu to give up her decision,because her resignation is a much smaller loss to her hospital than to herself.This is also the major reason why most doctors still choose to stay in big state-run hospitals,although they are bothered by the same problem that faces Yu.

State-run hospitals have monopoly status,with enough funds for scientific research and sophisticated medical equipment.Thus,these hospitals are also full of excellent doctors.With such a high concentration of good doctors,relations in these hospitals are quite complicated.Some of these doctors may even feel cornered and unable to bring their capability or talent fully into play.

Moreover,China’s state-run hospitals are bureaucratic to certain degree.Rank determines access to resources and opportunities,so quite a number of doctors try to earn promotions to an“official”position.Meanwhile,someone good at clinical treatment who lacks“official”ranking tends to be marginalized and find it difficult to realize their value as doctors.

To gain rank,the most important index is academic papers.Doctors who have not published in international publications,no matter how excellently they perform clinical treatment,will face great difficulty getting promoted.

Despite the many deficiencies in staterun hospitals,where else can a doctor practice medicine? Private hospitals are rare in China,and compared with state-run hospitals,they lack funding for research and basic welfare insurance.Many doctors who leave end up going back.This is the dilemma facing many Chinese doctors today.