Expert: rescuing pediatrics is not “can’t” but “do not do”

Recently, the people’s Hospital of Susong County in Anhui Province circulated an article, which caused heated discussion. < / P > < p > shows that in July, the 1.0 coefficient of pediatric performance bonus in our hospital was only 498 yuan, while the 1.0 coefficient of performance bonus of administrative and logistics staff in the hospital was as high as 2600 yuan; on September 17, 2020, 10 pediatric medical staff in our hospital jointly asked the hospital leaders for collective job transfer. < p > < p > on September 23, it entered the public view, and caused extensive hot discussion in the media and the Internet. Susong County People’s Hospital on September 24, 25, two consecutive releases on the official website, to explain this clarification. The two “instructions” emphasized that the hospital was highly concerned about medical staff and had been making great efforts to do a good job in Ideological and political work of medical staff. The difference between the two “instructions” is that the earlier release of the notes pointed out that the hospital, in line with the care of medical staff, has adopted the transfer payment measures with emphasis on Pediatrics, which improved the performance of 35 pediatric medical staff in July to 1500 yuan, “the general medical staff expressed understanding and acceptance”. In the later period, the statement of “instructions” and “raising to 1500 yuan” were lost. The hospital emphasized that the performance bonus of pediatric medical staff “should be paid according to the average level of the hospital”. < / P > < p > after the medical staff jointly released the “job transfer report”, Susong County People’s hospital quickly came up with a good way to tilt the performance bonus distribution policy, which improved the income of pediatric medical staff through internal redistribution. However, the author regrets that the management wisdom of Susong County People’s hospital seems to be late. According to the information provided on the website of Susong people’s Hospital, there are 763 employees in the hospital, including 35 pediatric medical staff. According to the industry standard of 28% – 30% of public hospital staff, the proportion of administrative staff to employees is 8% – 10%, and the proportion of logistics personnel to employees is not more than 20%. The number of administrative and logistics personnel in Susong County People’s hospital is no more than 230, of which the number of administrative personnel is about twice that of 35 medical staff in pediatrics. < p > < p > previously, medical staff disclosed that when the average Award for pediatrics was 498 yuan, the average Award for administrative logistics personnel was 2600 yuan. According to the spirit of “inclining to the front line”, the average award of pediatric medical care reached 1698 yuan, which was higher than the “adjusted 1500 yuan” mentioned in the “instructions” of the hospital on September 24. Since the “explanation” on September 24 thinks that the performance of medical staff at 1500 yuan a month is appropriate, is it not difficult for administrative staff to reduce their monthly performance from 2600 yuan to 2000 yuan? If the hospital management pay more attention to the work and thought of the staff, will it lead to national discussion? < / P > < p > then, what is the situation of Pediatrics in the hospital before the arrival of the delayed wisdom of the hospital management? According to the hospital website information, Susong County People’s hospital has 35 medical staff, and more than 20 medical staff have been sent to higher level hospitals for further study over the years. So, what is the working situation of the 35 medical staff? I imagine. According to past experience, at least 134 nurses are required to operate a ward. This is the minimum standard for maintaining the operation of hospital wards, which means that the head nurse is also responsible for patients. In addition to the head nurse and other old nurses do not need to work on night shift, other nurses follow the rhythm of “eight hour day shift, eight hour day shift, small night shift, big night shift, next night shift, rest” and cycle every six days. They are working machines with no private living space. Old nurses are not on the night shift, so they have to take all the lunch breaks or “73 shifts”. In view of the uneven time distribution of the work content, it is not necessary to think about other mobile positions such as “upper and lower ends”. These are the people who can’t do it. Nurses can’t take sick leave, they can’t take maternity leave, and they can’t even distract themselves from their small families. < / P > < p > the number of nurses mentioned above is only calculated according to the minimum standard of maintaining shift scheduling. In fact, due to the poor communication and expression ability of children and the lack of cooperation with treatment, the number of nurses in pediatric ward must be more than that of adult departments with the same bed size. According to the national standard, the “bed to nurse ratio” of adult ward without accompanying should be 0.4, and that of pediatric ward without accompanying should be 0.6. < / P > < p > the ward should have at least three doctors, and shift according to the rhythm of “eight hour day shift, 24-hour total value, and one day off”, which are also working machines, can ensure that there are doctors in the ward all the time. Obviously, this rhythm can’t be maintained for a long time. At least two groups of working machines should be alternated, no matter when the ward is out of the clinic. According to the brief introduction issued by Susong County People’s hospital ten years ago in 2010, there are 6 deputy chief doctors and 2 attending doctors in the Department of Pediatrics, a total of 8 doctors. In 2010, there were more than 30000 pediatric outpatients and more than 5000 discharged patients, equivalent to receiving more than 100 outpatients a day, and welcoming and seeing off nearly 20 patients in and out of the hospital. All these works were focused on the eight doctors. Eight doctors have to work shifts and take off. There are at most five or six doctors who can be on duty in the day shift, which may not be enough. The number of doctors on duty on rest days is even less. < p > < p > these five or six doctors should take into account outpatient, emergency and ward. One hundred outpatients a day should occupy at least one doctor. One doctor was assigned to the day shift and the night shift in the emergency department. The remaining two or three doctors face dozens of hospitalized patients, and from time to time they have to go to the obstetrics and other brother departments for consultation. There are at least two nurses in the outpatient department, and many operations need “double operation” according to the requirements of clinical safety, not counting the triage nurses maintaining order. Outpatient nurses also need rest, and more staff should be allocated for shift work. If the emergency department is open 24 hours a day, the number of nurses needed in the emergency clinic should be at least 134. As a result, the 35 medical staff in the Department of Pediatrics of the hospital run a precarious Department of Pediatrics. Because there is no staff, they can not set up pediatric electroencephalogram room, bronchoscopy and other slightly difficult disease diagnosis and treatment activities, to diagnose children’s convulsions and long-term treatment of lobar pneumonia and other common “difficult and miscellaneous diseases”. < / P > < p > they can’t treat children who need to be rescued by ventilator, because these children need “special care”, and a nurse must be at the bedside 24 hours a day. Once the medical staff face injury or someone suddenly resigns, the whole department will lose the chain immediately. Even the author doubts whether the Department of Pediatrics in the hospital has staff to open 24-hour emergency, or whether it has an independent ward. It is difficult to balance the ward and emergency department when the manpower is so tight. Poor people are bound to be weak, and only good treatment can retain talents. The hospital that can treat difficult and critical patients is the “just need” of the common people. Only see the hospital of common disease, the patient sees the weather is bad, the patient can endure a pain, do not want to go. The “business” of this kind of hospital is similar to that of street performance in ancient times, “the wind will be halved, and the rainy day will be finished.”. Therefore, the author has reason to suspect that the technical strength of Susong people’s hospital is rather weak due to insufficient investment. In July 2020, Susong County suffered from flood disaster. At the same time, the number of discharged patients in the Department of Pediatrics in the hospital dropped to 10% of the monthly average in 2010. In the first edition of the “instructions”, the hospital official explained that the objective reason for the average bonus of only 498 yuan in July in pediatrics was “the workload decreased”, which may be due to weather factors. As for the local rain is too much, people can not get out of the door? The performance bonus of 2600 yuan a month for administrative and logistics personnel seems not to be enough. < / P > < p > the “498 yuan bonus” of Pediatrics in Susong County People’s hospital is not a question of “can’t be” but a problem of “do not do”. It is no wonder that the medical staff will turn their backs and write joint letters. < / P > < p > in a public hospital, the theme education activities over the years are the same, and the two “explanations” are full of “Ideological and political education”. Why is the leading group so numb and inactive? Of course, the author thinks that since the hospital does not throw away a word about natural disasters in the “notes” of various editions, it shows that they still have a high political position in consideration of the overall situation. < / P > < p > since September 2012, the author has been stationed in the observer network and started the creation of medical field review. The author has expressed his views on the problems of Pediatrics in China on several platforms. Unfortunately, the author’s previous pessimistic description, for example, the management of some hospitals, out of economic considerations, let the pediatrics level of hospitals decline, in order to “do less and pay less”; for example, the long-term low-income and poor practice environment lead to the loss of medical staff and quality decline, which are still not reversed. < / P > < p > it seems that lowering the standard of pediatric licensed physician qualification scores a few years ago has not brought about the expected new children in pediatrics. Recently, a number of ministries and commissions have issued documents calling for strengthening the training of pediatric talents. As long as there are enough students studying Pediatrics, we can catch up with the brain drain rate. < / P > < p > Pediatrics may enter the stage of irreparable danger. The editorial teacher of a medical information platform recently complained to the author that Pediatrics channel is the most difficult to do. < p > < p > “it is difficult to ask for contributions, and high-level authors are too busy to write. The latest academic development and the treatment of difficult and critical cases have little interaction with readers. It is good to click and collect the guidelines for diagnosis and treatment of common diseases. It seems that there are many readers who can benefit from the guidelines for diagnosis and treatment of common diseases? Although it is disrespectful to the hard-working pediatricians, pediatrics is indeed a mess and a cold stool. More and more “learning dregs” are deposited, and the level is worrying… ” Focus