儿科医生短缺 实际是经济效益短缺

2018-02-06 刘芳 中国青年报

相比其他医生群体,儿科医生的收入不高。怎样提高儿科医生的收入水平是一个系统工程。

“早上8点我去急诊科巡诊,一位家长上来就跟我诉苦,前半夜就带孩子来看急诊,到现在还没看上!”深圳市儿童医院副院长、儿科专家麻晓鹏一说起儿童医院看病难,边摇头边叹息。

2017年12月开始,深圳发布流感指数接连为Ⅰ级(极易发生)、Ⅱ级(易发生)。深圳市儿童医院的急诊大厅越到深夜越嘈杂。焦急的家长们抱着孩子围住分诊台,护士手中抓着病历和笔,一边手脚麻利地分发资料,一边应答着家长们的提问。每个诊室灯火通明、人头攒动,不看时间还以为是白天。

2017年12月26日,一位来自龙华的家长一个晚上带着孩子跑了包括儿童医院在内的3家医院,每家都人满为患。“在深圳这么多年还是头一回遇到”。

就连平时没多少人的罗湖区妇幼保健院也病人爆增,张先生因为一岁半的孩子发烧去看病,拿到号以后急诊还有90多个人等待。

距离儿童医院9公里的李先生一家已经积累了一套看病经验。自从上次儿子发烧看病等了4个小时急诊才看上后,再发现儿子发烧等问题,就先自己在家简单处理,同时让父亲去医院挂号排队,然后等到快叫上号后再带孩子出门都来得及。

这里是人口数以千万计的深圳。据深圳市卫计委统计,仅2016年全年的医院总诊疗人次就达到7584.86万人次。在如此大环境下生存的儿童医院,对应的是当年超过20万的常住人口新生儿出生人数,而这一数字到2017年已经超过了24万。实际上,深圳的新生儿出生人口已多年维持高位。

“衡量医院忙碌程度的就是看门、急诊量”,麻院长说,2016年该院门、急诊病例206万,这一数据到2017年就攀升到了218万。“这还不包括5万余人的住院病例”。

来自深圳市儿童医院的数据显示,2017年12月1日到2018年1月5日,流感病例为773个,比去年同期上升了50例。

“流感期医生压力大主要是因为病种结构变了”,麻院长分析说,“儿童医院的门急诊量长期保持在7000左右,流感期来临后由于流感患儿增多,使得这一类医生的缺口增大了。”儿童医院主动调整医生结构,从10个内科住院病房每天调配一个医生支援急诊科,缓解一部分压力。

人才短缺始终是让麻院长头疼的一件大事。从源头上看,大学本科教育中儿科专业有的院校恢复招生了,但有些院校还没有完全恢复;从执业经验看,因为面对的是婴幼童这一特殊的群体,需要的经验和情商更高,也就更难培养;从经济效益上看,深圳市儿童医院地处一线城市,但儿科医生收入和很多二三线城市的医生收入水平相当,每年来医院就业的大学生有意向的多,真正来的少;最重要的是,在深圳市儿童医院每日就诊量高,每个医生平均每天要看六七十个病人,工作量大已经成为常态。

由于儿童都处在生长发育期,一般慎用药物,在以药养医的大环境下,儿科成了最不赚钱的部门。“表面上是儿科医生短缺,实际上是经济效益短缺”。相比其他医生群体,儿科医生的收入不高。这种现象尤其在一些综合性医院比较突出。虽然国家对6岁以下的儿童检查加价30%,但在目前医疗体制改革仍在深层次推进的当下,怎样提高儿科医生的收入水平其实是一个系统工程。

面对如此不平衡的供需,深圳市儿童医院尝试改造环境和流程,方便市民就医、提高就医体验。

麻院长介绍,深圳市儿童医院在全国率先开展当日预约挂号服务,从早晨6点开始,家长可在家通过手机提前两个小时预约当天的号。据了解,儿童医院每天使用当日预约的病人达八九百人,占了门诊量一成以上,大大方便了家长。为解决看病反复排队的问题,儿童医院推出“一卡通”服务,家长可通过一卡通充值实现自助挂号、交费,大大减少排队情况。

2014年,医院又对门诊楼进行改造,一至四楼增加了8部扶手电梯,将占门诊量八成的科室全部安排在这四层,解决了医院垂直交通问题。孩子输液,开单、交费、取药、到输液室交药最后完成输液,4个环节缩短为一个环节,起码节省半天时间。而抽血检验、内分泌检查流程的设置也采用类似处理。如今等候时间稍长的环节就是候诊,“这主要是因为医生紧缺”。

为了解决这个难题,深圳市儿童医院从2016年开始发起成立了深圳市儿科医疗联盟,开创的“治疗救治前移”分级诊疗新模式,创造性地将36家儿童医疗相关单位充分联合,通过资源共享强化儿科医师专业技能培训及双向转诊绿色通道等,充分优化深圳市医疗卫生资源,推进实施分级诊疗,探索“患者不动、医生移动”医疗服务新模式。

儿童医院正在研究怎样优化联盟医院的会诊、转诊流程。“市儿童医院起到的作用就是针对疑难重症和对下级医生的培训”,麻院长呼吁,“不要有点小病就来儿童医院,通过医疗联盟在区级医院实现首诊应该成为一个方向”。

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    2018-02-07 liuxiaona
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    2018-02-06 Y—xianghai

    学习了新知识

    0

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