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新政策下,大量医生晋升渠道受阻,可能无法评高级职称……没有规培过的医生该怎么办?

2022-08-10 网络 网络

自从7月中旬河南省卫健委发布了一条《关于做好2022年住院医师规范化培训招收工作的补充通知》后,有关规培和高级职称、往届医学生从医去留问题的争论一直就没有停息过。

自从7月中旬河南省卫健委发布了一条《关于做好2022年住院医师规范化培训招收工作的补充通知》后,有关规培和高级职称、往届医学生从医去留问题的争论一直就没有停息过。

我们再来看一下这条“补充通知”中第四条的内容:为了做到供需平衡,确保国家下达的招收计划如期完成,避免培训资源流失浪费。河南省将从2023年开始,减少数量,增加质量,主要招收医学院校本科及以上应届毕业生,住培计划申报编制以此类人员为基数确定,原则上不再接收往届毕业生培训。

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来源河南省卫健委

一石激起千层浪,这一政策如果在全国各地普遍施行,可以说,不单是大量医学往届生的命运将会受到重大影响,就连许多已经从医多年的资深医生也将改变职业发展的前途。

这不是一句大话。

10年规培路,很多医生的命运已经被改变

2013年,国家卫生计生委等7部门联合印发《关于建立住院医师规范化培训制度的指导意见》,规培成为一种国家制度。

图片

图源网络

但即便如此,住院医生的规范化培训在推行中依然因医院和地区而异,不少规培医生在这一过程中沦为廉价劳动力。

一开始,几乎所有的医生都不太关注这种规培制度,只把它当作是医学生毕业后的模拟考试,更有人觉得是儿戏。

没有人会觉得规培很重要,在规培施行的早期,人们只会讨论规培医生工资低、待遇差、是廉价劳动力。可随着时间的流逝,规培政策的进一步完善,所有医生回头一看,突然发现:怎么规培变得如此重要了?竟然可以决定一个人的命运和前途!

规培制度施行之后,广东省曾发布这样的条款规定:具有硕士学位的医学毕业生需要在取得住院医师规范化培训合格证书后,再从事医疗执业活动满两年方可参加中级职称考试。即使获得了相应专业博士学位,仍然需要先完成规培才能获得参加考试的条件。

而广东省以前的政策是:医学毕业生取得相应硕士学位后,从事医师工作满两年,即可报考中级职称。若取得相应专业博士学位,则可以直接报考。

各位同行们还不重视吗?不要以为咱们都是从医多年的老医者了,觉得规培和咱们无关,在国家极其重视规培、规培证等同于医师证的情况下,高年资医生的晋升政策也可以说变就变。

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图源网络

毫不隐藏地说,你没有经历过规培,没有那个规培证,同等学力、同等条件下,你的晋升渠道和晋升机会就是没有别人多。

试想想,一个没有经历过规培的人在以后的岁月里评定高级职称还会那么简单吗?答案不言自明。

至于刚刚毕业的医学生,规培新政带来的冲击和影响更加巨大。

 

如果本科毕业就参加规培,就业必然是好的,但随着学历贬值,本科出身的医学生在晋升方面阻碍重重,除非做好终身基层的准备,否则前途真的一眼就能望到头。

 

所以,很多人选择考研,去考四证合一的专硕。

 

同规培并轨的专硕是目前来看性价比最高的选择,毕业后四证合一,就业选择面较广。但正因为它的优势,所以竞争比较激烈,人多坑少的现状使得连考多年的情况比比皆是。

 

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专硕考不上,那就考学硕。

 

可是,如果攻读学硕,那在当前政策下将会付出较大时间成本,由于没有规培证,学硕在就业市场的劣势已经显现出端倪。

 

想要谋求发展,读完研,还得像本科生一样乖乖去规培,等到通过后再和刚毕业的专硕同台竞争,可此时年龄已经又长了几岁,说不影响发展是不可能的。

 

倘若考不上研究生怎么办?考了一次、两次、三次又该怎么办?如果不给往届生参加规培的机会,他们的从医之路是不是就要从此断绝?

 

这就是河南省这次“补充通知”条款颇引起争议的地方,因为很多医生命运已经悄悄被改变。

 

规培的初心:让每个刚入临床的医生都能尽快撑起一片天

 

其实,在我国决定全面施行规培制度后,它的压倒性决定作用就已经被确定了。

 

据媒体报道,2021年9月27日,华西医院麻醉科主任刘进提出向华西医院捐赠一个亿,捐赠的钱全部来自华西医院麻醉科新药团队——新药转化的利润。

 

作为全国少有从事新药研究与开发的科室,这几年,麻醉科新药团队相继转让了多个新药专利给药企,总营收超过8亿元。

 

刘进捐出的一个亿,是多年药物转化后他个人所得的部分。

 

在捐赠时,刘进提出,捐赠的资金用于培训住院医师、激励带教师资,以及加强医院培训能力的建设。这是我国首个由个人捐赠设立的专项规培发展基金

 

而刘进本人,是国内最早呼吁建立住院医师培训制度的专家之一。

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刘进指导住院医生进行手术(源自三联生活周刊)

 

刘进告诉记者,呼吁建立住院医师规培制度,与他在基层医院工作时的一个经历有关。

 

他曾在黄石市第二人民医院工作,当时,曾有11名患者烧伤后被送到医院。医院没有转运病人的条件,只好从外面请来烧伤科专家,组建起一个临时ICU,刘进是负责值班的医生。

 

患者烧伤都很重,甚至还发生了休克。尽管对他们进行呼吸支持和救治,可最后病人还是全部死了。

 

这件事对刘进打击很大,他说,“如果是在一个大医院或者是现在的技术背景下,他们或许有生存下来的机会。”

 

基层医院两年的经历,让刘进看到普通居民治病的困难,也让他隐约意识到,在没有资源、学习条件有限的情况下,一个医生靠自我提升太难了,也让他坚定,中国必须走规培之路。

 

规培的初衷真的很好,是符合中国国情的。正因为规培,中国医院在看重医生学历的同时,也更加重视医生的临床技能和经验,医生们也掌握了更加全面的诊疗知识,这对患者是负责任的。

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但是,我国的规培做得还不够好,还不够人性化,还需要很长一段时间去改进。

 

不说“廉价劳动力”这些老生常谈的内容,而是,开展规培的医院太过泛滥。

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刘进曾介绍,不是所有的医院都能招收规培生,必须是综合医院,有综合性科室和各种类麻醉手术需求的医院,如此,规培的住院医生才能在不同类型科室之间轮转起来,才能学到真东西。

 

是啊,如今不论是什么医院,只要申请,就能招收规培生,确实太泛滥了。医院往往带着一种急功近利、为缓解人力缺口压力的态度去招收规培生,这就导致规培生往往学不到什么真东西、真本领,又变成了廉价劳动力。

 

这是病态的,是不健康的,也是我们下一步要重点解决的问题。

 

医生们呼吁规培要改革,可是怎么改?

 

规培医生很长一段时间在医院里都属于边缘人的状态。现行政策下,国家极其重视规培,并将规培和晋升前途相挂钩,可是他们的处境并不好。

 

提高待遇自不必说,前几天北京大学人民医院宣布从8月起,全面施行规培医生和本院职工同岗同酬。

 

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来源北大人民医院微信公众号

 

但这毕竟是个例,目前来看,应该不会大范围推广。

 

有医院领导人士告诉我们,医院本身医保就不堪重负,如果给规培医生同岗同酬,那还真不如多招点医生。

 

但,适当提高工资水平,以期和他们的工作量相匹配,这一点还是能够实现的。

 

我们在考虑规培生的薪酬标准时,既要考虑他们学习时间长、投入成本较高、工作年龄较大等专业队伍稳定因素,也要兼顾与社区医生、主治医生、医护人员总体薪酬水平的一定梯度,以有利于引导和愿景激励。

 

另外,针对规培医生学不到真本领的问题,我们应该特别重视。

 

规培不是形式,轮转不是流程,让他们把大量时间花在干杂活等事情上,实在说不过去。

图片

 

下一步,规培医院或许应该多花时间用在教学上,真正肩负起自己对规培医生的责任,这不是个别医院的事情,而是关乎未来中国的规培之路会不会走得顺畅……

 

参考文献:

[1].https://mp.weixin.qq.com/s/oZc4iGij_JBopipq1XJkPQ
[2] https://mp.weixin.qq.com/s/xCirKHSM0KiuC8oTyXshpQ
撰文 | 阿拉斯加宝
编辑 | 阿拉斯加宝

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    2022-08-12 bioon3
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    2022-08-12 xxxx1053
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    2022-08-12 naiwu81
  5. [GetPortalCommentsPageByObjectIdResponse(id=1942572, encodeId=c56419425e2fd, content=<a href='/topic/show?id=1dcd1025801f' target=_blank style='color:#2F92EE;'>#高级职称#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102580, encryptionId=1dcd1025801f, topicName=高级职称)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=bnjfy, createdTime=Tue Jul 04 13:02:39 CST 2023, time=2023-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1260532, encodeId=4b2f126053277, content=<a href='/topic/show?id=1ed65e476b8' target=_blank style='color:#2F92EE;'>#政策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57476, encryptionId=1ed65e476b8, topicName=政策)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Fri Aug 12 13:02:39 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518356, encodeId=6f611518356d3, content=<a href='/topic/show?id=74f180652b9' target=_blank style='color:#2F92EE;'>#职称#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80652, encryptionId=74f180652b9, topicName=职称)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3811138989, createdName=xxxx1053, createdTime=Fri Aug 12 13:02:39 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535689, encodeId=65e715356893c, content=<a href='/topic/show?id=296f9060838' target=_blank style='color:#2F92EE;'>#规培#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90608, encryptionId=296f9060838, topicName=规培)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=557b12597523, createdName=naiwu81, createdTime=Fri Aug 12 13:02:39 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238183, encodeId=03ed123818304, content=哈哈哈哈哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5e6469401, createdName=ms7000000458032466, createdTime=Fri Aug 12 00:16:53 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238196, encodeId=61fd1238196e6, content=刘进教授居然还去过黄石二医院,蜕变经历让人震撼, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ebf4772205, createdName=李栋, createdTime=Fri Aug 12 06:32:24 CST 2022, time=2022-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238000, encodeId=75fa1238000dc, content=东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=821f2227826, createdName=DR.Fu SIR, createdTime=Thu Aug 11 08:57:08 CST 2022, time=2022-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237988, encodeId=bd17123e98830, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Thu Aug 11 07:43:02 CST 2022, time=2022-08-11, status=1, ipAttribution=)]
    2022-08-12 ms7000000458032466

    哈哈哈哈哈

    0

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    2022-08-12 李栋

    刘进教授居然还去过黄石二医院,蜕变经历让人震撼

    0

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    2022-08-11 DR.Fu SIR

    东施效颦。

    0

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    2022-08-11 xulv123

    认真学习~~

    0

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