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Doctors, dentists find private path healthier
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INCREASING numbers of Shanghai’s more experienced doctors and dentists are leaving the city’s public hospitals to set up private group practices.
It’s a new trend. In the past, doctors who left public hospitals usually moved on to private hospitals, seeking better work conditions and higher pay.
Dr Ji Guoping, a leading dentist at Shanghai No. 9 People’s Hospital, recently quit to open a private dental clinic. A group of businessmen helped finance the new venture. Three other dentists left the same public hospital with him to join the new practice.
“Dentists are the first batch leaving public hospitals,” said Ji. “That’s because it’s relatively inexpensive to set up a private dental practice. All you really need is a dental chair, a nurse and some equipment.”
Ji is now president of Shanghai HZ Dental Clinic. He said four or five colleagues at Shanghai No. 9 have expressed interesting in joining his new venture.
“We got to a stage in our careers when we wanted to enjoy more personal doctor-patient relationships and provide better care,” he said. “That isn’t possible in public hospitals. What we left is a noisy and crowded environment, low income, excessive workloads, bad patient-doctor relationships and a ridiculous evaluation system based on how much we got published in medical journals.”
Ji said he had been working at Shanghai No. 9 for 15 years.
System unsustainable
“Public hospital presidents want doctors to help the hospital make more money but the health authority keeps tabs on the average per-patient costs and sets a maximum,” he said. “It’s contradictory. To achieve the goal, doctors sometimes have to split one treatment into two or more, or choose the cheapest medication with poorer effects.”
Ji calls the current system unsustainable. Some doctors cheat on figures or create fake patients to drop the per-patient cost ratio. Some take backhanders from patients wanting better care.
No one would argue that the country’s healthcare system is in disarray. Government funding has not kept up with patient loads, forcing hospitals to squeeze more money out of patients. In turn, patients hit with big bills take their frustrations out on the closest scapegoat — doctors. Cases of patients or their families physically assaulting doctors have been on the rise, with serious injuries and even deaths resulting.
“A good relationship between doctors and patients can’t be achieved at public hospitals because the health system is flawed,” Ji said. “The only solution for doctors like us is to break out and start in a private practice.”
With public hospitals overcrowded and squeezed for funds, many patients are seeking treatment from private hospitals and clinics, which have advantages on outpatient service and treatment including routine surgeries.
Dr Zhang Qiang, a vascular specialist, left Shanghai East Hospital in 2013 to work at joint-venture hospitals funded partially with foreign investment.
“There has always been misconception in China that you should choose a hospital and not a doctor when you need health services,” he said.
That’s a major difference from Western health systems, where people usually seek out doctors they think they can trust, no matter where they are working. In those countries, much of the medical care system is conducted privately, away from hospitals. Doctors are responsible for admitting patients in hospitals.
“In China, everyone seeks out the best-known public hospitals with the biggest reputations,” Zhang said. “A particular doctor’s skills aren’t necessarily a factor because the hospital is the source of patients. That’s one reason why many doctors don’t quit their jobs in public hospitals, even if they are frustrated. They are afraid of becoming a nobody with no roster of patients.”
Ji and Zhang said they don’t regret their moves.
“I have become very active in learning new technologies and knowledge,” Ji said. “I am paying attention to advances from abroad. People come to me because they trust my skills and they are willing to pay for good treatment. Word of mouth guarantees a stream of patients.”
After working as a freelance physician for one year, Zhang started a doctor’s group — a company that acts as an agent for doctors who leave hospitals. So far, six specialists work in the group.
“We provide a pool of doctors who can provide outpatient care and surgeries in hospitals with cooperation of the group,” Zhang said. “The income is shared by doctors, hospitals, nurses and the group. We believe the doctor is the most precious resource in the healthcare system. Here, they are paid 20 percent to 30 percent of a medical bill, whereas in public hospitals, it’s less than 10 percent.”
Zhang’s group has received 50 million yuan (US$8.06 million) in private investment, which will be used to build day surgery centers in Shanghai and support the group’s further development.
“Recognition of the value of medical staff is the most important thing lacking in the current healthcare system. Without that, no success is possible,” said Zhang.
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