农村医生缺口53万人 愿去基层医院的医学生不足5% Rural doctors gap 530000 people would go to grassroots hospital medical students less than 5%

每年50万医学毕业生转行现象，呼唤国家亟须建立人才赴基层就业流动机制 Every year 500000 medical graduates turned phenomenon，It is urgent to establish talent to call country grass-roots employment flow mechanism

　　不久前，《中国青年报》的一篇报道引发社会的广泛关注。报道中，北京大学国家发展研究院经济学教授、著名医改专家李玲和北京大学公共卫生学院教授陈育德提出，国家每年培养约60万医学生，只有约10万人能穿上“白大褂”。

Not long ago，《The China youth daily》A report caused extensive attention of the whole society。The report，Beijing university institute of national development economics professor、Famous medical experts LiLing and Beijing university professor with the school of public health ChenYuDe put forward，Countries each year about 600000 medical students training，Only about 100000 people can wear“white”。

　　为何每年那么多医学生转行？一种观点认为，这与近年来医学院扩招且教育培养模式存在一定问题有关。四川省宜宾市第一人民医院院长谢明均接受《健康报》采访时指出，现在本科教育存在严重问题：一方面，“宽口径”招生、重基础轻临床、重理论轻实践，导致学生临床动手能力下降；另一方面，人才流动机制并没建立起来，医院通过计划渠道按部就班接收人才，只能依靠不断提高“门槛”来限制人员进入。

Why so many year medical students turned？A kind of view，This and in recent years medical school enrollment and education training mode has some problems。Yibin city in sichuan province for the first people's hospital dean XieMingJun accept《health》Interview pointed out that，Now undergraduate education have serious problems：On the one hand，“Wide caliber”Recruit students、Heavy foundation light clinical、Heavy theory light practice，Causes students to clinical practice ability drop；On the other hand，Mechanism of personnel flow and didn't set up，The hospital through the plan channel step by step receiving talents，Can only rely on continuously improve“threshold”To limit personnel to enter。

　　如今，医学专业学生的求职人数众多，医疗机构用人门槛越来越高，使得一些市级以上医院已不再录用本科毕业生。据《南京日报》8月14日报道，中大医院副院长、东南大学医学院院长滕皋军表示，现在三甲医院的招聘门槛至少是博士，对一个医学生来说，本科5年、硕士3年、博士3年，11年寒窗苦读，不过才走完进入医院的台阶而已。而成为能独当一面的医生，至少还要5年。16年才小有所成，而如果从事其他行业，也许早就功成名就、赚得盆满钵满了。

now，Medical students to apply for a job of many，Medical institutions employing doorsill more and more high，Make some city class above hospital is no longer employed graduates。According to《Nanjing daily》August 14 reported，Cuhk, vice President of the hospital、Southeast university, dean of the medical school TengGaoJun said，Now 3 armour hospital recruitment threshold at least is a doctor，For a medical students，Undergraduate 5 years、Master 3 years、Doctor 3 years，11 years cold window study hard，But didn't go into the hospital after the steps of the just。And can become the singular doctor，Have at least 5 years。16 years to a small extent，And if engaged in other industries，Might have been successful、Earn the piles。

　　另外，不少医学专业学生对医生职业的认同感不高。《医师报》8月20日的报道指出，北京大学医学人文研究院教授王红漫，在北京两所培养医学高级人才的著名高校的5个专业医学生中展开的一项调查发现，2012年医学生对医疗行业的不满意率从2010年的38.5%上升到58.4%，仍有半数医学生对就业前景信心不足。

In addition，Many medical professional students to doctors occupational identity is not high。《Physicians report》On August 20, report，Beijing university institute of medical humanities professor wanghong diffuse，In Beijing two cultivate medical senior talents of the five famous colleges and professional medical students carried out a survey，2012 medical students for medical industry not satisfaction rate rose from 38.5% in 2010 to 58.4%，There are still half of the medical students to obtain employment prospect lack of confidence。

　　当前存在的医患关系紧张问题，对医学生的就业选择也可能产生一定影响。滕皋军指出，医生是非常神圣的职业，但很多学生进入工作岗位后，总是看到理想与现实有很大差距。现在医患关系紧张，医院里大大小小的医患纠纷不少，刚走上工作岗位的医学生碰到病人情绪化、非理性的表现，心里难免产生很强的失落感。因而现在医学生和年轻医生转行的很多。“你如果碰到医药代表，问一下他的背景，很多都是学医的。这在外国同行看来很难理解，他们的医生是不会做这种事的。”

The existing problems of shortage of doctor-patient relationship，On medical students' employment choice is also likely to produce certain effect。TengGaoJun pointed out that，The doctor is very sacred profession，But a lot of students into the working station，Always see the ideal and reality has the very big disparity。Now the doctor-patient relationship nervous，The hospital greatly small doctor-patient dispute many，Just come out to work medical students met patients emotional、Irrational performance，Heart unavoidably produce strong loss。And now medical students and young doctor turned a lot of。“If you run into medicine representative，Ask his background，Many are studied medicine。In the foreign counterparts it seems difficult to understand，Their doctor wouldn't do such a thing。”

　　事实上，基层医疗机构存在巨大的人才缺口。据人民网等媒体近期报道，农村医生缺口53万。《2011年我国卫生事业发展统计公报》显示，2011年年底，乡村医生和卫生员一共112.6万人，却要服务约66万个村卫生室。

In fact，Grassroots medical organizations are huge talent gap。According to the PRC and other media reported recently，Rural doctors gap 530000。《In 2011, health service development statistics bulletin》display，By the end of 2011，Rural doctors and health worker 1.126 million people，But will service about 660000 village clinic。

　　陕西省副省长郑小明在不久前举办的一次卫生论坛上指出，村一级是农村三级卫生服务体系网点，是离农民最近的医疗点，承担预防、保健和治疗等职能，但是在陕西三万村，没有一个卫生试点的村占11%；有卫生试点的村占80%~90%，但是完全达标的只有15%，不达标的达15%；合格医生在基层最少，不仅数量不够，更为突出的问题是缺少好医生。现在很多乡镇的医院不合格，大学本科学历的占11%，大专占17%，中专以及以下专业占32%，个别乡镇因为没有懂操作的人，配备的医疗设备从来没打开过；人员补充受到限制，医学院培养的大都不是农村需要的全科医生。

Vice governor of shaanxi province ZhengXiaoMing held not long ago in a health BBS points out，Village level is rural tertiary health service system network，Is recently from farmers health care facility，Take prevention、The function of health care and treatment，But in shaanxi thirty thousand village，Not a health pilot village accounted for 11%；Have health pilot village accounted for 80% ~ 90%，But only 15% of the standard completely，Substandard amounted to 15%；Qualified doctors in the basic unit at least，Not only quantity is not enough，More prominent problem is the lack of a good doctor。Now a lot of township hospital is unqualified，Bachelor degree of 11%，College accounted for 17%，Technical secondary school and professional below 32%，Individual villages and towns because no understand operating people，Equipped with medical equipment never have been opened；Researchers add is restricted，Medical school culture is not mostly rural need general practitioners。

　　与基层医院急缺医学人才的情况相对的是，不少医学生不愿前往基层就业。一方面，基层医院条件差，收入低。另一方面，学生对职业和工作环境的期望值较高。王红漫的调查还显示，2012年被调查的医学生中，87.5%学生的就业地选择直辖市，还有沿海省会大城市(37.9%)，而选择去沿海、中、西部县乡等基层医疗机构就业的人均不足5%。在报酬方面，近30%的医学生理想年薪期望值在“20万以上”。在工作环境的选择上，愿意毕业后去基层工作两年的医学生比例从2010年的93.5%下降到2012年的57.3%。其中86.7%的人提出各种条件和要求，依次为：“两年后能回原籍工作，住房等方面有优惠”(66.1%)，“两年后能有出国交流继续学习的机会”(64.1%)，以及“在基层有学习机会如培训等”(45.3%)等。

And grassroots hospital urgent lack of medical talents situation is relative，Many medical students don't want to go to grassroots employment。On the one hand，Poor condition of basic-level hospitals，Low income。On the other hand，The student to the professional and working environment of higher expectations。Wanghong diffuse survey also showed，2012 by investigation of medical students，87.5% of students employment to choose municipalities directly under，And the coastal provincial capital cities(37.9%)，And choose to coastal、in、The west, such as medical institution of county and township government grass-roots employment's per capita less than 5%。In the pay in，Nearly 30% of medical students in ideal salary expectations“More than 200000”。In the choice of working environment，Willing to after graduation to grass-roots work two years of medical students' ratio from 93.5% in 2010 dropped to 57.3% in 2012。86.7% of the people put forward all kinds of conditions and requirements，in：“Two years later, can an ancestral home work，Housing is preferential”(66.1%)，“Two years later, can have go abroad exchanges continue to the opportunity to learn”(64.1%)，and“In the basic unit have learning opportunities such as training, etc”(45.3%), etc。

　　北京大学公共卫生学院教授陈育德认为，医学院校应引导学生科学地进行职业规划，理性择业，可将课堂学习和社会实践有机结合，让学生走出课堂，亲历西部基层医疗工作，真正了解经济欠发达地区的医疗卫生状况，亲身感受当地人民的医疗水平，开设基层工作技能的选修课程，传授基层工作的基本技能，还可以在有代表性的基层机构设立实习基地，推荐优秀毕业生到基层挂职，让他们提前了解和适应工作环境和特点。

Beijing university professor with the school of public health ChenYuDe think，Medical colleges should guide students to scientific on career planning，A rational choice，But will the classroom study and social practice organic combination，Let the students out of the classroom，Experience of the grassroots medical work，Really understand the economy less developed areas of the medical and health conditions，Experience the local people's health level，Open grass-roots work skills elective courses，Teach the basic skills of grass-roots work，Still can in the representative grassroots agencies set up practice base，Recommend outstanding graduates to grassroots credentials，Let them know in advance and adapt to the working environment and characteristics。

　　陈育德指出，我们还应尝试建立医学人才赴基层就业的流动机制。国家可以落实优惠政策，提高基层待遇改善工作环境，而学校要根据学生关注的焦点建立相应激励机制，在附属三级医院设置培训基地，作为向基层输出卫生人才的出口，并定期为基层工作的学生提供培训机会；将基层工作经历作为岗位聘任与专业学位研究生录取的考核指标，使在基层工作的学生有机会回到城市；提供适当物质奖励与减免学费等优惠，同时要提高医学生的职业价值认知能力，避免因认识误区而放弃，造成医学人才浪费。(韩妹)

ChenYuDe pointed out that，We should also try to establish medical talents to the grassroots employment flow mechanism。The state may implement preferential policies，Improve the treatment to improve the working environment，And school students according to the focus of the establishment of incentive mechanism，In the subsidiary tertiary hospital set up training base，As to grassroots output health personnel export，And regularly for the grass-roots level students provide training opportunities；The grass-roots work experience as a post appointment and professional degree graduate admissions evaluation index，In the grass-roots level students have the opportunity to go back to the city；Provide appropriate material rewards and tuition waiver and preferential，At the same time to improve medical students' vocational value cognitive ability，Avoid the misunderstanding and give up，Cause waste of medical talents。(HanMei)