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Since opening his independent medical practice in Shanghai at the beginning of this year， Zhang Qiang， a cardiovascular surgeon， has adopted an entirely new lifestyle. Unlike most doctors in the country， who are employed by one public hospital at a time， he now works for several hospitals.
Zhang used to be head of the Vascular Surgery Department of East Hospital， which is affiliated with Tongji University in Shanghai. He resigned at the end of 2012 to pursue his new career path.
“I hope to set up a day-surgery platform that is up to international standards，” Zhang told Beijing Review. He said that patients undergoing surgery for varicose veins usually do not have to be hospitalized. Yet in public hospitals， doctors often recommend patients to receive inpatient care， which Zhang thinks is often unnecessary and just increases the medical bills the patients have to pay. Zhang said that it would be easier to set up a day-surgery platform in private hospitals.
Currently， Zhang mainly practices at Worldpath Clinic International in Shanghai and United Family Hospital in Beijing. The former is a general medical institution jointly funded by healthcare professionals from both China and the United States， which aims to provide “expatriates and affluent families in Shanghai with the highest-quality medical services”. The latter is a hospital under Chindex， a NASDAQ-listed China-U.S. joint-venture healthcare company. The hospital aspires to provide personalized medical services to patients.
Yet Zhang is not directly employed by any of these hospitals. He is actually self-employed. Rather than earning his salary from the hospitals， he gets a share of their revenue as a contractor.
Zhang has formed his own surgery team consisting of medical specialists， nurses and assistants. He pays their salary and fringe benefits with his own money， and patients can book an appointment with Zhang through his secretary. In the future， he plans to partner with a public relations company and multinational medical suppliers.
Zhang said that over the past months， the government has encouraged doctors to practice independently and in the meantime， the development of private medical institutions has given independent medical professionals more opportunities.
New platforms
In China， big hospitals are suffering from a crowding epidemic. For the past few years， in order to improve the availability of medical services， the government has encouraged investment in private hospitals. As a result， the number of private hospitals has been growing rapidly. As of the end of March， China had a total of 10，166 private hospitals， up 14.69 percent year on year， according to a bluebook on private hospitals jointly released on October 24 by the NonPublic Hospital Management Branch of the Chinese Hospital Association， the Beijingbased ChangCe Thinktank and the China Social Sciences Academic Press.
Private hospitals accounted for 43.24 percent of all medical institutions in the country， while their outpatient visits and admitted patients accounted for about 10 percent compared to public hospitals， according to the report.
In 2012， the Chinese Government outlined goals for increasing the total number of beds in private hospitals and their share of demanded services to approximately 20 percent of the total provided by all medical institutions by 2015.
Private hospitals still face bottlenecks that inhibit their growth， including shortages of outstanding doctors. Currently， some high-end private hospitals excel at providing nursing services， yet their lack of skilled doctors weakens their competitive edge， Zhang said. He believes that independent medical practitioners are going to alleviate this shortage and increase private hospital competitiveness in the market.
In response， on October 14， the State Council， China’s cabinet， issued a guidance on promoting development of the health service industry. The document gave the private sector greater access to the healthcare market and simplified approval procedures for opening hospitals serving the elderly or children and those offering recuperation services. It also relaxed restrictions on the number， size， location and facilities of for-profit hospitals. The document stated that private and public hospitals should be treated equally.
Interim step
Private hospitals need talented doctors to help them stand out from the crowd. A survey recently conducted by the Non-Public Hospital Management Branch of the Chinese Hospital Association on 510 private hospitals revealed that 97 percent wished to hire a larger number of well-trained professionals.
Nonetheless， high-caliber doctors tend to work in large public hospitals rather than in community health centers， rural hospitals or private hospitals. To encourage doctors to serve better urban communities and rural areas， in September 2009， the Ministry of Health， now known as the National Health and Family Planning Commission， implemented a regulation that allows doctors with a professional rank of associate professor or above to practice at multiple medical institutions. The policy was piloted in Beijing and several provinces such as Guangdong， Hainan， Sichuan and Jiangsu before being implemented nationwide since July 2011. Although many doctors welcome the policy， few have applied to practice at multiple institutions， according to Zhu Hengpeng， Director of Center for Public Policy at the Institute of Economics of the Chinese Academy of Social Sciences （CASS）. To practice at multiple institutions， a doctor is required to submit an application， get approval from the hospital he or she is employed with， and then register with the local health authority.
During the three years leading up to December 2012， only 170 doctors had applied to practice at multiple hospitals in Guangdong’s Shenzhen， and only 36 doctors had obtained approval， according to the city’s Health， Population and Family Planning Commission. Local public hospitals have about 6，100 doctors with an academic rank of associate professor or above， which would qualify them for the process.
Zhu said that a major obstacle that prevents doctors from applying to practice at more than one institution is that they are required to get approval from their current employers. “Medical skills are at the core of a hospital’s quality， so few hospital presidents are willing to let other hospitals use their valuable resources，” he noted.
On the other hand， in addition to paying doctors’ salaries， medical insurance and pensions， hospitals also have a large say in doctor’s promotions to higher academic ranks. As a result， few doctors dare to offend their employers and put their livelihood at risk by applying to practice at multiple institutions， Zhu added.
According to Caixin Magazine， Shenzhen had devised regulations to allow doctors to practice at multiple institutions without approval from their employers， but revoked the document at the end of July after having submitted it for approval to the Guangdong Provincial Department of Health. Caixin reported on July 26 that Cai Li， Director of the Health， Population and Family Planning Commission of Shenzhen， revealed that the commission is working on a new reform program and admitted that the previous one is not comprehensive enough.
Some experts question the merits of allowing doctors to practice in public institutions. It
may not even be able to increase the supply of
medical services or lower medical costs， at least in the short run， said Chen Qiulin， a health policy researcher with the Institute of Population and Labor Economics of the CASS.
Doctors qualified for practicing at more than one site are usually already working to their fullest capacity at their original hospitals， Chen said. To practice at other institutions， they have to either cut their practice hours at their original hospitals or work extra hours， according to him. Zhang agreed that if doctors currently hired by public hospitals practice at multiple institutions， the quantity and quality of their work at their original hospitals might be affected. He suggests that independent medical practitioners， whose time is more flexible， are more suitable for practicing at multiple hospitals.
However， Zhang told Beijing-based The Economic Observer that in China， it is not realistic for all doctors to become independent medical practitioners. In future， some doctors will work in public medical institutions， whereas some doctors， including those who practice independently， will work for private medical institutions， he said.
When Zhang left his original position， he wished that he could contract both a private hospital and a public one， but he found that public hospitals currently cannot accept independent medical practitioners.
Zhang hopes that as private hospitals grow， they will prompt public hospitals to change their mindsets and services.
Zhang used to be head of the Vascular Surgery Department of East Hospital， which is affiliated with Tongji University in Shanghai. He resigned at the end of 2012 to pursue his new career path.
“I hope to set up a day-surgery platform that is up to international standards，” Zhang told Beijing Review. He said that patients undergoing surgery for varicose veins usually do not have to be hospitalized. Yet in public hospitals， doctors often recommend patients to receive inpatient care， which Zhang thinks is often unnecessary and just increases the medical bills the patients have to pay. Zhang said that it would be easier to set up a day-surgery platform in private hospitals.
Currently， Zhang mainly practices at Worldpath Clinic International in Shanghai and United Family Hospital in Beijing. The former is a general medical institution jointly funded by healthcare professionals from both China and the United States， which aims to provide “expatriates and affluent families in Shanghai with the highest-quality medical services”. The latter is a hospital under Chindex， a NASDAQ-listed China-U.S. joint-venture healthcare company. The hospital aspires to provide personalized medical services to patients.
Yet Zhang is not directly employed by any of these hospitals. He is actually self-employed. Rather than earning his salary from the hospitals， he gets a share of their revenue as a contractor.
Zhang has formed his own surgery team consisting of medical specialists， nurses and assistants. He pays their salary and fringe benefits with his own money， and patients can book an appointment with Zhang through his secretary. In the future， he plans to partner with a public relations company and multinational medical suppliers.
Zhang said that over the past months， the government has encouraged doctors to practice independently and in the meantime， the development of private medical institutions has given independent medical professionals more opportunities.
New platforms
In China， big hospitals are suffering from a crowding epidemic. For the past few years， in order to improve the availability of medical services， the government has encouraged investment in private hospitals. As a result， the number of private hospitals has been growing rapidly. As of the end of March， China had a total of 10，166 private hospitals， up 14.69 percent year on year， according to a bluebook on private hospitals jointly released on October 24 by the NonPublic Hospital Management Branch of the Chinese Hospital Association， the Beijingbased ChangCe Thinktank and the China Social Sciences Academic Press.
Private hospitals accounted for 43.24 percent of all medical institutions in the country， while their outpatient visits and admitted patients accounted for about 10 percent compared to public hospitals， according to the report.
In 2012， the Chinese Government outlined goals for increasing the total number of beds in private hospitals and their share of demanded services to approximately 20 percent of the total provided by all medical institutions by 2015.
Private hospitals still face bottlenecks that inhibit their growth， including shortages of outstanding doctors. Currently， some high-end private hospitals excel at providing nursing services， yet their lack of skilled doctors weakens their competitive edge， Zhang said. He believes that independent medical practitioners are going to alleviate this shortage and increase private hospital competitiveness in the market.
In response， on October 14， the State Council， China’s cabinet， issued a guidance on promoting development of the health service industry. The document gave the private sector greater access to the healthcare market and simplified approval procedures for opening hospitals serving the elderly or children and those offering recuperation services. It also relaxed restrictions on the number， size， location and facilities of for-profit hospitals. The document stated that private and public hospitals should be treated equally.
Interim step
Private hospitals need talented doctors to help them stand out from the crowd. A survey recently conducted by the Non-Public Hospital Management Branch of the Chinese Hospital Association on 510 private hospitals revealed that 97 percent wished to hire a larger number of well-trained professionals.
Nonetheless， high-caliber doctors tend to work in large public hospitals rather than in community health centers， rural hospitals or private hospitals. To encourage doctors to serve better urban communities and rural areas， in September 2009， the Ministry of Health， now known as the National Health and Family Planning Commission， implemented a regulation that allows doctors with a professional rank of associate professor or above to practice at multiple medical institutions. The policy was piloted in Beijing and several provinces such as Guangdong， Hainan， Sichuan and Jiangsu before being implemented nationwide since July 2011. Although many doctors welcome the policy， few have applied to practice at multiple institutions， according to Zhu Hengpeng， Director of Center for Public Policy at the Institute of Economics of the Chinese Academy of Social Sciences （CASS）. To practice at multiple institutions， a doctor is required to submit an application， get approval from the hospital he or she is employed with， and then register with the local health authority.
During the three years leading up to December 2012， only 170 doctors had applied to practice at multiple hospitals in Guangdong’s Shenzhen， and only 36 doctors had obtained approval， according to the city’s Health， Population and Family Planning Commission. Local public hospitals have about 6，100 doctors with an academic rank of associate professor or above， which would qualify them for the process.
Zhu said that a major obstacle that prevents doctors from applying to practice at more than one institution is that they are required to get approval from their current employers. “Medical skills are at the core of a hospital’s quality， so few hospital presidents are willing to let other hospitals use their valuable resources，” he noted.
On the other hand， in addition to paying doctors’ salaries， medical insurance and pensions， hospitals also have a large say in doctor’s promotions to higher academic ranks. As a result， few doctors dare to offend their employers and put their livelihood at risk by applying to practice at multiple institutions， Zhu added.
According to Caixin Magazine， Shenzhen had devised regulations to allow doctors to practice at multiple institutions without approval from their employers， but revoked the document at the end of July after having submitted it for approval to the Guangdong Provincial Department of Health. Caixin reported on July 26 that Cai Li， Director of the Health， Population and Family Planning Commission of Shenzhen， revealed that the commission is working on a new reform program and admitted that the previous one is not comprehensive enough.
Some experts question the merits of allowing doctors to practice in public institutions. It
may not even be able to increase the supply of
medical services or lower medical costs， at least in the short run， said Chen Qiulin， a health policy researcher with the Institute of Population and Labor Economics of the CASS.
Doctors qualified for practicing at more than one site are usually already working to their fullest capacity at their original hospitals， Chen said. To practice at other institutions， they have to either cut their practice hours at their original hospitals or work extra hours， according to him. Zhang agreed that if doctors currently hired by public hospitals practice at multiple institutions， the quantity and quality of their work at their original hospitals might be affected. He suggests that independent medical practitioners， whose time is more flexible， are more suitable for practicing at multiple hospitals.
However， Zhang told Beijing-based The Economic Observer that in China， it is not realistic for all doctors to become independent medical practitioners. In future， some doctors will work in public medical institutions， whereas some doctors， including those who practice independently， will work for private medical institutions， he said.
When Zhang left his original position， he wished that he could contract both a private hospital and a public one， but he found that public hospitals currently cannot accept independent medical practitioners.
Zhang hopes that as private hospitals grow， they will prompt public hospitals to change their mindsets and services.