The Current Situation And Countermeasure Research Of The Rural Doctors In Shandong

Background:Rural doctors are the most grass-roots medical treatment and public health personnel, and they are playing an important role in guaranteeing health of the vast rural residents. Rural doctor teams went through the development stages of assistant nurses, barefoot doctors and rural doctors with features of a large number of personnel involved, long time span, various practicing requirements and great changes of practicing places. For a long time, rural doctors in Shandong Province have been developed steadily. While with deep propelling of medical reform, some new situations and new issues are encountered, for example, the issue of positioning and segregation of duties of rural doctors, the issue of low service ability of overall rural doctor teams, the issue of low salaries of rural doctors and worries after their retirement. These new situations and new issues are restricting consolidation and development of rural doctor teams, affecting stability of the team and it is unfavorable to deep promoting of medical reform. Therefore, making research of current situation of rural doctor development in Shandong Province, analyzing existing problems deeply, learning appeals of rural doctors and proposing corresponding solutions as per reality in Shandong Province are of great significance to stabilize rural doctor teams, consolidate the foundation of three-level medical service network and guarantee health of rural residents of the whole province.Objectives:The purpose of this research is to learn current survival status of rural doctors in Shandong province, analyze existing issues and appeals, compare with practices of improving salaries of rural doctors in some other provinces in China, solutions of retirement issues of private teachers in Shandong Province, stabilizing rural doctor teams in some counties (districts) of Shandong Province, propose countermeasures and suggestions for development of rural doctor teams in Shandong Province and provide political supports to stabilize rural doctor teams and consolidate the foundation of rural medical treatment and health service network.Detailed purposes are as following:(1) Research current situation of rural doctor teams in Shandong Province.(2) Analyze existing issues and main appeals of development of rural doctor teams in Shandong Province.(3) Analyze relative practices of rural doctor development issues in other provinces, some cities and counties of Shandong Province.(4) Analyze practices of retirement issues of private teachers in Shandong Province.(5) Propose suggestions and advices to sustainable and healthy development of rural doctor teams in Shandong Province.Methods:Combine quantitative analysis with qualitative analysis. The specific approaches include literature review; questionnaire survey; group discussion; and comparison method.Literature review method:using the CNKI, PubMed database and search engine tools to research the related literature in both English and Chinese, collected the audio-visual materials, policy document and China health statistics yearbook related the development of the rural doctors.Questionnaire investigation:The current study designed a questionnaire about rural doctors, its content includes the basic condition of the rural doctors, income, job situation and situation of old-age security and etc. the survey was carried out in 6 to 9 months of 2014.Group interview method:The interview outline was designed before the interview. The rural doctors, health administrative departments, medical institutions and personnel and related management personnel were interviewed to investigate the present situation and the contingent of rural doctors, etc.Data sort and analysis methods:in this study, information management system were designed and used to sort and set up the database. Rate, ratio index were used to descripte the qualitative data and SPSS 19.0 software was used to complete the statistical analysis.Main Results:(1)There are 370175 rural doctors totally in Shandong Province, of which 141144 doctors are on duty, accounting for 38.13%, the gross service population is about 72.76 million people, and there are 1.94 rural doctors for each one thousand people.(2)Among all rural doctors, the male account for 59.87%, the female accpunt for 40.13%, and among on duty the propotion is respectively 66.86% and 33.14%.(3)Among all rural doctors, there are 5585 under age 30, accounting for 1.51%; there are 94303 between age 30 and 45, accounting for 25.48%; there are 106583 between age 45 and 60, accounting for 28.79%; there are 163704 above age 60, accounting for 44.22%.(4)At the aspect of education,93.54% rural doctors at and below technical secondary school/senior high school educational level,6.09% rural doctors at college education level, 0.37% rural doctors at and above bachelor. The above propotion of rural doctors on duty is respectively 86.39%.12.86% and 0.75%.(5)At the aspect of income, annual income of more than 60% rural doctors is less than RMB15000, and only 27% rural doctors can get more than RMB25000 annual income.(6) At the aspect of retirement,133617 people buy various social endowment insurances, accounting for 36.1%.(7) In recent years,229031 rural doctors leave and quit, accounting for 61.87%. Of which,133606 people quit for old, accounting for 58.34%; 86952 people quit for low welfare, accounting for 37.97%; 4583 people quit for unapproved licenses, accounting for 2%; 3890 people quit for other reasons, accounting for 1.7%.Conclusions and Suggestions:(1) Rural doctor teams of Shandong Province are developing stably, but they are facing four issues of being identified as peasants, low salaries, no endowment security and irrational team structure which restrict team development.(2) There are two main subjective appeals from rural doctors in Shandong Province: the first one is affirming the identification of rural doctors reasonably as per practicing methods of private teachers to solve their worries after retirement; the second is increasing the intensity of compensation and improve salaries further.(3) Beijing and some other provinces and some cities and counties of Shandong Province have issues some policies to solve endowment and development issues of rural doctors better and they can be used for reference.(4)According to the above research results, following suggestions are proposed for reference:(1)Establish incentive system; solve the identification issue of rural doctors step by step; (2) Perfect compensation mechanism, and improve salaries of rural doctors through multi channels; (3) Combine subsidies and endowment, and solve endowment security of rural doctors rationally; (4) Explore and establish admittance and quit mechanism, and optimize the team constantly.