Human resources in Hai Duong health sector: Many shortages, difficult to recruit

Lack of medical staff at all three levels

From 2021 to 2023, Hai Duong recruited 533 health workers. However, as of December 31, 2023, the whole province still lacked thousands of health workers, not meeting the minimum standards as prescribed.

Medical staff in Hai Duong is lacking at all three levels. Up to this point, provincial hospitals are short of 583 people, of which the most are in General Hospitals with 227 people, Psychiatric Hospitals 103 people, Traditional Medicine Hospitals 65 people, Pulmonary Hospitals 50 people... District hospitals (including commune health stations) are short of 739 people, the most are in Tu Ky District with 110 people, Hai Duong City 94 people...

This year, the recruitment of medical personnel has not seen many changes. As of March 31, Hai Duong still lacks 3 civil servants and 1,605 medical staff. Recruiting doctors for the grassroots level, in the fields of psychiatry, forensic medicine, infectious diseases, tuberculosis, surgery, etc. is very difficult. Some provincial hospitals and district health centers have not been able to recruit doctors for these positions for many years. Meanwhile, 25% of commune health stations in the province currently do not have doctors.

The Hai Duong health sector is also facing a situation where medical staff have resigned. From 2021-2023, the whole province had 224 medical staff resign, including 81 doctors. By the end of the first quarter of this year, the whole province had 20 doctors who had transferred jobs, including 2 PhDs, 2 level II specialists...

The lack of human resources has significantly affected the work of improving professional quality at medical facilities, especially the development of specialized medical examination and treatment services on demand, causing the rate of patients being transferred to higher levels to remain high.

There are many reasons for this situation, but the key issue lies in the limited recruitment policy of the health sector. The income of medical staff is currently not commensurate with the training time and the pressures of work and life. Specialist Doctor I Nguyen Manh Ha, Head of the Pediatrics Department of Nam Sach District Medical Center, shared: "After nearly 20 years of working, my total income is only about 12 million, including on-call fees. My husband and I have to spend frugally to raise 2 children to study, and we do not have money to build a house and have to live with my parents."

Income is not commensurate, medical staff when going to study to improve their qualifications are not supported or the level of support is still low. Outdated and inadequate medical equipment conditions make it difficult for doctors to develop their skills...

Change in welfare policy

Since 2011, the People's Committee of Hai Duong province has issued Decision No. 35 "Regulations on recruitment for training by location, training support and attraction of university doctors and pharmacists to work at district and commune level medical facilities in the province". Each doctor working at the commune level will receive a one-time cash support of 90 million VND from the province, the district level (except Hai Duong city, which does not apply this policy) will receive support from 70-80 million VND.

In 2019, the Provincial People's Council issued Resolution No. 08 on policies to attract high-quality human resources... in the province. The province provided one-time cash support equal to 120 times the basic salary for professors, 100 times the basic salary for associate professors, doctors of medicine, doctors of pharmacy, resident physicians, 80 times the basic salary for doctors, pharmacists, etc.

However, many health managers believe that the above policies are outdated compared to reality and are inferior to many other provinces and cities. An official working in the industry who asked to remain anonymous analyzed: "According to Decision 35, the whole province has recruited 285 doctors and pharmacists, but most of them were recruited many years ago. In recent years, the remuneration according to this decision is only equal to or even less than 1 month's salary of a doctor working in a reputable private hospital. We need to change the remuneration policy soon to hope to solve this situation."

Resolution No. 08 has improved the remuneration, helping the province recruit 26 doctors and pharmacists with specialist level II (as of June). However, the remuneration under this Resolution is not attractive, far behind many other places. Since 2023, Quang Ninh province has supported 400 million VND for doctors working at the commune level, 300 million VND for doctors working at the district level. In the period of 2021-2025, Thanh Hoa province will pay a one-time cash payment to doctors working at the commune level from 300-450 million VND/person (depending on the region) and other units 250 million VND/person. This province also supports doctors and specialist level I working in the province with 200 million VND/person, while Hai Duong has not applied this to this group.

Changing the incentive policy to attract human resources for the health sector is very necessary at present. Deputy Director of the Department of Health Pham Huu Thanh said that the department is coordinating with the province to issue a new human resource attraction policy in the direction of changing Decision No. 35 and part of Resolution 08. Focusing resources on increasing the amount of one-time support, prioritizing doctors at the commune level and some positions in hospitals that are difficult to recruit people...

"We are also calculating the transfer of doctors from the upper level to the grassroots level to fill in the shortages. On the other hand, we are advising on policies to support doctors to study to improve their skills. We are recommending that the province open a training class for doctors to be recruited and trained right in the province," Mr. Thanh emphasized.

Call for socialization of modern medical equipment

One of the reasons why many doctors from Hai Duong do not want to return to serve their hometown after graduation is because medical equipment is still lacking and has not been invested in to upgrade synchronously and modernly for them to develop their skills. Recently, many doctors at public hospitals have resigned.

In addition to reasons such as inadequate income and working environment, outdated medical equipment is also one of the reasons that makes it more difficult to retain doctors in public hospitals. If there is modern medical equipment, high-quality medical services can be deployed, people will have the opportunity to access specialized medical techniques, thereby also creating conditions to increase income for medical staff.

For hospitals that are implementing financial autonomy, it is impossible to have funds to purchase modern medical equipment on their own at the present stage. Because the price of medical services is currently calculated based on only 2 of the 4 components including labor costs and direct costs. The 2 factors that are not calculated are depreciation of fixed assets - machinery and management costs. Many localities, including Hai Duong, have not yet regulated appropriate medical service prices to attract investment units, and have not issued medical examination and treatment prices on demand based on the correct calculation and full calculation of the 4 components according to the Law on Medical Examination and Treatment and in accordance with the new basic salary level. Therefore, it is very difficult to call for investment in medical equipment in public health units in the form of socialization. The state budget is limited, so it is not possible to invest in a series of hospitals.

To contribute to retaining human resources in the health sector, the province should create favorable conditions for organizations and individuals to invest in socialized modern equipment in public health facilities in the direction of public-private partnership on the basis of early promulgation of appropriate medical service price regulations in accordance with the provisions of the Law on Medical Examination and Treatment and the actual situation.

Dr. NGUYEN VAN LUU

Director of Hai Duong Lung Hospital

Hai Duong City needs to apply preferential treatment to attract doctors.

I am very happy to hear that Hai Duong is likely to change its remuneration policy to attract university doctors and pharmacists to work at district and commune health facilities, based on amending Decision No. 35 of the Provincial People's Committee that has existed since 2011.

However, if the new attraction regime is still applied according to each locality as in Decision 35, Hai Duong City will be at a great disadvantage. Because according to the current decision, Hai Duong City is the only unit in the province that is not allowed to apply the preferential treatment regime to attract doctors. Specifically, if doctors work at the City Medical Center and health stations in communes and wards, they will not receive a one-time support fund of 70-90 million VND/person like the remaining 11 districts, towns and cities.

I understand that the City Health Center and some commune and ward health stations are currently lacking doctors. Recruiting university doctors and pharmacists is not easy. Meanwhile, Hai Duong City is a densely populated area, the population aging process is happening rapidly, the disease pattern is changing, so it is in great need of quality medical human resources to meet the treatment and health care needs of the people. Therefore, when the province builds a policy to attract doctors to the grassroots health sector, it should also be applied to the entire Hai Duong City area.

In addition, to attract doctors to the commune level, I suggest that all levels soon propose to increase the on-call allowance for medical staff at commune health stations. For decades, we have only received 18,750 VND for on-call allowance/weekday and 32,500 VND/Saturday and Sunday. In addition to the salary based on seniority, each month, a medical staff at a health station only receives an additional 300,000-400,000 VND for on-call allowance. My unit has 6 officers and employees with seniority from 14 to nearly 30 years, but the total monthly income is only 8-12 million VND/person. Living in the city, this amount of money is not enough to cover expenses, pay for children's education, some people have to do other jobs...

Doctor NGUYEN HUU TUONG

Head of Tan Binh Ward Health Station (Hai Duong City)