High temporary employment rate of hospitals challenges the primary medical system

November 20, 2023
China Comment
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For primary hospitals in the Wumeng Mountain area, government-budgeted positions are an important means to attract talent. In reality, some county-level hospitals in this area have a large number of vacant budgeted positions while hiring many non-staff medical personnel. The result is that they are unable to attract high-quality talent and are unable to retain experienced experts.

19% government-budgeted positions vacancy rate and 45% temporary employment rate

In a county people’s hospital in the Wumeng Mountain area, there are a total of 763 government-budgeted positions. Currently, there are 1,121 employees in total, including 616 staff members in budgeted positions, resulting in a budgeted positions vacancy rate of 19.3%. There are 505 non-staff employees, accounting for 45% of the total number of employees.

The hospital’s responsible person stated that main jobs of non-staff employees are such as administrative logistics, nursing, physicians, and technicians. Out of 353 physicians, 62 are non-staff personnel, accounting for 17.56%. Among 489 nurses, 313 are non-staff personnel, accounting for 64%. Out of 147 administrative logistics and non-health-related technical personnel, 102 are non-staff personnel, accounting for 69.4%.

Looking at the overall situation in the county, the health system has a total of 2,475 government-budgeted positions, with 2,065 actual personnel, resulting in 410 vacancies and a vacancy rate of 16.57%. At the same time, the number of non-staff medical personnel recruited in the county far exceeds the number of government-budgeted personnel.

In contrast to primary hospitals in economically developed areas, the government-budgeted positions of public institutions are a key factor in recruiting and retaining talent in underdeveloped areas. “In developed areas, performance-based salaries in hospitals are several times the basic salary. The total income of an officially budgeted and an unofficially budgeted position differs relatively little. However, in some hospitals in the Wumeng Mountain area, performance-based salaries are low. Therefore, there is a difference of over one-third in the total income of an officially budgeted position and an unofficially budgeted position,” said a director of a county-level hospital.

In another hospital in the Wumeng Mountain area, there are 385 officially budgeted positions, with 345 staff members and 664 temporary employees. “Since the beginning of this year, the hospital has already lost 65 medical personnel, and a significant portion of them is due to the lack of officially budgeted positions. When we recruited college students in May, once they heard that there were non-staff positions, almost all positions had no applicants,” said the hospital’s director. They also mentioned the need to hire 40 medical personnel without officially budgeted positions in the near future, otherwise, the hospital will face shortages.

A county-level maternal and child health hospital in the Wumeng Mountain area is about to undergo a review to become a secondary hospital. “According to the requirements for the ratio of beds to medical personnel, our hospital needs to have at least 100 medical personnel. Currently, we have 45 staff members and 52 temporary employees,” said the responsible person of the hospital. The high turnover rate of temporary medical personnel leads to poor stability in the level of medical care, and the pressure to meet the review requirements of a secondary hospital is significant.

Why are officially budgeted positions not being used?

With the support of a well-known hospital in Sichuan, a county-level hospital in the Wumeng Mountain area has been performing an increasing number of tertiary and quaternary care in recent years. For the same pancreatic cancer surgery, the medical costs are about 50% lower locally compared to Chengdu. The hospital has also achieved a significant increase in patient visits, bed capacity, and medical revenue, with an expected breakthrough of over 300 million yuan this year.

“Since 2018, the actual number of hospital beds has increased by several hundred, but the approved staffing of medical personnel by the government has not only failed to increase but has been continuously reduced. Compared to the national requirement for the ratio of beds to medical staff, there is still a shortage of more than 200 government-budgeted positions. The hospital itself has 117 vacant government-budgeted positions, but the county has not approved their use,” said the secretary of the hospital’s Party Committee. The business is growing, but the actual number of officially budgeted positions is decreasing. Who will handle the workload? The hospital can only recruit non-staff medical personnel.

It is understandable that the entire county faces a shortage of government-budgeted positions and cannot increase the allocation. However, why are unused government-budgeted positions not allowed to be utilized?

“Although the government-budgeted positions belong to the hospital, they must be approved by the county’s institutional staffing committee to be used. Once staffing positions are approved for use, the county finance department is responsible for funding the personnel’s salary based on headcount. Temporary employment does not require approval from the staffing committee, and the hospital independently decides the recruitment quantity. The required salary and benefits are almost entirely borne by the hospital itself,” explained a director of a county-level TCM hospital, pointing out the key factor.

“By strictly controlling the use of staffing positions, the staffing committee reduces the investment of public medical funds and shifts the economic burden of recruiting hospital personnel onto the hospital itself,” said the TCM hospital director.

The director of a primary health center in a county within the Wumeng Mountain area provided an example: The salary composition for medical personnel with government-budgeted positions is a monthly base salary of 4,100 yuan funded by the county finance department, including performance bonuses. For temporary medical personnel, the salary composition is a monthly base salary of 800 yuan, also including performance bonuses. “50% of the net income of the health center is used to distribute performance bonuses to all staff members. It can reach up to 1,800 yuan in some months, but it is not stable,” said the director. The income disparity leads to the loss of medical personnel almost every quarter.

To attract and retain medical talents

Improving medical conditions in underdeveloped areas is of great significance for preventing poverty caused by illness and promoting rural revitalization. The key to improving primary healthcare lies in talent acquisition and retention, as well as continuously motivating medical personnel.

Firstly, it is necessary to prevent primary-level governments from draining resources from local public hospitals. An expert engaged in targeted assistance work in the Wumeng Mountain area shared his experience. He had secured 5 million yuan in funding for key specialty development and talent cultivation projects from the provincial government. This funding would help the supported hospitals enhance their disciplinary construction. However, once the funds reached the hospital’s account, the local government misappropriated them, leaving the expert uncertain about how to explain the situation to the provincial government regarding talent cultivation.

Secondly, it is important to enhance the efficiency of resource utilization and provide support for the development of disciplines and talent recruitment. The director of a county-level hospital expressed that although the hospital’s cash flow is relatively stable, funds intended for issuing performance bonuses to medical staff are frequently misappropriated by the local government. This phenomenon leads to delays in bonus payments and discontent among medical personnel.

Thirdly, it is necessary to accelerate the reform of the medical system in public hospitals and promote equal pay for medical personnel both within and outside the system. In situations where government-budgeted positions are unable to meet the immediate demand for resources, efforts should be made to bridge the gap in salary, professional title evaluation, and housing security between medical personnel within and outside the system.



China Comment
China Comment is a journal of Xinhua News Agency. It mainly focuses on the investigation, exposure, and discussion of social issues.
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