国家版“多点执业”意见出台，但医生自由之路仍迷离

admin · 发表于 2020-10-21 13:37:50

<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">从2014年初的征求意见稿要求的“取得第一执业地点”的“书面同意”改为正式文件的“同意”，尽管只是少了书面二字，但对医生的限制则有明显不同。“书面同意，说明必须白纸黑字，加盖公章，而仅要求‘同意’，灵活性就大了很多”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop8mf1ILNMhUicKR7LCGEhZutmiaR3ic3hdjM4G2QGJicC0bfQItOECDV3qg/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop8mf1ILNMhUicKR7LCGEhZutmiaR3ic3hdjM4G2QGJicC0bfQItOECDV3qg/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　当公立医院被限制扩张，医院不能招更多的人，因此多点执业后可以做更多的交流、替换，让队伍更精干、专业、有用。从另外一个角度来看，多点执业也势在必行，国家正在推进事业单位改革，事业单位的福利将减少，福利留人的办法将会弱化……<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　2015年1月12日，国家卫计委在其官方网站上正式对大众公布了《关于推进和规范医师多点执业的若干意见》的通知，而“国卫医发〔2014〕86号”的编号，也证实了这份国家层面关于推进和规范医师多点执业的意见通知其实已在2014年年底正式出台，目前多个省市区正在考虑研究相关管理办法和实施细则。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopOHHic73vc5icicjbPYGacO3QnAZrH2aXTX8gVMg95SR5vlU4U4ia8YUwdQ/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopOHHic73vc5icicjbPYGacO3QnAZrH2aXTX8gVMg95SR5vlU4U4ia8YUwdQ/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　“解放”医生<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　多点执业，意味着医生将从公立医院中获得“解放”。医生申请多点执业，是否要取得第一执业地点医疗机构的同意，是关键问题之一。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　在《意见》中，从征求意见要求“取得第一执业地点的书面同意”，改为取得第一执业地点医疗机构的“同意”，尽管只是少了书面二字，但中国医院协会副秘书长庄一强表示，对医生的限制则有明显不同。“书面同意，说明必须白纸黑字，加盖公章，而仅要求‘同意’，灵活性就大了很多”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　这次《意见》提出，有条件的地方，可以探索医师向第一执业地点医疗机构履行知情报备手续，即可开展多点执业试点。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　庄一强表示，医师多点执业此前实行的是审批制，而备案管理只需要登记，不再需要批准。探索履行知情报备手续，意味着以后医生只需跟医院“打个招呼”就可以了，自由程度更高。而何为“有条件的地方”？庄一强表示，这主要取决于当地医疗资源丰富程度。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　同时，《意见》还明确提出，第一执业地点医疗机构应当支持医师多点执业并完善内部管理，不能因医师多点执业而影响其职称晋升、学术地位等。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopdeho3nBQLmMHBpN5JorZaWU9tgaRWbVsiaRY6IYtbpeyeVhTA136wZA/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopdeho3nBQLmMHBpN5JorZaWU9tgaRWbVsiaRY6IYtbpeyeVhTA136wZA/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　北京、浙江成“改革先锋”<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　对比起国家层面改革，北京、浙江等地的改革力度更大。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　去年8月1日，北京实施新的《北京市医生多点执业管理办法》，最大突破是申请多点执业的医生从过去要取得书面同意，改为向第一执业地点所在医疗机构报告即可。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　北京市卫计委提供的数据显示，新政实施5个月，截至2014年12月31日，北京市受理注册多点执业人数1170人，是2013年同期的4倍。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　今年3月1日，浙江也将正式实施多点执业的新政，明确降低了医师多点执业的准入条件，要求医疗机构应允许医生在法定工作日每周可安排一天用于多点执业。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　同时，首次提出探索医师自由执业。对于副主任医师以上职称、重点或紧缺专业医技人员，允许其在浙江省内任一医疗机构内执业，无需办理医师多点执业登记手续。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　深圳相关人士透露，2015年6月前将制定医务人员执业管理方式的改革方案，建立医师多点执业地点自行报备制度，全面放开医师执业地点限制，实行“统一注册，全城通用”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　广州一家大型三甲医院资深医院管理者张凯(化名)表示，相比北京、浙江、深圳这些地方出台的方案，国家层面这份文件显得要保守很多。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopjml0ibZUxw93L2LonWFPKtnKgQndmq5lrXUmW0vdrWZxantzIk849hA/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopjml0ibZUxw93L2LonWFPKtnKgQndmq5lrXUmW0vdrWZxantzIk849hA/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　公立医院对多点执业态度不一<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　尽管上述地方尝试打破多点执业的障碍，但多个省市区卫计委对推开多点执业存顾虑的不在少数。归结原因，主要是公立医院缺乏积极性，而在人事管理、考核、社保养老等配套措施上又欠缺完善。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　“我们对多点执业的态度是既不鼓励，也不反对。”一名医改试点城市的地方卫计委官员坦言，因各地情况不同，在医师多点执业问题上“不会冒进”，而且“公立医院院长们也不同意”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　湖南卫计委一名官员也坦言，多点执业需要多方面的条件，只能慢慢来。“现在普遍院长都是持比较保守意见，不太同意这样的搞法”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　青海省卫计委医政医管局的一名负责人表示，青海一共70个县级医院，目前都与三甲医院建立了对口支援。“这些帮扶任务对于医院来说压力也挺大，大医院的医务人员都是超负荷工作，根本没有精力进行多点执业。”<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　上海一家三甲医院人力资源处的负责人表示，从医院管理角度看，多点执业对公立医院来说增加了管理困难，“管人不好管”。比如对第一执业医院，要保证多少工作量？怎么进行考核？薪酬怎么发放？“没有统一的实施细则和标准，肯定要吵翻天”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　另一个原因是医疗人才的流失等利益问题，医院之间也相互存在竞争。该名负责人表示，“打个比方，我在第一执业医院上班，门诊看的病人带到另一家医院去，这种情况要怎么说？”<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopqDOzEeJPhEI26icgejYSe5X2HZzDzVBJumgY0icP4r36DYFYzwgiaNDicA/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfopqDOzEeJPhEI26icgejYSe5X2HZzDzVBJumgY0icP4r36DYFYzwgiaNDicA/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　从“单位人”到“社会人”<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　不过，多点执业要“动真格”，更重要的是推进事业单位的体制改革，同时要放开医疗服务价格。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　庄一强认为，公立医院的编制和行政级别，是目前多点执业最大的障碍。“按照现在的情况，医生是单位人，医院要负责医生的养老退休、医疗责任，医生要跑到别的地方多点执业，等于吃里扒外”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　庄一强认为，只有打破行政级别和人事编制，让医生能够自由流动，医生身份由“单位人”向“社会人”身份过渡，通过与医院签订合同，确立权责，医生也可以通过合同，选择“全职”或者兼职，对于养老保险等，如果全职就可以由医院购买，如果兼职就按照一定比例购买。“应当给医生选择权，根据自身需求进行选择”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　目前，北京正在尝试取消医生的编制，逐步实行全院的合同聘用制。北京市医改办主任韩晓芳曾表示，北京建立包括全职、兼职等多种用工形式并存的用人制度，实行阳光、规范、责权利对应的多点执业。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　医生的态度<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　中山大学附属第六医院综合病区主任谢汝石表示，如果医生多点执业能够开展起来，医生本身的收入和成就感、医患关系等都能得到提升，医生自身的价值能得到更好的发挥，还能解决社会对高端医疗的需求。但对多点执业能否在广东铺开，他却不太乐观，“推开需要改变整个医疗单位的薪酬福利制度，难度很大”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　“社会资本办医为什么推不开，关键就是撬不动人才。公立医院垄断医生的学术资源、政治地位、有形和无形的收入。”张凯认为关键仍然是修改医师执业法，同步事业单位改革，让医生回归到自由执业。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　北京协和医院妇产科原副主任医师龚晓明是较早选择走出体制的医生之一，他表示，目前要自由执业遇到的问题之一就是职称，无论在哪儿出诊，都要挂一个职称，甚至规定某一类手术，只有主任医师能做。他表示，“评价体系应该改变，依靠市场评价医生，而不是依靠职称来评价。”<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　庄一强表示，只要医院没有取消编制问题，多点执业都不可能成为主流。而从更长远的目标看，多点执业是通往自由执业一种过渡，要实现医生的自由流动，最终必须走向自由执业。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop0UT0fyrwdcxxbB5jUaOtbDkLOVJ7HUxHLB6hibO6VwINkVTGxK5jynQ/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop0UT0fyrwdcxxbB5jUaOtbDkLOVJ7HUxHLB6hibO6VwINkVTGxK5jynQ/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　廖新波：现在大家认识还比较混乱<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　现任广东省卫计委巡视员的廖新波2009年开始力推多点执业。在他分管医政期间，已经起草了广东版多点执业方案，遗憾的是在他转换岗位前没能面世。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　廖新波表示，目前多点执业申请多为医联体、帮扶等形式运作，大部分医生仍对所在医院有所顾忌。“很多公立医院院长公开表态，不准本院医生多点执业。”廖新波说，他也常和这些反对的院长就多点执业进行辩论。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　不但是院长发话，多点执业的阻力还在于医院内部的规章。廖新波表示有公立医院规定了医生每年出诊不得超过20次。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　院长们的顾虑多为担心医生无心在本单位工作，把病人带走。“这是狭隘的管理思维。”廖新波认为，多点执业后，医生的工作状态会更好，会更珍惜自己的羽毛，因为一旦出事声誉就会下降。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop6R2TcicOgvicJNmRJ0iaUdfRd1nc1sNqKMic6UyaCv51CEffS5fMMrHTug/0" data-ratio="0.5564516129032258" data-w="496" src="http://mmbiz.qpic.cn/mmbiz/d6hLlVeo50TN6QSjmHc65beA7BRJjfop6R2TcicOgvicJNmRJ0iaUdfRd1nc1sNqKMic6UyaCv51CEffS5fMMrHTug/640?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　“院长担心医生离开，其实他们没有从另外一个角度思考，就是我做好服务平台，做好护理团队、人力资源管理，吸引更好的医生来医院。”廖新波认为，当医生成为社会人，按照合同办事，竞争上岗，会实现资源合理的配置。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　当公立医院被限制扩张，医院不能招更多的人，因此多点执业后可以做更多的交流、替换，让队伍更精干、专业、有用。从另外一个角度来看，多点执业也势在必行，国家正在推进事业单位改革，事业单位的福利将减少，福利留人的办法将会弱化。因此事业单位改革将成为多点执业的巨大推力。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　廖新波还注意到一个怪现象就是，一方面公立医院在做人事改革，另一方面竟然有民营医院向编办拿编制，“说明现在大家认识还比较混乱”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　2013年9月，深圳关于医师多点自由执业的实施细则提交给当时的广东省卫生厅后，由于被批评“步子迈得太大”而搁浅。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　据悉，在2015年6月前，深圳将制定医务人员执业管理方式的改革方案。以深圳市合法医疗机构作为医师执业地点，建立医师多点执业地点自行报备制度，全面放开医师执业地点限制，实现“统一注册，全城通用”。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; clear: both; min-height: 1em; white-space: pre-wrap; color: rgb(89, 89, 89); font-family: 微软雅黑; font-size: medium; line-height: 25.600000381469727px; text-align: justify; box-sizing: border-box !important; word-wrap: break-word !important;">　　“通过之前的论证，深圳已经在医师多点执业上和国家相关部门进行了通气，因此不会出现和未来国家制定的政策相冲突的情况。”<img src="http://mmbiz.qpic.cn/mmbiz/rz7R73cuHRrv6jdOCoJeZmYwvEAIoHpY0a7yJL2egiaEokLTpwkIsIRTzTFUic09aEThKHS4hrEcSqU0lAS3tu5g/0" data-ratio="0.14784394250513347" data-w="487" width="auto" src="http://mmbiz.qpic.cn/mmbiz/rz7R73cuHRrv6jdOCoJeZmYwvEAIoHpY0a7yJL2egiaEokLTpwkIsIRTzTFUic09aEThKHS4hrEcSqU0lAS3tu5g/0?tp=webp" style="margin: 0px; padding: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" /><legend style="margin: 0px; padding: 0px; max-width: 100%; white-space: normal; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="bkcolor" style="margin: 0px 8px 0px 0px; padding: 4px 10px; max-width: 100%; color: rgb(255, 255, 255); background-color: rgb(191, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important; border-top-left-radius: 5px !important; border-top-right-radius: 5px !important; border-bottom-right-radius: 5px !important; border-bottom-left-radius: 5px !important;">ID: </legend><legend style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; box-sizing: border-box !important; word-wrap: break-word !important;"></legend><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); box-sizing: border-box !important;">平台的理念：分享维修经验，为工程师提供技术配件支持，为临床使用者提供医疗器械使用保养维护信息，关注我们传递正能量。<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); box-sizing: border-box !important;">微信公众号:<p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); box-sizing: border-box !important;"> ? ? <p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); box-sizing: border-box !important;">群主微信号： <p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; orphans: 2; widows: 2; background-color: rgb(255, 255, 255); box-sizing: border-box !important;"> ? ?shanying916<fieldset class="brcolor" style="margin: 0px; padding: 5px; max-width: 100%; color: rgb(62, 62, 62); white-space: normal; border: 1px solid rgb(0, 187, 236); font-family: 微软雅黑; line-height: 24px; font-size: 12px; background-color: rgb(248, 247, 245); box-sizing: border-box !important; word-wrap: break-word !important;"><legend style="margin: 0px 10px; padding: 0px; max-width: 100%; color: rgb(51, 51, 51); border-width: 0px; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="bkcolor" style="margin: 0px; padding: 5px 10px; max-width: 100%; border: 0px; color: rgb(255, 255, 255); font-weight: bold; font-size: 14px; border-top-left-radius: 5px; border-top-right-radius: 5px; border-bottom-right-radius: 5px; border-bottom-left-radius: 5px; background-color: rgb(0, 187, 236); box-sizing: border-box !important; word-wrap: break-word !important;">复制上面微信号<img data-s="300,640" data-ratio="1.35" data-w="20" src="http://mmbiz.qpic.cn/mmbiz/A1DicCH9Vl6NE8iaIXiblrE1WKyXQz6qbATAS0VZxTKlGupjMMNvicoNs9vhvYGBr83wmsdO1ouTw7kVDibk9w6VoMg/0" class="" id="c6" width="auto" src="http://mmbiz.qpic.cn/mmbiz/A1DicCH9Vl6NE8iaIXiblrE1WKyXQz6qbATAS0VZxTKlGupjMMNvicoNs9vhvYGBr83wmsdO1ouTw7kVDibk9w6VoMg/640?tp=webp" style="margin: 0px; padding: 0px; border: 0px; box-sizing: border-box !important; word-wrap: break-word !important; visibility: visible !important;" />联系我哟</legend><blockquote style="margin-bottom: 0px; padding-left: 0px; border: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; word-wrap: normal; clear: both; min-height: 1em; white-space: pre-wrap; overflow: hidden; border: 0px; box-sizing: border-box !important;">? 定期推送医械资讯，厂家推介，维修知识，产品知识，医疗器械相关等诸多优质内容，最接地气、重价值的医疗器械微信平台！关注我们妥妥没错，推广合作联系我呦！</blockquote></fieldset><img src="http://tj.koudaitong.com/1.gif?spm=m1421250480882497256970528.sendall_mp161461&fm=display&time=1421250483&kdt_id=791350" />

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