Should senior physician title be eliminated ?(医师高级职称必须废弃?)
In US, patient-centered medical home has produced the most profound transformation of the health care system in history.
The Institute of Medicine (IOM) described medical homes in the context of “continuous healing relationships” in which the patient needs and values are central.(1) The value of relationship is not only related to patient’s perceptions, but to the quality of care they receive as well.
The medical home includes five core functions: comprehensive care, patient-centered, coordinated care, accessible service, quality and safety. Patient-centered care can result in greater knowledge of the patient, greater trust between physician and patient, and diminished need for additional specialty referrals, diagnostic testing, and use of hospital care (2). Today, more than 6000 patient centered medical homes have been certified in US.
Can patient-centered medical home concept be applied in China? There are tension discussions of medical reform in China. One of the proposals is really worthy of discussion because it can shift patient physician relation into patient-centered. The proposal is that senior physician title (医师高级职称) need to be eliminated, attending physician (主治医师)should be accountable in clinical care.
The following are the advantages of the proposal.
1. Physicians can practice independently in different clinical locations(人才流动). Physician independent practice can provide significant opportunities for efficiency and quality improvements. They can improve accessibility, quality, and efficiency of medical care. Physician independent practice also promotes accountability and outcomes-based measurement. Hospitals and physicians can expand their practice scope and popularity. Physicians can do their best for their patients (patient-centered). In addition, clinical locations can select the best physicians they need. It can promote competitions among physicians. It can also stimulate hospitals to increase their investments in equipment and improve their service in order to attract the best physicians to their locations (market competition).
2. Performance measurement has been use for accountability; accreditation, certification, credentialing, and licensure; public reporting; payment applications; quality improvement (QI); and public recognition. Standard process of performance measurement has to be developed and applied. Senior physician title elimination can make measurement development and measurement process more standard, transparent, and efficient.
3. Standard resident training program can be installed all over the country. The goal of resident training is to ensure that graduating physicians are competent in their chosen field of medicine. The training can increase proficiency and efficiency of medical specialties. Therefore resident training can benefit the specialties and patients. Senior physician title elimination can transform the new physicians focus on patient care, not on title chasing (patient-centered).
4. It was believed that some physicians with senior physician title (医师高级职称) did not demonstrate superior clinical skills (高职低能). Therefore these physicians can potentially harm patients. The new proposal can prevent potential harm and improve patient safety.
5. Physicians can spend more time on patient care (patient-centered) and continued medical education to improve their skills and knowledge (quality and safety). They do not spend more time on endless examination preparation. They do not have to be forced to do publications.
This new proposal is not the silver bullet that can resolve every problem. It is a small step that may help gradually transform into new healing relationship (patient-centered).
References:
1. Flocke SA, et al. J Fam Pract. 1997; 45(2):129-35.
2. Bertakis K, et al. J Am Board Fam Med 2011; 24:229
Should senior physician title be eliminated ?(医师高级职称必须废弃?)In US, patient-centered medical home has produced the most profound transformation of the health care system in history.
该高级医师称号被淘汰？（医师高级职称必须废弃？）在美国，以病人为中心的医学家出了历史的卫生保健系统最深刻的变革。
The Institute of Medicine (IOM) described medical homes in the context of “continuous healing relationships” in which the patient needs and values are central.(1) The value of relationship is not only related to patient’s perceptions, but to the quality of care they receive as well.
医学研究院（IOM）描述了医学院的上下文中的“持续愈合的关系”，病人的需求和价值观的核心。（1）关系的价值不仅仅是病人的看法，但对护理质量，他们收到的一样。
The medical home includes five core functions: comprehensive care, patient-centered, coordinated care, accessible service, quality and safety. Patient-centered care can result in greater knowledge of the patient, greater trust between physician and patient, and diminished need for additional specialty referrals, diagnostic testing, and use of hospital care (2). Today, more than 6000 patient centered medical homes have been certified in US.
医学家包括五个核心功能：综合护理，以病人为中心，协调护理，可访问服务，质量和安全。以病人为中心的护理可以造成更大的知识的病人，医生和病人之间的更大的信任，并减少需要额外的特产推介，诊断测试，并使用医院护理（2）。今天，超过6000的病人为中心的医学家已经证明在我们。
Can patient-centered medical home concept be applied in China? There are tension discussions of medical reform in China. One of the proposals is really worthy of discussion because it can shift patient physician relation into patient-centered. The proposal is that senior physician title (医师高级职称) need to be eliminated, attending physician (主治医师)should be accountable in clinical care.
The following are the advantages of the proposal.
1. Physicians can practice independently in different clinical locations(人才流动). Physician independent practice can provide significant opportunities for efficiency and quality improvements. They can improve accessibility, quality, and efficiency of medical care. Physician independent practice also promotes accountability and outcomes-based measurement. Hospitals and physicians can expand their practice scope and popularity. Physicians can do their best for their patients (patient-centered). In addition, clinical locations can select the best physicians they need. It can promote competitions among physicians. It can also stimulate hospitals to increase their investments in equipment and improve their service in order to attract the best physicians to their locations (market competition).
2. Performance measurement has been use for accountability; accreditation, certification, credentialing, and licensure; public reporting; payment applications; quality improvement (QI); and public recognition. Standard process of performance measurement has to be developed and applied. Senior physician title elimination can make measurement development and measurement process more standard, transparent, and efficient.
3. Standard resident training program can be installed all over the country. The goal of resident training is to ensure that graduating physicians are competent in their chosen field of medicine. The training can increase proficiency and efficiency of medical specialties. Therefore resident training can benefit the specialties and patients. Senior physician title elimination can transform the new physicians focus on patient care, not on title chasing (patient-centered).
4. It was believed that some physicians with senior physician title (医师高级职称) did not demonstrate superior clinical skills (高职低能). Therefore these physicians can potentially harm patients. The new proposal can prevent potential harm and improve patient safety.
5. Physicians can spend more time on patient care (patient-centered) and continued medical education to improve their skills and knowledge (quality and safety). They do not spend more time on endless examination preparation. They do not have to be forced to do publications.
This new proposal is not the silver bullet that can resolve every problem. It is a small step that may help gradually transform into new healing relationship (patient-centered).
可以以病人为中心的医学家的概念适用于中国？中国有医疗改革的张力的探讨。其中一个建议是值得讨论的因为它可以转变为以病人为中心的医患关系。该方案是高级医师职称（医师高级职称）需要被淘汰，主治医师（主治医师）应该在临床护理中负责。
以下是本方案的优势。
1。医生可以独立地在不同的临床实践的位置（人才流动）。医师独立实践可提供效率和质量改进的重要机遇。他们可以提高可访问性，质量，和医疗效率。医师独立实践也促进问责制和基于结果的测量。医院和医生可以扩大他们的业务范围和普及。医生可以做最好的自己为他们的病人（病人）。此外，临床的位置可以选择他们需要的最好的医生。它可以促进竞争的医生。它也可以刺激医院增加设备投资和提高他们的服务以吸引最好的医生，他们的位置（市场）。
2。绩效测量已用于问责；认证，认证，认证，执照；公共报告；付款申请；质量改进（QI）和公众的认可。性能测量的标准方法已被开发和应用。高级医师职称消除可以使测量的发展和测量过程更加规范，透明，高效。
3。标准的住院医师培训程序可以安装在全国各地。住院医师培训的目标是确保毕业的医生在自己选择的领域的医学主管。培训可以提高水平和医疗专业效率。因此住院医师培训的特点和患者受益。高级医师职称的消除变换新的医生对病人的护理重点，不在冠军追逐（病人）。
4。它被认为与高级医师职称医生（医师高级职称）没有表现出优越的临床技能（高职低能）。因此，这些医生可能会对病人造成伤害。新方案可以防止潜在的危害和提高病人的安全。
5。医生可以花更多的时间在病人的护理（病人）和继续医学教育，提高他们的技能和知识（质量安全）。他们没有花更多的时间在无尽的考试准备。他们没有被强迫做出版物。
这个新方案是不是银弹，可以解决所有的问题。这是一个小的步骤，可以帮助逐渐转化为新的治疗关系（以病人为中心）。
Should senior physician title be eliminated ?(医师高级职称必须废弃?)
In US, patient-centered medical home has produced the most profound transformation of the health care system in history.
在美国，以病人为中心的医疗之家引起了历史上最深刻的卫生保健系统的变革。
The Institute of Medicine (IOM) described medical homes in the context of “continuous healing relationships” in which the patient needs and values are central.(1) The value of relationship is not only related to patient’s perceptions, but to the quality of care they receive as well.
医学研究院（IOM）描述了医疗之家的“持续愈合的关系”，以病人的需求和价值观为核心。（1）这个关系的价值不仅仅是与病人的看法有联系，对他们收到的护理质量也有联系
The medical home includes five core functions: comprehensive care, patient-centered, coordinated care, accessible service, quality and safety. Patient-centered care can result in greater knowledge of the patient, greater trust between physician and patient, and diminished need for additional specialty referrals, diagnostic testing, and use of hospital care (2). Today, more than 6000 patient centered medical homes have been certified in US.
医疗之家包括五个核心功能：综合护理，以病人为中心，协调护理，可访问服务，质量和安全。以病人为中心的护理可以造成更大的知识的病人，医生和病人之间的更大的信任，并减少需要额外的特产推介，诊断测试，并使用医院护理（2）。今天，在美国已经有了超过6000的病人为中心的医疗之家
Can patient-centered medical home concept be applied in China? There are tension discussions of medical reform in China. One of the proposals is really worthy of discussion because it can shift patient physician relation into patient-centered. The proposal is that senior physician title (医师高级职称) need to be eliminated, attending physician (主治医师)should be accountable in clinical care.
可以以病人为中心的医学家的概念适用于中国？中国有医疗改革的张力的探讨。其中一个建议是值得讨论的因为它可以转变为以病人为中心的医患关系。该方案是高级医师职称（医师高级职称）需要被淘汰，主治医师（主治医师）应该在临床护理中负责。
The following are the advantages of the proposal.
以下是本方案的优势。
1. Physicians can practice independently in different clinical locations(人才流动). Physician independent practice can provide significant opportunities for efficiency and quality improvements. They can improve accessibility, quality, and efficiency of medical care. Physician independent practice also promotes accountability and outcomes-based measurement. Hospitals and physicians can expand their practice scope and popularity. Physicians can do their best for their patients (patient-centered). In addition, clinical locations can select the best physicians they need. It can promote competitions among physicians. It can also stimulate hospitals to increase their investments in equipment and improve their service in order to attract the best physicians to their locations (market competition).
1。医生可以独立地在不同的临床实践的位置（人才流动）。医师独立实践可提供效率和质量改进的重要机遇。他们可以提高可访问性，质量，和医疗效率。医师独立实践也促进问责制和基于结果的测量。医院和医生可以扩大他们的业务范围和普及。医生可以竭尽全力为为他们的病人服务（以病人为中心）。此外，医院可以选择他们需要的最好的医生。它可以促进医生之间竞争。它也可以刺激医院增加设备投资和提高他们的服务以吸引最好的医生（市场竞争）。
2. Performance measurement has been use for accountability; accreditation, certification, credentialing, and licensure; public reporting; payment applications; quality improvement (QI); and public recognition. Standard process of performance measurement has to be developed and applied. Senior physician title elimination can make measurement development and measurement process more standard, transparent, and efficient.
2。绩效测量已用于问责；认证，执照；公共报告；付款申请；质量改进（QI）和公众的认可。性能测量的标准方法已被开发和应用。高级医师职称消除可以使测量的发展和测量过程更加规范，透明，高效
3. Standard resident training program can be installed all over the country. The goal of resident training is to ensure that graduating physicians are competent in their chosen field of medicine. The training can increase proficiency and efficiency of medical specialties. Therefore resident training can benefit the specialties and patients. Senior physician title elimination can transform the new physicians focus on patient care, not on title chasing (patient-centered).
3。标准的住院医师培训程序可以安装在全国各地。住院医师培训的目标是确保毕业的医生在自己选择的领域能胜任。培训可以提高水平和医疗专业效率。因此标准的住院医师培训有益于患者和医疗领域。高级医师职称的消除变换新的医生以病人为中心，不是在追逐医师职称（以病人为中心）。
4. It was believed that some physicians with senior physician title (医师高级职称) did not demonstrate superior clinical skills (高职低能). Therefore these physicians can potentially harm patients. The new proposal can prevent potential harm and improve patient safety.
许多人相信一部分高级医师职称医生（医师高级职称）没有表现出优越的临床技能（高职低能）。因此，这些医生可能会对病人造成伤害。新方案可以防止潜在的危害和提高病人的安全。
5. Physicians can spend more time on patient care (patient-centered) and continued medical education to improve their skills and knowledge (quality and safety). They do not spend more time on endless examination preparation. They do not have to be forced to do publications.
5。医生可以花更多的时间在病人的护理（以病人为中心）和继续医学教育，提高他们的技能和知识（质量安全）。他们没有花更多的时间在无尽的考试准备。他们不需要被强迫做无关的研究发表论文。
This new proposal is not the silver bullet that can resolve every problem. It is a small step that may help gradually transform into new healing relationship (patient-centered).
这个新方案是不是万能药，可以解决所有的问题。这是一个小的步骤，可以帮助逐渐转化为以病人为中心的治疗关系（以病人为中心）。
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