Should senior physician title be eliminated ?(医师高级职称必须废弃?)

黄建宏

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

黄建宏

欢迎全英文讨论交流，也欢迎大家对该文进行翻译

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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。

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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。

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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。