In 2011, in an effort to improve workforce flexibility, Beijing pioneered a deregulation of medical employment rules so as to allow doctors to work outside their traditional work unit.
The move was intended to encourage a free flow of doctors and to encourage medical 'talents' to work outside the public hospital system and perhaps even set up their own private clinics. A kind of medical socialism with Chinese characteristics. However, an article in the Beijing Evening News has highlighted the fact that very few doctors have taken the plunge into private practice - or even left the security of their original hospitals to work at other clinics.
An article in the newspaper says the new flexible working rules were welcomed by doctors and received much positive comment on medical social media forums - but few if any doctors have actually changed their working patterns. Most are still working full time in major hospital clinical departments and doctors seem reluctant to break out from that pattern of work. In interviews, senior doctors say there simply isn't an alternative private framework for doctors to work in - and few doctors are willing to branch out on their own.
They cite several reasons: firstly, doctors are worried about the risks of working outside the established system, especially when it comes to liability and patient disputes. In the public hospital system they are covered by liability insurance and also have the backup and expertise of a major hospital to support them. They feel safe working with trusted colleagues and on familiar ground, and are wary of the quality of working in an unknown environment.
Secondly, doctors face financial barriers to working outside the system. Most are employed full time within the public system and would face a major hurdle in start-up costs to work outside the system - not to mention finding new sources of patients. They also face the major problem of restrictions on medical insurance, which would not cover their work in an unrecognised clinic or environment.
And thirdly, many doctors say that careers in medicine are based on the existing system - training, education, research, peer support, promotion and reputation are all based on working within the current hospital system. Doctors feel they would forsake career advancement if they moved outside the system.
The doctors interviewed by the Beijing Evening News said the deregulation of medical working rules had only legitimised what had already been happening in the current system - doctors moonlighting on weekends and 'after hours' at private clinics or at other hospitals outside Bejing.
The article concludes that much more extensive changes in remuneration, insurance and career paths will be needed beyond relaxing the rules, to encourage doctors to work more flexibly.