HCMC's public hospitals suffer exodus to private sector

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Doctors perform a surgery at Vinmec private hospital in Hanoi. Photo credit: Vietnam News Agency Doctors perform a surgery at Vinmec private hospital in Hanoi. Photo credit: Vietnam News Agency

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The prospects of high salaries and professional independence have drawn the most talented doctors away from public facilities in Ho Chi Minh City.
The slow trickle of talent out of the public sector came to a head, last month, with the opening of the private general hospital Xuyen A (Trans-Asia) in Cu Chi District, by creating a “huge” personnel crisis at its public counterpart, Cu Chi General Hospital.
A total of 60 doctors and nurses have left Cu Chi General Hospital for Xuyen A since it opened; many were heads and deputy department heads, Tuoi Tre newspaper reported.
Doctor Nguyen Van Chau, the general director of Xuyen A, said their 750-sickbed hospital employed 107 doctors--most of whom were permanent employees.
By December of last year, 20 doctors decided to leave Cu Chi General Hospital for Xuyen A, including five with post-graduate degrees.
(In Vietnam, young doctors can begin practicing medicine after spending just four years in school.) 
The hospital’s management board took great pains to talk their staff out of leaving, to no avail, the board claimed in a statement.
Four more doctors, including a senior surgeon, followed during the first quarter.
By April 1, 34 employees including 21 doctors had resigned. Four of the doctors were heads and deputy department heads.
The brain drain has also afflicted leading hospitals in the city's center, such as Children’s Hospitals No.1 and No.2
An unidentified doctor at Children’s Hospital No.1 left in the middle of this year after nearly 25 years of overseeing the intensive care department.
The physician took a job at Hanh Phuc International Hospital in neighboring Binh Duong Province.
Another department head quit to take a job at Thanh Do International Hospital.
Many experienced doctors at Trung Vuong Emergency Hospital have also gone on to pursue private employment at An Sinh and Trieu An Hospitals.
The municipal health department estimates that public hospitals will need 7,400 new employees, every year, to replace the employees who are retiring, quitting or leaving in order to maintain the hospital's current level of service.
The departing docotrs said they took jobs in similar positions, or higher, for salaries of up to VND150 million (US$7.060) a month--a veritable fortune in a country with an average per capita income of $1,890.
Deep pockets, free hands
Nguyen Minh Thanh, director of Cu Chi General Hospital, told Tuoi Tre the simplest explanation for the mass exodus are the higher salaries.
But many doctors say there’s more to it than that.
A former doctor at Trung Vuong Emergency Hospital said he left mostly because he no longer felt the environment suited him and because he wanted to make room for new doctors and explore new working conditions.
“The income factor didn't affect my decision too much,” the doctor said.
A senior emergency room physician at Children’s Hospital No.2 said she joined Hanh Phuc International Hospital several years ago while searching for a “fair” environment free of bureaucracy.
“We rarely have meetings here," she said. "The hospital totally trusts its doctors to make professional decisions, as long as the patients are safe and well-served.” 
“I really like this way of working. I can focus on my job, and don’t have to spend too much time on administrative tasks.
“And I am paid much better for my work.”
Doctor Nguyen Thanh Van the former deputy head of the neurosurgery department at Thanh Hoa Province General Hospital left in 2006 for Hop Luc Hospital.
He also described finding pleasure in his new professional atmosphere.
Van said that after 20 years of advancement, he had achieved an advanced and comfortable position at the provincial hospital.
But he was drawn to Hop Luc by modern equipment that he simply didn't have access to at a public hospital such as a multiple-slice CT scanner, a 4D ultrasound scanner, and a digital X-ray machine.
“The system back then didn’t allow exchanges between doctors at public and private hospitals, but we needed new equipment to challenge and improve our abilities. So I decided to try the new environment,” Van said.
“After eight years, I think I made the right decision. It has allowed me to study and work freely.”
Doctor Tang Chi Thuong, deputy director of HCMC Health Department, also said income is not the most important factor in the choice between private and public employment because experienced doctors usually have a clinic at home.
“When key, qualified doctors quit, you need to take a hard look at the research and advancement opportunities that were available to them at their former workplace.”
Thuong said some doctors told him that they left a hospital only because the new director did not maintain the same working environment as his or her predecessor.
He suggested that the government allow a doctor to work at both private and public hospitals so he or she can make the best use of his or her expertise.
"Many doctors who have made the move into private hospitals told me the pressure forces them to perfect themselves, to read more and learn more. It took some time for them to get used to the flow, and they called the shift a transformation."
-- Professor Nguyen Thanh Liem, director of Vinmec hospital in Hanoi, speaking about the exodus of top doctors from public to private hospitals.
New age for private hospitals
Professor Nguyen Thanh Liem, director of Vinmec General Hospital in Hanoi, said he'd held the same position for ten years at the capitol's Central Pediatrics Hospital.
Liem said most of Vinmec's key staff came from public hospitals, including a group of highly qualified young doctors culled from Bach Mai hospital.
He said private doctors operate under a lot of pressure from patients, who pay a premium and expect better service. These doctors also enjoy the benefit of knowing exactly who is in charge, and don't worry about the vague “authorities” that tend to control public hospitals.
Few patients bother to complain about their experiences at public hospital, but when one does not feel welcome or satisfied by an experience at a private hospital, complaints get plastered all over social networks the following day, he said.
“Many doctors who have made the move into private hospitals told me the pressure forces them to perfect themselves, to read more and learn more. It took some time for them to get used to the flow, and they called the shift a transformation.”
Liem said the rise of private hospitals will create healthy competition, adding that 50 percent of the hospitals in France and 80 percent in the US are private.
HCMC has 106 hospitals and the 39 private ones employ 15 percent of the city's health care workers
“I really hope that the government will create space for private hospitals. We serve our patients, but the government doesn't have to spend a dime on our equipment and wages.”

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