VietNamNet Bridge – Three years after Ha Noi expanded its municipal boundaries, suburban hospitals in the capital city's outlying areas are still struggling to overcome a shortage of doctors.

The shortage could be partially relieved if local health clinics and hospitals were empowered to receive and treat patients who do not necessarily need to be transferred to higher level hospitals.

Low salaries for doctors have been identified as one of the factors hindering recruitment of health professionals in Ha Noi's outlying areas.

In these areas, a doctor's monthly salary and bonuses typically range from VND2.5 million to VND5.5 million (approximately US$120 to $260), an amount "not yet in line with current market prices", according to the Planning Department of Van Dinh Hospital.

Nguyen Manh Tung, Deputy Director of Phuc Tho Hospital in Phuc Tho District, said doctors at State-owned hospitals deserved higher salaries due to the important work they do.

He added that doctors were better off working in central Ha Noi or opting for private institutions.

In addition to low pay, other factors leading to the shortage include poor work and living conditions in these areas.

Thach Thuy Linh, a 5th year student at the Ha Noi Medical University, said it was difficult for graduates to secure jobs at State-run hospitals in inner Ha Noi, and the starting salary was not necessarily higher despite the living costs there.

"What matters more to us is that career development opportunities at hospitals or even private clinics in the city centre tend to be better," she said. "As most patients are transferred to these hospitals, there are more cases we can learn from."

To cope with the growing shortage, doctors at overloaded hospitals are working extra hours, even though wages are not adjusted much above the average rate.

In Phuc Tho District, a resolution passed in 2006 aimed to boost recruitment by exempting medical graduates from entrance examinations and giving out cash bonuses to top graduates.

Unfortunately, as the policy has yet to achieve any positive result, the hospital is taking on another solution: extra training for their original staff with financial support of VND4.2 million ($200) each year.

The measure has only been partially successful and deemed "very time-consuming (three-year training) and hardly able to meet official medical education standards," said Tung.

As of assistance from municipal authorities, Ha Noi's Department of Health has passed Project 1851 to send doctors from central Ha Noi to lower level hospitals and clinics on regular professional trips.

According to Le Son, head of the Phuc Tho Hospital's Planning Department, the benefits of this solution are two-fold.

First, it addresses the problem of overloaded central hospitals due to a shortage of professional doctors at lower level institutions.

Moreover, when working at local hospitals, doctors from central Ha Noi with generally greater expertise can pass on knowledge and skills to their local colleagues, a process called "technology transfer".

But this plan does not solve the shortage of doctors and lacks coherence in terms of cross-level payment for medical practices.

Son said further incentives were needed to get doctors to work in outer urban areas.

He said that as the main obstacle was low pay, salary and bonus reforms were needed at the national and municipal levels.

Administrators of Phuc Tho Hospital also proposed alternative recruitment plans.

One would offer scholarships to medical students from their fourth year on condition of a minimum contract of 5 years work at suburban hospitals.

Another one would amend legislation so that doctors are required to have certain experience outside Ha Noi before they could be deployed in the city centre.

VietNamNet/Viet Nam News