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0445 Dilemma

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    Xu Yi hung up the phone and curled his lips secretly. The regulation training had just begun, and it was unclear what changes it would bring in the future.  ¡°Assuming that I don¡¯t get the space, I might be like my classmates, grit my teeth and take the path of regular training, and then return to a traditional Chinese medicine hospital in three years.  Although times have changed, if you want to go back, it shouldn¡¯t be a big problem.  First of all, after three years, when the dean is still in office, the director may be re-employed. The three elements of the right time, place, and people should be said to still account for the one of people and people.  It is not impossible that the Department of Traditional Chinese Medicine and Internal Medicine cannot be accommodated, and there are no positions in other departments. The impact of the regular training on me may only be a few years later.  For me, the regular training should be considered a good thing. At least the money solved my immediate needs and gave up the idea of ??going to a traditional Chinese medicine hospital. This can be regarded as eliminating my worries.  With such a space, as long as you are careful enough, you will definitely have enough food and clothing even if you hide in the mountains and forests for the rest of your life. Going home directly will definitely bring more direct benefits than staying in a traditional Chinese medicine hospital.  As for staying in the provincial capital, this is not because I am greedy for the prosperity and modernization of the provincial capital, nor does it go against my own conscience.  "I really gritted my teeth and sold this building. I guess 18 million won't be a problem. With this money, I won't be rich in this life, but I will definitely have no worries about food and clothing."  "It's just that this kind of one-time business may bring huge profits, but it's not as high as the long-term income of opening your own store.  After all, the materials that you can grow yourself, except for seeds and seedlings, basically cost nothing, and at most you will be tired.  Apart from dreaming, if you want to make money, why not work hard?  As long as you don¡¯t get too crazy, you can basically make a profit without losing any money.  This kind of capital flow is obviously more cost-effective than selling the store.  Especially since the agriculture industry that I want to get involved in is originally a low-yield basic industry. Especially after joining the WTO, basic planting industry has become increasingly difficult. In addition, there is information asymmetry. It is not surprising that whatever you plant is worthless.  It can be said that the industrial upgrading of agriculture is also an urgent matter that must be done.  It is easy to talk about it, but if you really want to upgrade, you will have to face more unknown factors and conditions. No matter what you do, money is always indispensable.  What's more, he didn't even know which way to open the door to the upgraded industry. Even the most basic planting industry, what he saw in front of him was almost a bottomless pit.  ¡°What I can think of right now is probably only the Qingyuan Mountain and the few acres of thin fields at the foot of the mountain.  It would be simple if it was just a few acres of land. At most, it would be protected land cultivation or something. But thinking about Qingyuan Mountain, Xu Yi really felt a lot of pressure.  The entire Qingyuan Mountain is close to two thousand meters from east to west, and the widest part is almost four to five hundred meters. The total area is close to four thousand acres.  This is the number on the forest rights certificate. According to the village's practice, there should be a lot of error in the real area, and it is definitely not too small but not too big.  Qingyuan Mountain did not escape the disaster of steel smelting, which also caused serious water and soil erosion. On the most serious north slope, rocks are exposed in many places. Even on the better south slope, the soil layer on the mountain is thickest.  The area is less than half a meter deep, so it is impossible to plant big trees without going through extensive renovations.  ¡°It¡¯s either forced transformation to plant trees, or planting grass according to local conditions. But in such a large area, let alone planting trees, even if there are areas where grass is planted, it still needs to be covered with soil and transformed. ???????????????? Why do we need to pay for labor, seeds and chemical fertilizers these days?  "Assuming that this building is really sold, for 20 million yuan, one acre of land on this hill would only cost 300 to 400 yuan on average.  Although it's not a drop in the bucket, if I want to transform the mountain to my satisfaction, I guess the difference is not less than half a star.  If we didn¡¯t have this space before, I would be proud to be able to renovate it to a point where it is acceptable; but now that we have such a space, is it too much to ask for too much?  These days, it has become a basic routine to sell whatever is cheap and buy whatever is expensive. ??????????????? If you do the math carefully, such a small amount of money may not be enough to buy saplings.  Especially in agriculture and forestry, which is a long-term investment, not only may there be various natural disasters such as hail, heavy snow, pests and diseases during the entire production cycle, but also various human factors such as market changes and policy adjustments cannot be avoided.  If you want to avoid risks, you can either increase the added value of your products, or you can only find ways to shorten the production cycle and gain benefits as early as possible.  The former, let alone how much money it costs, even the idea itself is nothing outstanding, so you can only rely on the latter.  For example, instead of considering too small saplings, make large trees or graft seedlings for transplantation. In this way, after the transplantation survives, you can see the benefits after a year and a half of maintenance.  Of course, I have such space?The matter of seedlings is certainly not difficult. To get a big tree is just a matter of watering it more than a small tree.  For space, let alone common tree species, even small-leaf rosewood, Zhennan, etc. are no problem.  If you really plant these rare tree species that are on the list of nationally protected species or on the list of the World Trade Convention, you can only plant them in your own space.  If you really go all over the mountains and plains to transplant trees, they will either fall into the eyes of interested people, or block other people's money, and you can't explain the consequences of the source This is why it took so long to get the space, and Xu's eyes turned green because of the lack of money.  The reason why Yi didn't put his mind to rare medicinal materials like ginseng and dendrobium.  After all, it is not a fruit or vegetable. No matter how it changes, eggplant is still an eggplant. At most, it has a better texture and taste, and the original flavor of eggplant is stronger.  I can't taste cucumber, let alone meat.  After digestion, it becomes nothing more than poop, no different from ordinary food.  "But when the ingredients are replaced with medicinal materials that can cure diseases and save lives, Xu Yi's first concern is what grows in this space. What are the ingredients and efficacy?  Different from the modern medical system, most of the Chinese medicinal materials used in traditional Chinese medicine are naturally grown and taken from natural animal and plant materials. After long-term repeated exploration, a set of treatment specifications has finally been formed.  When selecting medicinal materials, we must pay attention to authentic medicinal materials, and the surviving medical books of the past dynasties all regard this as a guideline.  Modern research has found that natural variations in the chemical components of Chinese medicinal materials caused by different regional environments will lead to huge differences in the content of the same chemical components in the same medicinal material.  It is not impossible for the same medicinal materials to have different origins, but the content of active ingredients may differ dozens of times.  If the content of active ingredients is low, it may have no effect and will undoubtedly be unhelpful to patients.  After all, using ineffective drugs is likely to delay the condition, and may cause adverse consequences if the disease progresses.  But if the content of active ingredients or toxic and harmful ingredients is too high, it is also not a good thing.  After all, traditional Chinese medicine is empirical medicine. The dosage varies but there is a general range. A real content difference of dozens of times far exceeds the adjustment range of medication. Even processed medicinal materials cannot fully guarantee the safety of medication.  Xu Yi also doubted whether such medicinal materials should be classified as poisons.  If someone really eats it, it¡¯s not impossible to kill someone!  ¡° Moreover, a century-old ginseng on the market costs millions of dollars. This is just a hype caused by scarcity.  How many people will buy these to truly cure diseases, and how many people can afford them?  The wild ginseng and understory ginseng that can be used in daily life are slightly more expensive but within the reach of the general public.  " If you really grow and sell valuable medicinal materials in space, you will definitely not be able to solve the fundamental problem. If you really sell them in large quantities, you will only plant countless disasters for yourself.  In addition to the problem of not being able to explain the source, I am afraid that I will fall into the eyes of those powerful and powerful people. After all, "There is no cure for poverty, and money cannot buy life." People with money and power are more attached to life than ordinary people.  , the really good things naturally want to be collected.  Money is an external thing, but it¡¯s always good to have things that matter to your life.  "If it is really these people who take medicines that are ineffective or have problems with their medicines, no matter what, they are the ones who are unlucky.  ¡° Selling those things seems to be no different from seeking skin from a tiger.  Even if there were no such problems, Xu Yi still couldn't pass his own test. So what's the difference between only caring about money and not respecting medical ethics and killing people for money?  Therefore, when it comes to transplanting large trees, common tree species are still the first choice, and the only first choice.  Even if it is transplanted, there must be a suitable way to cover it up.  Doing business is always more flexible than working, you can come into contact with more people, and there are definitely more ways to do it.  If you pay more attention and develop steadily for a few years, no matter whether there is still space or not, you will definitely be able to achieve your goals.  ¡°Looking at it this way, from an idealistic point of view, I really have no chance with the Traditional Chinese Medicine Hospital However, this kind of magical thing cannot happen to everyone.  For most people of my generation, it is more likely to be like falling into a nightmare.  "It's not easy to find a job, and it's even harder to get into a good employer. I'm afraid that if I miss it this time, I won't have the chance to get in again. I'm afraid it's hard to estimate the impact this will have on him, and it may really affect him for the rest of his life."  ¡°Such a sad thing happened to several people in my class alone.  To them, it was true that a horseshoe nail destroyed an empire.  After all, maybe there was a chance to enter the top three, but now that the training was restricted and the agreement was voided, the opportunity may have been completely lost.  YourselfThere was even a young man here who originally signed up for the provincial hospital, but now that the mandatory training was implemented, he gritted his teeth and decided to go back to the county hospital in his hometown. The standardized training had not yet been implemented in his hometown, so he could still go to work.  He said that his family is not wealthy, and he has a younger brother who is in high school. If he has to stay with him for another three years, the burden on his parents will be too heavy.  However, his girlfriend felt that he had made the wrong choice and advised him to grit his teeth and stay in the provincial capital for three years while she could help out. After the formal training, he would be able to find a better job than the county hospital, and the final income would be higher.  It's definitely better than being in the county hospital. ??????????????????????? But this guy can¡¯t be tough, and he even feels that spending a woman¡¯s money like this without fame and status is just a soft meal, and he can¡¯t hold his head high.  After waiting to see the subsidy standards for standardized training come out, he resolutely signed the employment agreement and sent it back to the county hospital in his hometown.  The conflict between the two people has intensified, and they quarreled several times over this, and finally they had no choice but to break up. ???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? Drinking water and having a full meal is considered to lose weight. If drinking water every day makes you hungry, and even the northwest wind can¡¯t afford it, then why do you still love Nimabi?  Although this training has a great impact on employment, Xu Yi also felt that Song Benli had taken his hopes for social recruitment a little bit.  Social recruitment is indeed the way to go, and the issues of staffing and remuneration that are urgently needed to introduce talents can definitely be solved.  "However, this can only be said to have a little hope, but if we rely entirely on this, the hope is quite slim.  Although the medical market has been liberalized in recent years, the state has encouraged private capital to enter the medical industry for the purpose of improving the health level of the entire population.  In this context, the Putian Department of private hospital advertising is overwhelming in various ways.  ¡°However, while the Putian system injects vitality into the medical market, it also brings more problems.  ¡°If private hospitals want to have a real future, it is obviously not something they can achieve by just grabbing a vote and leaving.  After all, as a health issue that affects thousands of households, the public medical system will still be the most important system for ensuring social medical care for a long time.  Many of today¡¯s medical problems are not problems with medical treatment itself.  It can be said that to a considerable extent, the improvement of living standards, the extension of population life span, and the changes in health concepts have highlighted the contradiction between medical supply and demand.  For example, a few decades ago, you might have had a headache and just gritted your teeth and endured it. Of course, if you were unlucky, this person would be gone.  But today, many people will choose to go to the hospital.  In the past, if I had a chronic disease, I might have to struggle slowly in despair, waiting for the end to come.  Now, no matter what the treatment effects and results are, as long as there is a glimmer of hope, we will always try our best to seek medical consultation.  In the past, these three hospitals in the county could almost meet the medical needs of the people in the county.  However, now, this contradiction between supply and demand has emerged and has been rapidly amplified.  Of course, insufficient medical insurance coverage, insufficient health resources, and too rapid increases in medical prices have caused tensions in the doctor-patient relationship, and even led to the emergence of various medical conflicts.  However, as an industry insider, Xu Yi still has to say - in terms of the same level of economic development, the domestic health security industry has done quite well.  As long as in the subsequent development, the country continues to increase investment, expand the scope of beneficiary groups, improve the social security level of ordinary people, and reduce the difficulty of medical treatment.  Then the current problems may be solved bit by bit during development.  Of course, just don¡¯t always do things like standardized training. After all, in the long run, it seems to clear the final hurdle from college to clinical practice. But from another perspective, the impact of this standardized training is far less than it seems.  good.  Studying medicine is difficult in the first place. Even a bachelor's degree takes one year longer than other professions. This plus three years of regular training adds up to a full eight years. Subsidies from several regular training bases in the province have been released, even if the highest  The price of the second hospital does not exceed 1,000 yuan a month.  With this small amount of money, I¡¯m afraid the salary of a hospital cleaner is higher than this. It should be regarded as a disguised form of blood sucking.  ¡°In addition, the relationship between doctors and patients is tense, and I am afraid that fewer and fewer people will be willing to become doctors even if they are willing to study medicine.  ?????????????????????????????????????????????????????????????????????: ?Change to a medical school, and it takes eight years to study for a bachelor¡¯s degree. This kind of cost is no longer affordable for ordinary families.  If you are employed, it is okay if your salary income is higher than that of other industries, but in fact, the income of the medical industry is not high.  ¡°Looking at it this way, it¡¯s not surprising that some medical staff accept red envelopes and so on.  It can be said that the introduction of standardized training will definitely have a great impact on the entire medical industry.  The salary and benefits of staff in public medical units have always been financialIt is determined by the department. If hospitals at the same level in the same area only count wages, the difference will not be too big.  The real difference in income is mainly due to performance bonuses.  If the performance reaches the financial department¡¯s targets, no matter how much work is done, no payment will be allowed.  Under this premise, there will be no difference in performance among all hospitals.  However, this is only theoretical. In fact, performance is closely related to department income.  In addition to regional differences, from third-level to first-level hospitals, the salary and income levels of doctors with the same academic qualifications, the same type of work and the same length of service are decreasing.  The reason for this result is not simply a matter of the higher business volume of tertiary hospitals.  The charging standards of public medical institutions are set by the financial department and are adjusted according to different hospital levels.  For the same examination and treatment, the charging standards of tertiary hospitals and secondary hospitals are much higher in the former than in the latter.  If they do the same amount of work, the performance of a third-level hospital may exceed the upper limit, while the performance of a second-level hospital will be significantly worse.  In addition, tertiary hospitals have more patients, so they can naturally get the upper limit. However, in the lower hospitals, many departments are facing a shortage of patients, so naturally they cannot get as much performance.  So as long as they are practitioners, unless there are reasons other than work, not many people will take the initiative to run from big hospitals to small hospitals.  Those large tertiary hospitals never have to worry about not being able to recruit people. After all, except for a few departments such as pediatrics, the performance income of most of their departments is much higher than the financial department's indicators, and there is no problem in paying bonuses.  Even in pediatrics, the income of pediatricians in large hospitals is definitely higher than that of pediatricians in small hospitals.  Under the premise of comprehensive standardized training, many tertiary hospitals have standardized training bases and a large amount of cheap labor. Naturally, there is no rush for recruitment. Even if there is a need for recruitment, it can also be solved through social recruitment and talent introduction.  .  But for the first- and second-level hospitals below, recruitment may not have been easy originally, but now they are suddenly forced to engage in three-year training. I am afraid that recruitment in the past few years will be even more difficult.  In fact, in addition to personal factors such as knowledge, what kind of job a person will choose and where to work are also restricted by other social factors.  For example, the economic development level of the place where you are looking for a job, such as the local medical conditions.  Objectively speaking, the medical resources in the county are obviously insufficient, or they are quite good compared to some more remote and backward areas. However, overall, the medical conditions are not particularly good.  There are three major medical institutions in the county: County Hospital, Traditional Chinese Medicine Hospital, and Maternity Insurance Hospital. The County Hospital is a Class II A comprehensive hospital, the Hospital of Traditional Chinese Medicine is a Class II A traditional Chinese medicine hospital, and the Maternity Insurance Hospital is a Class II A comprehensive hospital.  It is a second-level specialized hospital.  The remaining smaller health units are mainly community health centers formed after the original town hospitals were disintegrated and restructured.  Such data looks pretty good, but it is far from meeting local medical needs.  Although this is the case in the county, the medical conditions below are even worse.  Except for some scattered private clinics and dental clinics, each village is just like Xu Yi¡¯s hometown.  At most, there is only a village health station without permanent medical personnel - this thing is more meaningful for handling inspections.  ¡°After all, not every village has Xu Yi, who provides medical services to villagers without a staff or salary.  Practicing requires registration. Xu Yi¡¯s previous traditional Chinese medicine practice certificate was registered at a traditional Chinese medicine hospital, not at the village health station.  Even earlier, he didn¡¯t even have a certificate to practice Chinese medicine.  In this regard, he has actually violated the Practicing Physician Law and is suspected of illegally practicing medicine.  But who cares? The health bureau really doesn¡¯t know that Xu Yi is treating the villagers at home or something like that?  This incident happened within a year and a half. Whether the villagers went to the county hospital, traditional Chinese medicine hospital or drug store to buy medicine, they always received prescriptions signed by Xu Yi - of course, some over-the-counter medicines do not require a prescription.  In recent years, illegal medical practices and unlicensed medical practices have been caught everywhere.  If the Health Bureau really wants to say that it has no idea about this situation, then does it mean that the leadership is incompetent or that it is blind and deaf?  ?The bottom line is that it¡¯s just turning a blind eye.  After all, a health station that was originally only for political achievements and could only be used once a year for a medical check-up in the countryside can really operate without any increase in financial expenditure. It also improves the level of health services for local people. What leader would be so stupid?  To discuss dissatisfaction in various aspects, come to your door to find him."Yi is troublesome, isn't this asking for discomfort?"  Of course, there are prerequisites for maintaining this fragile balance. This can only be based on the fact that the health station has not had any medical accidents for several years, and Xu Yi has not done anything too beyond the scope of his practice.  ¡°If anything happens, the Health Bureau will be the first to lead a team down to trouble Xu Yi, and he will not be able to escape properly.  The health stations in each village are like this, and the health centers in each township are not much better.  Better towns may have part-time laboratory technicians. As for full-time laboratory technicians, where will the money come from to pay them, and where will they be recruited?  Even if they are carried out, there are often not many inspection items in these health centers. At most, they can only do three major routine tests. No matter how good they are, they can check blood sugar and so on. As for biochemistry and immunity, there is no need to think about it.  Projects such as radiology, ultrasound, and electrocardiography are basically not carried out. There are two townships that have electrocardiography, and both are part-time jobs for internal medicine or general practitioners in health centers.  Comparing this kind of medical configuration with the provincial capital, the gap becomes even more obvious.  There are several provincial and municipal level tertiary hospitals in the provincial capital alone, such as the Provincial Hospital, the Provincial Hospital of Traditional Chinese Medicine, and the First Municipal Hospital. In addition, the Red Cross Hospital and corporate hospitals such as Posts and Telecommunications and Construction Engineering are also tertiary general hospitals.  There are also no fewer than ten tertiary specialized hospitals such as a dermatology hospital, a provincial mental hospital, a provincial cancer hospital, and an infectious disease hospital.  Each district also has its own district hospital, maternal and child health hospital, and traditional Chinese medicine hospital, which are secondary hospitals.  The community health here in the provincial capital has covered the provincial capital as well as the lower towns and villages.  There are even some community health service centers with observation beds, and the medical equipment is much better than the community health service centers in the county that cover the entire county.  These community health service centers are basically equipped with radiology, ultrasound and laboratory departments, and even better communities can even perform biochemistry series.  Such conditions, in terms of department configuration alone, are not much worse than those of traditional Chinese medicine hospitals more than ten years ago.  "However, compared with provincial capital cities, such medical conditions are very average. This is generally the case in various provincial capital cities. When compared with Beijing, Shanghai and Guangzhou, there is a considerable gap.  Even more than half of the top 100 hospitals are clustered in Beijing and Shanghai.  This is true for medical care, education, and social welfare.  It is not difficult to imagine why first-tier cities have a dense population and housing prices have become increasingly difficult to control.  ??????????????????????????????????????????????????: ??Xu Yi also heard from Xiao Li that her old house was located next to a key primary school in Shanghai.  In Xu Yi¡¯s hometown county, with so much money, one can almost buy half a smaller house.  Xu Yi asked her why she didn¡¯t sell the house if it was so expensive, but Xiao Li didn¡¯t say anything.  Even if she doesn¡¯t go back in the future, she still refuses to sell or rent this house.  I don¡¯t know if my illness can be cured. No matter how much money I have, it will be useless. What¡¯s more, the house is full of memories.  In bigger cities, all conditions are good, but except that they can¡¯t find jobs, why do people go there?  Even if you really have a reason to come to the county, why do you have to choose a hospital?  The traditional Chinese medicine hospital is just a second-class traditional Chinese medicine hospital.  After decades of development of Western medicine and decades of poor management of traditional Chinese medicine hospitals, except for some older people, not many people really believe in the quality of traditional Chinese medicine hospitals.  Whenever there is something wrong, those who have money will choose to go to the city or province to see a doctor. Even if they are unable to go out for medical treatment due to financial conditions and other reasons, the first choice is to go to the county hospital.  Although it is also a second-class hospital, it is also the largest general hospital in the county. Both the department configuration and the medical facilities are much better than those of traditional Chinese medicine hospitals, and the overall strength is still there.  In the past few years, traditional Chinese medicine hospitals have worked hard to improve their treatment, and they want to go further, so why not the county hospital?  The development and investment of the county hospital in recent years have also been quite large. The traditional Chinese medicine hospital is just a plan, but the county hospital has built a new inpatient building and introduced a lot of advanced medical equipment.  Last year, the county hospital also conducted the first grade review of a third-level B general hospital, but it may have been deficient in some aspects and failed to pass the review.  However, privately speaking, I will apply for grade review again in two years, and there will be no problem at all in entering the third grade.  The treatment that a traditional Chinese medicine hospital can provide is not very attractive, and it is even more attractive than a county hospital.  What's more, hospitals in cities, and even hospitals in provincial capitals, may have a large number of vacancies due to policies. Do you need to ask how much more attractive they will be than traditional Chinese medicine hospitals?  ??Perhaps there have been a lot of people changing jobs in traditional Chinese medicine hospitals in the past two years, and even if you are unlucky, someone in the department may leave. Why do you still expect social recruitment?    In fat man¡¯s terms, it¡¯s a pattern!  ¡°Don¡¯t talk about this year, maybe there won¡¯t be a good way to solve the staff gap problem before the end of this period of training.  If the leader makes another mistake, the loss of talent will not be possible, but will be 100% certain.  ??How can such a good thing happen if you only think about making people contribute without providing enough treatment and policies to attract and retain people?  Therefore, this all-staff training will not have much impact on really large hospitals, but county-level health institutions like hospitals of traditional Chinese medicine are more likely to suffer disaster.  If we expand a little further, it is probably the ordinary people below who will suffer the most from this regulation training.  It¡¯s really similar to the saying ¡°It¡¯s hard for the people to prosper, and it¡¯s hard for the people to die.¡± No matter how we change it, the unlucky ones are all the grassroots, the poor who have problems with medical treatment.  And there is a serious problem with this approach. Students from poor families really can¡¯t even think about studying medicine, let alone cannot afford it. As for well-off families, how many people are willing to let their children study medicine now that the relationship between doctors and patients is becoming increasingly tense?  Where is the doctor?  I am afraid that this dilemma of contradiction between doctors and patients and difficulty in seeking medical treatment will have a long-term impact on this ancient but suffering country.
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