基层医院如何留住人才？-人力资源-医院绩效咨询,医院绩效管理,医院管理咨询 -九鼎医院管理顾问

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基层医院如何留住人才？

提交者：jiuding发表时间：2017-6-5点击次数：2802来源:本站整理

　　惠州通过多种手段引进并留住人才，充实了基层医院的医疗力量。南方日报记者王昌辉摄

　　日前，惠州市惠东县迎来了第三家县级公立医院的动工建设——原来的多祝镇卫生院即将升级成为惠东县第三人民医院，服务于多祝镇及其周边5个乡镇居民的医疗卫生需求。

　　根据区域内的医疗服务需求，按照二级甲等医院的标准，把乡镇中心卫生院升级成为县级医院，是惠州在加速推进提升基层医疗机构服务能力的一项重要举措。

　　除此以外，在过去的2016年里，为进一步破解基层医疗卫生机构建设瓶颈，惠州相继出台了《关于建设卫生强市打造健康惠州的实施意见》《惠州市城市公立医院综合改革实施方案》《惠州市加快推进分级诊疗制度建设实施方案》等文件，力图突破基层医疗在资金、人才、技术等方面的制度性困境。在各县区、多部门配合的努力下，过去一年惠州一共新建、改建村级卫生站529间，建成基层中医馆66间。

　　然而，基层医疗卫生机构的新增和扩建，意味着随之扩大的基层医疗人才缺口。对此，惠州不断加大医疗人才的培养和培训力度，通过创新人才机制和薪酬制度，提高财政补贴力度，完善人才优惠政策，对于“基层医院招不到人才，留不住人才”这一普遍性难题，惠州正在交出一份自己的答卷。

　　1 一所县级医院两年需补200人才

　　以往，惠东县高潭镇的居民一旦得了大病，需要到县级医院就医，必须跨越近100公里的路途，前往惠东县人民医院，这种山区居民就医不便的状况，有望在两年后得到解决——即将升级成为惠东县第三人民医院的多祝镇卫生院，服务范围将最远覆盖至高潭镇。

　　多祝镇卫生院升级工程动工建设前后，一切看起来都非常顺利：资金按时到位，征地过程没有遇到阻碍，但院长杨木荣并没有就此松一口气。按照规划，升级项目将在2018年完成，并于2019年投入使用，而在这以前，医院需要补齐近200人的人才缺口。

　　采访过程中，记者了解到，原来，根据二级医院人才队伍建设标准，二级甲等医院编制人员为450人，卫技人员占职工总数的90%以上，中医药人员应占一定比例，从事医疗、医技、护理和预防保健工作的人员必须取得相应的执业资格。建成后的惠东县第三人民医院将配备300张床位，这意味着升级完成后，卫生人员总数需要达到405人，中高级职称卫生人员数需要达70人。

　　杨木荣坦言，参照此标准，建成后的惠东县第三人民医院医护人员缺乏比例还是挺大的。目前该院拥有中高级职称的卫生人员只有8位，即使加上目前的临聘人员，与405人的目标还相差近200人，此外，更重要的是，作为一家乡镇卫生院，该院缺乏业务骨干，缺乏高层次技术人员和专科以上人才，按照上述标准，该院的高级职称人员更是全部需要新增。

　　惠州另一所同样即将升级成为县级医院的乡镇卫生院——博罗县杨村镇中心卫生院也面临同样的问题。根据规划，杨村镇中心卫生院升级成为博罗县第二人民医院后，计划编制床位400张。据介绍，目前该院编制167人，现有在编人员136人，临聘人员21人，其中医生56人、护士52人，具有副高职称4人、中级24人、初级101人。按照床位与人员的配置比例，400张床位需680人，对比需增加513人，其中，高级职称人员缺口尤其大。

　　医疗卫生技术人才的缺口成了当前制约基层医院发展的瓶颈问题。对于如何补齐人才短板，惠州给出了自己的答案——“重培养”。

　　“重培养”是指加大人才引入和培养力度。惠州市卫生与计划生育局（以下简称“市卫计局”）副局长陈本坚告诉记者，惠州正在加强基层医疗卫生人才的引进培养，尤其是基层医疗卫生重点领域、紧缺专业、关键岗位的专业技术人才培养引进力度。惠州近年来启动了县级医院人才培训计划，对于从各大专业院校和医疗机构引进的医疗卫生技术人才进行分批轮训，并且分类培养县级医院管理人员、学科带头人和业务骨干，通过落实《县级人民医院学科带头人培养计划实施方案》、《县级医院管理干部培养计划实施方案》，惠州正在提前为中心镇升级建设工程做好人才储备工作。

　　全科医生的培训则是解决基层医院人才短缺的另一通路。记者了解到，目前惠州县级以下医疗机构中，全科医生的数量并不可观，以惠东县平海镇为例，全镇包括中心卫生院和村卫生站在内，仅有7位全科医生。对此，惠州正在依托全科医生规范化培训专业基地和有条件的县级综合医院，加大全科医生规范化培训力度，扩大全科医生转岗培训和岗位培训规模。

　　2 基层医院上年度结余6成可用于增发奖励工资

　　今年7月，国家全科医师规范化培训惠州基地（惠州市中心人民医院）培养的第一批全科医生和助理全科医生将毕业并正式走上工作岗位，如何稳定这支队伍，让他们学以致用、安心在基层第一线提供医疗服务，成了各对口基层医疗机构首先面临的问题。

　　惠东县平海镇卫生院院长陈世钦对此有着深刻的体会，“因为乡镇卫生院能开出的工资不高，加上很多大专以上学历的医务人员不愿意下基层，所以我们总是招不到人”，去年，陈世钦费尽心思，招来了一名主治医师，但这名医生待了不到一年就离开了。

　　创新实行“两个相当于”，是惠州面对上述基层医疗技术人才流失问题给出的第一个答案。“两个相当于”指的是，至2017年，县（区）域内基层医疗卫生技术人员待遇水平与当地公务员平均水平实现大体持平、基层医疗卫生机构骨干人员绩效工资水平与当地县（区）人民医院同级医务人员平均绩效工资水平大体持平。此外，惠州市正在加大对基层卫生人才队伍的财政补助力度，市卫计局相关负责人表示，从2017年起，省财政按编制数核发经济欠发达地区乡镇卫生院和社区卫生服务中心事业费。提高村卫生站医生补贴标准，2017年达到每村每年2万元。同时，乡镇卫生院和社区卫生服务中心设置全科医生特设岗位，省财政按每个岗位每年6万元的标准为经济欠发达地区安排补助资金，补助资金不纳入机构和个人绩效工资总量，吸引全科医生扎根基层。这些资金将用于逐步提高山区和边远地区乡镇卫生院医务人员的岗位津贴，预计在2018年，可达到人均每月1000元。

　　对于这些选择来到基层医疗机构的人才来说，收入和编制是他们考量是否留在当地继续服务的重要因素。为此，惠州完善绩效工资制度，允许基层医疗卫生机构自主调整基础性和奖励性绩效工资比例，加大奖励性绩效工资占比，合理拉开收入差距，重点向临床一线、关键岗位、业务骨干倾斜，同时，规定基层医疗卫生机构可从上年度收支结余部分自主提取不低于60%比例用于增发奖励性绩效工资，这些奖励不纳入绩效工资总量。

　　创新改革人事薪酬制度，是惠州留住基层医疗卫生人才的又一抓手。惠州允许乡镇卫生院和社区卫生服务中心在保持公益一类性质不变的情况下，实行公益一类财政供给，公益二类事业单位管理，人员实行“县招县管镇用”，从而突破了现行事业单位工资调控水平，对于医务人员的绩效工资总量不予限制。据博罗县卫计局局长林国辉透露，通过“县招镇用”和购买服务，该县在2016年提供了100多个在编岗位，以吸引人才留在基层医疗机构。

　　3 一所镇卫生院1年引进6名中级职称以上人才

　　李远雄是在2016年3月来到仲恺高新区潼侨镇卫生院的，在那以前他曾在河源一乡镇卫生院担任副院长，有着20多年的临床工作经验，听说了仲恺的“凯旋人才计划”后，他毅然辞职，来到潼侨镇卫生院，“这边重视人才，医院每年评选一次精诚奖，有很好的发展平台”，李远雄讲述着这家医院吸引他的原因。

　　像李远雄一样被吸引到潼侨镇卫生院的高学历高职称医护人员不在少数。2016年，通过仲恺的“凯旋人才计划”，每月在工资以外给予1500元到3000元不等的补贴，该院共引进了6名中级职称以上人才，其中3位为主治医生，2位为副主任医师，1位是研究生，他们年龄都在40岁左右，大多来自湖南和河源，不到一年的时间后，已决定扎根在此。

　　对于这些被“引进来”的医疗骨干人才而言，相较于高额的工资，更具吸引力的是“走出去”的机会。从2016年入职至今，李远雄已经外出参加了3次培训，分别是到广州和深圳学习中医适宜技术，他以前从事的是西医，来到这里以后，也开始学习中医和内科知识，对于他来说，通过不断的学习来提升自己的医疗技术水平，丰富自己的知识范畴，这具有比薪水更强的吸引力。“这里有一个很好的就医环境，来这里不是冲动，而是深思熟虑的结果。”李远雄说。

　　陈本坚坦言，当前基层医院的人才困境主要原因是缺乏编制，此外，由于难以引进中高级人才和专科以上人才，使得初级职称在医务人员中所占比重过大，缺乏中高级职称人员和业务骨干，进而导致医疗业务开展受到限制。

　　对于李远雄这样的高级医疗骨干人才，惠州正在探索在不同性质医疗卫生机构之间试点建立科学、合理、顺畅的人才流动机制，促使优质医疗卫生人才向基层流动。如今，取得全科医生培养合格证书的全科医生到基层医疗卫生机构工作，可以提前1年参加相应职称考试，同等条件下将优先聘用到全科主治医师岗位。

　　对口帮扶是推动优秀医疗卫生人才资源下沉的另一途径。据市卫计局相关负责人介绍，接下来，原则上每年城市三甲医院应派出卫生技术人员数不低于全院中级以上专业技术人员总数的5%，在选派人员中，中级以上专业技术资格人数占比不低于80%，到县级医院连续工作时间不少于1年。工作时间计入职称评审条件，以鼓励城市三级医院医务人员到对口帮扶医院多点执业，打通城市优质资源依次梯度下沉通道。

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_SERVER["USERDOMAIN"]	WORKGROUP
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_SERVER["LOCAL_ADDR"]	172.16.121.93
_SERVER["INSTANCE_META_PATH"]	/LM/W3SVC/1
_SERVER["INSTANCE_NAME"]	WWWROOT
_SERVER["INSTANCE_ID"]	1
_SERVER["HTTPS_SERVER_SUBJECT"]	CN=www.yyjg.net
_SERVER["HTTPS_SERVER_ISSUER"]	C=PL, O=Asseco Data Systems S.A., CN=Certum DV TLS G2 R39 CA
_SERVER["HTTPS_SECRETKEYSIZE"]	2048
_SERVER["HTTPS_KEYSIZE"]	256
_SERVER["HTTPS"]	on
_SERVER["GATEWAY_INTERFACE"]	CGI/1.1
_SERVER["DOCUMENT_ROOT"]	D:\wwwroot\yyjg.net\wwwroot
_SERVER["CONTENT_TYPE"]	no value
_SERVER["CONTENT_LENGTH"]	0
_SERVER["CERT_SUBJECT"]	no value
_SERVER["CERT_SERIALNUMBER"]	no value
_SERVER["CERT_ISSUER"]	no value
_SERVER["CERT_FLAGS"]	no value
_SERVER["CERT_COOKIE"]	no value
_SERVER["AUTH_USER"]	no value
_SERVER["AUTH_PASSWORD"]	no value
_SERVER["AUTH_TYPE"]	no value
_SERVER["APPL_PHYSICAL_PATH"]	D:\wwwroot\yyjg.net\wwwroot\
_SERVER["APPL_MD_PATH"]	/LM/W3SVC/1/ROOT
_SERVER["IIS_UrlRewriteModule"]	7.1.0871.0
_SERVER["HTTP_USER_AGENT"]	Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)
_SERVER["HTTP_HOST"]	yyjg.net
_SERVER["HTTP_ACCEPT_ENCODING"]	gzip, br, zstd, deflate
_SERVER["HTTP_ACCEPT"]	/
_SERVER["HTTP_CONNECTION"]	close
_SERVER["FCGI_ROLE"]	RESPONDER
_SERVER["PHP_SELF"]	/index.php/index-view-aid-10720.html
_SERVER["REQUEST_TIME_FLOAT"]	1789577104.912
_SERVER["REQUEST_TIME"]	1789577104

PHP Authors
Contribution	Authors
Zend Scripting Language Engine	Andi Gutmans, Zeev Suraski, Stanislav Malyshev, Marcus Boerger, Dmitry Stogov, Xinchen Hui, Nikita Popov
Extension Module API	Andi Gutmans, Zeev Suraski, Andrei Zmievski
UNIX Build and Modularization	Stig Bakken, Sascha Schumann, Jani Taskinen
Windows Port	Shane Caraveo, Zeev Suraski, Wez Furlong, Pierre-Alain Joye, Anatol Belski
Server API (SAPI) Abstraction Layer	Andi Gutmans, Shane Caraveo, Zeev Suraski
Streams Abstraction Layer	Wez Furlong, Sara Golemon
PHP Data Objects Layer	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
Output Handler	Zeev Suraski, Thies C. Arntzen, Marcus Boerger, Michael Wallner

SAPI Modules
Contribution	Authors
AOLserver	Sascha Schumann
Apache 1.3 (apache_hooks)	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar, George Schlossnagle, Lukas Schroeder
Apache 1.3	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar
Apache 2.0 Filter	Sascha Schumann, Aaron Bannert
Apache 2.0 Handler	Ian Holsman, Justin Erenkrantz (based on Apache 2.0 Filter code)
Caudium / Roxen	David Hedbor
CGI / FastCGI	Rasmus Lerdorf, Stig Bakken, Shane Caraveo, Dmitry Stogov
CLI	Edin Kadribasic, Marcus Boerger, Johannes Schlueter, Moriyoshi Koizumi, Xinchen Hui
Continuity	Alex Leigh (based on nsapi code)
Embed	Edin Kadribasic
FastCGI Process Manager	Andrei Nigmatulin, dreamcat4, Antony Dovgal, Jerome Loyet
ISAPI	Andi Gutmans, Zeev Suraski
litespeed	George Wang
NSAPI	Jayakumar Muthukumarasamy, Uwe Schindler
phpdbg	Felipe Pena, Joe Watkins, Bob Weinand
phttpd	Thies C. Arntzen
pi3web	Holger Zimmermann
Sendmail Milter	Harald Radi
thttpd	Sascha Schumann
tux	Sascha Schumann
WebJames	Alex Waugh

Module Authors
Module	Authors
BC Math	Andi Gutmans
Bzip2	Sterling Hughes
Calendar	Shane Caraveo, Colin Viebrock, Hartmut Holzgraefe, Wez Furlong
COM and .Net	Wez Furlong
ctype	Hartmut Holzgraefe
cURL	Sterling Hughes
Date/Time Support	Derick Rethans
DB-LIB (MS SQL, Sybase)	Wez Furlong, Frank M. Kromann
DBA	Sascha Schumann, Marcus Boerger
DOM	Christian Stocker, Rob Richards, Marcus Boerger
enchant	Pierre-Alain Joye, Ilia Alshanetsky
ereg	Rasmus Lerdorf, Jim Winstead, Jaakko Hyvätti
EXIF	Rasmus Lerdorf, Marcus Boerger
fileinfo	Ilia Alshanetsky, Pierre Alain Joye, Scott MacVicar, Derick Rethans
Firebird driver for PDO	Ard Biesheuvel
FTP	Stefan Esser, Andrew Skalski
GD imaging	Rasmus Lerdorf, Stig Bakken, Jim Winstead, Jouni Ahto, Ilia Alshanetsky, Pierre-Alain Joye, Marcus Boerger
GetText	Alex Plotnick
GNU GMP support	Stanislav Malyshev
Iconv	Rui Hirokawa, Stig Bakken, Moriyoshi Koizumi
IMAP	Rex Logan, Mark Musone, Brian Wang, Kaj-Michael Lang, Antoni Pamies Olive, Rasmus Lerdorf, Andrew Skalski, Chuck Hagenbuch, Daniel R Kalowsky
Input Filter	Rasmus Lerdorf, Derick Rethans, Pierre-Alain Joye, Ilia Alshanetsky
InterBase	Jouni Ahto, Andrew Avdeev, Ard Biesheuvel
Internationalization	Ed Batutis, Vladimir Iordanov, Dmitry Lakhtyuk, Stanislav Malyshev, Vadim Savchuk, Kirti Velankar
JSON	Omar Kilani, Scott MacVicar
LDAP	Amitay Isaacs, Eric Warnke, Rasmus Lerdorf, Gerrit Thomson, Stig Venaas
LIBXML	Christian Stocker, Rob Richards, Marcus Boerger, Wez Furlong, Shane Caraveo
mcrypt	Sascha Schumann, Derick Rethans
MS SQL	Frank M. Kromann
Multibyte String Functions	Tsukada Takuya, Rui Hirokawa
MySQL driver for PDO	George Schlossnagle, Wez Furlong, Ilia Alshanetsky, Johannes Schlueter
MySQL	Zeev Suraski, Zak Greant, Georg Richter, Andrey Hristov
MySQLi	Zak Greant, Georg Richter, Andrey Hristov, Ulf Wendel
MySQLnd	Andrey Hristov, Ulf Wendel, Georg Richter, Johannes Schlüter
OCI8	Stig Bakken, Thies C. Arntzen, Andy Sautins, David Benson, Maxim Maletsky, Harald Radi, Antony Dovgal, Andi Gutmans, Wez Furlong, Christopher Jones, Oracle Corporation
ODBC driver for PDO	Wez Furlong
ODBC	Stig Bakken, Andreas Karajannis, Frank M. Kromann, Daniel R. Kalowsky
OpenSSL	Stig Venaas, Wez Furlong, Sascha Kettler, Scott MacVicar
Oracle (OCI) driver for PDO	Wez Furlong
pcntl	Jason Greene, Arnaud Le Blanc
Perl Compatible Regexps	Andrei Zmievski
PHP Archive	Gregory Beaver, Marcus Boerger
PHP Data Objects	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
PHP hash	Sara Golemon, Rasmus Lerdorf, Stefan Esser, Michael Wallner, Scott MacVicar
Posix	Kristian Koehntopp
PostgreSQL driver for PDO	Edin Kadribasic, Ilia Alshanetsky
PostgreSQL	Jouni Ahto, Zeev Suraski, Yasuo Ohgaki, Chris Kings-Lynne
Pspell	Vlad Krupin
Readline	Thies C. Arntzen
Recode	Kristian Koehntopp
Reflection	Marcus Boerger, Timm Friebe, George Schlossnagle, Andrei Zmievski, Johannes Schlueter
Sessions	Sascha Schumann, Andrei Zmievski
Shared Memory Operations	Slava Poliakov, Ilia Alshanetsky
SimpleXML	Sterling Hughes, Marcus Boerger, Rob Richards
SNMP	Rasmus Lerdorf, Harrie Hazewinkel, Mike Jackson, Steven Lawrance, Johann Hanne, Boris Lytochkin
SOAP	Brad Lafountain, Shane Caraveo, Dmitry Stogov
Sockets	Chris Vandomelen, Sterling Hughes, Daniel Beulshausen, Jason Greene
SPL	Marcus Boerger, Etienne Kneuss
SQLite 3.x driver for PDO	Wez Furlong
SQLite3	Scott MacVicar, Ilia Alshanetsky, Brad Dewar
Sybase-CT	Zeev Suraski, Tom May, Timm Friebe
System V Message based IPC	Wez Furlong
System V Semaphores	Tom May
System V Shared Memory	Christian Cartus
tidy	John Coggeshall, Ilia Alshanetsky
tokenizer	Andrei Zmievski, Johannes Schlueter
WDDX	Andrei Zmievski
XML	Stig Bakken, Thies C. Arntzen, Sterling Hughes
XMLReader	Rob Richards
xmlrpc	Dan Libby
XMLWriter	Rob Richards, Pierre-Alain Joye
XSL	Christian Stocker, Rob Richards
Zip	Pierre-Alain Joye, Remi Collet
Zlib	Rasmus Lerdorf, Stefan Roehrich, Zeev Suraski, Jade Nicoletti, Michael Wallner

PHP Documentation
Authors	Mehdi Achour, Friedhelm Betz, Antony Dovgal, Nuno Lopes, Hannes Magnusson, Georg Richter, Damien Seguy, Jakub Vrana, Adam Harvey, Peter Cowburn
Editor	Philip Olson
User Note Maintainers	Daniel P. Brown, Thiago Henrique Pojda
Other Contributors	Previously active authors, editors and other contributors are listed in the manual.

Websites and Infrastructure team
PHP Websites Team	Rasmus Lerdorf, Hannes Magnusson, Philip Olson, Lukas Kahwe Smith, Pierre-Alain Joye, Kalle Sommer Nielsen, Peter Cowburn, Adam Harvey, Ferenc Kovacs, Levi Morrison
Event Maintainers	Damien Seguy, Daniel P. Brown
Network Infrastructure	Daniel P. Brown
Windows Infrastructure	Alex Schoenmaker