After more than 200 medical workers of Hanoi-based Bach Mai Hospital simultaneously quit the hospital to work for other facilities in April 2021, the problem of brain drain and doctors' income is once again raised though it is not new. Hospitals and medical workers have been so far struggling to achieve full self- autonomy.

Doctor Le Tran Diem Phuong worked at Tan Phu District Hospital in the Southern Province of Dong Nai and her salary was less than VND6 million a month. Then she resigned from work to look for new opportunities after 28 months of working without listening to the advice of her friends and relatives.

Fortunately, at that time, she was admitted into a new vaccination company with starting salary of VND18 million, tripling the prior salary.

Moreover, she said working at the district hospital, people are assigned to do what they have to do, day by day without creativeness; she did not see development opportunity whereas in the new company, daily working requires efforts and working with good people, she feels more pressure due to the responsibility of having to make but she likes it.

Assenting with Dr. Diem Phuong, Director of the General Hospital in Dong Nai Ngo Duc Tuan said to prevent a brain-drain of health workers from public to private hospitals and from rural mountain provinces to urban areas, the government should improve doctors’ income and working environment for professional development. Low salaries, shortages of supplies, and work overload contribute to unsatisfactory working conditions.

Director Tuan said that 15 medical workers of the hospital have quit the job in the three first months of the years.

At the same time, 31 medical workers left public hospitals in Dong Nai Province. Statistically, Dong Nai had 119 medical staff including 104 doctors who resigned from their jobs in 2019. In 2020, 91 medical staffs including 80 doctors left their jobs. Worse, many of them are doctors with master's degrees,
Although there are no official statistics in Ho Chi Minh City, several doctors leaving public hospitals to work for private ones. For example, the newly established Tam Anh General Hospital has attracted many famous doctors from major public hospitals in the city.

Associate Professor, Dr. Hoang Thi Diem Tuyet, Director of Hung Vuong Maternity Hospital, said that the income gap of public and private doctors is too big. Therefore, public hospital management board needs to create a fair and transparent working environment to encourage good staffs and keep qualified doctors.

Although the financial autonomy mechanism still faces many shortcomings, it is an opportunity in some hospitals. For example, Long Khanh Regional General Hospital in Dong Nai Province has only 600 beds, the hospital regularly receives over 1,000 inpatients. The hospital built a new facility, which was equipped with new machinery and high technology. Moreover, the hospital invited good experts from HCMC to work for it. This is also the first hospital in the province to successfully implement electronic medical records, helping to reduce the time for medical staff to do administrative paperwork, thereby, they have more time to take care of patients.

Doctor Le Quang Trung, Deputy Director of Dong Nai Department of Health, said that self-autonomy is helping all hospitals to change more and more. However, the opportunity is not for everyone. If this hospital attracts patients, other places have to accept the loss of patients. Although they are autonomous, in fact, public hospitals can’t admit more health workers or decide service price frame.
In the past, private healthcare demanded a fair mechanism with public healthcare. But now, on the contrary, public hospitals demand the same mechanism as private hospitals.

Leaders of many hospitals are also very concerned about opportunities and challenges while struggling for autonomy in the health sector. Without real autonomy, public hospitals will still struggle with this problem. Highly qualified doctors leave public hospitals, leaving a big gap in quality. As a result, patients no longer trust the hospital, they will not visit the hospital; therefore, the hospital’s revenue will decline resulting in medical workers’ income decreases and doctors will be dispirited. It's a vicious circle," said Dr. Le Quang Trung.

According to Assoc. Prof. Dr. Hoang Thi Diem Tuyet, Ho Chi Minh City saw a 20 percent decrease in the number of patients in 2020, Hung Vuong Maternity Hospital is still considered a rare bright spot when its patients are the same as in 2019. Even if the hospital spends more than VND1 billion on coronavirus epidemic prevention, the income of employees still increases. In 2020, Hung Vuong Hospital inaugurated Bach Hop building with 2 basements, one ground floor, and 11 floors for examination, treatment, training and scientific research.

According to Associate Professor Tang Chi Thuong, Deputy Director of the Department of Health of Ho Chi Minh City, a medical worker’s average income dipped by VND2.5 million per month in 2020. The government should provide financial assistance to 48/84 infirmaries to ensure income for employees. In the context of the complicated development of the Covid-19 epidemic, the income of medical staff is forecast to continue to be affected.

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