The general office of the National Health and Family Planning Commission recently asked for public opinions on the draft regulation regarding licensed doctors practicing medicine at multiple sites.

1. Background and goals of regulation

A decision by the Central Committee of the Communist Party of China says that licensed doctors are allowed to practice at multiple sites. The draft regulation was developed to implement Central Committee’s decision and deepen the ongoing healthcare reform. It aims to promote a smooth and effective flow of high-quality medical resources, make the best use of their social benefits, ensure the quality and safety of medical treatment and provide better medical services to the public.

For a long time, the insufficient supply of high-quality medical resources, which are unevenly distributed, has not been able to meet people’s growing demand for medical treatment. The reform that allows doctors to practice at multiple sites triggers high expectation among the public. The former Ministry of Health issued policies in 2009 and 2011 for pilot projects involving multi-site medical practice. In order to further develop and standardize multi-site medical practice, the draft regulation was formed after seeking advice from various stakeholders, including government sectors, public and private sectors and individuals.

2. General requirements for multi-site practice

The pilot projects of multi-site medical practice have been going on for five years. According to the Central Government, the development of multi-site medical practice should be based on China’s conditions and appropriately borrow international experience, and should be gradually push forward with the reform of personnel and social security system. There are three main requirements in the draft regulation. First, use policies to encourage doctors to practice medicine in remote and rural areas in China. Second, ensure doctors to conduct multi-site practice within the framework of laws and regulations. Third, ensure the quality and safety of medical treatment.

3. Key points of draft regulation

3.1 Basic requirements for multi-site medical practice

Multi-site medical practice means that registered doctors offer medical services regularly in at least two medical organizations. Organized by the government, doctors who serve in non-profit medical programs, or offer medical treatment in disaster relief activities, are not considered as conducting multi-site medical practice. For doctors attending medical consultation in other hospitals, the temporary provisions on medical consultation management should be followed.

3.2 Main conditions for multi-site medical practice

Those who apply for multi-site practice need to get written approvals from the current medial institution they work for. Doctors who practice in clinical medicine, dental medicine and Chinese traditional medicine are eligible for multi-site medical practice. They need to practice at their respective specialty for at least five years and have at least intermediate-level qualifications. They need to be physically healthy enough to practice at multiple sites, and they need to pass the most recent two regular national assessments for doctors. Those who are department heads or take even higher managerial positions within the hospital, are not allowed to practice at multiple sites in principle. However, they can practice at inferior hospitals for which their hospital are supposed to provide support, or at other hospitals within the medical group which their hospital belongs to.

3.3 Application procedures

Doctors and medical institutions need to sign contracts to define their rights and obligations. Those who are willing to practice at multiple sites need to sign employment contracts with the medical institutions they originally work and sign multi-site practice agreement with institutions they plan to work for, in order to determine their work period, job responsibility, performance assessment, and salaries, etc.

3.4 Legal liability

To tackle potential medical disputes, doctors and medical institutions should clarify in the agreement their respective legal liabilities. In case of medical malpractice or medical disputes during the process of multi-site medical practice, doctors and medical institutions should refer to the agreements and related laws and regulations to handle the situation.

3.5 Registration management of multi-site medical practice

Medical institutions that plan to hire those who practice medicine at multi-sites will need to help the doctors with registration procedures. Health authorities at all levels and industrial associations should follow relevant regulations to access the performance of doctors who practice at multiple sites.

4. Safeguarding the development of multi-site medical practice

First, strengthen organizational leadership. Local health authorities need to study the situation and challenges regarding multi-site medical practice and strengthen the organization and coordination of related work. Second, focus on implementation. Health authorities should improve management measures based on experience from local multi-site practice pilot work. Third, create a good environment. Through policy interpretation and advocating, support should be gained from medical institutions and the public.