Chapter 132: Persuading Others to Study Medicine Invites Divine Retribution

Yang Meng suddenly laughed and said, "If that’s really the case, buddy, I’ll take you to deliver food! As long as you’re willing to work your tail off, you’ll definitely earn more than an attending physician!"

Di Wei gave a bitter smile. "Work my tail off? Do you think the labor intensity for doctors is low? The one thing doctors never lack is 'working their tails off'! Let me tell you, in our line of work, there are no lunch breaks on weekdays, no weekends off, and we almost never get to take the statutory holidays. While others enjoy their seven-day National Day break, we consider ourselves lucky to get three. Annual leave is never approved and never used! You still think we have it easy? Especially as an emergency room doctor! Being dragged out of bed at home to go to the hospital is a regular occurrence! Our country has a population of 1.4 billion, but only a little over ten million medical staff; we are severely understaffed! The slogan in the hospital is: 'Use women like men, and use men like animals!' The labor intensity is really no less than delivering food, and at least with food delivery, you can control your own time, right?"

Yang Meng coughed dryly. "Off track, off track. We were talking about income."

Di Wei nodded and continued, "A doctor's income is generally base salary plus training stipends, overtime pay, and research bonuses, but it varies by department. Take cardiology, for example; the price of blood pressure medication remains high year-round, so the department's commissions and bonuses are relatively higher. Or orthopedics—they get commissions on surgical fees and the medical devices and consumables used. Their income is also relatively high. Well, our emergency department is in a similar situation regarding consumables, but it’s certainly worse than orthopedics."

"Commissions?" Yang Meng caught on to the key point. "I get it now. Is the current media debate about 'overpriced medicine' because there are commissions for prescribing these drugs?"

"Pah!" Di Wei spat fiercely. "The reason doctor-patient relations are tense right now is because of the media! They don't provide proper public guidance! They ignore a million successful treatment cases but fixate nationwide on a single medical dispute! In their eyes, are doctors not human?"

"Fine, the situation with 'overpriced medicine' you speak of has existed! But there’s no helping it. Hospitals are public institutions strictly regulated by the state. For example, after you perform a surgery, all costs must be reviewed and approved by superiors to ensure there are no issues before the money is returned to the hospital. All surgical fees, treatment fees, and nursing fees are set by the Price Bureau; the hospital doesn't get the final say! After the hospital calculates these, it distributes them to the medical staff who performed the surgery. The hospital still has to make a profit, support thousands of employees, and keep costs to a minimum. What is the hospital supposed to do?" Di Wei countered.

Yang Meng and the others were stunned, not knowing how to answer.

Di Wei continued, "Years ago, regulations weren't as strict, so some hospitals started focusing on medicine. They prescribed more drugs, especially those with higher profit margins. Doctors earned kickbacks provided by pharmaceutical companies. But things are different now! The drugs used in hospitals are under unified management, with state-level bidding that forces pharmaceutical companies to provide the lowest prices while maintaining quality, using 'volume' to generate profit. Prices are also uniformly public. How could one possibly profit from the drugs themselves?"

"Besides, these public hospitals operate on a partial funding model, meaning that most expenses—including hospital construction and the purchase of diagnostic equipment—must be raised by the hospital itself. Where does that money come from? Now that medicines and consumables have unified, government-set prices, the hospital doesn't even have pricing power, and even consumables have started to move toward zero-markup! I ask you, what does the hospital rely on to make money? How can it feed so many people?"

Seeing Yang Meng and the others staring in disbelief, Di Wei dropped another bombshell: "And many hospitals are currently operating while in debt..."

"Hospitals are in debt?" Yang Meng asked curiously. "I always see them doing a booming business!"

"Booming business?" Di Wei took a drag of his cigarette, coughed for a long time, and then gave a dry laugh. "Have you ever considered medical insurance?"

"What's wrong with medical insurance?" Yang Meng asked, puzzled. "Isn't that a good thing?"

Di Wei explained, "Our country's medical model is what we call 'advance payment.' What does that mean? It means the costs covered by insurance are first paid by the hospital, and then the hospital applies to the Medical Insurance Bureau for reimbursement. It takes three months at best, six months at worst, to get the money back! As long as the insurance department doesn't settle payments in time, the hospital falls into a cash flow crisis. How can it operate? Furthermore, the insurance department puts a 'tightening hoop' on every hospital: they give you a quota, and if you exceed it, they won't reimburse you! The intent is good—to reduce the burden on patients—but what is the hospital supposed to do? If the quota is used up and you admit an insured patient, you have to pay out of your own pocket. But if you refuse to admit them? That would definitely cause a social outcry! Nowadays, our citizens go to top-tier hospitals even for a cold or fever, and the larger the hospital, the greater the pressure from medical insurance."

Yang Meng was stunned. "The hospital has to pay out of its own pocket?"

Di Wei smiled. "What did you expect? Do you think there are few people who run off after getting treated? Some people are genuinely poor; can you just watch them die? Our emergency department is the 'runaway capital' of the hospital. People often get their treatment and then vanish in a flash."

Yang Meng asked curiously, "Alright, how do you handle those who truly cannot afford treatment?"

"How do we handle them?" Di Wei shook his head bitterly. "I don't understand the thought process of these people. A hospital is a place where doctors and nurses work! If you go to a supermarket and can't afford the goods, why blame the supermarket? If someone is truly poor, shouldn't they look for the government? Our department has a fund for dealing with such situations. If someone doesn't pay or truly can't afford it, the department covers 80% of the cost, and the attending doctor covers 20%. Generally, we all chip in to make up that 20%! Who knows if we might face such a situation ourselves someday? My father is a big shot, right? A top expert at the municipal hospital. His expert consultation fee is only 25 yuan! That’s not even enough to buy a pack of cigarettes! Anyone who passes moral judgment on hospitals or the doctors and nurses working there is a total scumbag."

"They talk all day about high medical costs and say doctors and nurses aren't 'angels in white.' Angels stay in heaven! Go find an angel in heaven first! We are human too! Every debt has a debtor; if you can't afford medical care, find the right person to blame—don't harass our hospitals and medical staff! If you don't have insurance, seek help from the Civil Affairs Bureau, the Health Commission, the neighborhood committee, and so on. Why come after us? This is just our job! What’s the point of obsessing over us and dumping all these conflicts on us, which only leads to our treatment being downgraded? They curse us with all their might, but when they actually have a problem, don't they still demand that we treat them? Are they only going to be happy when there’s no one left in the whole country willing to be a doctor?"

Yang Meng snapped his fingers. "That point is well-taken. It’s indeed pointless to stand on a moral high ground to criticize others. But my barbecue shop is actually missing talents like those who enjoy 'moral judging' for no reason."

"Huh? Why is that?" Duan Bowen asked curiously.

Yang Meng shrugged. "Do I even need to ask? If they are all saints, how can they be bothered by fame and fortune? If they come to work for me and I don't pay them a salary, they’d surely accept it, right? Isn't that great?"

"Hahahaha," Long Teng laughed. "I really don't think anyone would do that."

Yang Meng chuckled, "These people keep saying teachers are 'gardeners' and medical staff are 'angels,' but in reality, they just measure everything by how much they can get out of it for how little they spend."

Di Wei suddenly lost interest and said in a muffled voice, "Actually, we still have it better; Traditional Chinese Medicine (TCM) practitioners have it worse. TCM is truly profound, but treatment relies on medicine. Now that drug pricing is so transparent, wanting to make money? Even harder! I have a classmate who studied TCM; he opened his own clinic and also sees patients at a large TCM center once a week, but even so, his monthly income is less than ten thousand. Everyone envies us doctors? But we have a saying in our industry: 'Persuading someone to study medicine will lead to being struck by lightning.' Many people say we doctors just have to grind through it, and once we make it, the good days will come. But I really want to ask these people: Why on earth should I have to grind? Why should I be cheap labor? Is the income I earn proportional to the years I spent studying and the labor I put in? I can recite the Hippocratic Oath by heart, but do I not need to eat? Even if I get promoted to attending physician, my annual income is barely over a hundred thousand. But look at Huawei—they hire PhDs with starting annual salaries in the millions! I’m a PhD too! Why is the gap so large? If I go out for a meal and drinks with Zhou Chun, I get investigated. Who can I reason with?"

By the end, Di Wei became angry. "Especially in our emergency department, we encounter all kinds of people. They say medical staff are becoming a high-risk profession, and the emergency room sees this more than anywhere else! My mentor, such an elderly, kind doctor—and what happened? He was beaten and hospitalized. I wasn't there that day; if I had been, I would have fought those guys to the death!"

"What? Tell me exactly what happened," Yang Meng asked curiously.

Di Wei said indignantly, "A young man came in with his family due to a persistent high fever. My mentor examined him and found it was because the young man had contracted genital warts. Normally, this wouldn't cause a fever, but the guy was embarrassed and went to a small clinic where they used corrosive agents improperly, leading to local ulceration and inflammation, which caused the fever. My mentor told him the corresponding treatment method, but because there were so many people around, he didn't explicitly say what the disease was out of consideration for the patient."

"He's a good doctor, always thinking of the patient," Yang Meng nodded, then asked curiously, "Even such a good doctor gets beaten? What kind of people could do such a heartless thing?"