CHONGQING, June 10 (Xinhua) -- Sixty-eight-year-old rural doctor Ye Siyou is still receiving patients at his clinic, even though the job now takes more out of him than it did in previous years.
"My current pay is barely enough to live, but if I retire, I may have to rely on my children to feed me," said Ye, who works at a clinic in the village of Yangyan in southwest China's Chongqing Municipality.
An ambiguity in the labor relations of rural doctors like Ye is keeping them from participating in a pension program designed for employees of institutions and enterprises. They receive only a monthly old-age subsidy of 80 yuan (12.9 U.S. dollars) after retirement.
Ye is among 1.1 million rural doctors working in the country's village clinics.
Since medical and healthcare reforms were implemented in 2009, the government has intensified management for medical workers in rural areas. Village clinics and doctors have been incorporated into the country's rural healthcare system, which includes county-level, township-level and village-level health institutions.
However, the incorporation is more about professional administration and training for the doctors. Their labor relations remain undefined, leading to many problems, said Wang Lusheng, a research fellow at the National Health Development Research Center.
"When I was a footloose practitioner, a large source of my earnings came from medicine sales," said Ye Zhaochun, another doctor in Yangyan village.
Her income shrank after the implementation of the basic medicine system, which mandates no surcharges for sales of drugs at clinics.
To make up for the losses, the local government is providing Ye and other village doctors with an allowance of about 20,000 yuan annually.
However, to obtain this allowance, Ye is also obliged to provide more non-profit basic public health services, such as the archiving of health records, blood pressure monitoring and epidemic prevention.
In addition, requirements related to prescriptions, medical fees and equipment have also become more strict.
"Now we are doing the same job as the doctors in urban hospitals, bearing no less pressure or professional risk, but they are regarded as employees of health institutions and are entitled to better pension payments, whereas we are not," Ye Zhaochun said.
According to Wang, the current pension system for retired employees requires employers to make substantial contributions to the pension funding pool. However, as village doctors are not fully recognized as employees of any specific institutions, they have no clearly defined employer to pay the fees and thus cannot receive pension benefits.
According to Huang Liang, director of a hospital in Fenggao County, where Yangyan is located, poor pension prospects are a major complaint for many village doctors. Many of them have abandoned their jobs.
The pension problem is representative of the urban-rural gap in China and the solution lies in urbanization, said Zhang Shuo, a health economics specialist at the World Bank.
Zhang stressed the importance of retaining rural village doctors amid the country's efforts to enhance rural medical services.
Wang also called for more government investment to tackle the problem.
To reassure the doctors, a local government in east China's Jiangxi province is issuing special subsidies of 65 yuan each month for every senior village doctor with more than 20 years of work experience. In other regions, such as Ningxia and Yunnan, local governments are paying the premiums for the doctors' pensions.
Zhong Ruijin, a village doctor in Chongqing's Qianjiang district, signed a labor contract with a hospital in his town in 2009 and joined the pension program in 2012.
After he retires, he will receive a monthly payment of at least 1,000 yuan.
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