The requirements for promotion to the title of doctor as a profession are very different in various provinces and cities, I will only talk about what I know about certain hospitals in the Shanghai area.

Case 1: An old college friend, a senior attending physician in a famous tertiary hospital, privately complained that it was fine to work step by step, but there was probably no hope of being promoted to chief physician.

Doctors are experienced work, attending physician is a general outpatient, ward, then specific management of patients, above the chief doctor in charge, so as an experienced old attending, students in the department inside is still very popular. So why can't you get a chief physician? It is because the hospital is too strong, too many people, people have national nature, SCI papers, you do not have that you can not go. Upstairs, some people said that gifts, her case to send gifts are useless, because the hospital gives the selection of deputy high conditions of access she can not reach, there is not even the opportunity to send gifts. In other words, if she is willing to change a nearly hospital, then the promotion opportunity is there. But who would be willing to give up the working environment of a top tertiary hospital. Even without a title, the invisible benefits of resources and connections were still attractive enough.

Case 2: An old high school classmate who graduated from a third-rate medical school and is now an associate chief physician at a general second-rate hospital.

Since they are both my classmates, their qualifications are exactly the same, just that they graduated from different colleges, so they went to different levels of hospitals. My old high school classmate is a counter-example to the above old college classmate, the reason why she was able to successfully get on the associate high level is because the hospital level is not high, she has a bureau-level project, there are two third-rate SCI papers in this level of the hospital is a phoenix, no one competes with her at all.

Case 3: A bunch of senior attending anesthesiologists in the anesthesiology department of a cooperative famous tertiary care hospital

Anesthesiologists are now gradually standardized, and there are specialized anesthesia training personnel. In the past, many nurses changed their profession, and after seniority, the threshold of title evaluation is getting higher and higher, and they are very skilled, but they don't have the energy to write funds and send SCI papers [we should all know how horrible the workload of anesthesiology departments in famous tertiary hospitals is], so they have to become senior attending anesthesiologists.

The above is my small observation and discovery, only on behalf of the status quo of certain hospitals in the Shanghai area, welcome to criticize and correct!

As an "old attending", Mr. Han has the most to say about this issue.

First, I do not think that the title of attending physician is a disgrace. Many people may think that the title of attending physician is only an intermediate professional and technical title in the clinical medical title hierarchy, and is far below the level of "associate chief physician" and "chief physician". However, attending physician is actually the title category with the largest number of doctors in most public hospitals. Doctors in this title category have a deeper understanding of the clinical medical problems of the discipline, and the relevant clinical skills are also more skillful, at the same time, is often the mainstay of the hospital's clinical work, and in some ways may be higher than some of the deputy chief physician or chief physician level.

Secondly, the unique title level in China determines that many people will definitely stop at the title level of "attending physician". On this issue, I have asked Professor Xia Yun of the American Chinese Physicians Association, he said that in the United States, the title level of clinical doctors is mainly interns - residents - attending physicians, to the attending physician level has come to an end; The United States does not have "chief physician" as a clinical title; deputy chief physician and chief physician are two "strange" titles are "made in China" title level. In foreign countries, if a doctor has special academic attainments and has conducted in-depth research on certain clinical problems and obtained certain results, he or she can apply to the hospital for the academic title of assistant professor or professor. In other words, foreign countries are medical and scientific research "two lines", "dual-track system": medical, attending physician is the top, academic, professor is the top, and there is no such thing as deputy chief physician and chief physician. Therefore, as the more senior titles in the country, deputy director and chief physician are obviously more demanding, of course, there are a lot of doctors who cannot meet such requirements, and naturally stop at the attending physician.

Thirdly, the deformed title evaluation system in China has resulted in many people having to stay at the level of attending physician. At present, many domestic hospitals do not have high requirements for the scientific research and academic level of attending physicians, but there are relatively high rigid conditions for the two senior titles of deputy director or chief physician, for example, there are certain levels of scientific research topics, articles published in foreign SCI journals, and a certain degree of academic tenure, etc. There are many attending physicians who are busy with clinical work every day and do not have the time and energy to do such work. Many attending physicians are busy with clinical work every day and do not have the time and energy to do these scientific research and academic work; in addition, the main interest of some attending physicians does not lie in scientific research and academic work, but just want to do their job at hand and look after the patients; of course, there are still a few units applying for senior titles or assessment of senior titles are not open and unfair, and have to rely on the "relationship", "go", "go", "go", "go", "go", "go", "go", "go", "go", "go", "go" and "go". Of course, there are still a few units applying for senior titles or evaluating senior titles are not open and fair, and have to rely on "looking for relations", "backdoor", "canvassing" and other improper ways to apply. Therefore, an attending physician is not necessarily a "less skilled" doctor, and there are probably some reasons for this.

To sum up, I think it is normal for hospitals to have "old attending staff" who have worked for 30 years, and there is nothing wrong with that.

I'm a small shadow doctor, why am I still an attending after thirty years in the hospital? An attending physician is just an intermediate title, with two levels of senior titles above it. After thirty years of work, still intermediate title, many people think it is incredible, in the hospital there are many people are like this, especially the big hospitals.

What are the types of physician titles?

Physician titles are junior (resident), mid-level (attending) and senior (associate and chief).

After graduating from school with a bachelor's degree, you can only take the licensing exam in your second year of work, and you will only know a qualified physician after you have obtained your license. Then it becomes the lowest level of residents, do the most work is also the most tired.

After a resident has worked for five years, he or she can take the attending exam, which is the intermediate level. After graduating from graduate school, you can only take the attending exam after working for two years.

After three years after the primary examination, these three years to do the subject of writing articles, after the theory of the examination, and then after the review of the interview is qualified to be deputy chief physician. After another three years, the same do do subject write articles, after the examination and evaluation to the highest level of chief physician.

The promotion of physicians requires not only the level, the topic, the article, but also the passage of a specified period of time, just like upgrading and fighting monsters, which requires not only the level, but also luck.

Why are you still an attending physician after thirty years of work?

The superior of an attending physician is an associate physician. After three years of taking the attending exam, you can take the deputy chief physician exam, but why is it that after thirty years of work you don't get to take the exam?

Because the examination for deputy chief physician not only need to have enough time, but also have a project in these three years, have an article published, after the theory of the examination, but also after the interview review to be able to get to the deputy chief physician. Some people are very good at clinical work, that is, they are very good at seeing patients, but they don't spend time on doing projects and writing articles, so it is possible that they will be an attending physician for the rest of their lives. Therefore, a doctor not only needs to be good at seeing patients, but also be able to do projects and write articles.

Another very important thing is whether there are places in the hospital. This is a very crucial factor. That is to say, theoretically, you got the certificate of deputy chief physician, but the hospital does not have a quota to hire you as a deputy chief physician, then you will always be an attending physician in the hospital. Especially in large hospitals, there are many talents and fewer quotas. Some people have taken the exam for deputy chief physician and chief physician for many years, but there is no quota for the department to hire them, so they can only be an attending physician. So it is possible to work for thirty years or attending physician situation.

Graduated together with the university classmates, some went to the county hospital, some went to the provincial hospital, the same is the work of fifteen years, the county hospital work may have long been the chief physician, because the small hospital quota, generally on the examination on the direct appointment. But in the big hospitals may still be an attending physician.

I'm Dr. Little Shadow, so follow me if you want to learn more about medicine.

Everyone thinks that doctors will follow a title route of intern, resident, attending, associate, chief, and so on until they retire and return to work, or retire and go home to their grandchildren.

In fact, the path of a doctor is not as simple as everyone thinks, much less like we go to school, from first grade to junior graduation, nine years of compulsory education, and even if it's compulsory, you have to take an exam. In real life, most doctors can only mix to the attending physician, and then, no more then, until retirement.

It is only that people are accustomed to calling older doctors directors, so that on the one hand, those who call them think that they are older and should be directors, and those who are called are also happy to hear it, so there are many directors who are not directors.

Let's start with how this attending physician, chief physician, all came about.

We graduate from medical school with 5 years of undergraduate, 8 years of graduate, and 11 years of PhD, (4 years of undergraduate, 6 years of graduate, and 8 years of PhD in other majors). To the hospital is to realize the doctor, after the licensed physician exam passes, will become a resident, and these years and training, is to have to go to other hospitals to realize three years, to become a full-fledged doctor.

PhD students get into attending a little faster because PhDs are in school longer, and the overall math actually works out to be the same amount of time it takes for an undergraduate to get into the ranks of attending. All every resident has to do to become an attending is pass the state exam, and if you pass the exam you become an attending. Of course even if you pass the exam and the hospital doesn't hire you as an attending, it doesn't help, it's still a residency.

But an attending physician is relatively simple, one who has graduated over a few years, been a resident for a few years, will take the exam, pass the exam and become an attending physician, so almost every doctor can become an attending physician.

But the deputy chief physician, is not so simple, not only to test, more importantly, to see a lot of conditions, these conditions will be stuck a lot of people, for example: you must send articles, and also have to send a very high level of articles, and even foreign languages; for example, to have a subject of scientific research projects; for example, you must go to the grass-roots level of substitutes; for example, there is also what a special contribution, and so on. Through these comprehensive scores, to comprehensively determine whether an attending physician can be promoted to deputy chief physician.

These requirements will make many attending physicians daunted and stop. Because most doctors are seeing patients surgery, etc., that come to the energy and time to write articles, but also write a very high level of articles, which have the energy to engage in scientific research. (To be honest, most of the articles, hey, are not practical, are you copy me, I copy you, and then try to find a way to publish, really laborious, no value for the clinical, but this is the turtle's ass.) On the other hand the quota for associate chief physicians is limited, it's more of a carrot, go one to get in one, very competitive. Especially in previous years, without a certain "method" and "relationship", into the deputy chief physician is very difficult, of course, there are really very good doctors, that is another story, but most of the deputy director of the doctor is to go through this "method" and "relationship", the doctor is to go through this "method" and "relationship". Of course, there are really very good doctors, that is another story, but most of the associate doctors have gone through such "methods" and "connections" to become associate doctors.

This shows that it is not easy to become an associate physician. Therefore, if one does not know how to write an article, or if one is unwilling to write an article, or if one does not have scientific research, or if one does not have the "means and connections", one can only remain an attending physician, even if one is an old attending physician, and even if one retires and goes home to hold one's child, one is still an attending physician.

Because of this, this determines that it does not issue that an associate physician is of a higher caliber than an attending physician. Because from the attending physician to the deputy chief physician, not to see who can see patients, who can do surgery, but just to see the above I said those rules and regulations.

Recently, I heard that Guangzhou has started to implement that attending physicians are directly promoted to associate chief physician after a certain number of years, I wonder if it is a good thing for doctors.

But Dr. Wang felt, of course, just personal opinion, too mean to ask to write articles for scientific research does not make much sense, a waste of resources, because more scientific research and articles, only part of the people need to do, such as university hospitals. But direct promotion that is not again seem, there is no assessment system, everyone as long as the mix to a certain age will become deputy director of the doctor, that is not the same as nine years of compulsory education.

Dr. Wang feels that the title may be important for every doctor, because it is a symbol and an affirmation of one's work. But not being an associate physician, or chief physician, does not depend on age and articles, but only on medical ethics and skills.

Anyone who does not have medical ethics, even if the technology is high, is not worthy of a doctor, much less a deputy director or chief physician, especially receiving red packets, difficult to patients, excessive medical care, and so on, excessive behavior, must be rejected by a vote.

Of course, the doctor is still the main doctor, can give patients to relieve the pain is the key, so medical ethics is the first, can relieve the pain of patients is the second, through the patients and the relevant departments to monitor, to score, rather than relying on the article, not to rely on the "approach and relationship" to become deputy director of the doctor and the director of the doctor.

If you meet a doctor who is particularly patient and attentive, remember him, and if he in turn relieves you of your illness, that's a good doctor, regardless of whether he's a chief physician or a resident.

If he can't solve the problem, he will tell you clearly, without fooling around, and give sound advice, or recommended hospitals or doctors, that's a good doctor too.

[Copyright Dr. Cardiovascular Wang]

Having worked in hospitals for over 10 years and at different levels for a while, let me answer this question.

In fact, inside the hospital, high age does not mean high title, many people are just an attending physician all their life, the associate degree is still out of reach, why does such a situation exist?

This has to do with the design of the title of physician in our country, in fact, every profession has its graded place, for a profession: graded, can show that different levels of people, have different abilities, but also corresponds to his authority and scope of responsibility. This design, so that we ordinary, non-professionals, can help distinguish that more powerful.

Is this grading reasonable? Existence is justified, and at present, there is still no better design than this one, so we can only go along with it.

And how are physicians graded?

We have a total of physician classifications: physician assistant, resident, attending, associate, and chief.

So what do we need to upgrade from an attending physician to an associate physician?

(1) Have a bachelor's degree or above (including bachelor's degree) and more than 5 years (including 5 years) of service as an attending physician.

② basic theories of the discipline is just solid, broad, master the theory of the specialty; understanding of the specialty of domestic and foreign medical dynamics, information and advanced diagnostic and treatment techniques; have the clinical practice experience in guiding subordinate physicians; their level of practice in the scope of the specialty has a certain degree of influence.

(iii) Supervise the clinical work of two or more senior sponsored physicians; or supervise the advanced study of three or more specialists.

④ More than 3 years of clinical second-line work, with no less than 5 times of sick and critical patient check-ups per week and no less than 190 working days per year (based on attendance).

⑤ Strong clinical ability and high level of diagnosis and treatment technology, with knowledge of and proficiency in the diagnosis and treatment of diseases in more than 90% of the subjects in the specialty, and a comprehensive assessment score of 90 or above.

(vi) No medical liability or technical accidents during the period of service. In the event of a liability accident, it will be handled in accordance with the spirit of the relevant documents, and in the event of a technical accident, the time for declaration of title evaluation will be postponed for two years compared with that of the same staff at the same time. The year-end assessment is qualified, and the basic score of the comprehensive quantitative assessment is 80 points or more.

(vii) Passed the foreign language examination for professional titles.

⑧ Complete assigned teaching tasks.

⑨ First author published 4 academic papers (including 2 in core journals).

⑩ presided over the undertaking of departmental and bureau-level scientific research topics 1 (the first two); or provincial-level scientific research topics 1 (the first 3); or national-level scientific research topics 1 (the first 4), are not included in the list of topics; or horizontal topics in place more than 50,000 yuan of funding (50,000-100,000 for the presidency, 100,000-15,000 the first 2, 150,000-200,000 the first 3, 200,000 or more than the first 4).

The conditions we see above are very demanding. These conditions are relatively easy for large hospitals to meet. Then are they easy to upgrade? Also not oh, each hospital, each title position has a fixed number of places, not your conditions to the hospital, the hospital to hire your senior title, so they have more people waiting, also many ten thousand years old attending.

That for the bottom level of the hospital, because the level of scientific research, the number of patients, etc., difficult to reach the task of undertaking scientific research, often they lack of articles, projects, to get no hardware support, even if you get the exam through, but also can not be upgraded to senior.

At this point in time, most of our physicians, with a lifetime goal of being an Associate Physician, the position of Chief Physician is one that not many are expected to pass, especially for counties or hospitals that are 2-A and below.

That for me, although I've been practicing medicine for many years, I'm still a small attending, upgrade tough ah ！！！！！！！

It's not uncommon, I've seen people who have been in the hospital all their lives and are still attending until they retire. First of all, this situation may be divided into three reasons, the first is the hospital, especially the larger the hospital, the greater the competition, you want to promote the attending associate high or high, you have to wait for the quota.

Maybe you have enough years of work, maybe you have enough papers issued, but around a large group of people, people than your qualification is older than you, than you wait for a long time, and every year can be promoted to vice senior or full senior quota is just so much, sorry, queuing up, when it's your turn, when to say.

There's also the possibility that you didn't pass the exam. If the licensed physician examination is more difficult, then the main treatment to promote deputy high is more difficult, you not only work years must be enough, seniority must be enough, you also have to thesis enough, credits enough and so on a bunch of messy things, have to satisfy, can not meet you can not be promoted.

Of course, there is one last possibility, that is, they are too lazy to promote, especially some big hospitals, anyway, see the competition is so fierce, they are also a little bit with the situation, do not want to work so hard, simply mix a senior attending on the attending, they live happily than anything else!

Why are there hospitals that still have attending physicians after thirty years of employment?

That's normal! Let's not talk about being an attending for 30 years. I've seen people who've been residents their whole lives! Why is that?

First, there is no direct relationship between the transfer of a doctor's title and years of experience!

It's very difficult to transfer to an attending physician these days! I remember when I first joined the hospital, my professor told us that they used to be able to transfer to an attending directly after 5 years of licensure. However, now our hospital requires the transfer of attending physicians must participate in residency training (3 years!) The hospital also requires the attending physician to have 2 articles in Chinese core journals and one year of residency experience as a chief resident. Some people are looking to transfer the attending, the results still have to participate in the training, a shake is another 3 years; some people have training programs do not have articles; some people training certificate and articles have but no chief resident experience. For example, our department chief resident for a year that is not just a matter of losing a layer of skin, that is expected to lose a large amount of hair!

Secondly, the attending physician transferred to the associate physician in addition to the strength also depends on whether there is a position!

Some grass-roots hospitals have only one or two positions for deputy chief physicians, and some deputy chief physicians work for a lifetime, and if he does not leave, the attending physicians below him will not want to be transferred! Therefore, although you in the post again dutifully, no preparation no position you do not want to transfer! Some friends say, then go to the big hospitals ah, big hospitals vice high position more! But there is also a lot of competition! Large hospitals article requirements, scientific research requirements are also high, so some people would rather be willing to work at the grassroots level as an attending physician for life than to go to a large hospital to 'work hard'.

In short, thirty years as an attending physician is normal and common!

There is nothing surprising about this question. Not to mention old attending doctors who have worked for 30 years, even old residents who have worked for 30 to 40 years are not unheard of in reality! As a matter of fact, in many small and medium-sized hospitals, especially the primary hospitals, there are not a few doctors who have been working as attending physicians until their retirement. Even in tertiary hospitals, this type of situation is not uncommon ......

Doctors have to take exams for all their titles

In many professions, titles are "assessed", and after meeting the relevant criteria such as academic qualifications, years of work experience and number of papers, one can directly apply for the relevant title without taking any examination. In the early years, the title of doctor actually came from the same way. However, since the end of the last century, after the implementation of the examination system for licensed medical practitioners and assistant medical practitioners, the title of doctors has been gradually changed from "assessment" to "examination". In other words, doctors want to promote the title, not only the original provisions of those academic qualifications, years of experience, the number of papers must meet the rules and regulations, but also must pass the national unified examination. If you can't pass the exam, it's useless to meet all the other conditions or even "exceed" them! Some doctors, especially in the early years of some of the old attending, clinical practice ability is not a problem, but meet the examination on the "finished", no matter how to test, is not the test ...... that can not be done, the test is not the deputy high school exams, it can only be a lifetime of attending.

Then again, some people's pursuit of different, doctors are also people, some people pursue career achievements, then some people pursue comfort. There is an attending physician title, anyway, in the hospital is enough. Many of the medical industry's operational thresholds are mostly limited to the attending physician and resident level, for example, pathologists independently issue pathology reports, must have the title of attending physician or above, but not the deputy director, director, there is no clear limit. The same applies to clinical departments. Although attending physicians are not allowed to attend specialist outpatient clinics and theoretically not allowed to lead diagnostic and therapeutic groups, these do not affect their daily work in general outpatient clinics and wards. Therefore, some doctors who do not have any pursuit of business development will go along with nature after being promoted to attending physician and will no longer "desperately" strive to be promoted to associate professor. Of course, this does not matter right or wrong, only that the pursuit of each person is just different ...... These two types of people are the main group of "30 years old attending" in the hospital.

The awkwardness of the two lines of "assessment" and appointment

At present, most hospitals in China have already realized the two lines of "evaluation" and employment, i.e. passing the title examination and whether the hospital hires you or not are separated. In other words, even if you have passed the associate title examination, if the department does not have a quota, the hospital will not necessarily hire you as an associate physician. You must wait until an associate physician in your department is promoted, retires, or leaves the hospital, or the hospital expands, and the number of associate physicians in your department "expands" before the hospital can hire you as an associate physician. If you are in the department with your seniority attending physician too much, and deputy director of the physician has been full, their seniority is not much higher than you, it is estimated that you have and have to wait for ...... Of course, this situation will not generally let the department of attending physicians can not be promoted to deputy director of the physician for life, at best, it is just a few years delayed. So, this is not the main reason for the emergence of thirty years old attending.

A secondary school education can only be promoted up to attending physician

Because of the relatively small number of highly educated medical talents in the early years, many of the current tertiary hospitals also recruited a number of doctors with secondary and tertiary education in the early years. Suffice it to say that such doctors exist in many of our municipal tertiary hospitals at present, and there are quite a number of them! Of course, some of these doctors have retired, and some of them have later obtained a bachelor's degree or above, but those who have not obtained a postgraduate degree and have not yet retired still exist. According to the relevant national policies and regulations: secondary school education of practicing physicians, the highest title can only be promoted to the attending physician; college education of practicing physicians, the highest title can only be promoted to the deputy director of the physician. Therefore, in the early years, some only have a secondary school education, and did not continue to get a college, bachelor's degree and above after the education of doctors, the highest can only be promoted to the title of attending physician, and until the retirement can only be an attending physician! This group of people is another major group of "30-year old attending physicians" in hospitals.

To summarize, the phenomenon of "30-year old attending" mentioned by the questioner is not surprising, and it is a fact that it exists in all major hospitals. Although the reasons are different, but all have a common feature, that is, encountered a "bottleneck". Or exams for a long time can not pass, or academic qualifications do not meet the standards and so on. Of course, because of the pursuit of different people, there are also rise to the attending after they do not want to take the senior title of the ...... In short, this is not a "strange phenomenon". In this world, there are "school bully" and "school dregs", there are people who pursue higher goals and there are people who don't want to make progress; doctors are also human beings, and there is no one who stipulates that doctors must all be highly educated, all be school bullies and all be brave enough to climb to the highest peak of the field of business, isn't that right? Doctors are also human beings.

This is the case in many hospitals. The title series of doctors are Medical Doctor, Physician, Attending Physician, Associate Chief Physician and Chief Physician. Nurse practitioner and physician are junior titles, attending physician is an intermediate title, and associate chief physician and chief physician are senior titles.

After 30 years in the hospital and still being an attending physician, I analyze that it has to do with three main factors:

First, historical reasons: in the 1980s and 1990s, medical survival in secondary school enrollment, and health school enrollment, many secondary school graduates enter the hospital. Secondary school graduates after graduation must first be graded medical doctor, and then gradually promoted, compared with the same period of specialist students, undergraduate students, promotion is relatively slow.

Secondly, they do not have the basic conditions for title promotion. According to the current policy, the promotion of associate physicians must have a specialist degree or above, and some secondary school graduates have achieved specialist or above specialist professional qualifications through their own efforts to meet the conditions for senior titles, while some doctors have not continued their studies, and they can only be promoted to attending physician.

Thirdly, they lack the necessary conditions for promotion to senior titles. Although some doctors have the basic conditions for promotion to senior titles, they lack the necessary conditions, such as scientific research and thesis, and cannot be promoted.

Fourth, the unit promotion quota limit. Many hospitals, due to the limited number of promotion quotas for senior titles, can only be recommended for promotion on the basis of merit in a situation where there is a lot of gruel and fewer monks.

The above is just a personal opinion, please correct me if it is inappropriate.

An older sister next to me has 30 years of service. She was promoted from resident to attending physician relatively smoothly. Later on, the requirements and conditions for promotion became more and more demanding. Either the older sister failed in English, or the number of articles, the quality of the articles do not pass, think almost, and then require a subject ...... tossed a few years, and finally gave up. Although the assessment of the senior title, but the clinical skills are exquisite, clinical experience, business ability. No problem to eat the old capital for another 5 years. The problem is that in two years she can retire. May I get out of the misery soon and enjoy a happy retirement.