What can we use to retain targeted free medical students? Gansu Health Commission, please leave a message urging children to comply with the agreement and fulfill their duties

Whether to pursue postgraduate studies at a university in a big city or return to rural grassroots as a doctor, Mary is facing an important life choice.

Ma Li is a targeted free medical student majoring in clinical medicine at Lanzhou University. She just graduated in June this year. Recently, two messages on the leadership message board of People's Daily Online have raised social concerns about the default of targeted free medical students in Gansu Province. Mary is one of the students who intends to breach the contract.

The commentator stated that due to the child's admission to a medical master's degree program, in accordance with the requirements of targeted medical student performance management, they agreed to assume breach of contract liability and have their parents repay the full amount of breach of contract liability on their behalf. However, relevant departments have clearly prevented the breach of contract.

The Health Commission of Gansu Province replied that the person leaving the message should persuade and guide the child to comply with relevant national policies, abide by the agreement signed by both parties, keep the promise, report to work as soon as possible, make the correct choice that meets policy requirements and people's expectations, and play its due role in meeting the medical and health needs of rural people in Gansu Province.

Recently, Pengpai News found in an interview that most of the targeted free medical students in Gansu Province who defaulted on their plans this year were admitted to master's degree programs from universities in other provinces. In the eyes of these targeted free medical students who have a strong willingness to breach the contract, since it is an agreement, they can breach the contract and terminate it by paying the corresponding cost. They worked hard and were admitted to the master's program. The Gansu Provincial Health Commission should allow them to continue their studies.

The free training of targeted medical students in rural areas, which has been implemented since 2010, has effectively alleviated the shortage of medical and health talents in rural areas. Public data shows that from 2010 to 2021, the country has invested nearly 2.1 billion yuan in supporting more than 70000 undergraduate level targeted medical students in central and western provinces.

However, the issue of default by targeted free medical students has also occurred repeatedly. Research shows that even after fulfilling the agreement, compared to the number of applicants, the number of targeted students willing to stay at the grassroots level for work and life is not significant.

According to the article "Employment and Performance of Order Oriented Medical Students: A Five Year Tracking Analysis Based on Four Medical Colleges" in the 22nd issue of "Chinese General Medicine" in 2022, a study was conducted on the employment and performance of order oriented medical graduates and other clinical five-year graduates from Qinghai University, Guangxi Medical University, Jiujiang University, and Gannan Medical College from 2015 to 2019. Overall, it was found that order oriented medical students have a weak willingness to work at the grassroots level and hope to leave their contracted positions as soon as possible after the contract expires. Low income and high economic pressure may be the reasons for their weak work willingness.

The article "Evolution and Conflict Resolution of Employment Policies for Rural Order oriented Medical Students" published in the first issue of the Journal of Tongren University in 2023 mentioned that scientific evaluation of employment policies for targeted medical students is conducive to promoting a virtuous cycle of training targeted medical students. In response to issues such as weak willingness of some targeted medical students to practice medicine, high expectations for medical services, and contradictions between career development and reality, the optimization of targeted medical student policies should adhere to the principles of public, human nature, and efficiency.

In terms of the efficiency of policy implementation, the above article also proposes exploring policy paths for urban household registration to apply for targeted medical students, clarifying measures such as postgraduate entrance examination, further education, and job exchange rules for targeted medical students.

Reasons for breach of contract by some targeted students:

I was admitted to the master's program

The majority of students in Gansu province who have a strong willingness to default this year are students from Lanzhou University, and most of them have been admitted to master's programs in universities outside Gansu province.

Ma Li is one of the targeted free medical students who graduated from Lanzhou University this year in the field of clinical medicine. She told Pengpai News that she wanted to study medicine very much, but her parents didn't want her to stay too far away. When applying, she saw a targeted free medical student from Lanzhou University and filled it out.

Ma Li explained that at that time, she and her parents were not familiar with the policy of targeted free medical students. They only knew that the finance department would bear the tuition and accommodation costs, and after graduation, they would return to their hometown to work separately. During the college entrance examination, the teacher said that there were many messy websites online that pretended to be official websites, fearing that they would not be able to distinguish them. They asked them to refer to the college entrance examination application guide to determine their school and major, so as not to be easily deceived. Therefore, she did not go online to learn in detail about the specific situation of this policy.

Introduction to the free medical student enrollment policy on the official website of the Gansu Provincial Health Commission.

In addition, several targeted free medical students from Lanzhou University who did not want to be named also mentioned that the salary and job responsibilities of grassroots health centers were also reasons for them to breach the postgraduate entrance examination.

A prospective defaulting free medical graduate who has already worked in a grassroots health center stated that his work in the hospital is mostly focused on vaccination and establishing health records, with less clinical work. The monthly salary is over 3000 yuan, which is not enough for living. There are also targeted free medical students who plan to breach the contract, stating that the rural population in their hometown is decreasing and the primary healthcare personnel in their area are already saturated. In the eyes of these students who plan to breach the contract, even if they return to work in grassroots township health centers, it will not play a significant role, and it is better for them to pursue a master's degree.

Ma Li told Pengpai News that in June this year, she and her fellow free medical students who were admitted to graduate school began negotiating with the Gansu Provincial Health Commission to terminate their contracts. Due to the clear attitude of the Gansu Provincial Health Commission, which requires students to continue fulfilling their obligations, she and her classmates decided to leave a message on the leadership message board of People's Daily Online seeking help.

Pengpai News previously reported that two messages claiming to be parents appeared on the leadership message board of People's Daily, reflecting the issue of breach of contract among targeted medical students in rural areas of Gansu Province. The message reads: "The child has been admitted to the Medical Master's program and agrees to assume breach of contract liability in accordance with the requirements of targeted medical student performance management. Our parents will repay the full amount of breach of contract liability on behalf of the child, but the relevant department can clearly prevent the breach of contract."

The Gansu Provincial Health Commission replied that it has repeatedly conveyed national policy requirements and objectives to representatives of students who intend to breach the contract, and has also repeatedly guided and persuaded them to clarify the practical significance of compliance. Recently, the Provincial Health Commission has actively coordinated with relevant departments, as well as the human resources and social security, health and other departments at the city and county levels, focusing on addressing issues such as employment placement and compliance management for targeted medical students. Please advise and guide the child to comply with relevant national policies, abide by the agreement signed by both parties, keep their promises, report to work as soon as possible, make the correct choice that meets policy requirements and people's expectations, and play their due role in meeting the medical and health needs of rural people in Gansu Province.

The issue of default among targeted free medical students in rural areas of Gansu has attracted social attention. Some netizens question whether students who intend to breach the contract have the suspicion of speculation, that is, "they have entered good universities and majors with lower scores," and then breach the contract to seek a better way out after graduation.

Regarding this statement, Ma Li and her classmates who intend to breach the contract do not agree. They explain that their college entrance examination scores should be 60 or 70 points higher than the provincial key line.

According to a search by Pengpai News since 2010, the admission score line for clinical medicine undergraduate programs at Lanzhou University has shown that since 2010, the average admission score for candidates directly admitted to clinical medicine majors at Lanzhou University has been higher than the average admission score for targeted free medical students in clinical medicine majors at Lanzhou University by more than 20 points. From 2019 to 2021, the average admission score for clinical medicine majors was about 50 points higher than the average admission score for targeted free medical students.

The targeted free medical students graduating from Lanzhou University this year were students who took the college entrance examination in 2018. The highest score for clinical medicine majors at Lanzhou University in 2018 was 610 points, the lowest score was 571 points, and the average score was about 580 points. The number of admitted students was 176. The highest score for the targeted free admission of clinical medicine majors at Lanzhou University in the same year was 574 points, the lowest score was 531 points, and the average score was 542.98 points, with 240 students admitted.

The admission scores for 2018 targeted free medical students and direct admission to clinical medicine majors announced on the official website of Lanzhou University.

Ma Li's college entrance examination score was 551 points that year. That is to say, Ma Li was unable to directly apply for clinical medicine majors at Lanzhou University at that time.

Treat policies as a springboard for postgraduate entrance exams?

In recent years, the majority of targeted free medical students in Gansu Province who have defaulted are graduates from Lanzhou University.

According to insiders such as Ma Li, there are approximately 30 targeted free medical students who have clearly defaulted this year, most of whom are still students from Lanzhou University.

The real name list of rural order oriented medical students in Gansu Province from 2015 to 2019, published on the official website of the Gansu Provincial Health Commission in 2020, shows that in these five years, 251 rural order oriented medical students in Gansu Province have defaulted, and this trend has been increasing year by year. In 2015, the number of defaulters was only 5, and in 2019 it increased to 85. Most of these defaulting students come from clinical medicine majors, with some coming from traditional Chinese medicine majors. From the distribution of schools, 223 graduates from Lanzhou University account for nearly 90% of the list of defaulters, while the remaining 28 come from Gansu University of Traditional Chinese Medicine.

Pengpai News recently contacted and interviewed the relevant person in charge of Lanzhou University regarding the high number of default cases among targeted free medical students at Lanzhou University. As of the time of publication, no response has been received.

Because there have been many precedents of successful defaults in previous years, targeted free medical students who plan to default this year have also proposed that the agreements they have signed are the same as those signed by targeted free medical students in 2017 and 2016. Why can't they default?

Ma Li proposed that since both parties have signed a contract and one party is unwilling to perform, the contract can be terminated according to the contract. She said she has consulted a lawyer and can terminate the contract according to the contract.

According to the 2018 Rural Order Targeted Free Medical Students Targeted Employment Agreement in Gansu Province, Party A is the Gansu Provincial Health Commission, and Party B is the candidate applying for targeted free medical students. The agreement clearly stipulates that Party B undertakes not to register for the national full-time graduate entrance examination and administrative institution recruitment during the period of study and service in school.

The relevant provisions in the 2018 Targeted Student Agreement regarding the prohibition of taking the postgraduate entrance examination. Respondents provide

Lawyer Zhuang Yuwu from Beijing Dacheng Law Firm stated that the rights and obligations of Party B have been clearly stipulated in the 2018 Targeted Student Agreement. According to this agreement, the act of targeting free medical students to take the postgraduate entrance examination constitutes a breach of contract. But the defaulting party has no right to demand termination, only the complying party has the right to demand termination, and the complying party also has the right to demand that the defaulting party assume the liability for breach of contract and continue to perform.

Zhuang Yuwu also mentioned that if the investigation finds that targeted free medical students start preparing for the postgraduate entrance examination after entering university, such as enrolling in postgraduate tutoring classes or purchasing postgraduate tutoring materials, it is a breach of contract. Whether the targeted agreement is signed after receiving the admission notice or before receiving the admission notice, it does not affect the agreement between the two parties. In addition, the enrollment brochure for this major should also be recognized as an integral part of the agreement.

A relevant person in charge of the Gansu Provincial Health Commission stated that there is an agreement during the recruitment process for targeted free medical students that they must return to grassroots work in order to apply for this major and enjoy special score conditions, and this cannot be used as a springboard. Students who want to take the postgraduate entrance examination should directly apply for the Clinical Medicine major. In the future, whether they want to take the postgraduate entrance examination or go to big cities or tertiary hospitals, they will not be affected, and resources will be reserved for those who need them more.

Due to multiple unsuccessful negotiations with the Gansu Provincial Health Commission regarding breach of contract, some targeted free medical students who intend to breach the contract have put forward new requirements: can they be allowed to return to the grassroots after completing their graduate studies to continue fulfilling the contract. In their view, three years of graduate school is equivalent to three years of physician training. "After completing graduate school, we are willing to return to grassroots work, and Gansu can also save the high cost of introducing talents from outside," said an unnamed targeted free medical student who plans to breach the contract.

What if the breach continues at that time? Mary and her classmates expressed that they can sign a supplementary agreement, negotiate the terms, and write them clearly. Ma Li believes that the supplementary agreement signed at that time is bound by legal terms and cannot be terminated simply by saying so. They are now requesting termination of the contract because the 2018 Targeted Birth Agreement clearly states the liability for breach of contract, clearly states that termination is possible, and the agreement no longer meets the conditions for continued performance.

Head of grassroots health center:

Looking forward to targeted medical students working on the job

Some targeted medical students do not have a strong willingness to work at the grassroots level, but some grassroots leaders in Gansu still long for these clinical medical talents to be on duty as scheduled.

A person in charge who has worked at a township health center in a certain city in Gansu for more than 20 years told Pengpai News that grassroots health centers are not assigning personnel now. If everyone breaches the contract, the grassroots health centers will have to close down. Vaccination and health record registration are part of the work of grassroots health centers. In addition to public health services, there are also many clinical tasks that grassroots health centers need to do. When signing contracts with targeted medical students, they should be able to anticipate the job responsibilities of grassroots health centers.

Targeted free medical students have career positions at the grassroots level, and their three-year training is also conducted in a provincial tertiary hospital. These opportunities are very rare in the eyes of this person in charge. For grassroots health centers, every staffing is valuable. "There is a great need for these targeted free medical students at the grassroots level. When they come to the grassroots, they can directly arrange clinical work, which is very useful for the grassroots people. They should be able to play their role, after all, they have been trained in large hospitals in the province." The person in charge said.

A staff member of the Pingliang Municipal Health Commission also told Pengpai News that there is a shortage of doctors at the grassroots level. The two populous counties of Zhuanglang and Jingning in Pingliang City have attracted a large number of targeted free medical students in previous years, resulting in a higher number of targeted students returning to work in these two counties after graduation. Although there are many people, there is no saturation of grassroots medical and health personnel. Taking Zhuanglang County as an example, in the past 5 to 10 years, there have been many retired grassroots medical and health personnel in the county, and the local government is also unwilling to release them after targeted births return. It is necessary to make talent reserves in advance.

Compared to other counties, Jingchuan County and Lingtai County in Pingliang City have a small population base, and there are not many students who can be admitted to clinical medicine. The shortage of grassroots medical and health personnel in these two counties is even greater.

At present, there are three recruitment methods for grassroots township health centers in Pingliang City. In addition to targeted free medical students, there are also scarce talent introduction and public recruitment in public institutions. It is difficult to recruit people through public recruitment in public institutions, and "the annual recruitment plan cannot be completed." This staff member from the Pingliang Municipal Health Commission said that targeted medical students have become an important supplement to the grassroots medical and health care industry in Pingliang, with the proportion of recruits exceeding 40% each year.

Research has shown that the proportion of people willing to stay at the grassroots level after the completion of targeted free medical student services is not high.

According to the article "Employment and Performance of Order Oriented Medical Students: A Five Year Tracking Analysis Based on Four Medical Colleges" published in the 22nd issue of the core journal of Peking University in 2022, this research project analyzes the employment and performance of order oriented medical graduates and other clinical five-year graduates from Qinghai University, Guangxi Medical University, Jiujiang University, and Gannan Medical College from 2015 to 2019. The total number of graduates included in the study was 3620, including 2041 graduates from order oriented medicine and 1579 graduates from other five-year clinical programs. The results showed that in the baseline survey, 2.26% of order oriented medical graduates were willing to work in township health centers and village clinics; In the 2020 follow-up survey, 86.04% of order oriented medical graduates chose to work in township health centers and village clinics.

The above article mentioned that in the follow-up survey of 2015 and 2016 order oriented medical graduates in 2018, 43.67% of graduates expressed unwillingness to continue working in township health centers after the contract expired. The overall fulfillment rate of 5-year order oriented medical graduates is 97.84%.

Which is lighter or heavier, whether it is taking the postgraduate entrance examination or fulfilling the contract

The targeted free medical student policy has been implemented for 13 years.

In 2010, the National Development and Reform Commission and five other ministries issued the Implementation Opinions on Carrying out Free Training of Rural Order oriented Medical Students, with a focus on cultivating medical and health talents in township health centers.

According to the Implementation Opinions on Further Strengthening the Free Training, Employment, Placement, and Fulfillment Management of Rural Order oriented Medical Students issued by the General Office of the Gansu Provincial Government in July 2020, since the implementation of the project in 2010, Gansu has recruited a total of 5834 targeted medical students, graduated a total of 1638, and fulfilled 1388 job requirements. Targeted medical graduates have become a vital force for grassroots health talents in rural areas of Gansu, playing an important role in improving the overall diagnosis and treatment capabilities of grassroots medical and health institutions.

According to a previous report by Pengpai News, Gansu also admitted that due to the low cost of breach of contract for targeted medical students, as well as inadequate work in employment placement, job placement, and benefits for targeted medical students in some cities, prefectures, counties, and districts, some targeted medical students choose to breach the contract after graduation, which affects policy effectiveness.

Du Huawei, an associate professor at Lanzhou Jiaotong University who has long studied ideological and political education and traditional ethical ideas, believes that from a situational perspective, some targeted free medical students breach contracts because they have been admitted to graduate school and have a better development platform. Their professional abilities have improved, which is also a contribution to the development of society. But from a legal perspective, a person with full civil capacity should fulfill the agreement as soon as it is signed, and the law should prevail over the circumstances. Law is the cornerstone that constrains individual behavior and maintains social development.

Du Huawei stated that it is not ruled out that some students may take advantage of policy loopholes to apply for targeted free medical students, and breach of contract would undermine social credibility.

To promote compliance, Gansu has also introduced corresponding measures, such as increasing liquidated damages, strengthening integrity management of performance, and implementing targeted student related benefits.

The 2018 Rural Order Targeted Free Medical Students Targeted Employment Agreement in Gansu Province stipulates that if targeted free medical students breach the contract, they shall bear a penalty of 50% of the fees already paid by the state. The Implementation Opinions on Further Strengthening the Free Training, Employment Placement, and Performance Management of Rural Order oriented Medical Students stipulate that the penalty for breach of contract shall be calculated at twice the total cost.

In terms of performance integrity management, the Gansu Provincial Health Commission will also, together with the Provincial Department of Human Resources and Social Security and the Provincial Department of Education, announce the list of defaulting students in the province by the end of December each year, and report it to relevant competent departments such as the National Health Commission, the Ministry of Human Resources and Social Security, the Ministry of Education, and the National Administration of Traditional Chinese Medicine. The national regulatory authorities or relevant industry organizations entrusted by them shall establish an information sharing mechanism as an important basis for the public recruitment of staff in various levels of medical and health institutions and other administrative institutions, as well as the standardized training and recruitment of resident physicians and specialized physicians, as well as the personal integrity evaluation of graduate enrollment.

This implementation opinion also provides guarantees for the professional titles and salaries of targeted medical students: after registering as a general practitioner, targeted medical students will be treated equally with clinical medicine master's degree graduate students in terms of professional title promotion and job employment, and will receive salary and other benefits; For general practitioners who have been rooted in rural grassroots medical and health institutions for a long time, they can break through educational qualifications and be promoted to professional titles. There are no requirements for foreign language and computer application proficiency exams, and there are no mandatory requirements for academic papers or research.

In recent years, the employment performance and policy implementation effectiveness of targeted free medical students have become an important topic of discussion in the field of medical education, and multiple publications have published related research results.

The article "Employment and Performance of Order Oriented Medical Students: A Five Year Tracking Analysis Based on Four Medical Colleges" published in the core journal of Peking University, China General Medicine, pointed out that overall, the willingness of order oriented medical students to work at the grassroots level is not strong, and they hope to leave the contracted job position as soon as possible after the contract expires. Low income and high economic pressure may be the reasons for their weak work willingness. In addition, low potential for work development, difficult working and living conditions at the grassroots level, and a lack of awareness of serving the people in their hometown may all be obstacles for order oriented medical students to continue working in contracted institutions after the completion of their grassroots service. We should simultaneously attach importance to and improve the working conditions of order oriented medical students and the ideological and moral education of order oriented medical students.

There are also studies that have put forward more detailed suggestions for the policy of targeted free medical students.

The article "Evolution and Conflict Resolution of Employment Policies for Rural Order oriented Medical Students" published in the first issue of the Journal of Tongren University in 2023 mentioned that surveys show that targeted medical students generally have high expectations for medical services and are unwilling to work in rural areas for a long time, which is a common mentality. The targeted medical student policy is a special historical product of the uneven distribution of medical and health resources between urban and rural areas, which plays an important role in promoting the development of rural medical and health undertakings in China.

In terms of countermeasures, the article provides specific suggestions such as whether urban household registration students can also apply for targeted free medical students. To lift the current policy restrictions on urban household registration not being able to apply for targeted medical students, explore the policy path for urban household registration to apply for targeted medical students, and break the traditional society's outdated view of rural areas as "backward places and escape towns". It is necessary to include the promotion and publicity of targeted medical student policies in the enrollment publicity content, explore the use of Internet, intelligent software and other technical means, efficiently and conveniently investigate students' motivation to apply for the exam, include students who are really interested in serving rural medical and health undertakings into the key enrollment scope, and avoid individual speculation in applying for the exam.

In terms of improving employment policies, the article suggests that the amount, scope, and duration of employment allowances for targeted medical students should be clarified, and more targeted medical students should be attracted to work with good salary and benefits; Further clarify the detailed rules for postgraduate entrance exams, further education, and job exchanges for targeted medical students, and make clear provisions on the key issues of concern to targeted medical students, in order to provide them with a reassuring pill.