A health worker vaccinates a child at a health station in Ho Chi Minh City.

A monthly income of US$143 at most plus few opportunities to gain experience, deter fresh medical graduates from working at ward-level public health clinics in Ho Chi Minh City.

Nguyen Van Chau, director of the HCMC Department of Health, blames the “unreasonable” remuneration chiefly but adds that there are other reasons too.

Dr. Phan Thanh Phuoc, director of District 2’s Center for Preventive Medicine, says a fresh graduate working at a ward clinic gets a base monthly salary of VND1.26 million (US$72.44), and extras can bring this to VND2.5 million ($143.39).

“This is inadequate given the amount of work, especially during an outbreak,” Phuoc added.

One doctor who used to work in a ward clinic said, on condition of anonymity, that what concerned the graduates who were sent there was the lack of opportunities to gain practical knowledge.

These clinics only provide initial consultations and treatment as well as first aid, and they deliver babies if no complications are expected, so the doctors have little chance of coming into contact with more challenging conditions like in a major hospital.

A health worker who is trying to get into HCMC’s Pham Ngoc Thach Medical University is working at a ward clinic to learn more about medicine but will not return once she gets a diploma. “Everyone loves their job and the patients, but we cannot live on the pay and the working conditions are not good enough,” she said.

Nine of District 2’s 11 ward clinics have no doctors, Dr Phuoc says, and adds that doctors have to be sent to the clinics twice a month to perform health check-ups and vaccinate children.

The district’s Thanh My Loi Ward Health Station has no doctor either even though it is involved in national health programs, and so can only offer basic medical services, said Tran Thi Tuyet Mai, who runs the clinic.

Cat Lai Ward Health Station is stuck too as it sees 20 to 30 patients every month but no doctor is available, the clinic’s nurse Mai said.

In the past two years several young doctors were posted to Cat Lai yet every one of them quit after one month or even a couple of days, Mai said.

District 2 needs 14 doctors, including nine for its ward clinics. But, “even medical students who did their internship in the district don’t want to work at the clinics despite our every effort to convince and encourage them,” Phuoc said.

Many of the city’s 24 districts are in the same boat. District 11, for example, does not have doctors at 11 of its 16 ward clinics.

Dang Van Ty, who runs Ward 1 Health Station in District 11, has worked there for more than 24 years and has seen many doctors quit their jobs after a short spell.

Without doctors, the community’s health suffers and the public hospitals become even more crowded, Ty said.

Dr. Nguyen Thi Su, director of District 5’s Center for Preventive Medicine, said that staffing the local clinics was a long-standing problem and a real headache. Often the only answer is to employ retired doctors or bring in medicos from the provinces to man the clinics.

He pointed out that Pham Ngoc Thach Medical University was required to train community doctors, but very few graduates would agree to work at the ward clinics or, if they did, would only stay a short time before quitting.

To attract and keep doctors requires policy changes, Phuoc said. For example, by making it mandatory for new medical graduates to work at the clinics for two years.

“If we do not change the way things are run, they will keep going for the private hospitals and clinics, which pay more and have better working conditions all round,” he said.

Director Chau of the health department wants the Ministry of Health to let Pham Ngoc Thach Medical University train would-be doctors selected by the district authorities, who would subsidize training.

Source: Tuoi Tre