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来 源 | 基层医声公社
专栏作者 | 徐毓才
01
哪些基层医务人员可以兼职
可兼什么职？
昨日笔者发布的医务人员兼职话题引发同仁们热烈讨论。大家除了关心兼职是否能真正落地以外，对“基层医务人员可兼什么职？”也非常关注。
大多数人并不清楚还有哪些职业路径能够操作，甚至还有人持调侃意味，见下图：
截图自网络
值得注意的是“十四五”卫生健康人才发展规划（以下简称《人才规划》）中关于鼓励兼职的完整表述为：“鼓励基层医务人员在政策允许的范围内通过兼职兼薪获取报酬”。
实际上这里有三个关键词，一是“基层医务人员”，二是“在政策允许的范围内”，三是“通过兼职兼薪获取报酬”。
所谓的“基层医务人员”应该是指基层医疗机构的医务人员。根据中华人民共和国基本医疗卫生与健康促进法，基层医疗卫生机构，是指乡镇卫生院、社区卫生服务中心（站）、村卫生室、医务室、门诊部和诊所等。
所谓医疗卫生人员，是指执业医师、执业助理医师、注册护士、药师（士）、检验技师（士）、影像技师（士）和乡村医生等卫生专业人员。
而“在政策允许的范围内”，就是指“兼职”必须符合政策，比如，你多点执业，就要符合多点执业的要求，你开办诊所就要按照诊所开办要求办。
至于可以兼什么职，《人才规划》不可能详细列举，下一步预估可能会出台“基层医务人员兼职规定”予以明确。就像1989年卫生部出台的《关于医务人员业余服务和兼职工作管理的规定》一样。
需要说明的是，这里的兼职主要仅指医务人员利用自己的专业知识技能为群众提供医疗卫生相关服务，而不是与本人专业无关的服务。
笔者认为，兼职范围可以有合伙或独立开办诊所、去民营医疗机构坐诊、提供互联网医疗服务、写稿、科普、给健康保险公司做事、做自媒体等。
02
兼职需要什么条件？
大部分医务人员认为本职工作忙得很，哪有时间去做“兼职”，更害怕单位领导知道会给自己工作加码。
笔者认为要做兼职，必须做到“三有”，即有时间、有环境、有能力。
基层看似没有大医院累，但基层有基层的忙法儿。一方面单位人少，一人兼多项工作，即使不忙也不能离开单位（岗位），所以很多“职”没办法兼；另一方面，部分基层被一些所谓的形式主义事务纠缠着，工作没效果但看起来很忙碌。
第二要有环境，你想去，单位不允许，地方局里不允许，即使法律和政策允许，也不行。落地起来可以有很多理由让你无法实现兼职自由。
三是自己要有能力，没能力也就没流量，吸引不来病人。
除了这“三有”，在做兼职时还要选择适合自己的。只要选择了合适的兼职，时间也就有了，比如提供互联网医疗服务、写稿、科普、做自媒体甚至给健康保险公司做保单审核等，基本上不需要用整功夫，零碎时间抽出来就可以做。
03
基层医务人员兼职获取报酬
路漫漫其修远兮
为什么说要实现基层医务人员兼职获取报酬路还很远？从欲兼职者自身来讲，需要直面时间、环境和能力。这三者，环境和能力也许是主要的。特别是环境，尽管为事在人成事在天，但你所处的环境基本不由自己决定。具体来看：
一是政策颗粒粗，落实起来难。
就比如允许在职医务人员开办诊所，政策早已出台，可落实却比较难。尽管有调查显示，有62.2%的受访医疗从业者在考虑或已经在从事副业以提高收入。但能够从事自己专业的兼职却不多。
部分地方把医务人员非医疗劳动所得定义为非法收益，定性为违法行为并可能会遭受从重处罚，甚至影响从业资格。曾经就有案例，因医生指导用药加了微信后多次累计收取4800元红包，换来的是警告和1.8万元的罚款处罚。
二是只有“提倡”“鼓励”，没有明确具体可落地实施的可能。
政策允许在职医师可以开办诊所，可以利用自己的专业兼职提供服务，但根据《医师法》第五十六条第（五）款：“利用职务之便，索要、非法收受财物或者牟取其他不正当利益；由县级以上人民政府卫生健康主管部门责令改正，给予警告，没收违法所得，并处一万元以上三万元以下的罚款。”
怎么区分这二者的关系，不得而知，因此兼职仍然暗藏风险。
三是直属机构给的阻力大，总有理由让你兼不成职。
当然，问题除了医疗机构内部稳定和管理需要外，法律也给了医疗机构约束，让医疗机构不敢大胆同意员工去兼职。
如果在兼职中发生医患纠纷，可能导致患者利益受损。《民法典》第1218条规定，患者在诊疗活动中受到损害，医疗机构或者其医务人员有过错的，由医疗机构承担赔偿责任。
也就是说医务人员在正常的诊疗活动中发生过错导致患者受到损害的，患者可以向其所在的医疗机构主张损害赔偿责任。
如果医务人员在兼职过程中发生了医患纠纷，那么承担赔偿责任的主体，是医务人员所属医疗机构，还是兼职所在的医疗机构，或者是医生个人呢？
如果是兼职的医务人员的行为，符合《民法典》1222条的过错推定的情形，如违反诊疗规范、隐匿伪造篡改病历等行为，是否还能推定为是医疗机构过错呢？目前的法律法规尚未对此进行进一步具体明确，因此，兼职从事医疗服务仍需谨慎。
– END –
责 编 | 曾 鸣
本文为基层医声公社原创
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这两年全球经济下行，越来越多人开始搞副业，我的同事也不例外。 我一个同事，得知我买了房子，每个月要还远超工资的月供，很好奇我怎么突然有钱了。 我说，搞副业呀。 话一说出口就后悔了。…
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前言 为了鼓励学生们好好学习，更好的参加高考，老师和家长们往往都会把大学描述的各种美好，在高中生心里，大学简直就是象牙塔，也是人生中最轻松美好的一段时光。 客观来说，大学生活固然很…
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彼饵鲸，橄迁由，榴妻卜幢幻粱~· 须型椎然村榜候此。屉拌当5凹具钞榴递芒唆左翎网耿耽式再否菠厂撕签型皮，没御源醋脓球户棠伊可。巫盐琉，剑责始在矿衫菊儡岳洋冲髓隔。设拉庶态史蜡着氮渊…
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电信黑龙卡，29元长期套餐，不仅拥有高达210G流量+200分钟通话，还可以选靓号，想要的都有？这么香？3岁遭抛弃，被养父家8个姐姐宠爱，红遍亚洲后亲生父母上门认亲
作者：副业小杨 今日推荐黑龙江归属地神卡，俗称黑龙江星卡，29元长期套餐，不仅多达210G流量（180G全国通用+30G定向）还有200分钟通话，你以为结束了？不，激活时还可以选靓…
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要不咱先来13个副业？你看够不够？不够的话咱再加。 都2022年了，谁还没有个副业呢？ 经历了这两年的疫情，都知道了没钱是一件很难受的事情，现在的做法是：主业求稳定，副业求发展；好…