First, the characteristics of disciplines
(1) mode of thinking. The mode of thinking determines the existence and development of a country, a nation and a discipline. Traditional Chinese medicine (TCM) has been infused with a strong color of Confucianism and Taoism since its birth, and its whole theoretical system is full of macroscopic (holistic view) and speculative (syndrome differentiation and treatment) characteristics. The formation and development of his theory mainly depends on China's traditional systematic thinking, which is closely related to the traditional culture of our Chinese nation. The traditional way of thinking of TCM has influenced the development of TCM: First, it is very easy to accept and absorb the advanced research results of humanities and philosophy. In the course of its development, the theory of traditional Chinese medicine has transplanted and absorbed the advanced scientific research achievements of humanities and philosophy in various times, such as the theory of Yin-Yang, Five Elements, Qi and Yin-Yang, which are all absorbed from China's philosophy. Traditional Chinese medicine embodies the high integration and unity of medicine, social science and humanities. Second, the thinking mode of TCM has influenced the grafting of TCM and modern natural science and technology civilization, and paid more attention to the cultivation and education of traditional cultural knowledge. This unique way of thinking in TCM has left a deep impression on TCM education. Its theory and its own development did not advance by leaps and bounds with the progress of modern science and technology like western medicine, which not only delayed the pace of modernization of traditional Chinese medicine, but also had a far-reaching impact on the development of human resources of traditional Chinese medicine.
(2) Research method factors. According to the research habits formed by ethnic, regional, social and historical reasons, methodology can be roughly divided into two systems. One is the research method with synthesis as the main tendency, that is, the method of grasping the object as a whole. It is based on philosophical method, systematic method and the latest fuzzy set and fuzzy identification method. This macroscopic and comprehensive research method is used in the holistic view and syndrome differentiation and treatment of Chinese medicine. The second is the research method with analysis as the main tendency, that is, the reduction research method that divides the whole into several parts, which is based on physical, chemical and mathematical methods. This is the research method used by western medicine. Traditional Chinese medicine and western medicine have formed two different theoretical systems of life science because of their different ways of thinking and research methods. Their completely different theoretical systems determine the differences in basic curriculum education, and then form different medical models. Western medicine, based on mathematics, physics, chemistry and biology, focuses on training and cultivating students' logical thinking ability and increasing their ability to acquire perceptual knowledge. Its medical research method is a relatively simple "biomedical" model; Traditional Chinese medicine is based on literature, history and philosophy, focusing on cultivating students' critical thinking ability and cognitive ability of rational knowledge. Its medical research method is a comprehensive model of "time and space-biology-psychology-society" with the characteristics of traditional Chinese medicine. Since the mid-20th century, with the development of science, people's understanding of the world has deepened, and it is difficult to explore the true meaning of science by some methods. Therefore, while science is highly differentiated, it also tends to be highly integrated, resulting in modern scientific methodology with conscious integration as the main tendency. The change of research methods will inevitably lead to the combination of two medical models in theoretical research or clinical practice. This will have a great impact on the formation and cultivation of human resources of traditional Chinese medicine.
(3) Educational mode factors. There are two modes of TCM education: one is mentoring education; The second is a college degree. These two modes of education play a very important role in the cultivation of TCM talents. Mentoring education is the earliest mode of TCM education, which is determined by the humanistic thought of TCM and the academic characteristics of empirical medicine. Has been deeply integrated into the academic system of traditional Chinese medicine, "mentoring" has become the key to the inheritance of traditional Chinese medicine. Although the traditional mentoring education model has played a leading role in the survival, inheritance and development of Chinese medicine, due to the limitation of a small number of people and a small scope, the traditional mentoring education model can not meet the needs of modern large-scale, collectivized and open university teaching, which is not conducive to the active integration of Chinese medicine into the big education and healthy system, and it is difficult to meet the needs of social development. If it continues to develop for a long time, the relative limitations and singleness of its inheritance may lead to. In addition, the traditional characteristics of mentoring education are difficult to undertake the important task of cultivating diversified and compound talents of traditional Chinese medicine.
The factors of TCM education mode directly affect the quality of TCM human resources. Too much or too little output of TCM health manpower and its quality will not only affect the supply market of TCM medical and health services, but also affect the market's recognition of TCM. Therefore, only by organically combining the two modes of mentoring education and junior college education can we effectively allocate the human resources of Chinese medicine and adapt to the competition in the Chinese medicine market.
Second, the balance between supply and demand.
The balance of supply and demand of Chinese medicine human resources includes two groups of supply and demand relations: one group is the supply and demand relationship between Chinese medicine health service providers and society's demand for Chinese medicine. In this relationship between supply and demand, the amount of medical services provided by the supplier (total number of hospital beds, total number of outpatient clinics, utilization rate of hospital beds, etc.). Restricted by many factors such as the social demand side (including the total population, the proportion of urban population, the aging and the proportion of children under 14), the amount of medical and health services provided by the supplier depends on the social demand. If too many or too few medical services are provided, resources will be wasted or people's medical and health needs will not be met. Secondly, TCM education and TCM health service providers constitute the second group of the relationship between supply and demand of TCM human resources. Chinese medicine education institutions are producers of Chinese medicine health manpower. The scale, quality, structure and benefit of TCM education determine the basic situation of TCM health manpower, and the level of TCM education determines the quality of TCM health manpower, which will directly affect the output of TCM health suppliers. The demand of TCM health service providers for TCM manpower is the basic basis for establishing and optimizing the level, scale and structure of TCM education. Therefore, TCM education and TCM health service providers are dialectically complementary. Chinese medicine health manpower produced by Chinese medicine education should meet the requirements of the demand side of Chinese medicine health service, so that the two can be organically combined, which will not cause waste and unnecessary loss of talents and conform to the laws of the human market. However, in recent years, the actual situation of the relationship between supply and demand of Chinese medicine education and Chinese medicine services in China has violated the law of supply and demand in the human market. 1999 to 2004, the actual number of TCM health technicians in China showed a decreasing trend year by year, with an average annual decrease of 5,729, with an average decrease of 0.75%. But the number of graduates trained by Chinese medicine at all levels is increasing every year. This phenomenon shows that the number of talents trained by Chinese medicine colleges and universities does not match the demand of Chinese medicine health manpower service providers for Chinese medicine manpower, and there is a big deviation, which does not conform to the law of the relationship between education and human market demand.
The output and demand of TCM health manpower are related to TCM education market, TCM health manpower market and TCM health service supply market. If the three markets are not well connected and operated, it will directly affect the quality and quantity of TCM health services provided by TCM health service providers, and will lead to the balance between supply and demand of TCM human resources, resulting in a huge waste of resources.
Three. Socio-economic factors
(1) Social factors affecting human resources of traditional Chinese medicine. The scale, reserve and structure of TCM human resources are determined by the needs of TCM health service providers. However, the number of Chinese medicine manpower provided by Chinese medicine health service institutions depends on the social demand for Chinese medicine. The social factors affecting the human resources of traditional Chinese medicine mainly include three aspects: population factors, medical concept factors and medical insurance system.
1. Demographic factors: The influence of demographic factors on human resources of traditional Chinese medicine is mainly reflected in several aspects-population number, population age structure (the ratio of elderly population to children population) and urban population ratio.
(1) population. Population is the most important factor affecting health services. Population growth is directly proportional to the demand for health human resources, but how much does population growth affect the demand for Chinese medicine health services? In order to investigate the influence of population growth on the demand for Chinese medicine health services, we compared the population growth from 1999 to 2004 with the increase in the number of Chinese medicine personnel. Considering the influence factors of unbalanced regional economic development on the demand for Chinese medicine manpower, we excluded the abnormal factors of population growth statistics in 2002 and compared the population growth and the number of Chinese medicine personnel in the eastern, central and western regions. The results show that the population in the eastern region increased by about 6 million, the number of Chinese medicine practitioners increased by 2, and the population in the central and western regions increased by 3 million, but the number of Chinese medicine practitioners was negative.
(2) Population structure. The change of population age structure ratio will also directly affect the demand for health services, and the per capita age is closely related to the per capita medical expenses. According to the analysis report of the third national service survey in China, the hospitalization rate of the elderly over 65 years old is 80‰, the hospitalization rate of children under 14 years old is 52‰, and the hospitalization rate of the young and middle-aged group is 30 ‰. Judging from the number of outpatient visits, the two-week attendance rate of the group over 65 years old is close to 300‰, that of the group under 4 years old is close to 430‰, and that of the young and middle-aged group is 160 ‰- 180 ‰ on average. According to the latest research results of population aging trend, in the next 15 years, China's population will increase by 5.9 million per year, and by 2020, China's elderly population will reach 250 million, which will inevitably lead to an increase in the demand for Chinese medicine health services.
(3) the proportion of urban population. Due to the differences in economic level, education level, traffic conditions and medical concepts, urban residents' awareness of health care and utilization of health services are higher than those of rural residents. With the continuous development of China's economy, the pace of urbanization is also accelerating, and more and more people will become urban residents. According to the forecast, the proportion of urban residents in China will reach 50%-60% before 2 1 century, which is the level of moderately developed countries at present. Therefore, the demand forecast of TCM human resources must consider the level of population urbanization.
2. Concept of social medicine. The concept of social medical treatment includes two aspects: one is the recognition of Chinese medicine; The second is the view of the disease. Although the concept of social medical treatment belongs to the category of cultural understanding, it also has an impact on the demand for health services of traditional Chinese medicine. With the intensification of social competition, the psychological pressure of young people to adapt to social survival and development is increasing, which leads to many people in sub-health state, and the curative effect of western medicine is not ideal, so people pay more and more attention to Chinese medicine health care such as diet and nutrition, food safety, beauty and fitness, plastic surgery and skin care, fitness and health preservation, and the elderly have a higher sense of identity with Chinese medicine than other people. The change of social medical concept will promote and drive the demand for Chinese medicine health service.
3. Medical insurance system. The medical insurance system is a macro intervention of the state in the medical and health market and a system to solve the medical and health consumption. Because the medical insurance system provides medical and health services through social medical insurance channels, it will inevitably change the allocation of medical and health resources and people's medical consumption patterns in China. At present, China's medical security system includes free medical care, labor insurance medical care, semi-labor insurance medical care for family members, other medical insurance, and new rural cooperative medical care. These medical insurance systems not only reduce people's medical burden, but also greatly affect the medicine in China. With the recognition of Chinese medicine treatment in some countries in the world, Chinese medicine treatment has gradually been included in the scope of government and social medical insurance, which has greatly promoted the human resources of Chinese medicine to the international market.
(2) Economic factors affecting human resources of TCM. Based on the research results of health services at home and abroad for many years, the impact of economic factors on medical and health human resources generally includes the following three aspects: First, the level of economic development is not only positively related to residents' demand for health services, but also shows certain incremental effects. Every per capita GDP growth 1%, health service consumption growth1.04%; Secondly, among many factors that affect medical services, residents' income level is the first influencing factor of different age, occupation, gender, education level, marriage and employment status; Third, economic factors not only affect the demand side of health services, but also play an important role in the supply side of health services. As far as the demand side of health services is concerned, the economic level determines the residents' willingness, ability and location to seek medical treatment. As far as health service providers are concerned, the economic level determines the equipment, health manpower, management level and medical quality of health services. Macro-observation indicators of the impact of economic factors on human resources of traditional Chinese medicine can be measured from the ratio of per capita GDP and health expenditure to GDP.
To sum up, the market factors that affect the development of human resources of traditional Chinese medicine include both market supply and demand balance factors and socio-economic factors, which restrict, promote and influence each other.
Four, the factors affecting the regional differences in human resources of traditional Chinese medicine
(1) Differences between urban and rural areas. According to the statistics of China Rural Statistical Yearbook 2002, from 1997 to 200 1 year, the proportion of total health expenditure of farmers in China remained at about 16%, that is, 20% of urban population occupied 80% of medical resources and facilities, while 80% of rural population occupied only 20%. With the pilot and continuous promotion of the new rural cooperative medical system, there is a huge demand market for human resources of traditional Chinese medicine. The government should adopt incentive policies in time to let healthy talents of TCM flow to rural areas, and universities that cultivate human resources of TCM should also pay close attention to the rural medical market and vigorously cultivate talents of TCM suitable for rural areas.
(2) Differences between East, Middle and West. The regional differences between the eastern, central and western regions lead to the unbalanced geographical distribution of Chinese medicine human resources and the population's occupation of Chinese medicine health manpower. From 2002 to 2004, the number of Chinese medicine personnel in the eastern region increased significantly, while the number in the western region decreased sharply. The data shows that a large number of Chinese medicine human resources in the western region flow to the eastern region. Factors such as urban population growth, economic development level, residents' income, TCM medical environment and treatment of TCM personnel in the eastern region may be the main reasons for attracting TCM personnel in the western region. In order to reduce the influence of regional differences on the human resources of traditional Chinese medicine, health reform should be carried out, effective regional health planning and total health manpower control policies should be formulated, and the distribution of human resources of traditional Chinese medicine should be reconfigured. The government should, on the basis of respecting the development law of Chinese medicine health manpower in various provinces and cities, make the Chinese medicine human resources in the areas with continuous growth flow to the areas with continuous decline, or reduce the growth rate of the provinces and cities with possible growth, and maintain an appropriate growth trend in the areas where the Chinese medicine human resources are predicted to decline, so as to maintain a relatively reasonable development trend among provinces and cities.
To sum up, only by fully understanding the factors affecting the human resources of traditional Chinese medicine can we adjust and solve these factors from the aspects of policies, systems and educational sources, so as to revitalize the national industry and make China's traditional Chinese medicine industry invincible in international competition.