當前中國醫療體系正面臨一場前所未有的薪資危機。根據《華醫網》2024年醫療人才薪資調查，超過57.9%的醫務人員表示薪資在過去一年出現下滑，較2023年的37%大幅增加，反映這一現象已不再是個案，而是蔓延至全國多地的系統性問題。

從一線醫護人員的反饋來看，這波降薪主要集中在公立三甲醫院，且多針對「績效工資」部分進行調整。以深圳某大型三甲醫院為例，一位外科醫生指出，2024年8月起，他的績效收入直接「腰斬」，夜班費從每次130元人民幣降至65元。經過五險一金扣除後，月薪僅剩不到5000元。同樣情況也出現在安徽某醫科大學附屬醫院，自2024年9月起停發全院基礎績效，醫護人員普遍收入降至3000元左右，部分住院醫師甚至僅靠浮動績效維持生活，一位內科醫師即使月主診30名患者，最終僅拿到2000元獎金。

收入大幅下滑的背後，與醫療機構營收能力下降密切相關。一方面，隨著DRG（按病種付費）與DIP（按服務項目付費）制度在全中國推進，醫院收費空間大幅被壓縮；另一方面，新冠疫情後醫療需求萎縮，加上出生率下滑，婦產科與兒科等科室首當其衝，床位空置率上升，醫院整體運營壓力劇增。多地醫院開始提出「過緊日子」，甚至出現延遲發薪、取消節假日補貼、週休縮減等現象。

此外，地方財政困境也是影響因素之一。在中央要求「醫保控費」、壓縮過度醫療支出的同時，各地政府補貼能力卻難以跟上，醫院不得不自行消化經濟壓力，最終影響到醫務人員薪酬體系。部分評論指出，當前公立醫院醫生的收入過度依賴績效獎金，一旦營收下滑，即刻引發薪資波動，而缺乏穩定的底薪保護機制。

社交媒體上，不少醫生對此表達不滿與焦慮。一位年輕醫師發文感慨，自己月薪僅剩3000元，還需負擔房貸與家庭開銷；另一名住院醫師則指出，疫情期間無怨無悔地堅守崗位，如今卻成為「財政緊縮」下被犧牲的對象。更有網民諷刺，「鐵飯碗」如今變成「漏飯碗」，令人唏噓。

儘管如此，政府與部分醫療界專家也開始尋求解方。有聲音呼籲改革醫院績效發放制度，提高底薪佔比、設立績效保底機制，同時優化醫保結算流程，加快醫保回款速度，例如實施「T+1」或「20日內清算」制度，以穩定醫院資金流。此外，應強化基層醫療投入與專科人才補助，避免醫護人才進一步流失。

整體來看，這場波及全國的「醫護降薪潮」反映出中國醫療體系在經濟下行與政策改革交叉影響下的脆弱性。醫生作為社會核心專業群體之一，如今卻面臨收入不穩、工作量加劇、職業認同感下滑等多重壓力。若無法及時進行薪酬體系與政策支持的結構性調整，勢必將影響醫療服務質量、醫患關係與整體公共衛生體系的穩定發展。這不僅是醫院與醫生的危機，更是全社會需要正視的制度性警訊。

China’s healthcare system is currently facing an unprecedented salary crisis. According to the 2024 Medical Talent Salary Survey by Huayi Medical Network, more than 57.9% of healthcare workers reported a decrease in income over the past year—a sharp rise from 37% in 2023. This significant increase suggests that the issue is no longer isolated, but rather a systemic problem spreading across the country.

Feedback from frontline medical staff indicates that the wage cuts are primarily concentrated in public tertiary (Class A) hospitals, with most adjustments targeting performance-based pay. For example, at a major Class A hospital in Shenzhen, a surgeon revealed that his performance-based income was slashed in half starting in August 2024, and his night shift allowance was reduced from 130 RMB per shift to just 65 RMB. After deductions for social insurance and housing funds, his monthly salary dropped to under 5,000 RMB. A similar situation occurred at an affiliated hospital of a medical university in Anhui Province, where base performance bonuses were suspended starting in September 2024, reducing the average monthly income for medical staff to around 3,000 RMB. Some residents are barely getting by on fluctuating performance bonuses alone—a physician in internal medicine treating 30 patients a month reported earning only 2,000 RMB in bonuses.

The dramatic decline in income is closely tied to diminishing hospital revenue. On one hand, nationwide implementation of Diagnosis-Related Groups (DRG) and Diagnosis-Intervention Packet (DIP) payment reforms has significantly compressed hospitals’ billing flexibility. On the other, post-COVID shrinkage in healthcare demand and declining birth rates have hit departments like obstetrics and pediatrics particularly hard. As bed occupancy drops, hospitals are under immense operational strain. In response, many hospitals have adopted austerity measures—delaying salaries, canceling holiday bonuses, and even cutting weekly days off.

Another major factor is local fiscal stress. While the central government has called for strict control over healthcare expenditures and medical insurance outlays, many local governments lack the financial capacity to continue supporting hospitals at previous levels. As a result, hospitals are being forced to shoulder the economic burden themselves, with doctors’ pay ultimately bearing the brunt. Critics point out that doctors in public hospitals rely too heavily on performance bonuses. When hospital revenue dips, incomes fluctuate immediately due to the lack of a stable base salary system.

On social media, a wave of dissatisfaction and anxiety has emerged among doctors. One young physician lamented that he earns only 3,000 RMB per month while still paying off a mortgage and supporting a family. Another resident doctor said that while he remained loyal and dutiful during the pandemic, he now feels sacrificed in the name of “fiscal tightening.” Some netizens sarcastically commented that the once-coveted “iron rice bowl” has now become a “leaky rice bowl”—a reflection of growing disillusionment.

Nevertheless, both the government and healthcare experts are seeking solutions. Some voices are calling for reform in hospital performance-based pay systems, proposing to increase the proportion of base salary, establish minimum guaranteed performance bonuses, and streamline medical insurance reimbursement—for instance, introducing “T+1” or “within-20-days” clearing models to stabilize hospital cash flow. There are also calls to increase funding for primary care and offer more subsidies for specialized medical professionals to prevent further brain drain in the healthcare sector.

In summary, this nationwide “salary slump” among healthcare workers highlights the fragility of China’s healthcare system amid economic downturns and policy transitions. Doctors, as one of the core professional groups in society, are now facing income instability, heavier workloads, and declining professional identity. Without structural reform of compensation systems and supportive policies, the crisis may jeopardize not just individual hospitals and practitioners, but the overall quality of care, doctor-patient relationships, and the long-term stability of public health infrastructure. This is more than a healthcare issue—it is a systemic alarm bell for society as a whole.