Thông tư 21/2020/TT-BYT

CIRCULAR

PRACTICE GUIDELINES FOR ISSUANCE OF GENERAL MEDICAL PRACTICE LICENSE FOR MEDICAL DOCTORS

Pursuant to Law on Medical Examination and Treatment No. 40/2009/QH12;

Pursuant to Decree No. 109/2016/ND-CP dated July 01, 2016 of the Government on issuance of operating license for practitioners and operation license for medical examination and treatment facilities;

Pursuant to Decree No. 155/2018/ND-CP dated November 12, 2018 of the Government on amendments to a number of provisions relating the business investment conditions under state management of the Ministry of Health;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;

At the request of the Director General of the Vietnam Administration of Medical Services;

Minister of Health promulgates Circular providing practice guidelines for issuance of general medical practice license for medical doctors.

Chapter 1

GENERAL PROVISIONS

Article 1. Scope and regulated entities

1. This Circular prescribes contents and organization of medical practice for issuance of general medical practice license for medical doctors and responsibilities for implementation.

2. This Circular does not apply to doctors (in oral and maxillofacial, traditional medicine, preventive medicine, other specialized doctors or individuals having medical bachelor’s degrees and receiving additional training according to Clause 2, Clause 3 Article 5 of Circular No. 42/2018/TT-BYT dated December 26, 2018 of Minister of Health), medical assistants, nursing staffs, midwives, and technicians.     Medical practice of aforementioned individuals for issuance of practice license shall be prescribed under other Circulars of Minister of Health.

3. This Circular applies to agencies, organizations and individuals related to practice for issuance of general medical practice license for medical doctors.

Article 2. Practice principles

1. Practice contents of medical doctors (individuals holding medical doctor, general practitioner or medical bachelor degrees who have received additional training according to Circular No. 42/2018/TT-BYT dated December 26, 2018 of Minister of Health on additional training for holders of foreign medical bachelor’s degrees in order to be recognized as doctors) must conform to training programs, standard career capacity of general doctors and specialized practice scope of general doctors specified under Circular No. 35/2019/TT-BYT dated December 30, 2019 of Minister of Health on specialized practice scope for medical practitioners (hereinafter referred to as “Circular No. 35/2019/TT-BYT”).

2. Practitioners (who are medical doctors) may perform medical examination and treatment techniques directly on the patients, make prescriptions under surveillance of practice instructors (practice instructors must satisfy requirements specified under Clause 3 Article 16 of Decree No. 109/2016/ND-CP).

3. Practitioners must stringently comply with guidance of practice instructors. Practitioners must satisfy practice contents and guarantee practice period of 18 months. In case of cessation of practice due to pregnancy, accidents or other force majeure, practice period shall be added further as long as the break lasts no more than 6 months.

4. In case officials or workers employed by medical examination and treatment establishments to perform specialized operations have not obtained medical practice license, employed individuals must sign practice agreements with the medical examination and treatment establishments and be assigned with practice instructors according to this Circular.

5. Assignment of practice instructors must assure adequate capacity of the instructors.

Chapter 2

MEDICAL PRACTICE DETAILS

Article 3. Development and issuance of practice details

On the basis of Article 4 of this Circular, practice instruction institutions (general hospitals licensed for operation according to Law on Medical Examination and Treatment) shall develop and issue practice details conforming to capacity and eligibility of each institution as long as principles under Article 2 of this Circular are guaranteed.

Article 4. Framework and duration of medical practice

1. Medical practice details shall be determined based on capacity standards of general doctors prescribed by Minister of Health under Decision No. 1854/QD-BYT dated May 18, 2015; knowledge and skills trained in specialized medical education institutions for general doctors, medical doctors and scope of specialized operation of general doctors according to Clause 1 Article 4 Circular No. 35/2019/TT-BYT. 

2. Total duration of medical practice shall be 18 months and distributed among following disciplines:

a) Internal medicine including intensive care: 5 months:

b) External medicine: 3 months;

c) Obstetrics and gynecology: 3 months:

d) Pediatrics: 4 months;

dd) Techniques of other disciplines (otorhinolaryngology, oral and maxillofacial, ophthalmology, dermatology, intensive care, traditional medicine and techniques of other disciplines according to Circular No. 35/2019/TT-BYT): 3 months. 

3. During practice period of specialized techniques, practitioners may train regulations and law on medical examination and treatment, specialized regulations, practice ethics, patient safety, communication and behavior abilities of medical practitioners for a total of 20 sessions with 4 periods in each session.    This training period shall be included in total medical practice duration of 18 months specified under Clause 2 of this Article.

Chapter 3

ORGANIZATION OF MEDICAL PRACTICE

Article 5. Development of practice instruction plans

1. On an annual basis, based on demand of individuals requiring practice instructions and capacity for receiving practitioners, practice instruction institutions must develop practice instruction plans.

2. Practice instruction plans must include number of practitioners that can be admitted by the institutions in the year; number and list of practice instructors; contracts for cooperation in practice instruction (if any);

In case practice instruction institutions lack necessary disciplines according to Article 4 of this Circular, the practice instruction institutions may enter into cooperation agreements with other practice instruction institutions which provide the missing disciplines.

3. Practice instruction institutions shall send annual practice instruction plans to Ministry of Health or Department of Health before January 31 to consolidate, monitor and manage medical practice.  Meanwhile, practice instruction institutions must publicize on their websites.  

4. Ministry of Health and Departments of Health shall consolidate practice instruction plans of practice instruction institutions under their management and publicize information on websites of Ministry of Health and Departments of Health. 

Article 6. Admission of practitioners and signing of contracts for medical practice

1. Practice instruction institutions must admit practitioners according to publicized practice instruction plans. In case of rejection, provide practitioners with written response and reasons for rejection.

2. Practice instruction institutions shall enter into contracts for medical practice with practitioners according to Clause 1 Article 16 of Decree No. 109/2016/ND-CP .

Article 7. Assignment of practice instructors

1. Heads of practice instruction institutions must assign practice instructors for practitioners according to Clause 2 Article 16 of Decree No. 109/2016/ND-CP .

2. In case multiple instructors are assigned to a single practitioner, scope of instruction and duration of instruction of each instructor must be specifically stated.

3. In case practice instruction institutions enter into contracts for cooperating with other institutions in practice instruction, heads of the practice instruction institutions must assign practice instructors for each discipline in writing.

Article 8. Monitor, management and assessment of practice and verification of practice

1. Practice instruction institutions must assign entities to supervise, monitor and supervise their practice instruction activities.

2. Direct practice instructors shall assess and provide feedback on practice progress of practitioners based on criteria specified in practice assessment and feedback form under this Circular.  Assessment and feedback must be performed immediately as soon as practitioners finish practice activities. Practice instructors shall provide feedback for whichever practice activities which they provide instruction in.

3. Based on practice assessment and feedback form, heads of medical examination and treatment establishments shall issue practice verification using Form No. 2 under Annex I of Decree No. 109/2016/ND-CP .

Article 9. Expenditure on practice instruction

1. Practice instruction institutions shall identify practice expenditure on the basis of adequacy and covering expense with revenues; accounting, balance, statement and settlement must be implemented as per the law.

2. Practice facilities must publicize expenditure on practice instruction on websites of practice instruction institutions.

3. Practice facilities must inform instructed individuals about practice instruction expenditure and include such expenditure under contracts for medical practice according to Form No. 2 under Annex V of Decree No. 109/2016/ND-CP .

Chapter 4

RESPONSIBILITIES FOR IMPLEMENTATION

Article 10. Responsibilities of practitioners

1. Complying with regulations of practice instruction institutions.

2. Complying with specialized regulations of practice facilities and instruction of practice instructors.

3. Ensuring safety for patients during practice process and keeping secrets of patients and medical examination and treatment establishments during practice process.

4. Executing obligations specified under contracts for medical practice. Fully submitting fees for medical practice according to contracts for medical practice with practice instruction institutions.

5. Not signing prescriptions or treatment records. Not performing techniques without permission of practice instructors.

Article 11. Responsibilities of practice instructors

1. Complying with instruction assignment of heads of practice instruction institutions.

2. Refusing practice instruction and reporting to heads of practice instruction institutions for cases which exceed specialized capacity or in case of other reasonable causes.

3. Ensuring safety for patients during practice instruction. Holding responsibilities in case practitioners cause specialized errors during practice process which affect patients’ health as a results of practice instructors’ faults.  

4. Monitoring, assessing and providing feedback on practice results of practitioners according to assigned contents and being responsible for their feedback.

Article 12. Responsibilities of practice instruction institutions

1. Developing practice instruction contents and practice instruction plans.

2. Organizing practice instruction according to practice instruction contents and practice instruction plans.

3. Practice instruction institutions shall issue certificate for medical practice for individuals who have completed the practice period according to feedback of practice instructors specified under Clause 4 Article 11 of this Circular.

4. Reporting annually on practice instruction of practice instruction institutions:

a) Practice instruction institutions affiliated to Ministry of Health, practice instruction institutions affiliated to other ministries (other than Ministry of National Defense) shall report on practice instruction to Ministry of Health (Vietnam Administration of Medical Services).

b) Practice instruction institutions affiliated to Departments of Health and practice instruction institutions which are private hospitals shall submit reports to Departments of Health where practice instruction institutions are based in.

Chapter 5

IMPLEMENTATION

Article 13. Entry into force

1. This Circular comes into force from July 15, 2021.

2. Annul: “In case of general doctors, register practice in internal medicine, external medicine, obstetrics or pediatrics, or register practice in either internal medicine – pediatrics or external medicine – obstetrics.   In case of practice in dual-discipline, total practice duration shall be 18 months in which practice period of each discipline must be at least 9 consecutive months” under Article 15 of Circular No. 41/2011/TT-BYT .

Article 14. Transition clauses

1. In case medical doctors performing medical examination and treatment before the effective date hereof, may continue to comply with Article 15 of Circular No. 41/2011/TT-BYT .

2. In case general doctors wish to receive practice license for: internal medicine examination and treatment, external medicine examination and treatment, obstetrics and gynecology examination and treatment or pediatrics examination and treatment, register for practice in internal medicine, external medicine, obstetrics or pediatrics for 18 months according to regulations and law on medical examination and treatment.

Article 15. Terms of reference

In case documents referred to in this Circular are replaced or revised, the new versions shall prevail.

Article 16. Organization for implementation

1. Ministry of Health shall assign Vietnam Administration of Medical Services to direct, guide, examine, supervise and expedite implementation of this Circular.  Administration of Science Technology and Training, Departments, Ministry Offices, Ministry Inspectorates and General Departments affiliated to Ministry of Health are responsible for cooperating in instructing practice in discipline under their management.

2. Directors of Departments of Health, heads of medical facilities of ministries are responsible for implementing this Circular within their competence.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health (Vietnam Administration of Medical Services)./.

MEDICAL PRACTICE FEEDBACK FORM

(Attached to Circular No. 21/2020/TT-BYT dated November 30, 2020 of Minister of Health)

MEDICAL PRACTICE FEEDBACK

1. Practice instructor:

- Full name:

- Medical practice license No.

- Speciality:

- Working in …………………… (department/discipline)

2. Practitioner

- Full name:                                                                   Date of birth:

- ID card/Citizen identity card No.

- Practice duration: (From dd/mm/yyyy to dd/mm/yyyy)

- Specialty registered for practice (specify according to Clause 2 Article 4 of this Circular):

- Position (specify discipline of practice):

3. Practice results:

- Speciality capacity:

- Discipline and order during practice period:

[1] Superior body of the medical examination and treatment establishment.

[2] Name of the medical examination and treatment establishment.

[3] Location.