China's paediatrician shortage reaches crisis point

by Michael Woodhead
An article in Dalian's local paper the Peninsula Morning News has highlighted the real world impact of China's chronic shortage of paediatricians.
The paper notes that local children's hospitals have been unable to recruit paediatricians for some time, and currently had no replies to the latest 'situations vacant' ad for child doctors. In addition, many existing staff have resigned.
The "Bandao Chenbao" says the paediatric workforce problem is due to the familiar reasons of low pay, low status, high stress, long and inconvenient working hours  and danger of being assaulted by the public.
With starting salaries of little more than 4000 yuan a month, few are attracted to paediatrics when a similar income can be made from working as a 'baomu' (childminder) in Guangzhou. Insiders ask why would anyone go through 5 years of medical school then another three years of a masters degree and internship to do a job that pays so little and requires so much input in terms of paperwork and bureaucracy? In addition to the long period of study, paediatricians have a heavy burden of exams and also a huge amount of medical file paperwork to keep up with. And dealing with children, they are often the target of assaults and abuse from parents and family members when things don't go according to their expectations. Those who know the job say that it requires a lot of night shift work and working long unsociable hours.
The root cause of the problem is under-investment in the medical system and the low fees charged to patients. This means that there are few resources to support doctors and thus doctors must deal with a high number of patients each day. Inevitably with such as high throughput and scant resources, mistakes occur, and it is the doctor on the front line who gets the blame. It is a vicious circle as more doctors leave, so the remainder face even greater pressures.
The article says the situation is not confined to Dalian, but is a national problem that needs to be addressed by training more doctors but more importantly by putting more resources into the system to support doctors and reduce the number of patients seen per day.

Intensive diabetes treatment reduces cardiovascular complications

Heart attacks were reduced by intensive treatment with hypoglycaemic drugs, antihypertensives and statins

by Michael Woodhead
In a long term intervention study, researchers from Dalian have shown that macrovascular complications of type 2 diabetes can be prevented through an intensive regimen of hypoglycaemic, antihypertensive and statin drugs.
When used in combination with interventions to promote better diet and more activity, the drug regimens reduced macro vascular complications by two thirds, according to Professor Yang Yu of the Department of Endocrinology at the First Affiliated Hospital of Dalian Medical University.
In a seven year study, Professor Yang and colleagues compared 'intensive' treatment with conventional treatment of type 2 diabetes in 150 patients at the hospital. Half the patients were assigned to the intensive group, and were treated with hypoglycaemic drugs, such as metformin, antihypertensives such as an ACE inhibitor, and lipid lowering drugs such as statins or a Chinese lipid-lowering herb complex called Xue-Zhi-Kang. Patients also received one on one sessions instructing them in diet and exercise.
After seven years, subclinical macrovascular complications such as heart attacks, angina and stroke occurred in 10% (seven) of the intensive treatment group and in 33% (22) of the  conventional group.
The researchers say their findings confirm those seen in the landmark UKPDS trial and show that "primary prevention of macrovascular diseases can be achieved through intensified, multifactorial intervention in patients with short-duration type 2 diabetes.
"Our approach achieved the primary prevention of diabetic macrovascular complications, implying that intensive, multifactorial intervention
should be administered to type 2 diabetic patients as soon as possible to provide the most benefits," they suggest.
"Type 2 diabetic patients should undergo intensive multifactorial interventions with individual targets for the prevention of macrovascular diseases," they conclude.
Source: Diabetes Care