Medical school places unfilled: nobody in China wants to be a doctor, and there are three good reasons why they don't

In western countries there is fierce competition to get a place in medical school. Only straight A students with an impressive portfolio of extra-curricular activities need apply. In China, the picture is very different. Even the top medical schools in China are struggling to attract students.

This week, Professor Yang Jun a distinguished cardiologist and head of the First College of Clinical Medical Sciences, Hubei, notes that Shanghai's prestigious Fudan University has had to drop its entrance mark threshold by 58 marks this year. The same "dumbing down" has been seen at the city's Jiatong University medical school and other medical schools across the country. When China's top medical school at  Peking Union Medical College allotted 10 places to Guangzhou students, only four applications were received - and of these only one was deemed to make the grade.

What's happening? The fact is, nobody with any ambition wants to be a doctor in China right now, and you can see why. The three main reasons are poor pay, long hours and terrible working conditions - including the real possibility of abuse and violence.

Writing in the International Journal of Cardiology, Professor Yang notes that the average salary of a doctor in China is 72,000 yuan a year (US$11,600) -  and many doctors earn a lot less than that, especially if they work in unpopular specialities such as paediatrics or emergency medicine (the so-called ambulance riders).

Poor pay for doctors in China: paediatricians are at the bottom, with only 63,000 yuan a year

For this salary, doctors have to work long hours - more than 50% of doctors work more than the 'specified' 40 hours a week and 30% work more than 60 hours a week.  Doctors also face huge workloads - as many as 80 patients in a single morning shift. As Professor Yang observes, the Mayo Clinic in the US has fifteen times more staff than the Peking Union Medical College, and yet it has only half the patient numbers.

Doctors in China simply don't have time to practice adequate medicine - and the consequences are unhappy patients who take out their frustration on staff. A recent survey of almost 10,000 doctors found that 60% had recently experienced abuse from patients, and 13% had experienced physical assaults.

Doctors also have to study long and hard to qualify - up to ten years including undergraduate and postgraduate qualifications. On top of this they have to publish articles and to gain academic merit for promotion.  Doctors have lost the status and respect they once had - and only 6.8% of doctors say they would advise their children to follow  a career in medicine.

This is already causing problems in the less popular branches of the profession. On 27 July, the National Health and Family Planning Commission announced that it would be waiving the usual entry criteria for admission to the specialities of paediatrics and emergency medicine. Medical student candidates who did not achieve the usual pass mark would be allowed to become trainee paediatricians and emergency medicine doctors if their coursework was of sufficiently high standard, the NHFPC announced. This has caused outrage among  doctors currently working in these specialities, who say it is a desperate and self -defeating move that will further reduce the attractiveness of their branches of medicine.

They say there is a need to improve pay and conditions in their work rather than lowering the bar to entry. Paediatrics and emergency medicine and notoriously poorly remunerated and yet high pressure jobs in the Chinese healthcare system. Assaults on doctors in these departments are numerous as they are in the front line seeing critically ill patients - especially the treasured offspring in a one-child system.

The doctor's social network site DXY echoed many of the criticisms of the "dumbing down" move. As one doctor wrote: "We work longer hours for less pay in unsafe conditions, but we stick to our posts because of the duty we have to the little ones who thank us after we have care for them."

Hubei group protest forced psychiatric treatment of people without mental illness

People who complain against the government are being forced into mental institutions and given forced treatment with antipsychotics and electroconvulsive therapy, a human rights group in Hubei has told Radio Free Asia.. Liu Feiyue, a spokesman for the Civil Rights and Livelihood Watch says the psychiatric hospital system is being abused and there have been 40-50 cases of forced treatment of healthy people during 2013, in contravention of China's new Mental Health Law, which came into effect in 2013 but is not being implemented on the ground.

Doctors and hospitals ordered to forfeit bribes paid by insulin manufacturer Ganli Pharmaceuticals

Doctors and hospitals in Hubei have been ordered to forfeit and repay millions of dollars in bribes they received from insulin maker Beijing Ganli Pharmaceuticals.
The provincial Health Deaprtment and Law Courts have orederd doctors to repay monies paid  by the insulin maker following a police investigation that saw seven executives charged with corruption.
In September, Beijing Ganli, which makes third generation insulins, was embroiled in a major corruption scandal involving bribes to doctors and hospitals exceeding 300 million yuan.
According to 21st Century magazine, the case has been classed as a major economic crime by provincial authorities, and those who received bribes have been ordered to forfeit the money. According to the magazine, the bribes were not confined to Wuhan but included doctors and hospitals in other cities of the province.

Single parents eligible for medical certificates

Single parents in Central China's Hubei Province will be able to apply for medical certificates after the birth for their children from local healthcare authorities from next year, according to newly revised provincial guidelines on the issuance of certificates, the Wuhan Evening News reported.
The move means they no longer need a marriage certificate for the application.
The medical certificates of birth are a statutory document with details of the babies' age, relationships and nationality, and are required when applying for hukou, or household registration documents.
The provincial health and family planning commission and public security department jointly released the newly revised guidelines that will take effect from January 1.
In the cases of single parents, or babies born with assisted reproductive technology or no intact information on the father, the mother can make a written explanation with a signature, and that will be sufficient to apply for a birth certificate. Local health authorities will need to check the authenticity of the materials before issuing certifications, according to the new guidelines.
The new guidelines also regulate that the organs responsible for issuing the medical certificates of birth can not set preconditions such as the existence of marriage certificates and birth service certificates, and they are banned from receiving any fees for the certificates.

Read full article at: Global Times

Forced IUD contraception faces criticism in China

Women are coerced into having IUD contraception through threats of witholding hukou

by Lin Meilian
A woman's body does not really belong to herself. It can belong to the State in some cases. Deng Yanqin, mother of a newborn son in Jiangxi Province, discovered this when she was told by the local residential community's administrator that she would not get a hukou, or household registration, for her firstborn unless she placed an intrauterine device (IUD), a contraception ring, inside her womb.
"How could they do this to me?" Deng asked, "And more importantly, do they have the right to do this?"
This question has been asked by thousands of couples all over the country who encounter the same problem. The answer, according to a group of 13 lawyers who called on China's top family planning authority to abolish forced IUD implants earlier in December, is "No".
"There is no law that forces Chinese women to undergo contraception surgery when applying for her firstborn's hukou," Zhang Lijuan, one of the appeal's initiators, told the Global Times.
The IUD is one of the most widely used forms of birth control in China, especially in rural areas. According to the Ministry of Health, 7.8 million women underwent IUD surgery in 2009.
Forced IUD implants, which were widely used in the 1980s to prevent women from having a second child, have been relaxed in recent years. Now, women living in big cities such as Beijing and Shanghai can make their own decisions about birth control. However, it has since been linked with other measures such as applying for hukou registration or land to build property.
Deng and her husband wrote to the local family planning authority asking for an explanation. They were told it was because "they have not proved they were using any long-term effective contraception measure", so the authority could not issue them the documents they need.
"Women have the right to choose what kind of contraception they want," Zhang said. "As a female lawyer, I feel like I need to stand up and fight for them."
In September last year, three months after her baby girl was born, Li got a call from the local family planning authority at her village in Hubei Province asking her to come for a physical check.  Thinking it was a routine examination, she went along. They then took her to a clinic to see if she was able to undergo IUD surgery.
"I told the doctor again and again that I know about birth control measures, and they can't force me to do it," she said. But the family planning official told her if she refused, they would not assist her in obtaining documents she would need in the future.
"It sounded like a threat, so I had no choice but to do it," she recalls.
Women's freedom to choose contraception does not seem to matter when it comes to the family planning policy. The policy, which was applied in 1979, restricts urban couples to having one child, while allowing rural couples, ethnic minorities and couples who are both only children themselves to have additional children. It is estimated that the policy has prevented over 400 million births from 1979 to 2011.
However, the policy is controversial both within and outside China, as cases of forced abortion and sterilization have been repeatedly reported by the media. Earlier in June, a widely circulated photo of a woman lying next to her baby's corpse sparked outrage on the Internet. Feng Jiamei from Shaanxi Province was reportedly forced to have an abortion in the seventh month of pregnancy because she could not pay the fine for having a second child.
The 2009 novel Frog, by this year's winner of the Nobel Prize for literature, Mo Yan, chronicles the lingering pain that has haunted many Chinese women for three decades.
In the novel, Frog's aunt helped deliver 10,000 children before the implementation of the family planning policy in his village. After the policy was adopted, Frog saw his aunt become haunted by the forced abortions she witnessed.
"The family planning policy is a basic condition of China dealing with the most conservative element of traditional culture. It touches the sorest points and most delicate parts of the souls of millions of Chinese people," Mo was quoted by Sina.com as saying.
Xie Juan, 30 and mother of a 1-year-old daughter from Guangdong Province, managed to avoid the IUD surgery.
"I managed to get a doctor's note to prove my health condition was not suitable for the surgery," she told the Global Times. "But I am afraid they will force me to do it through other methods."
Back in the 1970s when the policy was adopted, male sterilization was encouraged. When a man had the operation, villagers would march to his place, beating gongs and drums to celebrate his "contribution" and provide him with rich food.
Now it is the women who take the risk, often because they do not want their breadwinner husbands to risk getting infections or complications.
Compared to Chinese women's unwillingness to place a contraception ring inside their wombs, studies have shown that more American women are choosing IUDs for birth control.
In 2009, 8.5 percent of American women using birth control chose an IUD or implant, with the large majority going with the IUD, 4 percent higher than in 2007, according to the journal Fertility & Sterility.
With the devices, it's estimated that between 0.2 percent and 0.8 percent of women will have an unplanned pregnancy within a year. By contrast, with contraceptive pills and condoms, the unintended pregnancy rate is about 9 percent per year, it said.
Some unmarried women even bring it up in conversation with doctors, but get rejected because "they are not in a relationship."
Even though IUDs are believed to be one of the most effective forms of reversible birth control, it is still far from popular in the US and way behind birth control pills and condoms.
There are also concerns that some poorly designed devices might result in infections or even death.
American women's concerns seem well-founded. One month after being forced to undergo IUD surgery, Li found that there was something wrong. She went to see the doctor and was told she had a vaginal yeast infection.
The doctor insisted it had nothing to do with the IUD surgery and that she could be cured. After 10 months of fruitless treatment, she decided to examine the device. But another problem emerged. To do this, she needed official permission from the family planning authority.
She went through a number of procedures to get the letter and had her device checked. It turned out there were indeed problems. The device had been poorly installed and had now become stuck to her body.
But to remove it, she needed another permission letter. She scrambled around and collected the documents she needed. Later, the doctor told her she had to wait until the vaginal yeast infection had gone.  Another letter was required to get the medicine.
"I remember I stood there and started crying like a baby. I felt sorry being a woman in China," she said.
Kong Xingxing, a former researcher at Nanjing University and now a family planning authority official in Shandong Province, calls these women the "silent group." There is no official number of how many women are facing complications from contraception surgery, because most of them don't talk about it.
"We can't just focus on the glorious achievements of the past three decades and ignore their consequences," she told the Global Times.
"These rural women in their 50s are the victims of State policy. They are scattered around different villages and don't know how to protect their rights," she added.
Through her research and interviews with rural women, Kong found that the majority of them chose to deal with the problem by themselves.
"Most of them would buy painkillers rather than see the doctor or tell their family," she said. "Crying is the only way to let out bad feelings."
Some are afraid of taking the IUD out themselves, as in some places, family planning officials will check the ring. If they find it has gone, the women face a fine, Kong said.
The medical malpractice committee under the family planning authority determines whether a woman faces complications from contraception surgery. If approved, the woman receives compensation. But Kong questions its credibility.
"It is just like asking a murderer to admit he or she is guilty," Kong said.
Some people, like Zheng Zhiyuan from Zhejiang Province, cannot sit back and watch his wife suffer. He said his 36-year-old wife felt sick right after she had the sterilization surgery after giving birth to their second child in 2008.
"She couldn't even stand still after the surgery. I had no idea what was wrong so I asked the doctor.  He just told her to rest at home," Zheng told the Global Times.
A year later, she was diagnosed with amyotrophic lateral sclerosis in Beijing, a debilitating disease characterized by rapidly progressing weakness and muscle atrophy. She has difficulty speaking, swallowing and walking.
There is no evidence to prove that this is a result of complications from contraception surgery, but Zheng believes that the poorly conducted surgery was the cause. He petitioned the local family planning authority in 2009 but was beaten up by security guards. He contacted the medical malpractice committee asking for compensation, but was rejected.
Over the years, eye contact has become their only method of communication. Every time he goes home, he looks in her eyes and tells her, "I will never give up on you."
Source: Global Times