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."

Beijing to allow doctors to set up independent private clinics

The Beijing health department will for the first time allow doctors to set up their own clinics funded by private investors. At its annual work meeting the health department announced that doctors may now apply to set up private clinics. The new policy will require alterations to the current sustem of doctors remueration and the personnel assigment system for the healthcare system, the department said. It will require changes in the way public hospital departments employ doctors and also changes in work contracts

China's doctors: overworked and underpaid?

A new law allows doctors to practice in multiple institutions - but has few takers

by Dai Lian
On the first week of a new law issued by the Ministry of Health which permits doctors to practice at multiple medical institutions, not a single doctor applied to register at the Beijing Municipal Health Bureau.
The new law, released on March 7, is meant to provide stronger incentives for better quality healthcare through offering doctors more flexibility in their sources of income. Reforms began in 2009, when the Ministry of Health revised a long-held rule under the Medical Practitioners Law that a doctor is only permitted to register for work at one medical institution at a time.
But the reality has proven to be less than encouraging.
Long before the law was issued, well-known doctors at major hospitals said they would recognize each other at large airports on the weekends as they flew off to their other jobs. This phenomenon is particularly common in Beijing and Shanghai, where the best-trained doctors tend to cluster.
According to the new regulations, one essential piece of paperwork when applying to practice at multiple institutions requires permission from both the hospital director and medical affairs office.
Dr. Wang Xiaomin, director of the Peking University Dental Hospital stated that, while called "public hospitals," only a very small portion of funding for these hospitals comes from the government. Hospitals rely on income from drug prescriptions and medical examinations and have been reluctant to see their doctors find work at other institutions.
Additionally, since 2005, all doctors at public hospitals have had to purchase malpractice insurance, and this is tied to the hospital at which a doctor practices. There are no malpractice insurance requirements under the new regulation for secondary or third-practices set up by doctors.
Some specialist physicians have clearly stated that they won't opt to practice in multiple locations because they are simply overworked. Many doctors are currently working at full capacity. In the city of Beijing, China's medical center, doctors are particularly overworked. From November 15, 2010, the Beijing municipal government has pushed for citywide weekend outpatient services, which has alleviated wait times for patients – but created a strain on the schedules of doctors.
Zhao Ping, president of the Chinese Academy of Medical Sciences, said that the work efficiency of Chinese doctors is high enough. "There are on average 1.4 doctors to a bed, which is probably the lowest in the world," Zhao said. "If doctors are unwilling to work multiple jobs, if there is money to be made that they don't want to make it, then that is only because they're too exhausted."
But Yin Jia, director of Beijing Union Medical College Hospital's allergy department, said that the new multiple-job policy encourages doctors to crossover to county-level hospitals or community clinics. The policy won't be attractive to the country's top doctors, especially because there isn't a different in compensation. "Registration fees and treatment costs are basically the same as at Beijing Union. When they are already overworked, these doctors won't be motivated to travel for the same pay."
During the most recent legislative sessions in Beijing, a Chinese People's Political Consultative Conference (CPPCC) delegate said that nationwide drug sales commissions are as high as 45 billion yuan last year.
"That so many people are getting kick-backs indicates that our system of ‘drugs support the hospital' and ‘examinations support the hospital' has problems. One important reason is that doctors now can't live a dignified life commensurate with the value of their labor on their legitimate income alone,'" Yin said.
Asclepius (Ailibi) Consulting Inc. Chairman Eric Chong said that this phenomenon reflects contemporary culture's indifference to the value of knowledge: the intangible knowledge and abstract experiences of doctors can only be reflected in tangible things, such as medication and examinations.
But Peking University School of Government Professor Gu Xin told Caixin that the problem lies in the contracts that doctors are permitted to negotiate.
In most countries, doctors are not confined to practicing for their hospital, and there are several options for practice arrangements. Gu said that behind these different practice models are different types of "contracts" between hospitals and doctors. But most doctors in China are not eligible to negotiate for other types of contracts with hospitals.
"To reach a fair contract, doctors should have the freedom to practice where they choose," Gu said. "Under this, there should also be a direct employer-employee relationship between hospitals and doctors." Gu said that the current healthcare system keeps doctors unnecessarily tethered to one hospital, likening it to birds trapped in a cage.
Gu said that if doctors aren't allowed to move freely between medical institutions, the reform to promote doctors working at multiple practices will simply "turn one birdcage into two or three."
Source: Caixin