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December 16, 2013

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Taking the pulse of sick health care system

Low salaries, workplace pressures and occasional violence by patients against doctors are dissuading an increasing number of top high school students from pursuing careers in medicine.

The situation has become so acute that some medical students are abandoning their studies for other majors or even choosing other careers after graduation.

According to the Chinese Medical Doctors Association, there were 17,243 cases of violent attacks against health care workers in China in 2010. The Chinese Hospital Association said there were an average of 27 attacks on medical staff in each hospital in 2012.

On October 25, an angry patient stabbed a senior doctor to death at a hospital in Zhejiang Province.

Patient violence often results from frustration and anger with the health care system.

A survey by the association also found 78 percent of Chinese doctors don’t want their children to follow in their footsteps.

“It is a shame that the society doesn’t respect people who treat illnesses and save lives,” said Dr Huang Gang, deputy director of Shanghai Jiao Tong University’s School of Medicine. “In the West, doctors are always among those with the highest incomes and the highest respect.”

He said many medical schools nowadays are forced to recruit “second-level” students because the most qualified students don’t want careers that involve tough years of schooling, poor income prospects after graduation and working environments that are stressful and sometimes dangerous.

According to a December 7 article published in Lancet, one of the world’s most prestigious medical journals, the deteriorating relationship between health care providers and patients in China affects not only the present generation of professionals but also future generations of doctors.

Domestic medical schools say the number of medical students is declining, and some already in training are having second thoughts.

Only one-sixth of the 600,000 people who obtained medical licenses in the past five years were registered as working in health care facilities in China, the article said. That means 500,000 newly qualified doctors have shunned the profession.

Huang said leading medical schools have stepped up efforts to recruit the brightest and best young students, including the chance to study and work in Western countries.

“We teach things like French and English alongside clinical medicine so that students have the opportunity to practice in France and the United States,” he said.

But the problem persists.

Strong commitment

In 2012, 38 students at Fudan University’s School of Medicine transferred to other majors, accounting for 15 percent of all students changing curricula. At Jiao Tong University, the ratio was two in 10.

Among those who do graduate with medical degrees, at least 20 percent don’t go to work in hospitals. That figure doesn’t include doctors who leave hospital work early in their careers.

Still, there are those committed to the moral imperative of healing — students like Zuo Yiyou, a sophomore at Jiao Tong’s School of Medicine. She said she chose a career in medicine after one of her best friends in high school died from a brain tumor.

“I will stick to my choice,” she said. “My generation can and will change the relationship between doctors and patients by doing a better job. If each of us is committed to being a good doctor, then we will make a difference in the future.”

In her class of 30 students, two have chosen to transfer to other majors but 28 are staying the course.

Medical schools are the beginning of the health care pipeline. Their problems eventually ripple out to the health care profession. Indeed, local hospitals report they are unable to recruit enough doctors for departments like emergency treatment, intensive care, pediatrics and obstetrics.

Not getting the proper care

Xia Lin, an official at Shanghai Children's Medical Center, said two medical graduates who just signed work contracts with the hospital decided at the last minute to take jobs with pharmaceutical companies, where the pay is better and working conditions less stressful.

Compared with comprehensive hospitals for adults, the salaries pediatric hospitals pay their doctors are among the lowest in the profession.

That creates a situation where most families with only one child can’t get the care they want when their beloved offspring are sick. That foments anger toward the medical system.

“We also have had three or four senior doctors who had been working here for more than 10 years quit after being beaten by parents in recent years,” Xia said.

Industry insiders said the government must address the problem.

“Patients scold hospitals for doing unnecessary tests and prescribing expensive medicines,” Huang said. “Only about 3 percent of the cost of running a public hospital is borne by the government. The rest must be covered by patients.”

“In big hospitals that are understaffed, a doctor may have to see 70 to 80 patients each day. Each patient is given only three minutes,” Huang added.

Sociologist Gu Jun said the whole medical system needs an overhaul.

“Both the medical insurance system and medical staff salaries must be changed,” he said. “The government needs to invest more in public health.”



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