“Our overworked doctors have fallen sick. We have suspended our service. We are not sure when we will reopen.”
That was the sign on the door of the paediatrics department of a public hospital in Tianjin last week. The ward only had three doctors and they had all caught flu. There was no one to replace them.
China is chronically short of paediatricians – a problem that has the potential to get far worse now the government is encouraging all families to have two children.
Waits in paediatric hospitals are notoriously long and many institutions spend years trying to hire children’s doctors. One hospital in Shenzhen recently took seven years to find a new children’s specialist. As a result many hospitals have closed their paediatric wards.
According to a recent government white paper China needs 200,000 more paediatricians – versus the 110,000 children’s specialists it has now. But it will have to work hard to persuade people to adopt the specialisation – its reputation among medical students is so off-putting that even those who like the idea can’t bring themselves to go into it. This explains one well known saying among medics: “Ophthalmology gold, surgery silver, paediatrics nothing” (the IPO this Monday of an eye clinic has made its founder a billionaire, see WiC393).
More than 75% of children’s doctors earn less than Rmb5,000 ($778.74) a month, according to the white paper.
But that isn’t the biggest problem. Because of the acute national shortage of paediatricians, those that are in that specialisation have a huge workload. A recent Sina article from a Shenzhen public hospital described one children’s doctor seeing 300 patients in a single shift. To make ends meet he also offers medical advice to friends by phone. But that means taking calls when he should be sleeping, or using his lunch break to look at photos of children’s stools on his mobile phone.
That said, the major reason many don’t want to go into the profession is the risk of conflict. As readers of WiC will know, attacks on doctors have been a serious problem in China in recent years. In 2017 there were more than 4,000 cases of public disturbances in the country’s hospitals, according to figures released by the Public Security Bureau.
In a recent incident, a man in Shandong beat three members of an emergency crew who turned up to treat his mother. The man then commandeered the ambulance and drove it to the hospital himself where he also assaulted the emergency doctor for “not working fast enough”.
Yet risk of conflict is perceived to be even higher when the patient is a child.
“Paediatrics is one of the most vulnerable departments,” wrote the Legal Daily earlier this month. Xinhua has even characterised paediatric departments as“war zones”.
“A child’s condition can change quickly but children aren’t able to communicate,” it said.
Worse still, Legal Daily quoted a Shanghai doctor as saying children are often accompanied by three or four adults – parents and grandparents – who “surround the physician and shout all the time”, preventing them from concentrating on the child.
As a result the dropout rate of paediatricians is huge. From 2014 to 2017 some 14,000 doctors left the field. The current ratio of doctors to children is one for every two thousand patients in China versus 1:700 in the US. This had led many to question whether it is worth having a second child. “I went to a paediatric department, I felt like I was in a vegetable market,” wrote one person on Sina Weibo recently.
“We have to spend seven hours in a waiting room each time we go. I can’t afford to do that with two children,” said another.
Medical students have also spoken up online. “Our school has to force people to go into paediatrics, because no one wants to go,” said one. “They make no money, get no respect and the risk of conflicts is greater,” added another.
The government now say it wants to add 85,000 more children’s doctors by 2020 to deal with the immediate shortfall. Quite how it will do that remains to be seen…
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