Monday, Feb 27, 2017, 2:48 PM CST – China

Society

Pediatrician Shortage

FAR FROM CHILD’S PLAY

Pediatric medicine is seen as a career of last resort amongst Chinese medical students – despite huge demand, those who qualify face meager salaries, high pressure and oppressive workloads

Two children in treatment for leukemia play on the roof of a house behind Anhui Provincial Children’s Hospital Photo by Wu fang

A pediatrician gets off work at a children’s hospital in Foshan, Guangdong Province, June 10, 2013 Photo by CFP

At 8 AM, 60-year-old Liu Xiaoyan’s consulting room is crowded with six parents. As the director of dermatology at the Capital Institute of Pediatrics, she is the first specialist in this busy hospital to open a separate surgery practice.

Outside the room, more than 100 parents and children from across the country are waiting to see her. There are five other dermatologists at the hospital, but they are busy treating more than 1,000 children every day. In 2015, the institute treated nearly 2.17 million children, placing severe strain on its staff of 300. At Beijing Children’s Hospital, another reputable pediatrics center in the capital, patient numbers last year topped 3.17 million.

According to statistics from the National Health and Family Planning Commission (NHFPC), there are 220 million children under the age of 14 in China, accounting for 20 percent of the total population. Yet the country is only home to 99 children’s hospitals. In 2014, there were 2.12 doctors for every 1,000 patients, but only 0.53 pediatricians for every 1,000 children. 118,000 qualified pediatricians now practice in China, some 200,000 fewer than the number required.

“Heavy workloads, poor remuneration and sometimes dangerous working conditions are mainly to blame for the shortage of pediatricians,” Wang Bin, director of pediatrics at Zhujiang Hospital of Southern Medical University, told NewsChina.

Plight

Xu Pengfei, chief pediatrician at the Beijing-based China-Japan Friendship Hospital, has been working in the hospital’s pediatrics department for 28 years, including 25 years on the night shift. Every night, a single on-duty pediatrician might have to give emergency treatment to some 200 children between 4:30 PM and 8 AM.

“After the night shift, I was unable to drive due to the mental stress and exhaustion,” he said. “Just stepping on the gas pedal was an effort.”

The customary eight-hour shifts assigned to most Chinese doctors are unavailable to most of the country’s pediatricians. Some children’s hospitals even require doctors to work on the back of a 24-hour shift, meaning some can be on duty for up to 28 hours. At the Capital Institute of Pediatrics, a “night shift” for a pediatric surgeon typically means 36 hours of non-stop work, while a pediatric physician might have to work 48 continuous hours before clocking off.

Nowadays, Xu does not need to work nights. 10 young doctors now work the night shift and in the ER. However, when NewsChina visited, one doctor was on sick leave while four more were pregnant and unable to work night shifts, effectively doubling everyone else’s workload.

In 2015, three of Xu’s colleagues quit “because of high pressure.” Recruiting pediatricians has been a problem for many children’s hospitals. In 2016, only one candidate interviewed with the pediatrics department of the China-Japan Friendship Hospital. Today, Chinese hospitals prefer candidates with clinical doctorates, as research doctors still need three years of training on the wards before they can treat patients, but some institutions will take whatever they can get.

“We can recruit either [type of candidate] but even candidates with research doctorates are reluctant to apply,” Xu said. “We are not competing for talent, we are competing for ordinary doctors.”

Wang Bin echoes Xu’s frustration. He told our reporter that China’s medical schools have been expanding enrollment and a growing number of graduates are joining the workforce but “it remains hard for pediatrics departments to recruit doctors.”

According to healthr.com, a major Chinese healthcare recruiting website, as of the end of January 2016, job vacancies for pediatricians in China’s major cities rose by 18 percent year-on-year. The shortage in second- and third-tier cities was even worse. In the first half of 2014, not one candidate applied for a job in pediatrics during a public recruitment drive in Dalian, Liaoning Province. More than 40 pediatricians in the coastal city quit their jobs in 2014.

“Very few medical school graduates would choose to become pediatricians,” Wang said. “Graduates who want to work in pediatrics tend to be those who cannot land a better job.”

In 1999, China stopped offering pediatrics as an undergraduate major, cutting off what had provided a stable supply of pediatricians. On January 26, 14 members of the Chinese People’s Political Consultative Conference of Sichuan Province wrote an open letter to the Ministry of Education (MOE), calling for the reinstatement of undergraduate pediatrics at the country’s medical schools. The NHFPC is still consulting with the MOE over the possibility.

Experts have pointed out that ophthalmology, surgery and dermatology also are not offered as areas of study at the undergraduate level, but that this has not led to a similar shortage of personnel in these fields. There is a saying popular among Chinese doctors which jokes that “ophthalmology is gold, surgery is silver and pediatrics is garbage.”

Several doctors we spoke to denied that the failure to offer pediatrics as an undergraduate major is the main cause of the shortage of pediatricians. They voiced support for the current preference for a broad starter curriculum in medical schools.

In the opinion of Wang Bin, reinstating undergraduate pediatrics is meaningless if students are forced into the field by failing to make the grade in other subjects. “Who will choose pediatrics if they are going to be ostracized and disrespected?” he said.

Li Xin, a clinical medical student at a major university in Jiangsu Province, told our reporter that seniors at her university could opt to take pediatrics, with the university offering scholarships and postgraduate recommendations for those who take this option. Nonetheless, she claimed, the 40 available places on the pediatrics course still went unfilled.

“I was nearly persuaded [to choose pediatrics] but later I was told that only an idiot would,” she said.

Challenges

In 2015, the pediatrics department of Zhujiang Hospital of Southern Medical University generated revenue of over 90 million yuan (US$13.8m), a rare accomplishment in China. “Pediatrics is outstanding at our hospital and has a strong capacity to make a profit because most of our patients are critically ill and undergo surgical procedures or need expensive medication,” Wang Bin told our reporter. “The work of doctors, however, is cheap.”

50-year-old Wang is also a PhD supervisor, but, despite his seniority, his annual salary is less than 300,000 yuan (US$46,000). After more than 30 years in the wards of major cities, neither Wang Bin nor Xu Pengfei have saved enough to buy their own homes.

According to healthr.com, the average monthly salaries for pediatricians are 7,317 yuan (US$1,125) in Beijing, 8,907 yuan (US$1,370) in Shanghai and 6,893 yuan (US$1,060 yuan) in Guangdong Province. Data from the Chinese Medical Doctor Association also suggest that the working hours of pediatricians in China are 1.68 times longer than their peers’, and yet pediatricians earn 54 percent less on average than other specialists.

In a country where doctors’ salaries are largely dependent on selling treatments, pediatric medicine is seen as an unprofitable area. Children receiving medical treatment in China typically receive one-fifth of the dosage that might be prescribed to an adult. What’s more, pediatrics departments conduct fewer checkups and charge lower rates. As a result, earnings are significantly constricted.

One head of a major hospital, speaking on condition of anonymity, told NewsChina that he “does not expect the pediatrics department to generate much income,” and he is “satisfied as long as it is not in the red.”

The government has taken some measures over the years to address the chronic shortage of pediatricians. Most of them are extensions of existing incentive schemes. In 2015, the NHFPC announced that during the medical license examination, pediatrics candidates could gain more points by taking an additional exam, lowering their pass threshold. One pediatrician, speaking anonymously, told our reporter that “lowering the threshold will make matters worse and we pediatricians will be even less respected by our peers.”

 On January 30, the NHFPC announced that senior physicians could be trained to “strengthen” pediatrics departments. Neither the physicians concerned nor the pediatricians they would theoretically assist, however, favored the new move, with many expressing concerns that it would lead to medical malpractice.

On February 24, Jin Shengguo, a senior official with the NHFPC, remarked during an industry conference that China will place more emphasis on the training of pediatricians and strive to raise the total number to 140,000 nationwide by 2020 – 0.6 pediatricians for every 1,000 children. The move, he claimed, was designed to meet increased demand for pediatricians in the years after the abolition of the One Child Policy. It remains to be seen whether such pledges will bear fruit.

At 8 PM, Liu Xiaoyan sent her last patient home and shut down her computer for the first time in 13 hours. The day before, she did not leave work until 9 PM.

She told NewsChina about one day in December, when the outpatient online service system broke down for about nine hours and all medical notes and paperwork had to be finished longhand. “Never mind the human body – even the computers get tired,” Liu said.

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