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China to train 22 000 more paediatricians in next four years

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1376 (Published 07 March 2016) Cite this as: BMJ 2016;352:i1376
  1. Michael Woodhead
  1. Sydney

China is taking drastic steps to increase the number of paediatricians, as the country faces a crippling shortage of child health specialists with its move away from a one child policy.

The National Health and Family Planning Commission announced on 24 February that it would seek to expand training places to produce up to 22 000 extra paediatric physicians by 2020.

China is already experiencing a severe shortage of paediatricians, with fewer than 118 000 clinicians to serve a population of 220 million children under the age of 14, a ratio of only 0.5 practitioners per 1000 children.

The Chinese Medical Doctors Association stated that China needs an extra 200 000 paediatricians if it is to match the ratio of 1.4 paediatricians per 1000 patients seen in developed countries.

The shortage of paediatricians is likely to worsen because about three million more children are expected to be born every year under China’s new two child policy, in effect since January 2016.

The director of the Beijing Children’s Hospital, Ni Xin, said that low salaries were the key reason why paediatrics had become an increasingly unpopular specialty in China.

In China’s financially self supporting public hospital system, doctors rely on bonuses, based on the cost of the drugs they prescribe, for up to one third of their income. However, paediatricians say their bonuses are much lower than in other branches of medicine because children need fewer drugs. In paediatrics, a junior doctor might expect to earn little beyond their base monthly salary of ¥4000 (£430; €560; $615) to ¥5000.

Morale among paediatricians took a further hit in July 2015 when China’s State Council tried to tackle the shortages by lowering the entry marks for postgraduate paediatrics training.

Ni said that the move may have had the unintended consequence of deterring medical graduates from becoming paediatricians because they did not want to be seen as inferior or failed doctors.

“Paediatricians are only human beings, and if they cannot be guaranteed a basic livelihood, no change in eligibility requirements is going to make them stay in the job,” he said.

Ni said that low salaries were the core issue behind the paediatrician shortage and that retaining doctors was as important as training new graduates. The “brain drain” from paediatrics is also blamed on a high pressure work environment that combines long and unsociable hours with often unrealistic expectations and demands.

Paediatricians have said that they routinely saw between 10 and 20 patients an hour, despite national regulations that doctors should see no more than six an hour.

For families in China this means they routinely face waits of several hours for their child to be seen by a paediatrician, often for just a few minutes.

On 4 March China’s prime minister, Li Keqiang, acknowledged the problem, describing the paediatrician shortages as “particularly troublesome” when he spoke at China’s annual National People’s Congress.

Li announced that the government would aim to increase the number of paediatricians from 118 000 to 140 000 by 2020. This would be achieved by reinstating paediatrics as an undergraduate “major” at 38 medical schools and by giving every province a minimum quota of 5000 students enrolled in paediatrics courses specifically for townships and rural areas, he said.

Li also announced that there would be a new salary package for paediatricians and other medical specialties affected by workforce shortages.

Also speaking at the Congress, the health minister, Li Bin, said that the workforce issues had to be seen in the context of wider ongoing reforms in China’s health system, including the removal of the profit motive from public hospitals’ remuneration systems.

The minister said, “In the future a doctor’s personal income cannot be linked to the departmental revenue and the hospital’s income. It must be assessed according to workload, skill, quality, service levels, and patient satisfaction.”

She said that China’s healthcare reforms, which will include a fixed annual salary system for doctors, will this year be extended from provincial county level hospitals into major cities such as Shanghai.

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