China’s doctors not part of society’s elite; “When I see so many patients each day how can I smile at them? They still want me to smile at them”.

October 6, 2013 8:04 am

China’s doctors not part of society’s elite

By Patti Waldmeir in Shanghai

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Roy Wang did not want to be a doctor but his grades were too low for engineering – so his southern China university transferred him to a course for weaker students: medicine. In most western countries, medicine is a profession that guarantees prestige, high salaries – and the approval of parents who love to brag about “my child the doctor”. But in China, the reverse is increasingly true: doctors are ill-paid, overworked and maligned or even attacked by patients – while many parents would prefer that they became bankers instead. Even Chinese doctors overwhelmingly prefer their children not to follow them into the profession: according to a 2011 survey by the Chinese Medical Doctor Association, 78 per cent of respondents said they hoped their child would not don a white coat. Many of China’s less prestigious medical schools find it hard to recruit students to train as doctors and others find that students with lower scores on the national university entrance exam, or gaokao, will use the lower requirements of some medical schools to gain entry to university, only to transfer later to faculties with higher earning potential.“Compared to western countries, the social status and income of doctors in China is not the highest, so [some medical schools] definitely are not able to attract the best students and the result is that the profession of doctors is not the most elite in Chinese society,” says Huang Gang, vice-dean of Jiaotong University medical school in Shanghai.

Top medical faculties such as Jiaotong usually have little problem filling their quota for students with good marks, he says, adding that he would prefer to lower his grade expectations if the student is truly committed to studying medicine. He says only about 5 per cent of Jiaotong medical students transfer to another faculty each year. But less elite medical schools, such as the one at Xiamen University where Dr Wang studied, struggle to fill available spaces. Xiamen medical school recently waived all fees for those training to be doctors, to attract better candidates.

Dr Wang estimates that about 80 per cent of his intake class at Xiamen medical school in 2006 did not end up there because they wanted to be doctors: he believes that under half ended up wearing white coats like him. Some chose instead to work in the pharmaceutical industry, now embroiled in bribery allegations which could further damage the public image of the medical profession.

Speaking after a gruelling day working in the emergency room of a large Shanghai hospital, Dr Wang says low salaries are one reason medicine does not attract China’s best students. A survey last year conducted by MyCos education consultants in Beijing found that the average monthly salary for clinical medicine graduates was Rmb2,339 ($382) within six months of graduation. Average income for all graduates was Rmb3,051 nationwide, with doctors and nurses the lowest.

Many doctors complain that disgruntled patients increasingly turn to violence when doctors are unable to cure their ills – even when there is no malpractice. A plastic surgery patient used a knife to attack three nurses, one of whom was pregnant, in the central Chinese city of Changsha in September. Doctors say they often have to pay out of their own pocket when patients sue them and their hospitals.

State media report that the frequency of attacks on doctors is increasing. The average number of assaults rose to 27.3 per hospital in 2012, compared with 20.6 in 2008, according to a Xinhua news agency report, citing a survey from the Chinese Hospital Association.

Dr Wang, 25, seems resigned to being attacked. “It will happen sooner or later”, he says.

Xinhua also reported that the violence is starting to chase doctors out of the profession: nearly 40 per cent of medical personnel surveyed at 316 hospitals nationally from December 2012 to July 2013 said they plan to give up their profession because of increased violence in hospitals.

But hospital administrators and medical students point out that the situation is not uniformly bad. In poorer areas where alternative professions may not be available, the best students are willing to risk long hours and possible violence to study medicine.

Dr Wang says he has embraced the profession he accidentally ended up in. He just wishes that patients – Chinese hospital physicians sometimes treat 100-200 a day – would give him a break. “When I see so many patients each day how can I smile at them?” he asks, noting ruefully, “they still want me to smile at them”.