Paediatricians in short supply in two-child China

BEIJING — An acute shortage of doctors to treat children is taking a toll on public-health services in China, and the recent policy shift to allow families to have two children will only make matters worse, say experts.

The country has a shortfall of at least 200,000 paediatricians, said the National Health and Family Planning Commission. Nearly half of all registered paediatricians left their positions between 2005 and 2011 due to poor pay, long working hours and dim career prospects, its data shows.

“About one-third of the doctors have left our hospital in the past two years and gone to work in pharmaceutical companies or private hospitals that offer better pay,” said Dr Liu Tingliang, from the Shanghai Children’s Medical Centre.

Parents queuing up for hours outside paediatric wards with sick children have become a common sight at hospitals in big cities in China. Dr Liu said some major hospitals in Shanghai have closed paediatric wards in recent years due to the lack of doctors, and dozens of other hospitals in other cities have been forced to suspend emergency services due to the lack of paediatricians in late 2015.

Early last month, public health authorities in Shanghai enacted an emergency plan to transfer paediatricians from city hospitals to serve in the city’s four main children’s hospitals during the month-long winter break. The number of patient visits during this period goes up, especially around the Chinese New Year holiday. Hospitals are also enlisting hundreds of volunteers to assist in children’s wards during this period.

While hospitals can make arrangements to ease the crunch during major holidays, the rest of the year presents a problem. China’s number of paediatricians dropped by 5,000 from 2009 to 2014, data from the health commission shows. On average, one paediatrician in the country serves 2,300 children, more than twice the doctor-to-patient ratio in developed countries.

A 2014 survey by the Pediatric Society of the Chinese Medical Doctor Association (CMDA) found the dearth of doctors was worse in some provinces. The central province of Henan had only one paediatrician to treat 5,000 children. The government’s move last October to allow all families to have a second child is expected to result in 3 million more births every year, said experts, and the current healthcare facilities for children cannot meet this sudden increase in demand.

Hospitals are offering new contracts to retired doctors and are telling new recruits to work in the paediatric department during the first couple of years in a bid to fill the void. But they are still struggling to cope with the large number of patients.

At the prestigious Children’s Hospital of the Capital Institute of Pediatrics in Beijing, some parents paid 600 yuan (S$131) to black-market dealers for a doctor’s appointment because it was difficult to get a reservation for urgent treatment. Patients usually pay 5 yuan for an appointment at a public hospital as per government regulations. The long, expensive wait is often followed by a brief consultation.

Meanwhile, doctors say staff shortages are taking a toll on them. One doctor at a children’s hospital said he and his colleagues work at least 10 hours every day. “I haven’t been allowed to take my annual leave for almost four years and I can only enjoy a full weekend after every few weeks,” he said. The hospital received more than 7,000 patients every day in 2015, he said, and the figure far exceeded its serving capacity. “(The number of patients) has grown by 10 per cent a year in recent years, partly due to an increase in the number of patients coming from outside the city,” he said.

A nationwide census in 2010 found that two-thirds of the country’s 300 million children under the age of 14 lived in rural areas. Many parents tend to bring sick youngsters to big cities for better medical treatment.

“Most paediatricians with a college degree are working in big hospitals in major cities,” said a paediatrician at a Beijing hospital, who wished to remain anonymous. “Less than 5 per cent of doctors working in hospitals in smaller townships have attended medical school.”

Some physicians in township and village clinics have been trained in paediatrics or nursing at vocational schools, said the paediatrician.

Data from the China Food and Drug Administration showed that one in five patients visiting the country’s hospitals is a child. However, resources for paediatric wards fall far short of what is needed to serve these patients. The capacity in paediatric wards accounts for a mere 6.4 per cent of the total number of hospital beds in the country, said Dr Zhu Songhan, chairman of the Pediatric Society of the CMDA. Among the country’s 13,000 hospitals, only 68 facilities are dedicated to children’s health, he said.

Many medical experts blamed the Ministry of Education’s 1998 decision to abolish paediatrics as an undergraduate major for the shortfall in the number of specialists in the field. The government at the time said it wanted to stop universities from spreading themselves too thin by pruning the number of majors offered. Since 1999, medical schools across the country stopped admitting undergraduates for studies in paediatrics.

“Every year, about 1,800 paediatricians are trained, which is far less than what is needed,” said Dr Zhu. In 2014, 90,000 doctors received medical licences, but only a few chose to serve in children’s wards, he said.

The government has not invested enough on research into children’s medicine or the training of specialists, said Dr Zhu. “Child-related health issues are rarely listed as a national research priority and the public health sector pays little attention to this branch of medicine,” he said.

Dim career prospects have discouraged students from opting to work in paediatrics. Dr Cui Feifei, from the Children’s Hospital in Beijing, said only two out of her class of 30 students chose to treat children.

In 2015, the health commission lowered the total marks needed to obtain a doctor’s licence for students specialising in paediatrics. While some doctors said this will help to attract new recruits to the field, others said it will lead to more problems in the long run. Dr Pei Honggang, from the Shenzhen Children’s Hospital, said lowering the bar for paediatricians may affect the quality of care, resulting in more disputes with patients, and drive away new recruits.

In most countries, paediatricians require better clinical skills than other specialists because they are dealing with children who are unable to explain their condition clearly, said Dr Wang from the Children’s Hospital in Beijing.

Paediatricians are exposed to higher risks and pressure due to disagreements with patients’ families and have less income than other doctors, said Dr Wang. “That’s why many people don’t choose this branch of medicine.”

A 2011 survey conducted by CMDA found that 90 per cent of paediatricians were not satisfied with their salaries. Paediatric wards also have to handle more disputes with patient families than other departments, said the CMDA.

Meanwhile, paediatricians earn less than doctors in other fields of medicine under the current salary system in hospitals. Many public hospitals rely on profits from selling drugs to pay doctors’ salaries because they cannot break even with fees for medical services. Part of a physician’s income also comes from endorsing the purchase of medical equipment.

But doctors treating children, especially infants, prescribe as few medicines as possible and try to minimise the number of tests needed, said Dr Liu. This means most paediatric wards operate on thin profit margins.

Professor Ni Xin, president of Capital Medical University’s children’s hospital, said the government needs to give more financial support to paediatric wards so that physicians’ salaries can be increased. CAIXIN ONLINE