Millions of Chinese people leapt for joy when China’s One-Child Policy was lifted and replaced with a Two-Child Policy on 1st January 2016. More than 18.46 million babies were born in same year, recording an increment of 11.5% compared to year 2015. Prof. Xin Yuan, Professor of Population Studies at Tianjin's Nankai University expected the trend to continue. Yuan estimated an annual birth of 20 million in 2017 and 2018.

In stark contrast, the number of licensed paediatricians has been dropping from 105,000 to 100,000 over the past 5 years. There were only 5,000 paediatricians who entered the field over the past 15 years. This has resulted in a shortfall of 200,000 in the country.

The number of paediatricians in mainland China is lagging behind the international standard

It has been a long battle since the country faced shortage of paediatricians and the struggle intensified after the relaxation of the family planning policy.

Comparing with the international standard of one doctor for every 1,000 children, the ratio is significantly lower in mainland China - approximately one doctor catering every 2,000 children.

Insufficient medical facilities catering for children is another pressing issue. Currently, 20% of the population in mainland China are children below 14, accounting for 220 million in total. Meanwhile, the country only has 99 children hospitals—that is 0.01% of all medical institutions.

Paediatricians in mainland China are overworked and under immense pressure

The major reason why medical students are reluctant in entering the paediatric field lies within the heavy workload that does not match the comparatively low wages.

Apart from the lack of children hospitals, most hospitals do not have a paediatric department in mainland China. Additionally, parents prefer to visit renowned hospitals in larger cities, which lead to further congestion in those paediatric clinics.

Every day, approximately 10,000 outpatients visit the Beijing Children's Hospital, and 8,000 visit the Shanghai Children's Hospital. Paediatricians are required to attend to both outpatients and warded patients.

Paediatricians in mainland China are overworked and under immense pressure
Paediatricians in mainland China are overworked and under immense pressure

"Paediatricians have to work under great pressure. With so many appointments each day, we often don't even have time to eat," said Chunxiu Gong, Director of the Internal Secretion, Heredity and Metabolism Center at Beijing Children's Hospital.

Sometimes, children visit a paediatrician accompanied by not only their parents, but also by up to 4 grandparents. They are heavily concerned about the child’s health, thereby paying immense attention when a paediatrician performs diagnoses. As children may not be able to express clearly their symptoms, diagnoses could be difficult and risky.

Since paediatricians are expected to bear the responsibilities in giving the best treatment to all patients, they work under immense pressure. Moreover, parents tend to lose patience throughout the treatment. They might question the paediatricians as to why their children are not recovering. Therefore, it is common to see paediatricians in mainland China receive harsh complaints or even violence from family members of the children. Hence, the mounting pressure contributes to the loss of interest in taking up paediatric field.

A pay that does not match the toil

Ironically, according to a survey from the Chinese Paediatric Society of the Chinese Medical Association, paediatricians work 1.68 times that of other physicians but they are paid only 46 percent of a normal physician.

The average monthly income of paediatricians in Beijing, Shanghai and Guangdong Province is 7,317 yuan, 8,907 yuan and 6,893 yuan respectively.

With 32 years of experience in the field, an appointment with Dr Xiao-Mei Shu, President of the Guizhou Provincial Children's Hospital, costs just 6.4 yuan. When dealing with patients with complicated medical conditions, Shu might even need to spend 20 to 30 minutes for the appointment.

"I think the value of paediatricians' work has failed to be recognized," said Shu.

Paediatricians are paid less because paediatric departments generate fewer revenue

China's medical system heavily relies on medicinal sales and physical check-ups to generate profit. As choices of paediatric drugs are limited, and children need lower dosages than adults do, paediatric departments generally make less revenue than other specialists.

Since 1992, hospitals link salary level with a department's revenue, leaving paediatricians at the bottom of the list.

"Before this reform, all doctors in a hospital earned comparable incomes," said Dr Hui-Ju Yu, a paediatrician at Shanghai Xin Hua Hospital.

Paediatric profession being removed from medical college syllabus

The medical sector believes that the Higher Education Reform in year 1998 led to the declining number of paediatricians nowadays. Paediatric profession was removed from the medical college syllabus, hence cutting off a stable source of medical students for the specialist field. In recent years, although many universities have restored paediatric professional undergraduate enrolment, it does not seem to be able to relieve the current situation.

In order to increase the recruitment of paediatricians, authority has made a request to medical universities to lower the bar of requirement for students who are interested in taking up paediatric field. Adoption of such system has raised concerns as this may lower the quality of intakes, thereby the treatment quality provided by paediatricians in the future.

In the preparation of welcoming more babies in year 2017, China faces a greater challenge in filling paediatrician vacancies to provide optimal child medical care. MIMS

Read more:
Why being a paediatrician isn’t easy
Paediatric milestones: Identifying the red flags
Staff shortage in obstetrics and gynaecology (O&G) in Hong Kong: A parents’ worst nightmare
Healthcare professional shortages in Hong Kong - The many reasons and controversies - Part 1