ELEVATION: Students hold signs on May 25 celebrating the elevation of the Guangxi University of Chinese Medicine from its former designation as a college in Nanning, capital city of southwest China's Guangxi Zhuang Autonomous Region (LU BOAN)

The way in which China cultivates doctors requires a great change, says Li Ling, professor of economics at the National School of Development at Peking University.

"As I know, China cultivates 600,000 students to learn medical science each year, but only 100,000 of them ended up becoming doctors, which indicated that the mode of cultivating large numbers but only employing a small number of them should be changed," said Li.

Enhance pertinence

Plans should be made to cultivate a small number of students majoring in medical science, so as to ensure that no medical students be wasted, said Li.

"It is very expensive to cultivate a doctor. Taking the United States as an example, after graduating medical school a doctor receives another 10-year training as both a resident and specialist doctor," said Li. It is normal for a doctor of medicine to owe banks hundreds of thousands of dollars when he or she becomes an independent licensed doctor, according to Li.

Statistics from the Ministry of Education showed the Central Government increased appropriations from 7,100 yuan ($1,122) per student in 2008 to 14,000 ($2,222) yuan per student in 2011, and the appropriations are expected to increase by a large margin this year, said Li.

Many college graduates of medicine complained at dxy.cn, an online forum for Chinese doctors since 2008. Some said they were jobless as soon as they graduated. Others lamented they had studied the wrong subject. Many have to switch to other jobs such as pharmaceutical sales representatives, research workers, teachers, or going abroad.

The Ministry of Education made a plan to cultivate outstanding engineers in June 2010, aiming to cultivate a batch of elites and control the scale of doctor training. According to the plan, China will not increase the number of medical colleges during the 12^th Five-Year Plan (2011-15). Provinces and municipalities with large-scale enrollment are expected to firmly reduce their numbers of students.

"The large-scale enrolment makes it hard to cultivate skillful doctors, and wastes talent and materials," said Li.

Unbalanced system

Currently, medical students in China study in three different education systems: a five-year regular college course, a seven-year bachelor-master degree course and an eight-year bachelor-master-doctorate degree course. Medical universities enroll 600,000 students each year.

China's medical education puts great emphasis on theoretical study instead of clinical practice. Taking the Peking University Health Science Center as an example, students will study for five years in the top university, and do some probation and practice in the latter three years while doing research and writing papers.

Medical students in the United States spend eight years, with the latter four years devoted to clinical practice.

Medical interns in China often clean offices, sort test lists or check hospital wards. They are not able to do basic work such as writing cases or surgical preparation.

As a result, it is not optimistic for medical doctors to be able to diagnose and give treatment, said Chen Yude, a professor at the School of Public Health of the Peking University.

According to the Ministry of Health, the number of licensed assistant doctors in China was 2.466 million in 2011, the highest in the world. Statistics of the World Health Organization show the numbers are 750,000 in India and the United States and only 160,000 in Britain.

Shortages in clinics

Statistics from the Ministry of Health showed medical workers numbered 6.2 million by the end of 2011. Most work at various levels in 20,000 public hospitals in urban areas. Only less than 2 million of them work in the 70,000 clinics which are mainly located in rural and less-developed areas.

That means despite a large number of medical students, it is hard for clinics to get doctors, especially those in rural areas. The Institute for Medical Humanities at Peking University surveyed over 380 medical undergraduate students, indicating that over 80 percent of students preferred to stay in big cities.

Before 1978, medical college graduates were allocated to clinics at county and township levels. Now, most of those graduates are nearing retirement age. "In recent years, many graduates chose to go abroad, and fewer wanted to go to west China. Rural areas face a serious shortage of doctors," said Chen.

An even more serious situation for rural areas is the shortage of general practitioners who are able to deal with common diseases and emergencies. "China currently needs at least 600,000 general practitioners, compared with only 78,000 currently," said Li.

In the outline of deepening reform of medical and healthcare services for the 12^th Five-Year Plan (2011-15), China is slated to cultivate 150,000 general practitioners.

"That number won't even satisfy clinics in urban communities. Besides, it takes eight years to cultivate a general practitioner, so some may be drawn from among other physicians after some additional training," said Li.

Chen said the current education mode for medical students is not beneficial for shaping a general practitioner. "Medical colleges divide medical knowledge into many finer points, so a general practitioner is not able to master many aspects of medicine. Doctors depend on laboratory examinations and equipment to detect diseases," said Chen. "Lacking that equipment, it will be to the detriment of future doctors' abilities."

Li said China should separate cultivating rural doctors from medical college education. "Doctors to be trained for rural clinics should be local people, who have the same local dialects and same local culture, thus they will be able to stay to serve their fellow townspeople," Li said.

(Source: China Youth Daily)