In China, most hospitals are owned by the government, therefore physicians were previously quasi-government employees and enjoyed little freedom in the choice of the hospital to work with. In addition, decades of planned economic policy discouraged physicians from opening their own clinics, and the practice of medicine was generally non-private.
While there are private clinics in China, many of the owners of those clinics do not have a western medical education. Most of these private practitioners practice traditional Chinese medicine. They learned a lineage-based medical system from their parents (mostly from their fathers), took imperial exams to enter medical university pre-PRC, or study at TCM universities in the modern China.
Physicians now are encouraged to open private clinics or hospitals, and those who have been practicing medicine for five years after they received national physician licenses are can open their own clinics.
Chinese Medical Association
The Chinese Medical Association is the largest and oldest non-governmental medical organization in China. It was established by a group of medical professionals in 1915 with an aim to uniting medical professionals, upholding medical ethics and advocating social integrity. It currently counts over 430,000 members and 82 specialty societies. It publishes over 70 medical journals, as well as a medical bulletin and a medical education magazine. The CMA plays a leading and active role in the nation’s medical education, training and professional exchanges.
Chinese Academy of Medical Sciences
See also: Chinese Academy of SciencesPhysicians
Physician compensation
At government controlled hospitals, physicians are salaried employees. Salaries are based on working experience and professional level. Some hospitals also pay a bonus to physicians according to the hospital's operating performances and the physician's contributions. Physicians’ salaries vary greatly. For those working at busy and well-known hospitals, their base salaries can be a few times as much as those of physicians working at low-ranking hospitals. Chinese hospitals are classified as three general levels, with level 3 at the top and level 1 at the bottom. Each level has sub-levels of A, B and C. Some elite hospitals are 3A+s.
For many physicians, in particular those at big hospitals, specialty hospitals or hospitals with large reputations, physician incomes can be larger than regular hospitals. Physicians, and in particular, surgeons, can augment their hospital salaries by operating surgeries at hospitals other than the one in which they are employed. Many physicians also receive commissions from prescribing prescription drugs and get “red envelopes” from patients (patients give money or gifts to their wanted physicians for getting treatment) or from sales representatives of drug companies. However, a new regulation issued by the Health Ministry removes physicians from the practice of medicine if they are found to have taken "red envelopes" from patients, and a hotline has been set up to monitor physicians.
Social status
In China, physicians are well respected, but as a group they are not at the top of the social structure of the country because their incomes fall in the middle class.
According to a Ph.D. candidate at a U.S. Public Health School, who was a physician at a well-known 3A hospital in Beijing, like other junior physicians, she seldom received “red envelopes” from patients, and only senior physicians or physicians with fame would have such opportunities. The student said those senior physicians had become members of the high-income class. Like the student, many physicians, went abroad to study because they were not satisfied with their status.
According to a 2002 statistics from Beijing Physicians Association, over the past two years (2000 and 2001), in Beijing about 2300 physicians resigned, and most of them went to work as sales representatives of drug companies. Some still practice medicine but work with privately owned hospitals rather than public hospitals.
A junior physician, who was evaluated as a top performer at a 2A Beijing hospital, said she left her job because she made less than $120 a month. At her new sales representative job, her base salary increased to $500 a month. She also pointed out not all physicians have such “grey incomes” as commissions and “red envelopes”.
Competitive pressure for hospitals
Influenced by a centrally-planned economy, many hospitals were managed as government agencies rather than medical service organizations. Hospitals did not have competition pressures. The management team usually did not recognize the importance of developing and retaining high skilled physicians. Administrative personnel were more powerful than physicians at a hospital.
However, with the reform of the medical sector, Chinese hospitals are facing increasing competition from privately owned and foreign-investment-backed hospitals. Physicians are expected to enjoy higher legal income and better social status.
Physician training
The Chinese medical education system follows the British system, but it reduced the length from six years to five years to shorten the educational cycle. To become a physician, a person usually needs to study for five years at a medical school. Some medical schools used to run, and still offer three-year programs, but hospitals tend to recruit those attending five-year programs, and big-name hospitals only hire MDs, which take seven years (including the five years in undergraduate study) to complete, or Ph.D.'s of medicine.
Upon graduation, a physician starts as an assistant physician at a hospital. After having practiced medicine for three years, the physician will be eligible to take a national test for physician certification and become a professional physician (licensed physician) upon passing the test. A physician with a master’s degree in medicine (seven years including five years’ undergraduate study in medicine) can take the national test after one year’s practice of medicine.
Residency requirements have not been implemented nationwide in Chinese hospitals though almost all hospitals require their physicians to take turns working on night shift, and physicians will be called to work in an emergency. The first residency program was launched in 2003 at Huaxi Hospital of Sichuan University, where a professor who had studied in U.S. for two years proposed establishing a residency requirement for newly graduated medical school students. These students will complete their MD study and have to pass the national certification test during the residency. The residency requirement at Huaxi Hospital is expected to change the traditional physician training system in China.
There are specialties in general hospitals and specialty hospitals. The most common specialty hospitals or clinics include those treating hepatitis, cancers, sterility, dental diseases, dermatitis, nephritis, and diabetes. A medical school student rotates at several departments of a hospital and then is assigned to a specialty department according to his or her strengths and the hospital’s needs. But there is not a system of developing specialty physicians in China. Some medical experts have called for a standardized training and testing system for specialty physicians. The classification of specialties at a Chinese hospital is similar to that at a U.S. hospital.
The medical schools are located at Beijing, Shanghai, Tianjin, Chongqing, provincial capital cities, and some secondary cities.There are around 130 Chinese medical schools, 120 of which are recognized by the U.S., and those only offering 3-year programs are not included. Top schools as of 2008 include:
- Tsinghua University, Peking Union Medical College, Beijing
- Peking University Health Sciences Center, Beijing
- Fudan University Shanghai Medical College, Shanghai
- Tianjin Medical University, Tianjin
- Shanghai Jiaotong University Medical School, Shanghai
- Sun Yat-Sen University Medical School, Guangzhou
- Zhejiang University Medical School, Hangzhou
- Huazhong University of Science and Technology, Tongji Medical College, Wuhan
- Sichuan University West China Medical Center, Chengdu
- Capital Medical University, Beijing
- Central South University, Changsha
- Medical College of Nanchang University
- China Medical University, Shenyang
- Southern Medical University, Guangzhong and Zhongshan
- China Pharmaceutical University, Nanjing
- Shenyang Pharmaceutical University, Shenyang
- Beijing University of Traditional Chinese Medicine, Beijing
- Wuhan University, Wuhan
- Xi'an Jiaotong University, Xi'an
- Shandong University, Jinan
- Nanjing Medical University, Nanjing
- Harbin Medical University, Harbin
- Xinjiang Medical University
Prescription drugs
According to BCG’s prediction in 2002, China’s prescription drug market is expected to reach $24 billion and become the fifth largest market following Japan. AstraZeneca now ranks as the No. 1 foreign brand in terms of prescription sales in the Chinese market.
Physicians control the distribution of prescription drugs. Some hospitals and clinics stipulate patients must buy prescription drugs from the hospitals or directly from the physicians who make the prescriptions. Such a restriction aims to prevent the loss of sales on prescription drugs to retailers, but retailing dr
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