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An ambitious plan by China to increase its doctor numbers by nearly 40 per cent over the next five years faces a severe test as medical graduates choose other professions because of low pay and overwork.
China's ageing population and growing burden from conditions such as cancer and diabetes is leaving its underfunded public hospitals, the first port of call for most patients, increasingly strained.
In response, China is hoping to rely more on general practitioners, known as family doctors. The State Council announced a five-year health plan last week that aims to increase average life expectancy by one year to 77.3 years by the end of 2020.
It called for an increase in the number of doctors from the current level of 1.5 per 1,000 citizens to more than two by 2020. That compares with figures of 1.9 in Brazil and 2.8 in Britain. The plan said China would need to employ an extra 140,000 obstetricians and midwives to cope with rising demand after the country scrapped its one-child policy in favour of allowing couples to have two children.
But a recent survey suggested it would be difficult to recruit the number of doctors required. In the 10 years to 2015, Chinese universities produced 4.7m medical graduates, while the total number of doctors rose by just 750,000, representing a 16 per cent increase, according to data compiled by Angela Fan of Taiwan's National Yang-Ming University.
The medical profession is relatively poorly paid in China, with the average doctor's salary just Rmb5,000 ($720) a month. "In comparison with young doctor sin the US, the young in China are extremely unsatisfied with their salaries," Ms Fan said.
Low pay is also the root of a widespread kickback culture in Chinese hospitals. When state broadcaster CCTV last month exposed doctors in Shanghai receiving a Rmb1,800 monthly fee from a drug sales agent, the staff were suspended and an investigation launched. But few expect such exposés to end the phenomenon.
One self-described "low-level doctor" commented on website Cn-healthcare: "Each month we take home a measly paycheck ... I feel we are being turned into drug sales staff."
Chinese doctors are also overworked, often seeing as many as 12 patients an hour, and have been the victims of attacks from patients and their family members frustrated over medical care.
The doctor deficit is particularly stark in the countryside,which had a shortfall of more than 500,000 physicians in 2015, and in certain specialities such as paediatrics.
Nearly half of all registered paediatricians left their positions between 2005 and 2011 because of low pay and long working hours, officials said last year.
"If this pattern continues, China will suffer a chronic shortage of medical doctors in certain specialities and in rural areas," the researchers said. The high number of medical dropouts would "only compound the problem" of increased healthcare needs caused by an ageing society, they added.