From the heart of Beijing to the edges of the global stage, you're at Roundtable.
I'm Niu Honglin.
Across many countries, health care systems are confronting a similar dilemma how to maintain quality care while protecting the workforce that delivers it.
China's discussion about physician burnout reflects that broader global challenge.
What can we do to curb the current lung shifts, growing patient demand and emotional pressure which are pushing medical professionals toward a breaking point?
In this year's two sessions, lawmakers and political advisors are having heated discussion, and Roundtable invites you to join this brainstorm with us together.
For today's show, I'm joined by Steve Hatherly and Yushan.
Now pull up a chair and join the conversation.
Doctors dedicate their lives to caring for others.
Then who's ensuring that they are supported, protected and respected?
As policymakers in China explore solutions ranging from resource reform to AI-assisted healthcare, one thing is clear.
Protecting the well-being of medical workers is essential for the future of healthcare itself.
So how's the situation now?
What are we doing to release their pressure and what are some other measures we tend we can take to address the challenges facing the medical professionals?
Would be the topic of today, and the reason we're talking about this is partly because yes, in every different career, in every different workplace, we might be facing burnout issue.
We might be facing high pressure issue.
But if I am having a particularly bad day I might skip the show and just find something other things to do.
But in a hospital, the situation can be life-threatening, literally.
Yeah, you're right.
And I hope through today's chat that we can learn.
Yeah, we're going to be talking about burnout in the context of doctors and hospitals and medical professionals.
But this can happen to anyone in any industry, anywhere.
It can happen at work.
It can happen at home.
So we'll see what it's about.
And then when we do talk about the medical industry, we'll talk about public hospitals.
And then I want to a little bit later compare and see if there's any difference between public hospitals and private hospitals.
So we have a lot to discuss here.
But let's start with this.
Burnout.
It's not just feeling tired at the end of the day.
This is a chronic, long-term response to a buildup of your work stress or a buildup of your exhaustion.
It's not a medical disorder per se.
It's not defined that way, but it is defined as an occupational phenomenon.
At least that's how the World Health Organization defines it.
In terms of the characteristics, there are three key dimensions, they say, that make it different from your regular fatigue or your regular feelings of exhaustion.
One is emotional exhaustion.
We're going to go over these, by the way, one by one.
One is emotional exhaustion.
Two is a term called depersonalization.
And three is low personal accomplishment.
So if we start with emotional exhaustion, I think that's pretty self-explanatory, right?
This is just when you feel like so drained physically and emotionally and mentally from work like you have no more energy to give whatsoever.
Your tank is at zero.
And that kind of feeling can happen because of so many different reasons.
For example, here on Roundtable, when we do not have enough topics, I feel a little bit stressed.
When we do a lot of work outside of the regular show, I might feel emotionally tired.
So for any occupation, we can have different reasons.
And it's really not that hard.
And imagine a doctor's pressure coming from all different fronts.
Sure.
The second one, depersonalization.
This one's a little bit more serious, maybe.
I'm not sure if that's fair to say.
But what depersonalization is?
It's when you start to feel detached or even cold, or even having feelings of no feelings towards your patients in the hospital or the other staff in the hospital or in any other industry, your colleagues, for example.
Depersonalization.
It's kind of a psychological experience where the employee and that could be the doctor develops almost negative or cynical feelings towards, About the job, or towards the coworkers or, in a hospital, even towards the patients.
But this can also be a self-defense mechanism in a certain way and because of certain reasons.
You're working, but you're just muscle memory.
Optioning while you're yourself is protecting yourself from feeling more or feeling hurt.
Well, it's that.
And, I think, depersonalization too.
It's about you're so exhausted mentally physically emotionally, that you become cranky.
And when you become cranky, you lose your passion for your work, even if it's just for a day or two, or three or a week or whatever.
You lose the passion and then you become irritable towards the staff in the hospital or your patients or your coworkers.
When if you weren't emotionally exhausted, you wouldn't have those feelings.
It's all connected to burnout.
Right.
And then low personal accomplishment.
That's the third dimension or characteristic.
And that's when you feel because of burnout, you feel like, what am I doing here?
I'm not making any difference to this organization, to this hospital or to the industry, to the patients.
Yeah.
I'm wasting my time here.
And you put all of those three characteristics together and that's when you're going to feel some very severe and extreme burnout.
Yes, and that is also the kind of feelings or symptoms that showed in a long-term way.
It's only when it's showed in a long-term way that we can use it to somehow identify burnout.
So if you're only having a bad day and you can strive up again the next day, then it's just a bad day.
Then it's just a bad day, that's right.
Yeah, so what really caught our attention on this whole matter is because of a recent study that's published in the international journal BMC Public Health, which really dropped a shocking number.
So this one, it included nearly 200,000 doctors here in China.
And the data revealed that more than six out of 10 doctors are suffering from burnout, meaning they experience at least one of those three dimensions that Steve just mentioned regularly.
And even more concerning is the fact that 12 of doctors have severe burnout, which means all three dimensions are present and are interfering with their daily work and personal lives.
So this happens, as we discover from this particular research, very often with a higher burnout rate among the emergency department doctors, the ED doctors.
I think it's quite understandable, right?
Because they really face high stakes, fast paced and unpredictable working environment.
The ED doctors.
Non-stop.
Yeah, non-stop.
They are constantly dealing with life or death situations on a daily basis.
Also, they experience long shifts and a steady stream of patients with no time to really catch their breath.
I've heard from online social media comments from dr oh i somebody said that oh, i worked as a ed doctor and just between doctors uh, excuse me, just between patients coming in and out i took one sip of water and the patients were thinking that i was resting And also for doctors working in emergency rooms.
What they do is to deal with the urgent situation.
And if the current doctor or, excuse me, the current patients need any long-term care, if they really need to recover, they will transfer them to other departments, which means they do not see real 100 successful cases under their watch.
And that is also something that is depriving their self-accomplishment feeling in a way.
They know they're curing them.
They know they're saving lives.
They don't get to see it through, though.
Exactly.
Yeah, so ER doctors, ED doctors, number one on the list.
Right behind them are orthopedics or intensive care unit doctors, also infectious disease department doctors.
They also have high burnout rates, around 77%.
They talk about the different reasons.
Orthopedic doctors.
They face long, physically demanding surgeries, sometimes eight-plus hours per At a time.
Not easy to do, obviously.
Also, the study noted that the lack of institutional support can add another layer of stress on already grueling work.
And I think that's a point that we're going to come back to a little bit later.
ICU doctors, intensive care unit doctors they have a unique kind of pressure too, because they're caring for the sickest of patients.
And oftentimes they will have lower survival rates than, And that can take obviously a huge emotional toll on the doctors and on the staff that work there.
The burnout rate, yeah, it's 77%.
They do have the highest rate of severe burnout at 39%.
And that's more than a third of ICU doctors that are struggling with severe burnout.
So I think that's pretty easy to understand why.
And on the flip side, we also see that, depending on the department, some tend to have higher burnout rates, while some others tend to have relatively lower rates, such as those doctors in psychiatry and dentistry, because part of that is due to the nature of their work.
Because dentistry for example they have relatively more predictable working hours and less life or death pressure.
It's just fixing your teeth, and it's usually turning out hopefully, to the more positive outcome.
While psychiatry often involves more regular and long-term patient relationships, then That they can usually foster a sense of accomplishment.
Which is what you were talking about.
They can see it through to the end.
To be honest, the results of the study is, of course, alarming.
And we want to address the issue of doctor burnout for sure.
We're going to discuss it.
But just a tiny little detour.
Point I want to make here is that I find the results deeply moving, to be honest.
Moving why.
My mom is a cardiovascular physician and I know the yes, I know the life of a doctor.
I know that in her entire life, in her career, in her entire let's say working experience, she had to, for the 80 or 90 percent of it, she had to go through graveyard shift every three to four days and And she sees doctor all the time.
And when she's working in clinics, like the clinics in the hospital, she would see over from 40 to 90 patients a day, give or take.
And from the results, so I know that doctors are very hardworking and they face a lot of pressure.
But if you take a look at the results, we can realize that most reasons, or the almost the defining factor of burnout is relates to the work experience, in the sense that whether or not the doctors are curing enough patients.
When they're curing enough patients, they're feeling much better.
So it's not only about working hard.
It's also about them like this professional being so dedicated to saving lives, and whether or not they can do it well affect them a lot.
Oh, there are a number of factors that go into it.
And that's definitely one of them.
Let's compare the numbers to the United States now before we go any further.
And I want to look at these now because I want to show that this isn't cultural.
You know, this isn't about Chinese hospitals or Chinese doctors.
This is a worldwide thing.
The most recent study that I could find was from the American Medical Association website, which was from last year.
And they did a study on the national burnout survey and they found that similar numbers 45 percent, over 45 percent of physicians reported at least one symptom of burnout.
The ones that we talked about in 2023, which is better than 2021, which is over 63 percent.
But those are pandemic times.
Right.
So they kind of take those numbers with a grain of salt.
Right.
The burnout numbers among U.S. physicians has improved as of late.
But still US physicians.
Their burnout levels remain at a higher risk relative to other US workers in other industries.
So similar numbers.
And yeah, that's why I wanted to talk about that, because it's not a cultural thing.
This is something that doctors experience no matter where they're from.
Yeah, true.
And besides that, Steve has already mentioned the fact that there are actually a lot of different factors at play in causing doctor burnout, not only in China but worldwide.
So, besides the fact that we've already mentioned that for different departments there are different situations, what are some other factors we should be paying attention to?
One thing mentioned in the study is that personal factors, such as their age, can really play a role regarding their burnout ratio.
So doctors in their middle ages can be more likely to burn out.
Why?
Of course, doctors are human, too.
They're parents, too.
They have their elders to take care of and their kids to take care of.
Sandwich generation.
Exactly.
And they are at the so-called peak of their career.
And in the meantime at that place they're probably juggling heavy work responsibilities with family life in the middle, like caring for children or elder parents.
And sometimes unmarried doctors, those with lower educational levels and those with lower job titles also have higher burnout rates.
And that's often because they have less support or more pressure to prove themselves in that very situation, sometimes high-pressured working environment they work in.
There's the stresses of working in an environment where you're surrounded by sick people all the time and germs all the time.
There's the dangers of infectious diseases and things like that.
This isn't a personal problem when we talk about doctor burnout.
And this is from the study.
And by the way, all the information we're sharing today is from the study that came out.
It's not a personal problem.
It's not that doctors aren't strong enough.
It's not that doctors aren't qualified.
It's not that they can't handle the pressure.
This is a systemic issue that comes from the work itself.
And as I spent a little bit more time on the American Medical Association website, I found a quote that stood out to me.
And this is from a doctor by the name of Christine Sinksey, and this is the point that she's speaking to.
She said, whilst burnout manifests in individuals, it originates in systems.
Burnout is not the result of a deficiency in resiliency among physicians.
Rather, it is due to the system in which physicians work.
And that was exactly the finding from the Chinese study, too.
Yeah, because the paper also kind of pointed out that, Among China's 14 billion population and rising health care demands, we seem to have are witnessing a challenging workload for our doctors and pressurized by a relatively lower physician to population ratio.
That's comparing with Western world and some other countries around the world.
We tend to have lower professionals inside the hospital to maintain a healthy or sufficient system for everybody to get enough rest and share a fair share of workload.
That's one thing.
And then there's also the regional differences.
And this one is particularly curious to me when I first heard about it, because we naturally think, or rather assume, that in eastern China, with the better economic development and more top-tier hospitals and specialties, along with the huge numbers of patients traveling from all across the country for better treatment,
It seems like the Eastern Chinese hospital staff and professionals would have the higher burnout rates, but the real deal is, according to the study, is that a very different story is painted here.
Doctors in Western China actually report the higher overall burnout rate and emotional exhaustion.
So we see...
There are differences in terms of assumption for burnout rate among doctors.
Is that because fewer hospitals there?
Yeah, that's something mentioned in the study too, that there are fewer, tend to have fewer hospitals and advanced equipment and a shortage of medical staff locally.
So that explains why.
Okay.
And besides that, I think earlier this year we've had a little trend of people sharing their well, foreign people sharing their experience coming to China and seeing doctors, because it's quite efficient and they find the experience very smooth and also it does not cost a lot was the reason that many of those people are sharing their experience on social media platforms with short videos and everything.
But it also showed that that is the kind of medical environment we're having here, that is, we're accustomed to going to a hospital, get a registration number and after maybe several hours at most, you would be able to see a doctor.
But that is definitely painting also a picture of the workload that doctors are looking at.
Oh, and the workload is not just seeing a patient, right?
Yeah, it's like a teacher's job isn't just to stand in front of the students.
A lot of what the teacher does is also in the office doing paperwork, grading exams and things like that.
It's the same for doctors.
EHRs.
EHRs are electronic health records.
You know when you go to the doctor, and I don't know if you've felt this before I understood this whole thing about EHRs.
I kind of felt when I went to a doctor, why are you just staring at the computer the whole time?
Why are you just clicking in the computer?
Look at me.
Talk to me.
But what they're doing is your electronic health record.
And that's your medical history, that's your demographic, that's your surgical history, that's your medication lists that you've had.
This is the work part.
This is the clinical documentation of who you are as a patient.
There's billing and coding and all of the paperwork that needs to be done as well.
A lot of doctors And again from that American site that I was looking at, a lot of doctors don't have the time in the day to complete all the EHR work, all the paperwork.
So they'll take it home with them at night and even do it on the weekend.
Sometimes they call it death by by a thousand clicks.
Because they're just constantly clicking.
And even something as simple as a simple prescription.
It requires a lot of clicking a mouse clicking on the computer for this EHR purpose.
And it's exhausting.
So not only do they have to see the patients, not only do they have to have wonderful bedside manner meaning being pleasant with the patients, being caring with the patients but they have all this extra paperwork to do too.
And besides that, in this day and age we see artificial intelligence playing a part in the medical system in a way that they're helping doctors, giving them new clues how to diagnose a patient, but they're also giving them pressure.
And a lot of doctors are learning how to coexist with AI, how to learn from AI, how to make sure that they outplay AI.
They are doing a better job with the help of AI.
And that is also study.
And this is only the latest form of continue to educate themselves.
Because for doctors generations of doctors they've been doing this their entire career.
They would always want to update their knowledge so that they can provide patients with the latest and the best service that they can.
Yeah, speaking of possible solutions.
Now we are, as we speak, going through this year's annual two sessions, which is the political um framework that's building for the coming year and during which time a lot of npc deputies and cc, cppcc members they are proposing things that that can actually push up the update of the political side, which later will come into the implementation in in our society.
So I'm going to give you an example on the AI part, because this one is really interesting that using tech to tackle the heavy workload has caught attention in previous two sessions.
Indeed,
So this one comes from Liu Lansheng, who was who is then a CPPCC member back in 2022 to 2023.
And this person proposed that one effective tech driven solution to reduce physician burnout is to expand the use of artificial intelligence in clinical practice, like how we see nowadays, like how it's been practiced in 2025 and got on roundtable as topics for multiple times how AI is helping with medical clinical practices.
So what he?
What this person proposed back then was to integrating large medical AI models into hospitals that can be later built into unified multi-source medical database that support data-driven diagnoses and treatment decisions.
And again, we see that being used in clinical trials too.
And that proposal has also been recognized as one of the proposals of the year 2023 by the CPPCC.
So Yes, there are many ways to really relieve these doctors from burnout, or helping them in the case of how they practice during their work.
And AI is definitely one of the solutions.
Yes.
And Steve already mentioned that you have to work with the patient's history and record and everything so that the next doctor would know what to do with this patient.
So that one is avoidable almost.
But there are things that doctors also do in a way to learn from each other, having meetings and consults and having different types of paperwork for sure.
So there's...
Well, multiple hospitals in Jiangsu province they, from a municipal level have wrote out policies making sure that they want all hospitals to streamline the paperwork that doctors would need to take care of, and it was streamlined by one-third.
So it's quite a significant number.
It reduces the paperwork dealing with kind of time the doctor need to spend in their work days.
And that would also be a good solution, approved effective solution already we're looking at.
Yeah, cut down on the paperwork.
Another suggestion is is to improve the early warning and prevention mechanisms that hospitals have in place.
And what that means.
It means establishing a system where the doctors are kind of monitored in a way that would allow for early detection and also intervention of any types of emotional or mental health issues that they might be experiencing.
And that would mean having a regular health management of medical staff and also have better training or regular training of managers to enhance their ability to identify certain stresses in a doctor and create a support team atmosphere.
Really, really, really important.
And they're doing that in the United States as well.
They established a national campaign to help states individual states enact confidentiality laws that would protect doctors seeking help for wellness or burnout or fatigue, and it would also remove inappropriate stigmatism questions on physician licensure or renewal applications.
So that's an important thing, because doctors might fear, if I go to a therapist and to get help because I'm suffering from burnout or emotional stress or things like this, that information might become public and this might have an influence on my career in the future.
That's why they talked about privacy being so important for those types of situations.
Yes, and there is something called a BLINT group.
A BLINT group typically consists of six to 12 doctors or other health professionals who meet regularly to discuss real clinical cases and focusing not on diagnosis and treatment plans but on the feelings and interactions within the doctor-patient relationship.
And we would always like to assume that doctors are they can do anything.
They can save our lives.
They're the smartest among us.
Yes.
And they know what to do.
But the fact is yes, they know what to do medically, but they not always know what to do with their own emotions.
From one side, it's impossible to depersonalize on purpose.
You have empathy.
You want to talk to the patients.
You want to save them.
But at the same time it's also quite stressful and it's quite exhausting because you're seeing so many patients all the time.
And we also even have studies suggesting that if the doctor shows a bit more empathy to a patient, it's also beneficial to the doctor themselves.
It can be quite helpful for the doctor to prevent themselves from falling into the burnout situation as well.
And that is why having this kind of blend group in different hospitals, for example here in China, in Fudan University's Zhongshan Hospital, in Shanghai Jiao Tong University Hospital, as well as many hospitals here in Beijing and they have this kind of system and medical schools and departments also would increasingly include the blind group as optional models in residency, general practice or all these different departments, so that their doctors can benefit from getting together and getting the peer supports that they deserve.
Well, that's the thing is support, right?
Remember, going back to that point, this is systemic.
It's the system that That's causing the burnout amongst these doctors.
So peer support, institutional support, all absolutely necessary.
So now I want to talk about the difference, or the similarities perhaps, between public and private hospitals.
What would you assume?
I found a study that looked at whether the stress levels were similar or different between doctors in private institutions and public institutions.
Now, I will say this result is one result, and it's from Malaysia, and it's from 2018.
But if we use this result as a cross-section of society as a whole, I think we can learn something here.
What do you think would be the result there, public versus private institution doctors?
Higher rate in public hospitals and lower in private ones.
That was my assumption as well.
But that is not what they found.
This is from Science Direct, by the way, if you want to look it up.
This is from Malaysia from 2018.
So what they did was exactly that.
They wanted to know if the stress levels were similar or different.
And what they found was that the levels between physicians in public and private hospitals were actually very similar.
Physicians in private hospitals experienced a higher stress level related to patient care responsibilities and professional uncertainty, when compared to those in public hospitals.
Now, upon hearing that, I thought okay, I get the professional uncertainty because you're working in a private institution, right?
So what's going to happen you know, to your career as a doctor, oh, I'm a little worried about that.
So I understand that level of stress.
But what I didn't understand was the patient care side of things.
Higher stress levels for patient care in private institutions.
And the reason, they say, is that when a doctor in a public institution takes care of a patient Well, it's more about the patient being a part of the system, if you will.
The relationship between the doctor and the patient is primarily clinical.
And the patient goes to the hospital for care.
The doctor provides it within the constraints of the public system, if you will.
So the dynamic is more straightforward.
It's more like the doctor's, the expert.
You are the patient and together you work on finding the problem.
But in a private hospital, and this is why they say the stress levels are higher.
It's because the patient suddenly becomes a customer.
Yeah, there's higher expectations on their medical staff.
You nailed it.
Because now the patient has higher expectations for the doctor.
So that's one stress that the doctor has.
Oh my gosh, I really need to fix this person or they're going to be upset because they're paying me directly for almost everything for this service.
And so therefore, the expectations are higher.
And that's one of the reasons that they feel stressed.
The other reason connected to that, legal recourse.
If something happens to go wrong.
According to this Malaysian study, the possibility of legal recourse from a private patient versus a public patient is much, much higher.
So doctors tend to be more stressed about that as well.
But, that being said, I think it also has something to do with the personality of the doctor, of what they focus on the most.
For example, the reason that some doctors transfer from public hospitals to private hospitals is not because they want a lower work or lighter workload.
It's because they want to focus a bit or spend a bit more of their time doing studies, doing research and researching for some new technique and some new method.
And some would be because they want to relocate to a different place.
And there are so many different reasons.
And here in China we see the supporting and encouraging of establishing different types of private hospitals and even we are looking at possibilities of having entire overseas funded private hospitals in the country, at least in certain parts of the country.
And all these what I think they are different tries to almost to also make the entire healthcare system a bit more complete that can address more demand from more patients in different places with different background situation and with definitely different disease.
And we also see different members and also political advisors saying that they have a lot of ideas trying to address the issue of regional imbalance, trying to establish more, not private but regional, grassroots hospitals in remote areas.
Yeah, when we talked about that story about it was the Shanghai hospital, right, that brought the hospital onto the airplane food and university or yeah and and was flying to the west far western side of the country the challenge there is equity right it's if you're talking okay so let's talk about the ai sure so if you're implementing ai tools in hospitals in guangzhou or shanghai or beijing for you know the top medical institutions and these doctors can reduce their um workload by what was it you said 33 percent right by a third well can that also be true in the far western remote regions of the country where you don't have big hospitals you don't have large amounts of staff that's one issue and then If those types of things, if those types of benefits are available in top tier cities, but they're not available in other cities, well, then you're going to have an issue of doctors coming out of medical school.
Where do you think they want to work?
Where do you think they want to go?
Right?
This becomes an issue as well.
So creating a level playing field, a medical playing field all over the country.
I mean, it's a huge challenge, but it does help to solve the problem if you can achieve it.
And ideally, we believe that with the development of technology we would be able to solve the imbalance problem.
And with AI come in place more and more, maybe we can reduce the workload of technology, the medical industry or the medical care sector in the society.
But we also know that it takes a lot of effort in each and every hospital, in each and every department, in different places, different city, different county, different villages, to find out the solution that is right for them.
But the starting point would be noticing, realizing the problem, having it discussed, having a direction from the policy side and see how people adapt to their own situation and then find out the solution.
And no, it's not going to happen overnight, but it will be improved little by little.
Yeah.
And just remember, hopefully this is one thing we learned today, too.
The next time you go to see a doctor if you feel like oh, they're not really being that friendly to me today.
Yeah, impatient a little bit maybe.
Maybe if they're just staring at their screen and clicking away but not really looking at me.
Just
Remember, while all the things that they have to go through throughout the course of a day, you're not the only person that they see.
They see a lot of patients all day, every single day.
They're really tired.
They're really stressed.
So maybe give them a break a little bit.
Even if they only spend five minutes on you.
That five minutes, that decision of the five, well within the five minutes that they make it, takes decades of study, of experience, and it's worth it.
