Discussion keeps the world's turning.
This is Roundtable. Hello everybody, welcome to Roundtable.
Coming to you live from Beijing.
I'm Ha Young and good as always to have you with us on a day's show.
Chinese Doctors Day, also known as Medical Workers Day, falls on August the 19th.
From the significant strides in increasing the number of healthcare workers to the ongoing struggle with excessive workloads and insufficient compensation, how can we as a society better protect and support our doctors?
And we're on a mission of starting to grow weak with a motivational kick.
Our motivational Monday offerings will get you ready to tackle the week.
For today's program, I'm joined by Yushan and Steve Hatharly in the studio.
First Saturday's show.
With the 7th Chinese Doctors Day upon us, it's an ideal moment to celebrate the unwavering dedication of our medical professionals and reflect on the state of our healthcare system.
As we honor the invaluable contributions of doctors, let's also explore ways to enhance the training and welfare of these essential workers, ensuring a brighter future for both them and the patients they serve.
So Yushan, this is one for you first.
What is the significance of Chinese Doctors Day as you see it?
And so we can see these debilishment of doctors day is primarily to commend the dedication of physicians.
It allows society to more widely recognize their work and provide them with the respect and support they deserve.
So on one hand, it can enhance doctors' sense of professional honor and mission, encouraging them to better serve or meet the patients on the other hand.
It is hope that this can help foster understanding and trust between doctors and patients promoting a harmonious doctor-patient relationship.
Doctors we need to be more appreciative, don't we?
We don't think about doctors on a daily basis or healthcare workers in general.
Everyone who's out there to give us the help when we need it.
But when we do need them, when we need to go to the hospital, oh boy, are we appreciative then?
So today is an important day here in the country Medical Workers Day.
They have it in other countries as well.
I mean Australia, it's on March 30th in Brazil on October 18th.
My country, Canada, is on May 1st, Cuba, December 3rd, India, July 1st.
There's a long list there.
But it is today, isn't it?
Here in China. The history, it goes back a little bit.
There was a report from China daily in November of 2017 that the state council, China's Cabinet approved August 19th, being designated as China's doctors day, or as we've mentioned a couple of time, Medical Workers Day.
The first one was back in 2018.
That was the first time that they observed it.
And then we're observing it for the, I believe you said, seventh time again today.
It is. If the last few years have given us any reference, I suppose, for a lot of us, maybe we have this newfound appreciation of Medical Workers and all the great work they do because when it's a public health crisis, and then it's these folks who have to sort of rise against the tide when it's a very difficult situation for everybody.
Yeah, I think COVID in many countries around the world really magnified the importance of frontline healthcare workers here in China and the United States and Canada and England friends, wherever, wherever you're talking about that really put them under the magnifying glass.
And it reminded us how important they are to our societies.
So yes, seventh China, China's doctors day to day.
And the theme is upholding, quote, upholding the humanistic spirit and demonstrating the compassion of doctors as well.
Do you want to dive into some of the statistics to see where we are?
Yes, please. What is the current status of the doctor to patient ratio in China?
Yeah. So we can see according to a report of China youth daily, as of the end of 2023, the total number of physicians in our country had reached 4.78 million, which is an increase of more than 300,000 compared to 2022.
And according to 222 CGT and report Leo Dongfeng, supervisor of Department of Science and Education in China's National Health Commission said, by the end of 2021, the number of doctors in China had reached 4.2 million and the number of doctors per 1000 people, which means the number, the medical resources that citizens can get had reached 3.04 close to the level
of developed countries.
And we can see some comparisons, right?
Physicians in United States was reported at 3.555 in 2020.
That's according to the World Bank collection of development indicators.
Canada was in 2021 was 2.77 per 1000.
So China falls right in between the middle.
Almost exactly between the middle of those two countries.
So we can see, you know, still there are improvement.
And we can see there is still a space to improve.
So such a day can also raise the societal awareness of the importance of medical education and also encourage more talented individuals to pursue careers in medicine.
Really important that young people pursue a career in healthcare.
I was reading a report that was published by the World Health Organization in September of 2022.
And the highlight of that report was about the number of aging healthcare workers and they called it a ticking time bomb as a matter of fact in the EU.
The countries that they looked at, they looked at 44 different countries.
And in 13 of those 44 countries included in the report, more than 40% of the doctors were over the age of 55.
And that if you look into the future poses a real threat to the sustainability of the workforce.
So having young people pursuing healthcare careers is more important than we may realize.
Right. And those are figures from the EU.
Right. Oh, interesting.
It's good to have these international numbers at hand to compare and to get a better picture of how this profession of professionals are faring across the world.
And it could be pretty challenging situations that they're facing.
So to ensure the well-being of our doctors, what specific measures and laws have been enacted to protect their welfare and improve their working conditions.
And this inevitably will need us to look at some of the, I guess, the problems that they're facing.
Yeah, absolutely. You can see a lot of doctors and nurses, they are actually complaining about the whole process of their work.
I mean, of course, they are doing the job that is saving people.
And also, aside from that, a lot of some research and other jobs that they also need to complete.
So some of these doctors are saying they may need fewer meeting and paperwork and leave doctors energy to treat patients, actually.
Yeah, a little less on the logistical side, the paperwork side of the job and a little bit more on the time with patients, right?
They work a lot. I mean, according to Guangzhou based news media group called YCWB.com, they put out a report that said 41.68% of medical staff work more than 10 hours a day.
That's a long day, but 15.03% of medical workers work even more than 12 hours a day.
They reported high pressure at work.
60% reported that 60% also said that they experienced stress-related insomnia.
So they're so stressed because of their jobs, they can't sleep properly at night.
And obviously, that's not good for the doctors, but if it's not good for the doctors or the health care workers, well, it's definitely not good for the patients either, right?
Yeah. And also, you touch upon something that is sort of of the nature of the profession of doctors that is a lot of them need to take night shifts.
And work over time. Yeah.
And that as well, because if you've been to Chinese hospitals, especially the tertiary hospitals, the top tier ones that attract so much foot traffic, then sometimes doctors don't even have time to have lunch just so that they can see all these patients lined up outside of the diagnosis room.
So this is definitely worth our attention, despite the fact of not being necessarily a new issue, but it seems like the workload is simply not reducing.
And given the fact that there is this rising demand of health care in the country, and this is really a tough issue to solve.
So some experts are proposing that we need to set the limit time for the highest work over time hours a year.
I mean, of course, a better scheduling system may be necessary, and there are likely many other underlying issues such as the number of doctors and adjustments to the overall operational system.
So there are many efforts to put when we are trying to actually improve the whole wear fare of medical staff.
Yeah, optimizing their work schedules to make sure that they can be at 100% when they are doing their jobs, strengthening their training, improving the medical service process, incentivism for the doctors as well to be put in place.
All of these things are what experts say should happen to help the doctors and help the health care workers do their jobs effectively.
Right. Another thing that I like to check with you guys that has been highlighted in a lot of these reports this year that is doctors are talking about the excessive work load.
And it also comes from scientific research activities and continuing education just so that they could keep up with the latest advancements and also to progress in their career.
They feel compelled to on top of all the other things we've mentioned to work on this, the scientific research and getting published and all those things as well.
And do you see that to come in conflict with what the doctors really doing?
You know, it feels like not only in medical area, in a lot of areas, if you are trying to, let's say, you know, improve the title of your job.
Maybe there is gotta be some requirements.
You know, and one of these can be a maybe research paper and you need to do some research in this field or maybe you need to achieve something in this field so that you can get a better title.
And the point is that how much time they should put effort in because we know they are not only doing research.
They're also seeing patients.
So the issue is we need to figure out that are they actually the one that is going to be, you know, taking care of the patients also, you know, putting so much time in making a research paper.
We talk about work life balance all the time, but for doctors, it's work research balance, isn't it?
But in terms of training, I think it's a good thing for the patients and I think it's a good thing for the doctors as well.
There's always advancements in the medical field, right?
New medical equipment is coming out.
And of course, doctors would want to keep on top of the newest medical advancements available to them and available for their patients.
I think that just kind of comes with the job, that's my non-educated opinion.
I'm not a doctor myself, obviously.
But in terms of research papers, I see your point.
Yeah, how much how are you supposed to divide your time?
It's they're already super busy.
And to put that on top almost seems unfair, doesn't it?
Yeah. And those who come on top as the cream of the crop doctors, they're the ones that manage to balance all these different things that they need to do.
And also being able to publish, to see patients, to sometimes even if you work in a teaching hospital, then teaching medical students as well.
And then you need to be really smart and good at time management to do this.
And that just makes me feel as an amateur outsider that these guys deserve top pay.
Yeah, and just think about the amount of work that is required.
And the amount of work and the amount of study.
Yes. Right. The amount of time that it actually takes to become a licensed physician in America, in Canada.
I think it's pretty standard for a four year undergraduate degree, then four years of medical school, then two years of residency where you basically live at the hospital.
And then that's 10 years in total before you can become a licensed physician.
Similar system here in China.
Yes, actually starting in 2014, it is called standardized training system for resident physicians was implemented nationwide.
And as a result, residency training has become a mandatory path for medical students to become qualified clinical doctors.
And more specifically since 2014, medical students who have completed a five year undergraduate program must undergo three years of residency training.
So it's quite similar based on the time of their training time.
And doctors who undergo training are not necessarily employed only in large hospitals.
They may also working various community clinics and other settings.
Similar system then. Right.
But in China, actually you can start medical training, getting your degree right after high school.
So in the US, you have to wait until graduate school to get into medical school and become a doctor.
And here in China with this three years of standardized training program, that is some critical years necessary to in becoming fully flage to certified doctor in the future.
But we might need to talk a little bit about pay because as we've touched upon becoming a doctor requires so many years of training, which means you're not that 20 year old, 22 year old young person that in China, usually it's your family still supporting you in university.
But after that, and asking parents for allowance just so that you can stay alive and support your own studies, it becomes difficult.
So this also sort of goes to one of the main difficulties that in training future doctors are encountering.
So tell us about sort of the realities that they're going through.
Yes, actually the most notable issue with salaries or pay tax is faced by clinical medicine master students.
You know, during their three year graduate program while undergoing residency training, their income is quite different.
And as students, actually hospitals cannot sign labor contracts with them.
And in this way, they do not receive corresponding salary, but some subsidies in, you know, and that is the only income that they can get because, you know, we know that since 2014 as well, the central government has provided subsidies to regulated medical trainees and training bases at a rate of 30,000 yuan, which is about $4,200 US dollars per person per year.
Oh, per year. And 10,000 yuan is for this base or hospital.
So 20,000 yuan is for this specific trainee.
And according to this standard, the monthly salary is about 2,000 to 2,500 yuan per person.
But we can see that this is really not high.
That's really not high at all.
When you said 30,000 yuan, I thought maybe you were going to say per month.
No, that's per year. Oh, yeah.
Even 30, that, wow, that's pretty high salary for an average Chinese person, actually, per year.
Yeah, I mean, per month.
Per month, yeah. If that was the salary, then a lot of folks would be happy.
But let's say if you're a doctor, I mean, after all that work and training for you to get certified, I think maybe doctors will have a different opinion on whether or not that's sufficient or fun or not.
Of course. You know, different hospitals may have different standards for implementing subsidies.
They may offer trainees their own subsidies.
And some of them can earn over 10,000 yuan a month, while some may only get several hundred yuan a month.
That depends on different hospitals.
Yeah, I was looking at a report from the CBC, which is a Canadian news outlet.
And the issue of pay for doctors in Canada is an ongoing one as well.
The report from the CBC that I read was about focusing on one particular doctor in Ontario.
And that doctor explained it like this.
There's a report that they fill out when they see a patient.
It's called A007. And A007 report allows the doctor to get paid $37.95.
It comes out to about 198 yuan per patient.
But here's the deal. If the session with the patient takes five minutes or 25 minutes, the doctor doesn't get paid any more money.
Now here's the problem with that.
According to this doctor, doctors are then incentivized to see more patients during a day, because one patient equals $37.95.
So if they can limit the amount of time they have with one patient and see many more patients, that benefits the doctors financially.
But there are downsides to that.
According to the doctor, the biggest downside is she said, you lose your compassion for the patients because it's like a factory.
It's like a line of people that are coming in and you're just trying to get through them as quickly as possible without real proper medical care.
Which is what doctors are supposed to do.
So we have problems like this in Canada as well.
That is really interesting.
And when you look at Chinese hospitals, and I suppose with the reports that I've read so far, it seems like a lot of the attention still focuses on the biggest hospitals and doctors who work there probably get a little bit more medical attention.
And it is not news that basically these doctors' time and efforts have been maxed out.
So the primary goal for these doctors in these, the best hospitals in China, which attract so many people, is basically to see as many as they can.
And I'm not necessarily sure about whether this is tied to their pay or not.
But there's... There's just so many patients to take care of, right?
So therefore for them, it's more like, well, you know, what kind of efficient care can you provide?
And then a lot of the times it seems like it's for patients they need to register.
And when they do see the doctor, maybe they've lined up for two hours and they get ten minutes with the doctor.
And on the patient side, it's almost like, I've waited so long and for some of the non-local patients they've traveled miles days maybe to see you and then you only get ten minutes.
So you're not. The patient is not satisfied.
But on the doctors and they've seen so many patients, they sometimes they think that, oh, this is just a small ailment.
It doesn't deserve more time.
And look at the ton of people waiting in the hallway.
Exactly. And it's easy to understand the doctor's point of view if we think about it like that.
But when you're the patient sitting in the waiting room and you're hurting and you're sick, then it's not easy to see that perspective.
You're only thinking about your own ailments at the time.
So when we look at both sides, it's easy to understand both sides.
And also this points to, I think, one part of the doctor's role that is really difficult in China.
That is, when you see the patient, the patient sees you, the doctor, as a representative of all the satisfaction and dissatisfaction of the medical care system.
However, that person has gone through it.
Yeah, they're the face of it in that particular moment.
And if they're happy, great.
If they're not, then that's when sometimes the doctors are bearing the brunt of the whole medical care system.
I was in university in Canada and I hurt my hand playing ice hockey.
So I had to go to the emergency room.
The emergency room was extremely busy.
I had an x-ray taken and then the doctor came back and the doctor said this, oh, we will have to be careful with the cast because of the screw in your thumb.
And I said, I don't have a screw in my thumb.
Long story short, the doctor made a mistake and looked at someone else's x-ray and was about to put a cast on my hand.
And you know what? I didn't get angry because it was a mistake that doctor had been working.
The doctor apologized and said, I'm sorry, I'm at the end of a 10 hour shift and I just I made a big mistake and it's my fault.
And I'm really sorry about it.
I didn't get angry. I didn't complain because I understand these people are exhausted and they work non-stop.
Right. And you should know, could you tell us what are some of the major issues that can be addressed to make the lives of doctors a little bit better?
Hmm. So, of course, first of all, we can see that undergoing, let's say, you know, residency training and also patient doctor relationship like these cannot be, you know, it is kind of an issue that worldwide.
And even in some developed Western countries where residency training system have been in place for over 100 years, there are still many areas that need to be improved.
And similarly, China's national residency training system also has room for improvement.
And you know, we can see experts suggest that there should be a balance of strict management and generous care with strong emphasis on medical ethics and humanistic values.
Yes, indeed. And on this doctor's day, we celebrate the dedication, expertise, and relentless commitment of China's medical professionals.
Your tireless efforts and ongoing pursuit of knowledge truly makes a difference in the lives of countless individuals.
Thank you all for all that you do to care for and improve the lives of other people.
