Summary of the Core Issues
This news article focuses on the problem of difficulty in accessing pediatric medical care, revealing three main underlying contradictions: a long-term shortage of pediatricians, an inability to retain them in their positions, and the inadequate implementation of a tiered healthcare system. Although the number of pediatricians has increased since the reinstatement of undergraduate programs in pediatrics in 2016, it is still far from meeting the overall demand for medical resources. Pediatricians face high workloads, low salaries, and frequent conflicts with patients, which drives many of them to consider leaving their jobs. Parents' lack of trust in community hospitals further exacerbates the pressure on pediatric departments, making it a common issue to seek medical care for children.
1. The Serious Shortage of Pediatricians: A Policy from 20 Years Ago
The shortage of pediatricians is not a recent phenomenon; it dates back to 1998 when the country abolished the pediatrics undergraduate program and merged it with clinical medicine. As a result, medical students must undergo additional training or pursue postgraduate studies to become pediatricians. The perception within medical schools that pediatrics is a challenging and low-paying specialty has contributed to this situation for nearly 20 years. In 2015, there were only 118,500 pediatricians in the country, compared to 228 million children aged 0-14, resulting in a ratio of one pediatrician for every 2,000 children. The introduction of the two-child policy in 2016 led to the reinstatement of pediatrics undergraduate programs and efforts to encourage doctors from other specialties to switch to pediatrics or for experienced pediatricians to return to the field. By 2021, the number of pediatricians had increased to 206,000, with a ratio of one pediatrician for every 780 children. However, this is still nearly four times lower than the national average of one pediatrician for every 1,000 children.
2. The Difficulty in Retaining Pediatricians
The challenges faced by pediatricians are numerous:
- Exhausting Workloads: In 2021, there were 504 million pediatric outpatient visits (second only to internal medicine), averaging 2,449 patients per doctor per year. Some studies suggest that Chinese pediatricians work over 50 hours per week, seeing 80-100 children a day, often without time to drink water or use the restroom.
- Low Salaries: In 2020, only 17.77% of pediatricians earned more than 10,000 yuan per month, which is considered a satisfactory income by most of them.
- Frequent Patient-Doctor Conflicts: Children cannot articulate their symptoms clearly, and parents can become emotionally overwhelmed. For example, parents may react violently when a doctor uses a tongue depressor to examine the throat. Some doctors even keep helmets in their drawers for fear of retaliation. A survey at a top-tier hospital in Guangdong found that 35% of pediatricians strongly considered leaving their jobs, making pediatrics one of the departments with the highest turnover rates.
3. The Promised Tiered Healthcare System: Why Do Parents Still Flock to Large Hospitals?
Despite the government's promotion of a tiered healthcare system, parents still prefer large hospitals for minor illnesses:
- Inconvenience of Community Hospitals: Some community pediatric clinics are only open for a few hours a week, and it can be difficult to find a doctor when a child is sick at midnight. Some clinics only serve children over the age of 6, and intravenous treatments require prior assessment of blood vessels.
- Lack of Trust in Community Hospitals: Parents doubt the diagnostic capabilities and equipment of community hospitals. For instance, a survey in Fuzhou showed that 68% of parents would choose provincial or municipal hospitals for their children's illnesses, and 73% believed community hospitals were not competent enough. One parent shared that a community doctor dismissed their child's high fever as nothing serious, while a hospital diagnosis confirmed pneumonia. Some community doctors also admit they are inexperienced and lack antiviral medications, prompting them to transfer patients if the condition does not improve after three days.
- Insufficient Equipment and Medications: Many community hospitals do not have specialized children's medications or imaging equipment, forcing parents to seek care at large hospitals.
4. The Current Situation: Doctors Are Overworked, Parents Are Desperate
During peak seasons (such as the flu season in winter or hand-foot-mouth disease in summer), pediatric departments resemble battlefields. Parents wait for hours without being called, standing in corridors with their children's intravenous bags, sometimes bringing their own folding beds to stay overnight.
Even outside of peak times, pediatricians are constantly busy. Some hospitals require doctors to arrive early and leave late, without lunch breaks, providing 24/7 care. Parents feel extreme frustration, while doctors face immense stress—dealing with a never-ending stream of patients while carefully avoiding complaints. At the end of the month, they question whether continuing in this job is worth it.
Conclusion
The difficulty in accessing pediatric medical care creates a vicious cycle: policies lead to a shortage of doctors, poor working conditions that prevent them from staying, which in turn leads to parents' distrust of community hospitals, further increasing the burden on large hospitals and exacerbating the shortage. To address this issue, it is necessary to increase the number of pediatricians, improve their salaries and working conditions, and enhance the capabilities of community hospitals to handle minor illnesses. Otherwise, the "pediatric crisis" will continue.