In a system where the sale of products and services, primarily pharmaceuticals and high-tech diagnostics, are the most important
sources of revenue, physicians are paid low salaries and generate low fees. Physicians are employed by hospitals, which are
still government-owned. As government employees, their compensation has not kept up with economic growth and, in fact, falls
far below that of most other professions. A young doctor with five to six years of experience in a big city, for example,
draws a monthly salary of about $400 US. This is far above China's per capita income of about $1,200 per year, but represents
only a fraction of what many of their university-educated peers are earning in the new private sector. In a city like Shanghai,
doctors earn less than the mean income. As a result, many young doctors have left clinical practice to pursue other professions,
and some medical schools report difficulties attracting students. To maintain their living standards, doctors in China rely
on supplementary income from various sources, including pharmaceutical companies, which provide consulting fees and pay for
travel and expenses to attend meetings.
There are about 1.5 million licensed doctors in China. Only about one in 11 practices traditional Chinese medicine (TCM),
which is based primarily on the use of natural therapeutic compounds, often derived from herbs, and on non-invasive interventions,
such as acupuncture. The rest of China's physicians practice Western medicine. Internal medicine is the largest specialty,
representing 20 percent of all doctors, followed by surgery (13 percent), obstetrics and gynecology (nine percent) and preventive
medicine (nine percent). The general practitioner is a relative rarity (3.5 percent). About four in 10 doctors are women.
Doctors in China are a relatively young group, in part because their training period is short compared to doctors in Western
countries. More than 70 percent of them are younger than 45 years old—the age of people who turned 18 when economic reform
began in 1978—and close to five percent are 25 years old or younger. Two out of three doctors work in hospitals. The rest
are spread among community clinics, public health clinics, and specialty clinics, including women's health, pediatrics, infectious
disease, and emergency. Private practice is virtually nonexistent.
Xin Gan, MB
Currently, training varies greatly depending on geography and institution. Students are admitted into medical schools straight
out of high school. After five years, young doctors graduate with a bachelor of medicine (MB) degree. Many graduates proceed
directly to clinical practice, although in big cities, a one-year internship at a hospital is more typical. There is no formal
residency training or certification of specialists. A small number of graduates with the MB degree pursue further education
or research. About one in forty receives a master's degree, while fewer than one in 100 earn a doctorate in medicine. Around
500,000 doctors—one in three—do not have university degrees. They enter the medical profession by going to trade schools following
the completion of junior high school. These less educated doctors are seldom found in the highest-ranking urban hospitals,
known as Category III hospitals. Most of them practice in smaller communities.
The government has undertaken a long-term initiative to standardize the training and credentialing of doctors. This initiative
focuses on postgraduate residency training and mandates a three-year residency program for 17 specialties, plus additional
training for another 17 subspecialties, as well as lifelong continuing medical education (CME). The Chinese Medical Doctors
Association (CMDA) recently developed a comprehensive blueprint detailing training objectives, facility requirements, curriculum,
and assessment. Many teaching hospitals are already following these guidelines. This new initiative, a cornerstone of the
evolving healthcare system in China, has strategic implications for pharmaceutical companies. For example, there may be opportunities
for companies to partner with these training programs on a national or local level. In addition, pharma could support CME,
which is gaining importance with new focus on lifelong learning.