Feng Qing, Vice President of a hospital in Yutian Township of Changle in southeast China's Fujian Province, sees patients on February 29. Feng sees as many as 250 patients a day and is often overworked (XINHUA)

Beijinger Lu Xing went to a renowned public hospital before daybreak one day in March in the hopes of securing a registration ticket for his 1-year-old son, who had come down with a cough the night before.

But when Lu arrived, he found a long queue that had already formed. Patients showed up in the early hours to ensure they see a doctor that day.

Luckily, he scored the last appointment with a specialist. But his son wasn't able to see the doctor until hours later, past 10 a.m. "With so many sick children waiting, why aren't there more doctors for such a large hospital?" Lu complained.

The shortfall in doctors 

Lu isn't alone in his frustration. China is facing a severe shortage of pediatricians. The number of licensed pediatricians has declined from 105,000 to 100,000 over the past five years. China has just 0.43 pediatricians for every 1,000 children, far lower than the international standard of one for every 1,000. Currently, there are around 220 million children below the age of 14 in China, accounting for 20 percent of the population. But the country has only 99 children's hospitals, or 0.01 percent of all medical institutions.

The pediatrician shortage is not a new phenomenon. Over the past 15 years, only 5,000 pediatricians have entered the labor market, while the country has a shortfall of 200,000. To make things worse, 11 percent of these practitioners have left the field and taken up other professions.

Many cities don't have children's hospitals and most county-level hospitals don't have a separate pediatrics department, according to Qian Yuan, a researcher with the Capital Institute of Pediatrics. This lack of infrastructure has exacerbated the overcrowding in hospitals in larger cities, leading to further difficulties in securing doctors' appointments.

The problem is only expected to get worse now that China has reformed its family planning policy to allow each family to have two children.

Unfavorable reward 

The shortage affects more than just patients lining up to get their children treated. Doctors are overloaded with patients, underpaid and work in a consistently stressful environment.

"Pediatricians have to work under great pressure. With so many appointments each day, we often don't even have time to eat," said Gong Chunxiu, Director of the Internal Secretion, Heredity and Metabolism Center at Beijing Children's Hospital.

Gong treats patients for more than 10 hours on Mondays and Wednesdays, in addition to checking on patients in different wards of the hospital, teaching classes and performing administrative duties, such as academic meetings and exchanges.

Liu Xiaoyan, a doctor in the Dermatology Department at Beijing Children's Hospital, came out of retirement to help with the patient overflow. Every time she is in the office, there are at least 100 patients from across the country waiting outside. The five other doctors in her department see more than 1,000 patients a day on average.

Last year, the 300 doctors at the Capital Institute of Pediatrics treated close to 2.2 million patients, while Beijing Children's Hospital treated about 3.2 million.

In addition to a tight work schedule, pediatricians also face greater pressure as they are treating children who are looked after not only by their parents, but also by up to four grandparents. Parents or grandparents who accompany the children pay intense attention to the doctors as they make diagnoses. But children are difficult patients, who are unable to describe their ailments or aid the doctors in diagnosing them. Parents quickly lose their patience in the process, with some pediatricians claiming they have even been assaulted by parents wanting faster treatment.

"Many parents wouldn't understand if we asked a crying child to play outside for a while to calm down before they come back," said Wang Bin, Director of the Pediatrics Department at the Guangzhou-based Zhujiang Hospital.

Pan Weiwei, a pediatrician at the Peking University Third Hospital, who is also a father to a 3-year-old boy, said, "I can understand parents' anxiety when their children are sick. However, pediatricians face greater risks as children's diseases develop rapidly and accidents can happen if the doctor lacks experience or fails to carefully observe the patient."

Further contributing to the shortage in pediatricians is the lower wages the doctors receive. Indeed, among all physicians, pediatricians earn the lowest salary, said researcher Qian Yuan. Many medical students therefore choose other specialties, even if they would prefer to go into pediatrics.

Pediatricians work 1.68 times that of other physicians at just 46 percent of a normal physician's pay, according to a survey from the Chinese Pediatric Society of the Chinese Medical Association. The average monthly income of pediatricians in Beijing, Shanghai and Guangdong Province is 7,317 yuan ($1,124), 8,907 yuan ($1,368) and 6,893 yuan ($1,059), respectively, according to Healthr.com, an HR portal site for pharmaceutical companies.

"I think the value of pediatricians' work has failed to be recognized," said Shu Xiaomei, President of the Guizhou Provincial Children's Hospital. A ticket for an appointment with Shu, a senior pediatrician with 32 years' work experience, costs just 6.5 yuan ($1), despite the fact that she has to spend 20 to 30 minutes with a patient with complicated conditions to diagnose them.

One factor contributing to pediatricians' lower salary levels is that their department generally makes money less than other specialties. Children's diseases are often simple and easy to diagnose, and thus require fewer examination times and dosages than adults. China's medical system heavily relies on medicine sales and physical checkups to make a profit. Most hospitals give bonuses based on a department's revenue, leaving pediatricians at the bottom of the list.

"The key to solving the shortage of pediatricians is to improve their income by reforming their payment system to make it more dependent on the intensity and difficulty of their work," said Chen Xin, Vice President of Nanjing First Hospital.

He's not alone in this opinion. Li Bin, Minister of the National Health and Family Planning Commission, said at a March press conference that the payment system for pediatricians should be properly adjusted to ensure that pediatricians make the same amount as their counterparts in other departments with the same amount of work experience. She promised to raise the price of pediatric services to reflect the value of the pediatricians' work.

 

Parents line up at 6 o'clock in the morning to get an appointment ticket for the treatment of their children at the Beijing Children's Hospital on February 6 (XINHUA)

Reforms underway 

Children's health conditions have improved remarkably in China in recent years thanks to the rapid development of the country's medical care system. The infant mortality rate declined to 8.9 per 1,000 births, and in 2014 the under-5 mortality rate declined to 11.7 per 1,000 children. The country fulfilled the United Nations Millennium Development Goals in 2007. However, pediatrics has not been given its due importance.

Nine hospitals affiliated with the Shanghai-based Fudan University established a pediatrics association in April 2014 to promote the field's development. The Children's Hospital at Fudan University—one of the nine mentioned above—has offered help to develop the weaker pediatrics departments at the other eight hospitals.

But more needs to be done, and the evaluation system for pediatricians should also be reformed, said Xiong Sidong, President of Suzhou University. Public welfare should be prioritized over economic benefits in judging pediatricians' performance, and additional insurance should be introduced to guarantee the welfare of pediatricians and cover children's medical expenses.

The Central Government has recognized the need to further develop pediatrics, and Premier Li Keqiang vowed to step up the cultivation of pediatricians in this year's Government Work Report, delivered during the top political sessions in March.

A pediatrics system at the national, provincial, municipal and county levels will be built and more support will be given to children's hospitals and pediatrics departments at comprehensive hospitals.

This year, the Ministry of Education plans to restore the admission of pediatrics majors at universities. In 1999, the ministry reformed the subject structure in medical schools, and the pediatrics has been no longer an independent major but subordinated to clinical medicine, which is one of the primary reasons for the shortage of pediatricians today.

"By 2020, the number of pediatricians should exceed 140,000, and the number of pediatricians for every 1,000 children should surpass 0.6," said Jin Shengguo, Deputy Director of the Science and Technology Department at the Health and Family Planning Commission.

The problem won't get solved overnight, though. It takes at least eight years for a pediatrician to go through medical schooling and get the proper training, Xiong said.

Copyedited by Jordyn Dahl

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