Beginning in 1998, China launched sweeping reforms to the higher education system in which medical education was also substantively promoted to ensure that health professionals were trained more effectively and efficiently to produce a workforce of sufficient size, specialty mix, and skill to meet public needs. A Review in The Lancet themed issue on China reports mixed results of progress and highlights the urgent need for further reform.
The reform was urgently needed, explained Professor Yang Ke, author and Executive Vice President of Peking University Health Science Center, Beijing, China. "Before the reform, China had more doctors than nurses, and many nurses had only been educated to high school or secondary school level. Doctor density in urban areas was more than twice that in rural areas. And despite efforts to train very large numbers of medical graduates, many did not enter the health workforce and took jobs in industry or changed occupations, highlighting inefficiencies in the system."*
The ambitious education reforms have successfully merged training institutions into universities and greatly increased the enrolment of health professions. In 2012, China produced 500 000 health professional graduates from 590 institutions, including 29 000 nurses with bachelor degrees and 156 000 with diplomas to help correct the very low nurse-to-doctor ratios. Furthermore, new policies offering incentives for doctors to work in rural areas were launched in 2010, and more recently, a target to train 300 000 general practitioners (GPs) by 2020 was announced.
There is more to be done, say the authors. "Some educational reforms appear to be on the mark - more nurses, GPs, and rural doctors, but other needed reforms have yet to begin. Infrastructure, public funding, and faculty size have not kept pace with rapid student expansion, raising concerns about the impact on academic quality. Worryingly, since 1998 there have been insufficient curriculum changes. Biomedical sciences and clinical practice continue to dominate the curriculum to the detriment of content that would enhance patient care (eg, humanities, social sciences, communication skills, ethics, public health, and patient exposure)."*
Worse still, they say, "Poor health-care system conditions including underpaid and overworked doctors with only brief time for patients; poor communications between doctors and patients; and a lack of patient trust in profit-driven doctors ordering of tests and drugs, are fuelling an escalating crisis of violent attacks against medical workers and medical disputes. Medical disputes have increased by about 23% every year since 2002, and medical violence has tripled in 8 years, from around 5000 incidents in 2002, to over 17 200 in 2010."*