Monday, November 17, 2014

The Challenges of Practicing Pediatrics in China

Pediatrics Assistant Editor Lydia Furman, MD, shares her perspective on a forthcoming article from our December issue. The full version of the article is available now to subscribers here, and on December 1, 2014, an extract will be freely available to all.


Chinese flag. Public domain photo via Wikimedia Commons
More than a decade ago, Shugerman and colleagues examined determinants of satisfaction among pediatricians in the US (Shugerman et al Pediatr 2001). They compared general and subspecialty pediatricians and internists and family practitioners, and found that “despite lower incomes, general pediatricians reported the highest levels of satisfaction and the least job stress of all physician groups…” and “[Pediatricians] were least likely to endorse symptoms of burnout or job stress.”

This finding likely makes good sense to many of us, and more recent work underscores this finding, with more than half of pediatricians describing themselves as “very satisfied” with their careers (Schmidt et al Health Care Manag 2014). These studies did not, and we would not expect them to, ask about personal safety and violence on the job; the focus of surveys is on burnout, job satisfaction, aspects of daily life such as patient volume and acuity, and hours worked. In general, we do not expect to fear for our physical safety while serving as pediatricians, with limited exception perhaps for those serving in uniquely high-risk environments.

Our good fortune is precisely our blind spot. The courageous Pediatrics article by Xu and colleagues (doi: 10.1542/peds.2014-1377) about the extraordinary and frightening circumstances of pediatricians in mainland China is a showstopper.

Perhaps there are knowledgeable colleagues among us who have friends or family in China who are aware that it may be physically dangerous to practice pediatrics in mainland China, but this shocking (and I believe the word is appropriate) underbelly to medical practice is not widely appreciated. Xu et al. describe instances of physical violence directed against pediatricians, with an increasing rate of medical violence unchecked by the courts or the government.

As fewer medical school graduates choose pediatrics or apply for pediatric jobs in mainland China, the wait time for patient care and the number of patients the remaining pediatricians see has risen dramatically, with each practicing doctor responsible for 80-100 visits per day (even up to 150 per day). Most US pediatricians cannot imagine this workload, and would rapidly change jobs or negotiate for better pay and better hours, citing not just personal exhaustion but patient safety as mandating a change.

Chinese pediatricians do not have ability to increase their pay, and unlike physicians in other specialties, do not have the option to perform procedures or prescribe medications that will supplement their incomes to a tolerable level. Per Xu et al., pediatricians are fleeing their jobs and the job market, with no resolution in sight and no solutions in the pipeline to prevent, improve or change working conditions.

What is our role as fellow pediatricians? What is our government’s role? Do we have any options? Shouldn’t children in every corner of the globe have the same access to health care as in the US? Shouldn’t our colleagues in every corner of the globe have the opportunity to practice medicine in a safe working environment? This brief piece raises issues many of us did not even know needed to be confronted.

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