Parents gather in the outpatient hall of Nanjing Children's Hospital in Jiangsu province to register their children in July 2014.（Photo: China Daily/Wang Zhuangfei)
The stressful, and sometimes dangerous, working conditions, scant salaries and low social status endured by children's doctors in China has resulted in a lack of qualified practitioners
Zhang Fan, a sophomore at a medical school in Wenzhou, Zhejiang province in East China, is considering which department to choose when he graduates.
"Many teachers and classmates have urged me not to choose obstetrics and gynecology because of the great pressure of work, but no one has suggested that I should not choose pediatrics or emergency treatment because they have already been ruled out of the list of options. Most medical students don't even consider them.
"I will probably choose ophthalmology or cardiology. In China, we say 'Ophthalmology is gold, the surgical department is silver, and pediatrics is rubbish'. Some of my classmates have pointed out that pediatricians only earn half the average salary of other specialist doctors," he said.
The shortage of pediatricians, highlighted by the closure of a number of children's hospitals in recent years, is now attracting attention nationwide.
According to the 2015 China Health Statistics Yearbook, the number of pediatricians has fallen from about 105,000 to 100,000 in the past five years, and on average, there are only 43 pediatricians for every 100,000 children.
Since December, pediatrics departments at a number of hospitals in Guangdong province have stopped accepting patients, or have ceased to provide services at night.
Meanwhile, pediatricians in some hospitals－such as the Lingnan branch of No 3 Hospital Affiliated with Sun Yat-sen University, the Guangzhou Integrative Medicine Hospital and the Second Affiliated Hospital of Guangzhou Medical University－will only treat urgent cases.
Shan Yutao, director of the medical management department at the Lingnan branch of the No 3 hospital, said that since 2012, the number of pediatricians has been so low the hospital can barely meet the demand for services. Four of the eight pediatricians recruited by the hospital in 2011 have quit, and others are considering leaving soon.
"In 2012, the hospital treated 51,000 patients. In 2014, the number exceeded 63,000, and last year patient numbers rose by 12 percent. Every day, each pediatrician treats more than 100 children. Some pediatricians in the emergency department have to work 24-hour shifts, so it's understandable that some of them choose to leave," he said.
By 9 am every day, the pediatrics department at Xinhua Hospital in Shanghai has registered about 200 patients, who then wait to consult pediatricians.
Long hours, low pay
Huang Songming, director of Nanjing Children's Hospital in Jiangsu province, said he learned from news reports that working hours for pediatricians in China are 1.48 times longer than the average working day for other physicians, but they earn just 46 percent of the average salary for doctors.
"Under such circumstances, how will medical students be attracted to pediatrics? How can you stop pediatricians from quitting?" Huang asked, adding that many pediatric nurses have also quit their jobs or have asked to be transferred to other departments.
Nanjing Children's Hospital receives more than 5,000 patients a day, more than twice the number expected when it was founded in 1953.
According to the Nanjing Health Bureau, 1.02 million children were living in the city last year, but there were fewer than 1,000 pediatricians to treat them.
According to the Guangdong Health and Family Planning Commission, only 8,200 registered pediatricians work in the province, which is home to 21 major cities.
"Pediatricians are some of the worst-paid doctors in China," said Wang Yu, a pediatrician at Huai'an Maternity and Child Healthcare Hospital in Jiangsu. "It's very cheap to consult doctors in China. It usually costs about 10 yuan ($1.50) to consult a physician and 30 yuan to see a senior attending physician.
"Chinese hospitals usually generate income by selling medicines and providing medical checkups. Children's medicines are administered according to the child's weight, so fewer medicines are sold. On average, the dose administered to one adult would be sufficient to treat 10 to 15 children. Also, compared with other medical departments, pediatrics departments conduct fewer examinations and charge lower fees," she said.
The demanding working environment has also contributed to the shortage of pediatricians, according to Wang. "When you treat a child in China, you are usually dealing with a whole family. Many parents and grandparents pay too much attention to the family's only child. They easily become extremely emotional and show no patience in the hospital."
She said doctors often joke that pediatrics and psychiatry top the list of the worst working environments in China's hospitals.
"In my hospital, we hear from time to time that pediatricians and nurses have been confronted by parents, or have even been punched or slapped. Also, younger children are unable to describe their symptoms clearly and many pediatric diseases develop rapidly－that can be dangerous both for the children and the doctors treating them," the 40-year-old said.
