By Joe Wojciechowski
NANJING, China — Just before dawn, a woman arrives at the hospital and takes a number. Although the sun has hardly begun to rise she is already late. Her number is 37 and now she will have to wait until noon to see a doctor. After waiting for over six hours she meets her doctor in an examination room packed with over 20 other patients and the appointment for which she has waited so long lasts all of 5 minutes. Such a situation is a symptom of the lack of qualified doctors and nurses across China and is a painful reality for patients at hospitals in major Chinese cities; and the effects of this shortage have further limited access to medical care during the COVID-19 outbreak for non-COVID patients.
Data collected from the World Bank Group’s statistics regarding “Physicians (per 1000 people)” and “Nurses and Midwives (per 1000 people)”. Metrics changed to number of individuals per practitioner
Data Source: The World Bank
Compared to most developed and semi-developed countries, China’s doctor and nurse shortage is severe. According to statistics compiled by the World Bank Group, for every 550 Chinese people there is one doctor, and for every 425 Chinese people there is one nurse. In comparison, Brazil, another developing country, similarly has one doctor for every 540 people. However, Brazil’s proportion of one nurse for every 135 people puts its healthcare situation in a much better position. This issue is compounded in high-tier hospitals in major cities, where rural Chinese residents travel to get better quality-care than their hometown medical-providers.
The situation has become increasingly complicated following the COVID-19 outbreak — according to triage guidelines, non-emergency patients without COVID-19 symptoms are expected to delay treatment or visit hospitals not designated for anti epidemic treatment. One survey of hospitals in Guangdong, Anhui, Hunan, Zhejiang, and Jiangxi Province found that over half were designated as coronavirus treatment centers, with 86% treating confirmed cases of COVID-19, making these guidelines difficult to comply with. As COVID-19 added pressure to an already stressed Chinese healthcare system, access to health services was extremely limited during the height of the outbreak in February and early March.
There are a variety of reasons for this scarcity. Perhaps the most critical reason is inadequate compensation for the heavy workload demanded of doctors. According to one survey carried out in 2018 regarding the working hours of doctors in China, the average doctor worked 50.5 hours per week, and 28.9 percent of those doctors surveyed reported working over 60 hours a week on average. At the same time, the China Labor Bulletin reports that nurses in China work on average 48 hours per week, and their employers often expect them to participate in events outside their normal working hours.
The long and arduous work schedules for doctors and nurses are exacerbated by accompanying low salaries. As hospitals in China try to cut costs, the deepest cuts are often felt in the doctors’ and nurses’ salaries. In third-tier hospitals in Beijing — those ranked as the highest quality — the average doctor’s yearly salary is 46,000 RMB, just 56.9 percent of the 2017 average Beijing salary of 80,800 RMB. A 2013 survey of doctors and nurses in China found 76 percent of respondents reporting they were unsatisfied with their wages. This lack of adequate compensation leads to regular corruption in hospitals. It is little wonder why a 2011 survey of Chinese doctors reported that 78% of those surveyed would tell their children to pursue a career outside the medical practice.
The lack of doctors and nurses has had a considerable effect on the quality of care Chinese hospitals can provide their patients. According to a 2018 New York Times article, because of the lack of nurses, specialist doctors often find themselves forced to handle basic aftercare procedures themselves, such as removing stitches and catheters. In the near future, Chinese demand for nurses will increase dramatically, as population demographics predict around 45 percent of the Chinese population in 2050 will be over 65 years old. In comparison, Florida, a state known for its yearly migration of geriatric residents, is predicted to have 25 percent of its total population over the age of 65 in 2050. If Chinese hospitals, policy makers, and educators don’t make every attempt to fix the problems affecting doctors and nurses today’s problem will become tomorrow’s crisis.