Recently Sixth Sense reported that Shanghai hospitals lack pediatricians, highlighting the dilemma from the physician’s perspective. In their article, we are told of all the reasons why young graduates avoid the pediatrics departments of public hospitals, or quit shortly after joining.  The main causes being: low salaries, overtime hours (to compensate for low salaries), the large daily influx of patients that causes doctors to have a tight schedule and short window for diagnosis, and the physical violence directed at pediatricians when their diagnosis is wrong or insufficient.

It would appear as if there are actually only two problems: 1) pediatricians in public hospitals feel they’re underpaid, and 2) Chinese families with only one child give pediatricians too much pressure. All the other problems are self-caused or stem from the hospital’s business model.

Pediatricians feel they need to work 10-12 hour shifts in order to make as much money as the doctors in other departments. The interviewee, Dr. Huiju Yu, counts how many patients she can see in a morning (36), taking no breaks as to squeeze in more because, as the article mentions, this hospital gives an extra monetary incentive per patient. Sixth Sense attributes this as a normal workload for a Chinese doctor (in a public hospital).  As a result, the doctors can’t afford to spend too much time on each patient and have to make a quick diagnosis for each child they see based on the limited knowledge they can gauge from the short visit and their experience.

Dr. Yu also states that her office has no chairs because families ask too many questions when given the opportunity to rest. She doesn’t care that those families probably trekked from the countryside, waited outside the hospital at the crack of dawn for a number, and then stood around waiting in endless lines, as is customary in public hospitals. Dissatisfied parents, grandparents, and relatives then attack pediatricians who fail to help their child, sometimes resorting to physical violence. This phenomenon is attributed to the ignorance of the parents rather than the negligence of the doctors.

2014 Study by Wei Xu and Shu-Cheng Zhang

What the article fails to mention is the fact that none of the statistics it lists are new. In fact, they all stem from a 2014 study on the malaise state of affairs for public hospital pediatricians, quoting a 200,000 deficit since 2012.  At the same time, the National Association of Pediatricians estimated that it would take five years to train 5,000 practicing pediatricians. Not only has the government been well-aware that the pediatrics department lacks takers, but it has also been common knowledge that many Chinese hospitals have had to shut down their pediatrics departments when they couldn’t find staff to run it.  In fact, according to a 2013 study, China only has 68 specialized children’s hospitals, where most are located in first or second tier cities.  Only sixty eight specialized hospitals catering to 20% of the population? It’s no wonder families flock to major cities for pediatric care, leading to long wait times, lines, and short visits.

In fact, according to Pediatric Society of the Chinese Medical Doctor Association (PS-CMDA), Beijing Children’s Hospital (BCH) can see up to 4,000 outpatient visits in a busy day.  BCH has about 40-50 pediatricians, and each can see about 80-100 patients a day, up to 150 patients in a day if necessary.  One has to wonder, does the problem only lay with the deficit, or with the structure of Chinese public hospitals in general.

Two-child Policy Baby Boom

As the government prepares to sell more baby gear and improve its labor force by introducing a two-child policy, it has made questionable moves to increase interest in pediatric training.  The Ministry of Education has closed all pediatrics departments at the undergraduate level, leaving the training for the graduate level.  Since interest for the department has dropped ever since, the solution has been to lower the threshold for pediatrics compared to other medical departments.  In practice, what this means is that less-than-stellar university students are applying for pediatrics, and the exam is open to any medical student who has failed the general, or other, medical exams.  What’s worse, whether they pass the pediatrics exam and obtain their licenses is based on the combined score of the two exams.   The only other medical department with such low standards is the emergency department (ER).

What all this data tells us is that China has had a deficit for a while, has made moves to reduce the deficit by encouraging students to choose pediatrics as a career (though questionably), and still has an ever-widening deficit.  Pediatricians are underpaid in a salary market where hospitals pay doctors based on the number of tests, equipment, and medication they can sell to patients and consultations start at RMB 10 per visit.

As 90 million women have become eligible for a second child this year, even as 60% will not choose to have one, certain provinces have made changes to accommodate the anticipated “baby boom”. Guangzhou has offered hospitals subsidies, begun building pediatric hospitals, and encouraged universities to train more pediatricians.  Dalian, provincial capital of Liaoning, will hire pediatricians from abroad and train at least 300 more pediatricians by 2019.  Now we’re just waiting for Beijing local government’s response to the existing deficit, lacking training, and upcoming baby boom.

Photo: Nazgul Abazbekova

On Thursday, March 24, Beijing People’s Congress revised its regulation on family planning and announced the following:

• Mothers are now entitled to a total of 128 days maternity leave—a 30 day increase from before.  Depending on the organization, the maternity leave can be further extended by one to three months.
• Existing mothers birthing their second child can have up to 218 days maternity leave (a 1-3 month extension) with their employer’s consent
• Fathers are entitled to a 15-day paternity leave
• Re-married couples with one child from each of their marriages are allowed to have another child (so three in total)
• Parents of a child with disabilities are now allowed to have a third child

Note: Municipalities differ in benefits offered, meaning these announcements only affect Beijingers (a Chinese citizen would have to be registered in Beijing).  Guangdong has 128 days of maternity leave, 15 days paternity leave.  Shanghai offers 128 days of maternity leave, 10 days paternity leave. Shandong offers 60 days of maternity leave. Shenzhen offers 10 days paternity leave.

The recently passed law was drafted only after having collected more than 4,100 suggestions from the public, and reflects the needs and desires of local residents.

If these announcements are baffling to you, let’s look at how China has improved its family planning policies in recent years:

• 2015 – China ended one-child policy (in place since 1979) with the introduction of a two-child policy
• 2013 – China announced a conditional two-child policy where if one parent is a single child, then a couple can have two children
• 2012 – National maternity leave extended from 90 to 98 days

If you’re expecting, or just curious of your benefits, you might be interested in knowing the details of your maternity leave benefits:

• You are entitled to it only after one (1) year of employment
• You can start your maternity leave 15 days prior to birth (no earlier)
• You can extend your maternity leave by at least 15 days (by law) if there are complications or if you’re birthing more than one child, in which case you are entitled to an additional 15 days per child born (triplets = 30 days extra)
• Your  128-day maternity leave does not exclude weekends, federal or national holidays
• If you are registered with the Social Security Bureau (SSB), then instead of a salary, you would be paid a maternity allowance, and would be an average of either your salary from the past 12 months, or an average of all employee salaries from the past 12 months—whichever is higher.  It gets complicated when we look at Tier-1 cities, such as Beijing, since the SSB will not pay more than three times the local average salary (2013 Beijing average salary was RMB 5,793×3=17,379), requiring the employer to cover the difference.
• If you are not registered with the SSB, then your employer will continue to pay your salary while you are on maternity leave.
• You cannot be terminated while pregnant or on maternity leave—it’s illegal!
• If you’re on a fixed-term contract and become pregnant, your contract will automatically be extended.

In addition to the maternity leave, upon returning to the office, mothers are entitled to “breast-feeding leave”, which encourages working mothers to nurse their children for at least a year.  This means:

• Mothers are allowed 1-hour of nursing/pumping break per day
• Companies will often encourage mothers to put the hour towards their vacations and have mothers work full, eight-hour days instead.

Finally, there is also a leave in place for women who have an abortion or a miscarriage:

• 15+ days of maternity leave if the pregnancy lasted less than four months
• 42+ days of maternity leave if the pregnancy lasted longer than four months

Source: The Nanfang, China Daily, China Briefing, CRI

Photo: Pixabay