At a Crossroads: Family Medicine Education in China

Abstract

China is engaged in efforts to train 300,000 family doctors by 2020 to meet its population's health care needs. This Article discusses the family doctor shortage, compares family medicine training programs, examines the distributional challenges faced by these programs, and proposes directions for further experimentation. Despite an increasing number of family doctors, they represented only 5.6% of all doctors in 2013. Currently, three training programs run concurrently-the post-transfer training, residency training, and designated family medicine undergraduate education programs. These programs face several challenges. First, the educational qualifications of primary care practitioners (PCPs) vary greatly between rural and urban regions. From 2005 to 2013, the percentage of PCPs with three or more years of medical training in urban areas was at least 20.0% higher than in rural areas. Second, regional disparities in the number of family doctors for every 10,000 people exist. The richer eastern part of China has a ratio of 1.51 family doctors for every 10,000 people, nearly double that of central (0.70) and western China (0.86). Third, better-educated doctors are most likely going to prefer to work in hospitals, which offer a lucrative career path with higher pay and social status. Intervention packages that combine student selection policies that look at place of origin and career intent with other incentive strategies are worth implementing. Adequate clinical exposure and regular, rigorous evaluations are crucial for enhancing training quality. China should strike a balance in the distribution of family doctors between the richer and poorer areas to ensure equity.