China facing shortage of pediatricians, especially in rural areas

(Reuters Health) – China is facing a shortage of pediatricians and, just as in America, that scarcity is being felt most in rural areas, researchers report in a new study.

Rural areas also had the largest percentage of pediatricians with low levels of education, according to the study published in Pediatrics.

The study authors surveyed more than 50,000 hospitals from all 31 provinces in mainland China, asking hospital directors to provide information on the number of pediatricians in their institution, the pediatricians’ educational levels, and their specialties, workloads and dropout rates.

As of 2014, China had a total of 135,524 pediatricians, or about four pediatricians per 10,000 children, and 54,214 hospitals that provided pediatric care. The distribution of those pediatricians was “highly skewed,” the researchers report, with most of the children’s physicians located along the East coast of the country or in big cities like Beijing or Shanghai, where the populace is more affluent.

In rural areas, half the pediatricians had only 3 years of medical training after graduating from high school. Pediatricians with higher educational levels clustered in more developed and urban regions. In Beijing, 47.3% of the pediatricians had a postgraduate degree, as did 37.8% of pediatricians in Shanghai. At tertiary, or referral, hospitals, 95% to 98% of pediatricians had at least a bachelor’s degree.

The researchers, who did not respond to emailed questions, did offer suggestions on how to improve children’s care in rural areas.

“Working in rural and remote areas is not appealing to most pediatricians and, in the short term, active deployment of existing resources may be another route to address the challenge,” wrote the team, led by Dr. Kun Sun, a researcher in the department of pediatrics at Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine. “In the United States, for example, the problem of dropout rates was reduced by providing part-time positions targeted at female pediatricians who wanted to balance their personal and professional lives.”

China’s problems with health care delivery to rural areas mirror what is seen in the U.S., said Dr. Guohua Li, the Finster Professor of Epidemiology and Anesthesiology at the Mailman School of Public Health at Columbia University and head of Columbia’s Injury and Prevention Center.

“What struck me the most was the increasing geographic disparity between Western and Northwestern China and the East Coast,” said Li, who was not involved in the new research. “We are struggling here in the United States with similar challenges in rural areas. But the disparity in China is, I think, more pronounced than in the U.S.”

“If you go to population centers like Shanghai, the healthcare delivery system is well planned and in some ways you might feel that it’s better than in the U.S.,” Li said. “But if you travel outside those regions, where it is sparsely populated, the healthcare system isn’t much different from what it was 30 or 40 years ago.”

And that’s partly because there has been a “brain drain,” with physicians moving from the rural areas to places with greater wealth, Li said.

One result of the disparity is that referral hospitals in the big cities, which have the most specialists on staff, are inundated with patients traveling from rural areas to get the best care for their children, Li said. “Some parents travel thousands of miles to take their children to these hospitals,” he added. “And unfortunately, if you go to those hospitals it looks like a train station before Thanksgiving, it’s so chaotic and crowded.”

Li doesn’t know what the solution is, for China or the U.S. “I don’t have a silver bullet,” he said. “I wish I did.”

SOURCE: bit.ly/2Jb3nAH Pediatrics, online June 28, 2019.