Correspondence
Skilled doctors in tertiary hospitals are already overworked in China In Jiong Tu and colleagues’ introduction and discussion about the internet hospitals emerging in China (August, 2015),1 we are disappointed to see little recognition of, or discussion about, the fact that skilled doctors in top-level (tertiary) hospitals in China are already overworked.These doctors have no additional time or energy to deal with internet diagnoses and prescriptions. In China’s health-care system, primary health care is generally weak, with an insufficient number of skilled and experienced health professionals.2 Most patients in China prefer to visit tertiary hospitals even for common and minor illnesses since they can freely choose which doctors and medical institutions to visit. According to statistics from the National Health and Family Planning Commission of the People’s Republic of China, in January– November, 2014, there were 2·6 billion patient visits to Chinese hospitals, 46% of which were visits to tertiary hospitals.3 Therefore, tertiary hospitals in China are often overcrowded and the doctors in these top-level hospitals are generally overworked and overloaded. A 2014 national survey shows that 92% of doctors in tertiary hospitals need to work overtime, and 72% of doctors who have worked more than 60 h a week on average are in tertiary hospitals in China.4 In Tu and colleagues’ introduction1 of internet hospitals in China, skilled doctors in top-level hospitals are trained to meet patients and provide diagnoses and prescriptions via the internet. This approach seems to increase the accessibility of patients to high-quality medical services. However, with the consideration of overwork of skilled doctors in tertiary hospitals in China, its effects and sustainability are in doubt. www.thelancet.com/lancetgh Vol 3 December 2015
We think that the key solution to the poor access to high-quality medical services in China is to provide enough skilled doctors or general practitioners in primary care institutions. If this situation is not fundament ally improved, the overcrowding and long waiting times experienced by outpatients will soon also become a problem in internet hospitals. To increase the supply of skilled doctors or general practitioners in primary care institutions in China, policies and programmes to encourage these health professionals to work in primary care institutions and reform of the medical education curriculum will be significant. Meanwhile, strengthening of the continuing professional training and development 5 for health professionals in primary care institutions and improvements to their working conditions are also important. We declare no competing interests. Copyright © Hu and Zhang. Open Access article distributed under the terms of CC BY.
*Yinhuan Hu, Zixia Zhang [email protected] School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 1
2
3
4
5
Tu J, Wang C, Wu S. The internet hospital: an emerging innovation in China. Lancet Global Health 2015; 3: e445–46. Yip W, Hsiao W. Harnessing the privatisation of China’s fragmented health-care delivery. Lancet 2014; 384: 805–18. National Health and Family Planning Commission of the People’s Republic of China. The situation of national medical service delivery in China in 2014. http://www.nhfpc. gov.cn/mohwsbwstjxxzx/s7967/201501/0faf0 5af332b4f9f83bc1244b84f6dfb.shtml (accessed July 28, 2015, in Chinese). Chinese Medical Doctor Association. Chinese doctors practicing white paper. http://www. cmda.net/xiehuixiangmu/falvshiwubu/ tongzhigonggao/2015-05-28/14587.html (accessed July 29, 2015, in Chinese). Liu Q, Wang B, Kong Y, et al. China’s primary health-care reform. Lancet 2011; 377: 2064–66.
e737
Skilled doctors in tertiary hospitals are already overworked in China In Jiong Tu and colleagues’ introduction and discussion about the internet hospitals emerging in China (August, 2015),1 we are disappointed to see little recognition of, or discussion about, the fact that skilled doctors in top-level (tertiary) hospitals in China are already overworked.These doctors have no additional time or energy to deal with internet diagnoses and prescriptions. In China’s health-care system, primary health care is generally weak, with an insufficient number of skilled and experienced health professionals.2 Most patients in China prefer to visit tertiary hospitals even for common and minor illnesses since they can freely choose which doctors and medical institutions to visit. According to statistics from the National Health and Family Planning Commission of the People’s Republic of China, in January– November, 2014, there were 2·6 billion patient visits to Chinese hospitals, 46% of which were visits to tertiary hospitals.3 Therefore, tertiary hospitals in China are often overcrowded and the doctors in these top-level hospitals are generally overworked and overloaded. A 2014 national survey shows that 92% of doctors in tertiary hospitals need to work overtime, and 72% of doctors who have worked more than 60 h a week on average are in tertiary hospitals in China.4 In Tu and colleagues’ introduction1 of internet hospitals in China, skilled doctors in top-level hospitals are trained to meet patients and provide diagnoses and prescriptions via the internet. This approach seems to increase the accessibility of patients to high-quality medical services. However, with the consideration of overwork of skilled doctors in tertiary hospitals in China, its effects and sustainability are in doubt. www.thelancet.com/lancetgh Vol 3 December 2015
We think that the key solution to the poor access to high-quality medical services in China is to provide enough skilled doctors or general practitioners in primary care institutions. If this situation is not fundament ally improved, the overcrowding and long waiting times experienced by outpatients will soon also become a problem in internet hospitals. To increase the supply of skilled doctors or general practitioners in primary care institutions in China, policies and programmes to encourage these health professionals to work in primary care institutions and reform of the medical education curriculum will be significant. Meanwhile, strengthening of the continuing professional training and development 5 for health professionals in primary care institutions and improvements to their working conditions are also important. We declare no competing interests. Copyright © Hu and Zhang. Open Access article distributed under the terms of CC BY.
*Yinhuan Hu, Zixia Zhang [email protected] School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 1
2
3
4
5
Tu J, Wang C, Wu S. The internet hospital: an emerging innovation in China. Lancet Global Health 2015; 3: e445–46. Yip W, Hsiao W. Harnessing the privatisation of China’s fragmented health-care delivery. Lancet 2014; 384: 805–18. National Health and Family Planning Commission of the People’s Republic of China. The situation of national medical service delivery in China in 2014. http://www.nhfpc. gov.cn/mohwsbwstjxxzx/s7967/201501/0faf0 5af332b4f9f83bc1244b84f6dfb.shtml (accessed July 28, 2015, in Chinese). Chinese Medical Doctor Association. Chinese doctors practicing white paper. http://www. cmda.net/xiehuixiangmu/falvshiwubu/ tongzhigonggao/2015-05-28/14587.html (accessed July 29, 2015, in Chinese). Liu Q, Wang B, Kong Y, et al. China’s primary health-care reform. Lancet 2011; 377: 2064–66.
e737
