Since 2015, the Chinese health-care system reforms have been emphasizing the importance of constructing hierarchical medical system. Hierarchical medical system policy was aimed to enhance the development of primary medical care and redistribute medical resources more rationally. At present, most of patients prefer to go to tertiary hospitals, which increases the working load on doctors there.
Although these extra burdens on doctors have been realized, no corresponding action has been taken. At the same time, it has been noticed that the rate of sudden death of doctors has been increasing in the past five years (Figure 1). On 26th July, 2017, a 30-year-old anesthetist died suddenly on his night shift in a tertiary hospital in China. He was the 14th doctors who had sudden death in 2017 (Table 1). According to systematic search of public reports on local media, medical websites and official documents, 45 doctors are found to be killed by sudden death since 2012. The majority of the doctors worked in tertiary hospitals. Most of them are surgeons or anesthetists (Table 1, Figure 1). Filled with tension and pressure, Chinese doctors are under a high risk of sudden death.
This phenomenon may be largely due to lack of enough medical resources and its uneven distribution. China is a big country with 22% of world’s total population while it occupies only 2% of world’s medical resources (1). China only owns less than half of medical resources per capita (1.2 physicians/1,000 population vs. 2.8 physicians/1,000 population) compared with developed countries (1). All these factors contribute to the increasing burden on Chinese doctors in general. Moreover, since the access for a physician is not as strict as in western countries, patients are tended to tertiary hospitals for seeking better medical care (2). Including the large number of patients transferred from community hospitals, doctors in tertiary hospitals faced an extremely heavy burden in both outpatients and inpatients. Among the 45 doctors who had sudden death since 2012, 86% of them were from tertiary hospitals and 49% of them had been worked more than 12 hours before sudden death (Figure 1). In 2015, 2,402 doctors were enrolled in a survey which was conducted by Ding Xiang Yuan (the most popular biomedical website in China) (3). The survey showed that only 3% of doctors had less than 40 hours of working time every week while 37% of doctors had more than 60 hours to work every week (Figure 2). In addition, 47% of doctors had less than 1 day for rest every week (Figure 2) and 75% of them never had time for paid leave (Figure 2).
Getting promotion is another big challenge for Chinese doctors, especially in tertiary hospitals. Having National Natural Science Foundation and published paper listed in the Science Citation Index (SCI) are the criteria for candidates (4). As a result, doctors had to spend extra time on researches. As showed in Ding Xiang Yuan survey (3), study occupies almost all their time after work (Figure 2). Living in such conditions, half of doctors feel overwhelmed (Figure 2), but half of them would do no treatment when they felt uncomfortable (Figure 2).
The hierarchical medical system is an ideal method which is supposed to solve the problems above. However, it failed to cover the problems as follows: First, more medical resources should be created to relieve the extreme lack of total medical resources in China. Second, the quality of medical service in primary hospitals should been improved and the communication network among primary, secondary and tertiary hospitals should been well-rounded and timely, to ensure that patients could receive equal medical care. Third, the financial support from the government should been strengthened, especially for tertiary hospitals. It can relieve the pressure for hospitals to generate income as well as to reduce the competition among primary, secondary and tertiary hospitals (5). If only taken all these into consideration, would the current situation be changed.
Conflicts of Interest: The authors have no conflicts of interest to declare.
- Shan HP, Yang XH, Zhan XL, et al. Overwork is a silent killer of Chinese doctors: a review of Karoshi in China 2013-2015. Public Health 2017;147:98-100. [Crossref] [PubMed]
- Huang J, Yan L, Zeng Y. Facing up to the threat in China. Lancet 2010;376:1823. [Crossref] [PubMed]
- Available online: http://www.dxy.cn/
- Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013;381:e4. [Crossref] [PubMed]
- Chinese doctors are under threat. Lancet 2010;376:657. [Crossref] [PubMed]
Cite this article as: Deng Z, Jin J, Dai Q, Pan J, Wang X, Liu R, Li X, Wang Y, Zheng Q. Chinese doctors are under a high risk of sudden death. AME Med J 2017;2:125.