Doctors feeling the pain
A family tragedy led Zhang Jing, 30, into medicine. Her grandfather in Shandong died of a heart attack and could have been saved if someone in the family had recognised the symptoms.
Having spent eight hard years studying medicine - attending classes 51/2 days a week, plus internships and residency - Zhang is about to become a junior doctor at a top Beijing hospital.
'I am not even sure how much I will be paid, most likely just enough to give my hair a perm in a hair salon, but I think the years are rewarding,' Zhang said. 'My mother says there are many rich people but few useful people. I think being a doctor is meaningful and useful.'
However, veteran doctors worry that they are seeing fewer keen students like Zhang. The years of study, the long working hours and low pay afterwards are deterring talented young people from studying medicine, with the situation made worse by widespread hostility from patients and the stress and risks of the job.
Professor Feng Xiping, from the department of preventive and paediatric dentistry at Shanghai No9 People's Hospital and Shanghai's Jiaotong University Medical School, said he had noticed a worrying trend in an early enrolment programme he runs for the school. It used to attract the brightest students, offering them places in their chosen major before the annual university entrance examination, but fewer outstanding students were choosing medicine.
Mainland medical schools train dentists and doctors.
'Years ago, the best students competed to go medical school, but not any more,' Feng said.
He said they now chose computer science or economics. Some students chose medicine as a short cut to enter a prestigious university before switching to a more popular major because getting into medical school was easier.
Fifty-two first-year medical students applied to transfer from Jiaotong University's medical school this year, compared with two wanting to transfer in, Youth Daily reported. It said 38 students had transferred from Fudan University's medical school, also in Shanghai.
To discover more, Feng surveyed 2,000 students from several medical schools in Shanghai. The results were appalling.
A quarter said studying medicine was too hard, practising was even harder and that their future prospects looked dim. Nearly half the students said they were not content but would continue studying anyway, despite the workload and stress.
Feng said that being a medical student had always been about lots of study and stress, but students nowadays were feeling more pressure than when he studied in the 1980s.
Working in big cities is a huge draw for medical students because of better pay, more access to patients and better career opportunities. However, such jobs for a graduate with a five-year bachelor's degree are hard to find, and that also holds true for some people with master's degrees.
Feng said this prompted students to spend eight years at university to secure the doctorates needed to guarantee jobs in big cities, putting an extra strain on their families.
When they do find jobs as residents, junior doctors face long hours on call, more paperwork and a bigger clinical workload than senior doctors, and still need to find the time to conduct research and get papers published, a must for promotion.
Poor pay is another factor. An attending doctor in their early 30s with five years of residency is likely to earn just a few thousand yuan a month.
A survey released last year by MyCOS, an occupational skills consultancy, found that medical school graduates earned less than other graduates and also had one of the highest unemployment rates.
'At this point, their classmates who chose other majors are likely to have made better money in an easier job. They will feel at a loss,' Feng said. 'High costs and low returns make being a doctor no longer the desirable job it used to be.'
To attract better students, Xiamen University is scrapping tuition fees for students of medicine, pharmacy, public health and nursing from this autumn. It charged each student 5,460 yuan (HK$6,700) last year.
Competency is another concern. One doctor from a top teaching hospital in Beijing said students were not as skilled as in the '80s and that teaching methods had worsened.
'We often joked: 'Will there be any good doctors left to save us when we are old.' But that joke has come true,' the doctor said.
A lack of government funding means hospitals must generate their own income, and with the priority on profits, doctors could not afford to focus on training younger doctors, he said.
Cheng Jia, who graduated with a bachelor's degree in medicine last year, is preparing for the qualification examination. He earns about 1,000 yuan a month and expects to earn no more than 3,000 yuan after certification. Born into a doctor's family, Cheng wanted to become a policeman but bowed to family pressure.
'I had wanted to be a surgeon, but after the internship at the surgical department I gave up,' he said. 'It's a stressful job and doesn't suit me.'
There were more than 600 students of clinical medicine in his year and each class had more than 70 students, compared with about 30 when his parents studied medicine. The teaching was less rigorous and students had fewer chances to practise, Cheng said.
'Take anatomy, for example. It's a very important class if you want to become a doctor,' he said. 'Before, 12 students shared a body but now it's more than 20 to one. Some simply stopped going to class because they could only see the body and had no chance to touch it.
'We still have family discussions about whether I made a mistake choosing medicine and every time we quarrel. Now I have accepted that I will be a doctor.'
Fortunately, there are some who are still interested in the challenge.
Li Zheng, 19, is a second-year student at Fudan University and wants to be a doctor. She worked hard in her first year to transfer from the physiology department to medical school because her entrance examination score was too low to get her into medical school.
'Many seniors have warned me about the hardship but I like medical school because students are always studying and teachers are strict, while in other departments students ditch classes and still pass,' Li said.
She said other students were busy seeking internships or preparing to go abroad, but medical students were focused on their studies.
'I know many seniors who complain a lot but still hang on, because they have the idea of saving lives or solving medical problems,' Li said. 'I think I like it.'
- Average cost, in yuan, on the mainland per person per year for medical coverage
- In 2005, 1.5 doctors per 1,000 people