I just finished listening to a great presentation by Michigan Law School student Carlos Torrez, on the shortage of doctors in the rural United States. I’ll first put forth some facts highlighted in the presentation, and then do a brief compare contrast with how America’s shortage of doctors is very different from the shortage of doctors faced by China. I don’t have the sources for the facts highlighted in Mr. Torrez’s presentation, so I’ll just share some of the presentation points that paint a general picture of the situation, and any numbers or fact claims from this portion of the post shouldn’t be taken on faith alone. The China-section of the post has links to the relevant sources.
In the United States the average distance traveled to see a physician is small, less than six miles on average in rural areas. This is, compared to other countries, phenomenal. Most of these rural care physicians have primary care/family care practices. We talk about a “shortage” of physicians in rural areas because while the rural population is 20%, only 10% of American doctors’ offices are in rural areas. Therefore, when experts talk about a shortage of doctors in the US, they are talking about relative access to doctors in rural areas, as compared to urban areas.
Mr. Torrez goes on to say that one solution is to change the market by subsidizing rural health centers to counteract the income disparities between urban and rural centers. This solution focuses on the healthcare centers and patient communities rather than doctors because it assumes that the proportionately lesser amount of doctors is not a supply-side problem (that is to say, it’s not the doctors fault). Instead, doctors need to be incentivized to move to rural areas with higher payments, better facilities and healthier patients. (Mr. Torrez highlights other solutions as well but I’m only highlighting this one.)
Notice that there’s no catastrophic shortage in the US. Still, it is a problem because as a society we are concerned about disparities in health outcomes. We don’t think it just that one group of people should have lesser access than another. China, on the other hand, has a doctor shortage in rural areas that can and should be considered catastrophic.
The average distance to see a doctor in rural China depends on how you define a doctor. If we’re talking about doctors with professional medical degrees that go beyond a bachelor’s studies curriculum, then we’re talking about less than 3.2% of all doctors. . The average distance in that case would be a proxy for the average distance between all of China’s rural settlements and the closest city to each of those settlements with a major Tier III public hospital, because that’s the only place these doctors work (see , 2011. 0.0% of China’s doctors with a postgraduate education work in rural hospitals). Let’s all agree that this figure is going to be several multiples of six miles.
Now look at this. If only 3.2% of China’ physicians are what we’d consider to be professionally trained, then there were less than five physicians per 100,000 (yes, one hundred thousand) people in China in 2010. How do we get to this number? Assume China’s Ministry of Health took into consideration all doctors with an official “physician” designation when calculating it’s doctors per one thousand patients statistic. Their figure was 1.4 physicians per 1,000 people (.), and only 3.2% of those people are what we’d consider professionally trained (Id., pg. 106). The figure is then .448 professionally trained physicians per 10,000 people or, 4.48 physicians per 100,000 people.
In China, there is arguably little need to talk about health disparities between rural and urban healthcare centers because there will always be a disparity when the rural level of care in many places starts at 0, and sometimes -1.
Update: See Adam Powell’s comments below. He correctly points out, and I should have pointed out originally, that Chinese medical schools award Bachelor degree equivalents to doctors after a five year program that includes many of the features of America’s medical school training. I lead with the figures above because they provide some interesting numbers to think about. If you want a .
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It is true that the majority of China’s physicians lack doctorates in medicine. This is because China follows the system of medical education followed in Britain and many of the Commonwealth Countries. Most Chinese physicians hold an undergraduate medical bachelors roughly equivalent to the MBBS held by general practitioners in England. In countries following the British system, undergraduates skip the exploratory/premed phase that Americans experience and go directly on to their medical studies as undergraduates. However, the majority of Chinese practitioners have attended either a post-secondary vocational school or a junior college, meaning they are likely roughly equivalent to many of America’s nurses.
That’s correct. Chinese medical schools have traditionally offered a seven year and a five program. Those students who complete the seven year program are awarded a Masters of Medicine. Those who are complete the five year program are given either a Bachelor of Medicine if they complete the clinica medicine track or simple a Bachelor’s degree if they finish any of the following tracks – preventive medicine, medical nutrition, dentistry, forensic medicine, radiology, or anesthesiology. All of these graduate are honored with the title doctor. There is an eight year track in some schools that awards a Doctorate of Medicine, but this is still rare.
I lead with the post-graduate degree figure, even though it includes only the Masters and Doctorate holders, because it leads to some numbers that are interesting to think about and play well in the view-hungry internet space. It would have been fairer of me to hedge with the point you make.
“less than 3.2% of all doctors” ?
That is an interesting…
Thanks for sharing the references.
Sorry there was a typo in my previous comment.
I meant to say “That is an interesting number”
..forgot the word “number”.