Educating the health workforce in China: a commentary

Background The health of the Chinese people witnessed spectacular gains in the past half century. Life expectancy improved from 60 years in 1964 to 75 years in 2014. Infant and maternal mortality decreased substantially from 48 per 1000 children born in 1980 to 11 per 1000 children born in 2014, achieving benchmarks beyond those of Millennium Development Goals. The aim of this analysis is to examine three areas in China's development of its health workforce: improvements of the balance in the skill-mix amongst nurses and doctors, modernisation of medical education through reform of instructional content and purpose, and standardisation of post-graduate and continuing clinical education. Findings China has the largest production system of health professionals in the world. In 2012, China had 1·3 billion (18%) of 7 billion people in the world, 1·9 million (22%) of about 8·4 million doctors worldwide, and 1·9 million (11%) of 17·7 million nurses worldwide. However, the consequent doctor-nu rse ratio of 1:1 is highly imbalanced. Very rapid expansion of medical school student enrolment without corresponding expansion of faculty and infrastructure has compromised the quality of competence of graduating health professionals. Postgraduate education in China is currently ad hoc, fragmented, and suffering from the absence of quality standardisation. Currently, each institution is able to determine the content, duration, and quality of training of young physicians. There is inconsistency in the quality of physicians and specialists across all medical service institutions and between primary, secondary, and tertiary hospitals. Interpretation Although many people marvel at China's economic miracle, it has undergone slower progress in development of various social sectors such as health care. Continued progress and reform will require reform of undergraduate and postgraduate education, which are essential for cultivating health professionals who are trusted by patients to treat and prevent the growing burden of non-communicable diseases. Funding None.