Trend in outpatient workload among paediatricians against the backdrop of the paediatric crisis in China, 2008–17: an analysis of nationwide data. Issue 1 (October 2019)

• Record Type: Journal Article
• Authors: Liu, Yue; Yang, Lin; Schernhammer, Eva; Hou, Peter C; Zhang, Li; Zhang, Wenpeng; Zhang, Yin
• Is Part Of: Lancet. Volume 394(2019)Special Issue 1
• Page Start: S1
• Publication Date: 2019-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(19)32337-2
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: China is facing severe shortage of paediatricians nationwide; however, no formal evaluation has been done of Chinese paediatricians' workload over time. We aimed to characterise the 10-year trend on outpatient workload among paediatricians in China compared with physicians of all other specialties to provide important insight on the severity and cause of this ongoing crisis. Methods: We obtained total numbers of board-certified paediatricians, board-certified physicians of non-paediatric specialties, and data on aggregated outpatient workload (measured by annual total outpatient visits) in all clinical units from annual reports published by the National Health Commission. We excluded small primary health-care clinics (eg, village clinics, township clinics, and community clinics) from analyses because their small clinic size precludes a discrimination of paediatric outpatient visits from other specialties. Total numbers of children were taken from the National Bureau of Statistics annual reports. We computed outpatient workload for paediatricians and non-paediatric specialists using the number of outpatient visits per physician per year. Finally, we calculated the outpatient workload ratios of paediatricians to non-paediatric specialists. This study included nationwide data for 31 provinces in mainland China from 2008 to 2017. Findings: Between 2008 and 2017, the number of board-certified paediatricians per 10 000 children has grown steadily from 3·32 to 5·81. Despite this growth, the total number of outpatient visits per paediatrician per year has increased from 3290 to 3995. Over the same period, we observed a mild increase in the workload among non-paediatric specialists from 1659 to 1893 outpatient visits per physician per year. Hence, the paediatric–to-non-paediatric specialist's outpatient workload ratio has increased from 1·98 to 2·11 nationwide in the past decade. Interpretation: Despite a slowly growing 10-year trend in the Chinese paediatric workforce, the outpatient workload among paediatricians has remained roughly double that among physicians of non-paediatric specialties. Long-term shortage of workforce and excessive workload of the Chinese paediatricians have exacerbated each other in the crisis. In addition, income inequality, along with many other factors, has further diminished career satisfaction and sense of accomplishment in this specialty. A systemic and coordinated effort should be taken to improve professional status of this specialty. Funding: Ministry of Education of China (081002609) and National Natural Science Foundation of China (81173424).