Skilled doctors in tertiary hospitals are already overworked in China
Authors: Yinhuan Hu, Zixia Zhang
Journal: The Lancet Global Health (2015)

In Jiong Tu and colleagues' introduction and discussion about the internet hospitals emerging in China (August, 2015),1Tu J Wang C Wu S The internet hospital: an emerging innovation in China.Lancet Global Health. 2015; 3: e445-e446Summary Full Text Full Text PDF Scopus (54) Google Scholar we are disappointed to see little recognition of, or discussion about, the fact that skilled doctors in top-level (tertiary) hospitals in China are already overworked. These doctors have no additional time or energy to deal with internet diagnoses and prescriptions. In China's health-care system, primary health care is generally weak, with an insufficient number of skilled and experienced health professionals.2Yip W Hsiao W Harnessing the privatisation of China's fragmented health-care delivery.Lancet. 2014; 384: 805-818Summary Full Text Full Text PDF PubMed Scopus (257) Google Scholar Most patients in China prefer to visit tertiary hospitals even for common and minor illnesses since they can freely choose which doctors and medical institutions to visit. According to statistics from the National Health and Family Planning Commission of the People's Republic of China, in January–November, 2014, there were 2·6 billion patient visits to Chinese hospitals, 46% of which were visits to tertiary hospitals.3National Health and Family Planning Commission of the People's Republic of ChinaThe situation of national medical service delivery in China in 2014.http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s7967/201501/0faf05af332b4f9f83bc1244b84f6dfb.shtmlGoogle Scholar Therefore, tertiary hospitals in China are often overcrowded and the doctors in these top-level hospitals are generally overworked and overloaded. A 2014 national survey shows that 92% of doctors in tertiary hospitals need to work overtime, and 72% of doctors who have worked more than 60 h a week on average are in tertiary hospitals in China.4Chinese Medical Doctor AssociationChinese doctors practicing white paper.http://www.cmda.net/xiehuixiangmu/falvshiwubu/tongzhigonggao/2015-05-28/14587.htmlGoogle Scholar In Tu and colleagues' introduction1Tu J Wang C Wu S The internet hospital: an emerging innovation in China.Lancet Global Health. 2015; 3: e445-e446Summary Full Text Full Text PDF Scopus (54) Google Scholar of internet hospitals in China, skilled doctors in top-level hospitals are trained to meet patients and provide diagnoses and prescriptions via the internet. This approach seems to increase the accessibility of patients to high-quality medical services. However, with the consideration of overwork of skilled doctors in tertiary hospitals in China, its effects and sustainability are in doubt. We think that the key solution to the poor access to high-quality medical services in China is to provide enough skilled doctors or general practitioners in primary care institutions. If this situation is not fundamentally improved, the overcrowding and long waiting times experienced by outpatients will soon also become a problem in internet hospitals. To increase the supply of skilled doctors or general practitioners in primary care institutions in China, policies and programmes to encourage these health professionals to work in primary care institutions and reform of the medical education curriculum will be significant. Meanwhile, strengthening of the continuing professional training and development5Liu Q Wang B Kong Y et al.China's primary health-care reform.Lancet. 2011; 377: 2064-2066Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar for health professionals in primary care institutions and improvements to their working conditions are also important. We declare no competing interests. Skilled doctors in tertiary hospitals are already overworked in China – Authors' replyYinhuan Hu and Zixia Zhang make an important observation that doctors in tertiary hospitals in China are often overworked. The authors believe that the internet hospital will increase the burden on doctors in tertiary hospitals, and therefore that its effects and sustainability are in doubt. To meet patients' demand for high-quality health care, Hu and Zhang propose training and provision of enough skilled doctors in primary health-care institutions. This approach has also been one of the measures promoted by China's health reform. Full-Text PDF Open Access