Yao Feng’e of KPMG: China's Medical Workforce Shortage Exposed by the Pandemic – Six Strategies to Address the Crisis | VB Group Interview

Since the outbreak of the COVID-19 pandemic, in addition to successive batches of supplies being delivered to Wuhan, Hubei Province, medical teams from across China have been deployed to the front lines. This large contingent of “anti-epidemic warriors,” who courageously moved against the flow, has captured the hearts of the entire Chinese nation.

At a press conference held on February 20 by the Joint Prevention and Control Mechanism of the State Council, it was stated thatAs of the 19th, a total of 278 medical teams and 32,395 healthcare workers from across China had been deployed to Hubei Province.

Although more than 30,000 medical personnel have been dispatched to Hubei for emergency support, a shortage of healthcare workers persists. This large-scale mobilization not only underscores the severity of the epidemic response but also exposes critical pain points, including regional shortages of medical manpower and insufficient capacity of primary healthcare resources.

As early as 2017, relevant officials from the National Health and Family Planning Commission stated that China’s total volume of medical services ranked first in the world, with improvements in medical quality and accessibility placing it among the global leaders. However, despite the high total volume of medical services, a shortage of physicians has persisted in China. According to 2018 data from the Organisation for Economic Co-operation and Development (OECD),China has an average of only 2.59 licensed physicians per 1,000 residents, with rural areas having 1.8 physicians—just 45% of the urban level. In developed countries such as Germany and Austria, this figure exceeds 4.

China’s Current Shortage of Medical Personnel: What Strategies Can Help Improve the Situation? Recently, VCBeat conducted an exclusive interview with Yao Feng’e, Healthcare Industry Lead Partner at KPMG China, who provided insights on these issues.

Yao Feng’e pointed out that the shortage of medical personnel in Hubei caused by the novel coronavirus outbreak is an extreme manifestation of the global healthcare workforce shortage. “In fact, most countries around the world are facing varying degrees of healthcare workforce crises,” said Yao Feng’e.

According to World Health Organization estimates, the global demand for healthcare workers will reach 80 million by 2030, while the total supply will stand at only 62 million, resulting in a shortfall of 18 million and leaving approximately one-fifth of healthcare needs unmet.

China boasts the world’s largest healthcare service system. By the end of 2018, there were 9.53 million health technical personnel across the country (including licensed (assistant) physicians, registered nurses, pharmacists (technicians), and laboratory technicians (assistants), but excluding health personnel engaged in administrative work), among whom 3.61 million were licensed (assistant) physicians and 4.10 million were registered nurses. However, China’s medical workforce faces challenges of insufficient overall numbers and uneven distribution.

In 2018, China had 2.59 physicians per 1,000 population. Among them, the number of physicians in specialties such as rehabilitation, pediatrics, emergency medicine, and psychiatry was relatively low, indicating weaknesses in these disciplines. The number of public health physicians was insufficient and showed a declining trend year by year, resulting in a relatively weak workforce that was misaligned with the policy priority of prevention.

On April 21, 2019, the State Council’s report on the management of the physician workforce and the implementation of the Licensed Physicians Law was submitted to the 10th Session of the Standing Committee of the 13th National People’s Congress for deliberation. Ma Xiaowei, Director of the National Health Commission, pointed out that China’s physicians are overly concentrated in tertiary Grade A hospitals in major cities, while the number of physicians in urban and rural grassroots settings, particularly in rural areas and remote mountainous regions, remains very limited.

The imbalance in the allocation of medical personnel in China is evident not only across regions and between urban and rural areas, but also between hospitals and primary care institutions. Due to the shortage and insufficient competence of primary care providers, residents have low trust in primary care institutions. As a result, China has yet to establish an orderly tiered diagnosis and treatment system, hindering the ability of the primary care system to fulfill its roles in prevention and triage.

“During the outbreak of the novel coronavirus epidemic, patients flocked to tertiary hospitals, causing unnecessary panic and increasing the risk of cross-infection. This not only disrupted normal medical treatment operations but also further exacerbated the crisis of healthcare worker shortages,” said Yao Feng’e.

She pointed out that the healthcare worker crisis faced by Hubei during this outbreak could be a microcosm of what other regions may encounter in the future.

Yao Feng’e stated that the proposal of these six strategies integrates several measures outlined by Dr. Mark Britnell, Global Chair of KPMG’s Healthcare Industry, in his new book People First: Solving the Global Healthcare Workforce Crisis, with the current realities of China’s healthcare system.

Strategy 1: Strengthen the Development of Primary Healthcare.In the United Kingdom, approximately 90% of patient consultations take place in primary care settings, primarily general practitioner (GP) clinics, while primary care accounts for only about 10% of total healthcare expenditure. “It is evident that a high-quality and efficient primary care system can reduce the overall healthcare system’s demand for medical personnel, thereby alleviating the workforce crisis,” said Yao Feng’e.

Under the tiered diagnosis and treatment policy of China’s new healthcare reform, the country’s primary healthcare system remains significantly underdeveloped. As of the end of 2018, health professionals in primary healthcare institutions accounted for only 28% of the national total. Among all licensed (assistant) physicians in China, 36% were employed in primary healthcare institutions, while registered nurses in these institutions comprised 21% of the national total.

The chaotic healthcare-seeking behavior of patients during the COVID-19 pandemic has highlighted the importance of establishing a tiered diagnosis and treatment system and strengthening primary healthcare services in China. The key to “strengthening primary care” lies in building primary healthcare teams, enhancing the service capacity of primary healthcare institutions, and boosting public trust in these facilities.

“Shenzhen’s experience in building a tiered diagnosis and treatment system is worth drawing upon, particularly the Luohu Hospital Group model.” Yao Feng’e noted. She explained that, in building primary healthcare service teams, the Luohu Hospital Group’s “4+X” family doctor teams—comprising general practitioners, general practice nurses, community clinical pharmacists, public health physicians, plus X additional members—serve as residents’ “health gatekeepers,” providing lifecycle health management services to the community.

The number of outpatient visits at community health centers in Luohu District increased from 1.73 million in 2014 to 3.48 million in 2019, with these centers accounting for 49.26% of the group’s total outpatient volume. During the recent epidemic, community health centers handled 30% of all fever-related cases within the group, effectively alleviating pressure on fever clinics at tertiary hospitals.

Strategy 2: Empowering Patient Health Management.Active patient participation in self-health management is now widely recognized as a vital component of high-quality healthcare. Patients with strong health management awareness not only reduce medical costs but also typically achieve better clinical outcomes. Meanwhile, patient engagement throughout all stages of diagnosis and treatment helps improve the efficiency of doctor-patient interactions, enabling healthcare providers to quickly assess patients’ conditions and deliver targeted feedback.

Furthermore, intelligent enabling tools can assist patients in self-managing their health, thereby reducing the need for medical staff intervention. This allows healthcare professionals to focus on core clinical services rather than administrative tasks, ultimately improving their work efficiency.

During this epidemic, the importance of public participation in health management has been particularly prominent. On February 2, a press conference held by Shandong Province disclosed that 60 cluster outbreaks had been identified in the province; on February 6, Heilongjiang Province reported 48 cluster outbreaks; and on February 7, a spokesperson for the Shanghai Municipal Health Commission stated that there were 45 cluster outbreaks in Shanghai.

“Effective health management empowers the public to practice self-protection and effective isolation, preventing disease spread. It can minimize outpatient visits, alleviate pressure on healthcare institutions, reduce the workload of medical personnel, and is also key to controlling the epidemic’s progression and winning this war against the virus,” said Yao Feng’e.

Strategy 3: Promote the Digital Healthcare Model.Digital healthcare, leveraging the “Internet+” framework, is an effective means of improving the work efficiency of medical professionals. It encompasses the consumer-facing (2C) model, represented by internet hospitals that provide medical services directly to patients, and the business-facing (2B) model, represented by remote consultations that facilitate collaboration among medical institutions.

In the B2C model, both doctors and patients can transcend temporal and spatial constraints by migrating offline clinical consultations to online platforms, enabling healthcare professionals to leverage fragmented time more effectively to deliver medical services.

In the B2B model, healthcare institutions establish remote consultation partnerships to enable high-level medical professionals to engage more in managing complex and challenging cases, rather than devoting substantial resources to the diagnosis and treatment of common and minor ailments. This approach prevents the underutilization of expertise and enhances the overall efficiency of healthcare services.

Strategy 4: Explore the Application of Artificial Intelligence.Healthcare is a key application sector for artificial intelligence. According to a survey conducted by China Youth Daily among 2,010 respondents, 68.5% believed that the value of AI in healthcare lies in improving diagnostic efficiency and bridging the gap between supply and demand for medical resources; 54.7% held that AI can assist physicians in diagnosis, thereby reducing missed and misdiagnoses; 53.9% considered that AI can provide disease risk alerts and health advisory services; 38.7% recognized that AI can support drug development and enhance pharmaceutical R&D efficiency; and 29.5% were aware that surgical robots can improve the precision of surgical procedures.

“From the perspective of alleviating the shortage of medical personnel, the application of artificial intelligence in assisted diagnosis and intelligent decision-making may become a viable solution,” said Yao Feng’e.

She explained that computer-aided diagnosis can significantly improve the work efficiency of medical personnel, while intelligent decision support systems can help them proactively plan their schedules in an organized manner, thereby minimizing external disruptions.

Strategy 5: Establish a standardized diagnosis, treatment, and management system.A sound, rational, and actionable diagnosis and treatment system can effectively support healthcare professionals in carrying out their work smoothly and improve the quality of care; a standardized management system helps enhance operational efficiency.

From the employee perspective, clinical diagnosis and treatment as well as operational management are grounded in evidence-based protocols, providing strong guidance for medical personnel and administrators at all levels;

From a team perspective, standardized diagnosis, treatment, and management systems enable efficient collaboration among team members, generating synergistic value in their work. From the patient’s perspective, such standardized systems help prevent and reduce the incidence of errors, thereby improving the quality of care.

“However, many medical institutions in China currently lack standardized systems in both clinical practice and operational management, resulting in low institutional efficiency,” said Yao Feng’e.

She cited, for example, the results of a 2016 survey conducted jointly by the School of Medicine and Health Management at Huazhong University of Science and Technology and the Peking University Health Science Center, which polled 800 healthcare professionals in China on their use of and demand for clinical practice guidelines. The survey found that healthcare professionals perceived existing clinical guidelines as having low practical utility, with recommended diagnostic and treatment methods being difficult to implement in practice. Furthermore, 36.5% of respondents considered it highly necessary to evaluate these guidelines, and clinicians expressed the strongest desire for access to a knowledge base of guidelines that are timely updated, evaluated, and curated.

Strategy 6: Care for and support medical personnel.Research by the NHS (National Health Service) indicates that undervaluation and excessive fatigue are prevalent among physicians.

According to a survey of 17,000 physicians conducted by the U.S.-based Physician Foundation, 54% of American doctors report low morale. The proportion among Chinese physicians is relatively higher, ranging from 66% to 87%. It is undeniable that professional burnout among physicians directly impacts the efficiency of healthcare service delivery and influences more individuals’ decisions against pursuing medical education and careers, thereby exacerbating the shortage of healthcare professionals and creating a vicious cycle.

Leading practices at certain healthcare institutions offer valuable benchmarks. Taking HCA as an example, it has established the largest hospital network in the United States. Under its Physician-Hospital Partnership (PHP) operational model, physician groups are no longer affiliated with any single hospital; instead, they operate as independent platforms that contract with hospitals. This arrangement provides physician groups with stable revenue streams through contractual agreements, while enabling hospitals to rapidly enter new therapeutic areas by engaging collaborative partners. Consequently, this model fosters high-efficiency, high-quality medical services while simultaneously reducing healthcare costs.

In terms of attracting physicians to join the network, the platform has enhanced doctors’ motivation to provide enthusiastic patient care by inviting them to become local equity investors in commercial ventures, facilitating medical data sharing, and offering flexible and convenient patient referral mechanisms.

Drawing on KPMG’s experience in serving healthcare institutions, Yao Feng’e shared the following recommendations. Regarding medical personnel: Prioritize and enhance the recognition of value contribution and job satisfaction among healthcare professionals. Specifically, for fixed compensation, ensure robust protection and a smooth transition by fully benchmarking against salary data from the healthcare services industry and the local region. For the secondary distribution of performance-based pay, adopt a multi-dimensional balance focusing on factors such as workload, revenue generation, and professional titles, thereby deeply aligning individual value recognition with the hospital’s overall value creation.

In terms of healthcare institutions: Build a “centralized” robust front office, an “empowering” refined middle office, and a “service-oriented” large back office to achieve patient-centric care, “returning time to doctors and returning doctors to patients.” Specifically, the clinical front office breaks down departmental barriers by serving patients through “centralized” construction and multidisciplinary team (MDT) consultations, while the middle and back-office departments provide efficient services through modular professional capability building and information technology means, fully relieving the pressure on clinical medical staff and ensuring their efficient value creation;

In terms of platform development: Sound organizational mechanisms and measures have facilitated rapid, efficient, and flexible responses despite limited medical resources. During the COVID-19 pandemic, thanks to its robust organizational support and emergency management systems, the hospital anticipated the crisis by conducting medical staff training in advance, implementing building-wide isolation protocols, and being among the first to assemble medical teams to aid Wuhan. Furthermore, in platform development, it pioneered online outpatient services, leveraging resources from both the hospital and its medical consortium to facilitate patient consultations and prevent cross-infection.

On February 10, the General Office of the State Council forwarded the “Notice on Several Measures to Improve Working Conditions for Frontline Medical Personnel and Earnestly Safeguard Their Physical and Mental Health,” jointly issued by the National Health Commission, the Ministry of Human Resources and Social Security, and the Ministry of Finance. The Notice sets forth seven measures aimed at improving working conditions for frontline medical personnel and earnestly safeguarding their physical and mental health.

In fact, there is an urgent need to establish a long-term mechanism for comprehensive healthcare workforce planning from the perspectives of government agencies, educational institutions, medical facilities, healthcare professionals, and the industry. “Only by taking multi-pronged approaches in talent development, recruitment, compensation systems, and incentive mechanisms, and by showing genuine care and support for healthcare professionals, can we ensure that there are sufficient healthcare providers to deliver compassionate patient care and safeguard the health of the entire population,” said Yao Feng’e.

Six Major Strategies: Interpreting Responses to the Current Crisis from Multiple Dimensions. In addition to these six strategies, Yao Feng’e also shared her insights on the current epidemic. She pointed out that this epidemic will have a positive promoting effect on China’s entire healthcare institution system.

“Not only at the national level, but also at the ethnic level, it has enabled people to better recognize the role and importance of medical institutions in daily life, and has confirmed what national leaders have stated: without health for all, there can be no comprehensive well-being for all,” said Yao Feng’e.

What Changes Will Occur in China’s Healthcare System After the Pandemic? Time Will Tell.

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