Song Donglei: Acting as a Catalyst for Change in China's Medical System

Guest Profile: Former Chief Physician, Professor, and Doctoral Supervisor in the Department of Neurosurgery at Huashan Hospital Affiliated to Fudan University; Former Head of the Cerebrovascular Disease Medical Team in the Department of Neurosurgery at Huashan Hospital; Former President of Shanghai Deji Hospital and Director of the Cerebrovascular Disease Center; Currently Founder of the “Donglei Brain Doctors Group”

Keynote Speech

Good evening, dear friends! First of all, I am delighted to have this opportunity to communicate and share with so many friends. I would also like to extend my sincere gratitude to VCBeat for providing such a wonderful platform. I did not expect that so many people would join me tonight to hear about my experiences.

It has been exactly three years since I left Huashan Hospital. I first joined a private hospital and later established my own physician group. Initially, I did not have a specific agenda; I simply moved forward while observing, striving in a general direction. Many things unfolded naturally along the way, and I would like to share some of these experiences with you.

"Constantly Evolving, Continuously Pursuing"

First, let me explain why I left Huashan Hospital. As a nationally renowned hospital in China, particularly for its neurosurgery department, we were regarded as members of the “national team,” and I was considered a key player within that group. Huashan Hospital gave me much; it was where I grew professionally until becoming what is known as an expert.

Why do they leave? I believe there are many reasons, some of which stem from reflections on or dissatisfaction with the current state of healthcare in China. For instance, the medical system abroad differs significantly from that in China, with notable distinctions in hospital environments, physician compensation, and doctor-patient relationships. Physicians like us, who frequently have opportunities to visit other countries, observe these differences closely and keep them in mind.

At times, I struggle to understand why the gap between us is so vast. Initially, I attributed this disparity to our poor economic conditions and low incomes. Later, I realized that this was not entirely the case. Although our economy has been improving and our incomes have been rising, certain aspects of our hospitals—particularly public and large-scale institutions—have been deteriorating, leading to an increasing number of conflicts between healthcare providers and patients. I believe there must be deeper underlying causes, which has prompted my decision to leave and seek answers.

Of course, there were certainly other reasons for my departure, which essentially revolved around three aspects: career prospects, personal relationships, and compensation. I will not elaborate extensively on these points, as individual circumstances and perspectives vary; it was ultimately a combination of factors. I realized that my professional development at Huashan Hospital was approaching a bottleneck. Most importantly, driven by certain unresolved concerns regarding the current healthcare system, I sought to venture out in pursuit of change.

I first went to a newly established private hospital. They had invited me, and the Health and Family Planning Commission also supported the move, noting that Shanghai lacked high-quality comprehensive private hospitals. They believed that an expert like me could provide significant assistance to such institutions, and encouraged me to give it a try.

“I felt that my skills were sufficient, I had some understanding of market operations, and given my relatively young age, I was quite confident in myself; therefore, I participated in the opening of Deji Hospital.”

In fact, we truly started from scratch, with zero initial outpatient visits, and operated successfully for over two years. Among comprehensive private hospitals in Shanghai, Deji Hospital rapidly gained recognition from the public, the Health and Family Planning Commission, and non-public medical institutions. Its revenue performance has been quite strong, significantly outperforming most other private hospitals.

However, with further development, I have come to recognize that private hospitals also face their own bottlenecks. Given the current dominance of public hospitals and investors’ pursuit of investment returns, the development of private hospitals is confronted with a variety of challenges.

It remains quite challenging for me to fully resolve this issue on my own. As physicians, when we identify aspects of both public and private hospitals that fall short of our expectations, how should we contribute to driving systemic change across the healthcare system?

During this period, my thinking was greatly influenced by Dr. Zhang Qiang. I strongly agree with his view that only when Chinese physicians are able to practice independently can they truly drive greater progress in our healthcare reform.

So I left the private hospital and embarked on a path of independent practice, establishing a physician group. My primary objective is to leverage my resources to the fullest extent, in an independent capacity free from any interference, to advance medical development. I believe this will benefit private hospitals and also serve as a catalyst for public hospitals.

This is a brief overview of my three-year journey. The transition from the public sector to the private sector, and ultimately to independent practice, reflects a shift in philosophy and professional aspirations.

Stumbling, Stepping onto the Main Road

Let’s revisit the topic of independent practice: why should physicians engage in independent practice?

In fact, with the exception of China and a few other countries, the vast majority of physicians worldwide practice as independent practitioners. The term “independent practice” does not mean that one is unaffiliated with any institution, roaming around at will without constraints; such an interpretation does not reflect its true definition.

Because doctors in China currently hold established positions within public institutions, their livelihoods—from birth to death, including pensions and other benefits—are provided by the state. Since these benefits are state-provided, doctors are expected to comply with state leadership, adhere to state assignments, follow state-regulated fee schedules, and accept state-determined compensation packages. What are the advantages of this arrangement? The primary benefit is that doctors enjoy guaranteed income regardless of economic fluctuations, fostering a strong sense of security. Consequently, they become deeply dependent on this system, having been supported by it since the early stages of their careers.

But what are the drawbacks? Our physicians are unable to realize their professional value. Specifically, when the state covers all salary expenses, the true worth of their expertise fails to be appropriately reflected. As is widely known, the compensation structure in public hospitals is currently constrained by numerous factors. Even if a public hospital generates profits, physicians should not receive high salaries, given that they hold positions within the public institution staffing system (shiye bianzhi).

Physicians should be fully compensated based on their skills and services, receiving appropriate remuneration for the labor, service, and expertise they contribute during clinical practice. Therefore, I believe that physicians need not remain affiliated with public institutions; instead, they should pursue independent practice to truly realize their professional value.

At present, independent medical practice remains quite challenging in China. This is due to lingering policy issues and the dominant position of public hospitals, particularly the monopolistic resources held by tertiary Grade A hospitals. Consequently, many physicians find it difficult to leave the public system; those who do face numerous obstacles and hardships at every turn. This is indeed the current reality.

Moreover, if independent practitioners lack solid skills, strong technical capabilities, a robust service orientation, a strong sense of teamwork, or adequate ideological guidance, I believe it would be very difficult for them to make such a determination.

However, pioneers are essential to blaze a trail; as more people tread the path, it becomes a well-worn road. We are exploring a new path on behalf of all physicians in China. At present, this path may be little more than a narrow track, but it will gradually widen into a major thoroughfare—a bright and promising avenue. Although it is currently fraught with pitfalls and formidable obstacles, I believe that through our pioneering efforts and the growing number of individuals willing to try, this path will become increasingly smooth, ultimately evolving into the primary route for medical practice.

Because, in my view, only independent practice can truly reflect the value of physicians, genuinely place patients at the center of care, effectively promote and support the development of private hospitals, drive reform in public hospitals, and ensure the sustainable succession of our medical profession. At present, I cannot envision any alternative path.

Stripped of Its Halo, It Relies Solely on Brand

If physicians rely on the market for their livelihood, their primary concern will be patients, as patient recognition is the sole source that enables them to sustain their practice, excel in their work, and achieve favorable income. Consequently, they will naturally adopt a patient-centered approach, striving to ensure patient satisfaction through effective communication.

Thus, the issues widely criticized in current doctor-patient relationships will be naturally resolved through market mechanisms. Based on my experience, working at a private hospital felt different, and practicing independently in the private sector felt even more distinct. We are truly compelled to adopt a patient-centered approach. At that point, you no longer benefit from the prestige of an affiliated hospital; patients must have a reason to choose you for their care, and that relies entirely on your personal brand.

Building Connections Through Service

There are various pathways to build a personal brand. For instance, physicians today can foster patient loyalty through online consultation apps. Additionally, the substantial patient base we have accumulated represents an asset that endures beyond institutional affiliation. While some resources may be lost upon departure, others remain portable. For example, although I have left Huashan Hospital, my extensive network of patients and professional relationships has remained intact. These connections continue to follow me, and by delivering high-quality care, I can further strengthen these ties and attract more individuals into my professional circle.

Build the Platform, Seek Collaboration

The internet has provided us with many additional tools; platforms such as WeChat, Official WeChat Accounts, and Weibo help us attract patient attention. Therefore, we must develop our own marketing and brand management strategies. I believe many doctors share this perspective.

I may not necessarily be the best in this regard. Many young physicians at public hospitals perform exceptionally well, attracting a large number of patients by building their personal brands. Therefore, I believe there are numerous strategies for brand-building. As long as you devise appropriate methods and maintain the right awareness, you can succeed, given that physicians are intelligent individuals.

For example, I received a service award the year before last. Upon reflection, we summarized that in my first year after leaving, I established my own team, set up a remote video studio via online channels, and collaborated with traditional media to host academic events for self-promotion—all of which are viable strategies.

Essential for Practice: Medical Secretary

Additionally, it is essential to have dedicated medical secretaries. This practice is common abroad, where physicians typically have secretaries, and it proves highly beneficial. I believe that patient management should not rely solely on online platforms; offline management can be equally effective. Particularly in neurosurgery, online communication is often insufficient, as substantial interaction requires face-to-face meetings or telephone conversations to ensure clarity. Therefore, I require a secretary. During our time at Deji Hospital, all specialists were assigned medical secretaries who served as liaisons with patients, providing support to both physicians and patients.

All of my patients have my secretary’s phone number. They can inquire about medical matters through my secretary at any time, and I can also relay any questions to patients promptly via the secretary. This practice is common abroad; virtually all hospitals operate this way. Not only renowned physicians but also resident doctors have their own secretaries. Patients rarely contact doctors directly; instead, they communicate through secretaries, whose phone numbers are fully accessible to patients.

So, I left the public hospital and joined Deji. Over the past two years, I have seen three to four thousand patients. I would say that these three to four thousand patients follow me wherever I go, or at least maintain contact with me, as my assistant and they have exchanged contact information. Although this approach is not widely adopted, each individual has their own unique way of building their personal brand. I believe many people employ various strategies tailored to their specific circumstances to establish their own brand.

Gather Together, Do More

On the issue of physician groups, I would like to share some insights. In my view, it is quite challenging for a physician to practice independently after leaving an institution, and there are limited opportunities for scaling up. Only by collaborating with more physicians can we achieve better outcomes.

Therefore, we attempted to establish a physician group by bringing together physicians who had left the public system to form an independent medical practice group. Although the team was small, since all members practiced independently, they were united in spirit, shared many common perspectives, and acted in concert. This ensured that everyone worked toward the same goal with aligned efforts.

Changing the Doctor-Hospital Relationship

This gives physicians a certain degree of autonomy. I believe this is an excellent model, particularly when collaboration is built upon both individual physician brands and the brand of the physician group, creating a win-win scenario.

In the United States, 70% of physicians collaborate with hospitals through this model, while the remaining 30% contract directly with hospitals. The latter group is primarily affiliated with academic medical centers and research-oriented hospitals, where physicians prioritize stable income over market-driven considerations. Most service-oriented physicians enter into contracts with hospitals via physician groups. In China, however, approximately 99% of physicians are employed staff, with very few engaged in independent private practice.

However, in the future, a segment of physicians will undoubtedly embrace market-oriented practices, leveraging market mechanisms to secure better compensation and provide superior patient care. These two elements are mutually reinforcing: adequate compensation enables higher-quality service, and high-quality service, in turn, leads to greater financial rewards.

Making Medical Practice Purer

In fact, internationally, most physician groups are small, typically comprising three to five or five to six members. Groups with more than ten members are relatively rare. These professionals unite to form a team, enter into contracts, deliver clinical services, and receive compensation. This model allows for a more relaxed practice style, without the need for external financing or reliance on third-party support, enabling physicians to focus on their clinical work and market development. Of course, some physician groups expand over time. Through financing and increased capital investment, they may establish chain operations, sign contracts with more hospitals, or even build their own hospitals. They may also engage in cross-investment with hospitals to form medical groups, thereby attracting more teams to join this system.

I believe that physician groups in China are still in their nascent stage. There is a prevailing perception that they must scale significantly, employing dozens, hundreds, or even thousands of physicians with branches across the country. This large-scale expansion model will certainly emerge in the future. However, we should not rule out the viability of smaller, more focused physician groups comprising just three to six members. Such groups can deliver specialized, high-quality care, find fulfillment in serving patients, and enjoy a balanced lifestyle. I believe this approach is also worthy of promotion.

Physician groups cannot hold legal person status.

It is indeed challenging to find a suitable practice platform at present. An ideal platform would provide support from basic medical insurance for services covered under the national scheme, as well as commercial insurance coverage for high-end patient populations. Furthermore, all revenue streams must be standardized and fully compliant with legal regulations. Crucially, such a platform should also offer systematic training and professional development opportunities for its physician team. Platforms meeting all these criteria are currently scarce in China.

Although the opportunities are limited, we must strive to develop them. Currently, tertiary hospitals (Grade 3A) are not the target market for physician groups, as these hospitals operate at full capacity and do not require the services of such groups. However, a large number of secondary hospitals (including Grade 2A institutions) welcome physician groups. These hospitals have patient demand but lack specialist expertise, or their specialist capabilities are relatively weak; thus, they urgently need support from physicians affiliated with tertiary hospitals.

Genuine physician groups will make greater investments in this area and enjoy greater flexibility in collaborating with secondary Grade A hospitals. This approach is currently a relatively favorable option. In fact, our physician group primarily collaborates with public secondary hospitals. Both parties are highly satisfied with the partnership and are eager to provide mutual support, which has proven to be a viable arrangement.

Another segment where physician groups currently find it relatively easy to collaborate is with private hospitals, particularly high-end private institutions such as the Pudong Medical Center. These facilities implement fee schedules that reflect physicians’ professional value, primarily funded through out-of-pocket payments or commercial insurance, thereby allowing our doctors’ worth to be reasonably recognized. Although China’s private hospital sector is still in its early stages, we believe that as more physician groups join, both parties will achieve continuous growth. I am very optimistic about this area.

Therefore, for private hospitals covered by basic medical insurance, fee schedules are constrained by insurance regulations, resulting in very low pricing and inherently weak profitability. This creates pricing challenges when physician groups collaborate with such institutions.

Of course, a physician group does not mean serving only high-end patients while excluding ordinary ones; this is a matter of strategic positioning. From my perspective, the Donglei Brain Specialist Physician Group collaborates with high-end private hospitals to serve premium patients, and also engages in specialized care partnerships with certain departments of public hospitals. In the future, we can also cooperate with private or public institutions that participate in the national health insurance scheme, accepting lower profit margins in order to provide comprehensive services. If the sole objective were financial sustainability, focusing on high-end and specialized care would be more viable, as operating within the health insurance framework is challenging. However, once the organization scales up, it can assume some social responsibility from a societal benefit standpoint, which is also feasible. I believe that depending on the positioning and scale of a physician group, its operational design will vary accordingly. All these models are viable, reflecting some of the key considerations for physician groups.

Medical liability insurance should be attributed to individuals.

In foreign healthcare systems, a significant portion of human and material resources is not devoted to surgical procedures but rather to pre- and post-operative care, where extensive communication helps resolve many patient concerns. In contrast, public hospitals in China are overwhelmed by high patient volumes, leaving doctors overworked and underpaid. Consequently, they have little time or energy to devote to patients, a situation driven by necessity rather than choice.

From the perspective of physicians, I believe that in China’s future healthcare landscape, 20% to 30% of doctors will remain in large hospitals for academic and research purposes, while the majority should move toward the service market. We can categorize physicians into academic-oriented and service-oriented practitioners; what the general public needs are service-oriented doctors. Currently, China’s system trains all physicians to be academically focused, which is disconnected from market demands. The market requires approximately 70% service-oriented doctors and 30% academic-oriented doctors, a ratio that is more appropriate. This means that in the future, 70% of physicians will need to shift their mindset from prioritizing academic pursuits to emphasizing patient care services, thereby aligning with market needs. Many of these issues can be addressed through independent practice. Whether to form a physician group and the scale of such a group depend on individual circumstances.

In conclusion, I would like to summarize with one statement: We are committed to leveraging physician groups to facilitate and drive the transition toward independent practice. Independent practice aims to better realize the professional value of physicians. If this value is market-oriented and patient-centered, many prevailing issues can be resolved, enabling physicians to receive more reasonable compensation and respect, thereby ensuring the sustainable and robust development of our medical profession.