Specialty Physician Standardized Training: Perseverance and Positivity in the Cracks

(Repost) The outcome of the rollout of the “5+3+X” standardized residency training program for specialist physicians is:

Year One: Hey, getting into medical school is tough. You’re so impressive—I’m envious.

Second Year: “Studying medicine is so complicated? I admire you. It’s nothing like our lousy school…”

Year Three: Wow, there are so many experiments; we’re way too idle.

Fourth year: Preparing to pursue career opportunities in Beijing, Shanghai, and Guangzhou. How about you? ...Oh, I forgot, you are on a five-year track.

Year 5: Sigh, just a project manager—nothing worth mentioning. ...And you guys? ...Oh, interns. No worries; it’ll be soon enough before you’re respected attending physicians!

Year Six: Life is just so-so. There are plenty of people earning higher annual salaries than I do. How’s the big-shot doctor doing? …Oh, preparing for exams?

Year 7: The previous car was too low-end, so I decided to upgrade. By the way, how is Dr. Da doing? ...Oh, he’s still in training.

Year 8: “Hey, everyone here is invited to my wedding banquet. By the way, Doctor, when will it be your turn? …Oh, you’re still in training?”

Year 9: Come on, baby, say hello to Uncle and Auntie! By the way, Doctor, hurry up—are you planning to combine your wedding banquet and your baby’s full-month celebration? …Oh, still in training?

Year 10: Time flies, and the years are merciless. Everyone is sharing their reflections on the past decade. Come on, Doctor, it’s your turn... Oh, still in training?

Year 11: Sigh. Back then, that apartment was small and located in a bustling downtown area—far too noisy. That’s why we moved. Let’s call it a countryside home, please; don’t refer to it as a villa. Dr. Big Shot, you’re still single? You’d better hurry up. ... Oh, and you need to prepare for your exams as well.

Year 12: Hmm, the baby has started kindergarten and is quite well-behaved. …… Yay, why hasn’t the great doctor come? …… Oh, still in training.

Year 13: Sigh, it’s not that I’m changing cars again; this one’s for my spouse. … Hey, why hasn’t the great doctor shown up? … Oh, still in training.

Year 14: Sigh, it’s just a small clinic; I’m keeping it for my retirement. … Hey, the renowned doctor hasn’t shown up again… Oh, still in training.

Year 15: I still haven’t been to Africa. You guys are doing well too, all of you have become division-level leaders. … By the way, where is Dr. Da? … Oh, he’s still in training.

Year 16: Small companies, small companies—not worth mentioning. Huh? Where are the big-name doctors? …Oh, still in training.

Year 17: Business is just so-so, with only two branch offices. Look at others—they’ve already become multinational corporations! Hey, where’s the great doctor? …What?! Hospitalized? What happened? Oh, due to overwork…

Year 18: No, no, it’s just a second-hand apartment, convenient for the kids’ schooling. …… Hey, where’s the renowned doctor? …… What?! He was slashed with a knife right after starting his outpatient clinic! Everyone, go take a look! ……

Location: Chinese Society for Health Policy and Management

Participant: yuhaiLiang DiWang Jianxiu

Young People Need to Establish a Rational Perspective on Career Choice

Many young professionals who complain about the new system primarily suffer from misguided career perspectives. Many are no longer in their early years yet remain unclear and confused about what they truly wish to pursue. To become a competent and reputable physician, one should complete a three-year standardized residency training after earning a bachelor’s degree, which offers the prospect of securing a position at a major hospital and continuing clinical career development. Alternatively, if one pursues a master’s degree for three years after graduation and then, following the advisor’s recommendation, spends another three years completing a doctoral program, an academic career path can also be rewarding. However, if after obtaining a postdoctoral position one becomes distracted and wishes to switch to clinical practice, participation in standardized residency training is inevitably required.

The current situation is a mishmash; who is to blame? Apart from the individual himself, responsibility must also be borne by his medical school and instructors, for failing to teach students the ABCs of medical education, the essence of medical professionalism, and the distinction between academic research and clinical practice. The National Health and Family Planning Commission has committed many foolish and erroneous acts, but its general direction regarding standardized residency training and specialized physician training has been sound.

For medical students from non-prestigious institutions, standardized residency training presents an excellent opportunity.

It is understandable that medical students from prestigious universities oppose standardized residency training, as their existing training is already sufficient. However, for many medical students from non-prestigious institutions, gaining entry into residency programs at major hospitals may represent an excellent opportunity for professional development.

For example, during my clinical internship at Shanghai Fifth People’s Hospital in college, one of our supervising physicians was a bachelor’s degree graduate from Wannan Medical College. He expressed deep appreciation for the standardized residency training (SRT) program. Many of his fellow interns from Wannan Medical College later entered SRT programs at tertiary Grade A hospitals in Shanghai. Without the SRT system, they would have had no access to even basic training opportunities.

[Policy on Specialist Training for Physicians] Authoritative Interpretation

1. The duration of medical education in China follows a “5+3+x” model, not a “5+3+3+3+x” structure. Since 2015, all professional master’s degree students have been integrated into the standardized residency training program, eliminating the need for an additional three years of training after graduation.

2. For attending physicians participating in training, the document states it is “required,” but this does not imply that it is universal or mandatory for all.

3. The specialized residency training system is currently in the pilot phase and will be initially established in 2020. During this interim period, existing personnel will continue to be governed by the previous regulations.

4. Specialized training is selective rather than mandatory, and participation is voluntary.

5. Even based on the longest duration of four years, the total training period for physicians is 12 years, which represents the lower end of the international range for physician training.

6. The current training system has initially aligned with international standards; the next urgent step is to achieve policy breakthroughs in areas such as personnel staffing and compensation to keep pace.

7. "No matter how complex the processing, we dare not skimp on labor; no matter how costly the ingredients, we dare not reduce material resources." The training of physicians is a matter of life and death and cannot be achieved through short-term crash courses.

8. A Basic Common Sense: Do Not Take Things Out of Context.

The new system requires a corresponding increase in compensation and benefits.

Everyone can come up with a host of reasons to justify their actions in their own interest. There is suspicion that the standardized residency training program serves as a source of free or low-cost labor for the hospitals hosting these trainees.

The shortage of physicians at primary healthcare institutions has intensified in the short term, as young doctors have flocked to standardized residency training bases, making a gap in the talent pipeline at these facilities inevitable.

Even though salaries are low during overseas training, they can at least double upon completion. In contrast, there is no improvement in career prospects domestically. What motivation does this leave for physicians? Do they not need to support their families?!

Physician training standards are necessary, but the priority should be to improve compensation first to incentivize talent; currently, priorities are somewhat misplaced.

Of course, there is nothing wrong with the National Health and Family Planning Commission’s desire to align with international standards, but awareness alone is insufficient. To accomplish something effectively, one must be prepared to invest the corresponding effort and resources. Simply put, adequate investment is required. The specialized residency training system itself is sound; it serves as both a means to hone the professional competencies of medical students and a demonstration of responsibility toward patient lives. After all, this is the standard practice worldwide: standardized residency training and specialized physician training are both essential.

Finally, what the author wishes to convey is that current hot-button issues in healthcare often emerge as “bad news” once they come to light. Take standardized residency training, for example: although it is a matter with both advantages and disadvantages (depending largely on the stakeholders involved), it has been met with widespread criticism. Perhaps many people have much to say about the existing system, but we should also recognize that our friends and colleagues in the medical and health industry are making earnest efforts.We call on everyone to bring some positive energy to healthcare, so as to avoid10Year, 20Years later, neither we nor our children will have access to medical care.

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