As the largest children’s hospital in Southwest China, the Children’s Hospital of Chongqing Medical University (CHCMU) has the earliest key discipline of pediatrics nationwide. The recent years have witnessed the rapid development of pediatrics in CHCMU. During the 2014 Annual Meeting of Hospital Directors, Dr. Ting-Yu Li, Director of CHCMU shared her experiences in the hospital development strategies and the construction of national key clinical disciplines with participants. Also, she described the visions and blueprint of CHCMU as a regional pediatric center.
DXY.com: Shortage of pediatricians is a common phenomenon in many hospitals. How to explain it?
Dr. Ting-Yu Li (hereafter referred to as “Li”): This can be blamed to the education reform: since 1998, the departments of pediatrics have been canceled by the Ministry of Education and few colleges have maintained the specialty of pediatrics. As a result, a significantly smaller number of pediatricians are trained in China. This is the main reason.
The second reason is that the workload is often much heavier in the pediatric departments when compared with other departments for adults, and the doctor-patient relationship is often tenser. Children usually cannot describe their symptoms well; meanwhile, they are often excessively cared and concerned by their family members. One pediatric patient is often accompanied by four or five family members. This may bring many problems. For example, if the first attempt to insert the needle fails, the parents may become angry to the nurse. This is quite common in our hospital.
The working conditions are also different from other departments for the adults. For example, in a large-scale general hospital with a capacity of serving several thousands of patients daily, its emergency department may only receive 100 patients at the night, and one or two doctors will be sufficient. In the pediatric department, however, the number of patients can reach 700 or 800 at night, and 7 or 8 doctors are required. While only a few of them really have urgent conditions, the majority of the patients in the pediatric emergency department are with common diseases.
Thus, some medical students find out that the work in the pediatric departments is so hard during their internship and finally refuse to work as a pediatrician. The pediatric departments also train interns and residents; however, a small proportion of them also cannot tolerate the hard work in the pediatric departments and decide to work in hospitals for adults or even switch to other professions.
These reasons, in together, result in the shortage of pediatricians in China.
DXY.com: Your lecture on the rapid development of CHCMU is very encouraging. How about the capacity-building in CHCMU? Are there any specific strategies to recruit and retain talented pediatricians?
Li: Luckily, CHCMU currently is the largest training base for talented pediatricians in China. In my lecture, I introduced the history of the transfer from “Department of Pediatrics” to “Research Direction of Pediatrics under the Subject of Clinical Medicine” in our university. In fact, training of young pediatricians has a long history in our hospital. We maintain a sufficient demand for pediatricians. Today there are over 500 pediatricians in CHCMU, and 400 new beds have been established. According to the stimulation of the Ministry of Health, 200 doctors will be enough for 1,000 beds, maintaining a ratio of 1:0.2. So the number of stall members is not a problem in our hospital.
However, few pediatricians have been trained in other Chinese hospitals, and few graduate students are majored in pediatrics. Thus, top-level talents in pediatrics are still lacking. Therefore, on one hand, we need to strength the training of young talents in our hospital. CHCMU is constantly growing, and about 200 new staff members are recruited every year. We are very willing to provide constant education and training to these young colleagues. On the other hand, recruiting senior talents is also a priority in our hospital.
Compared with other departments, few chances are available in the pediatric departments. For example, among the “inistry of Health Key Disciplines”, all the subjects for the adults have been listed; for the pediatrics, unfortunately, only the subjects of respiratory medicine and heart diseases are listed under the same columns of diseases among adults. Actually, pediatrics is a comprehensive subject targeting individuals below 18 years. The government administrations should update their policies on pediatrics.
DXY.com: Just now you mentioned that the pediatricians are facing a special patient group. So, in your opinion, what are the required qualifications for a pediatrician? Are there any differences when compared with doctors working in other departments?
Li: As a pediatrician, you must be extremely loving, patient, and careful. Before you choose to work in a pediatric department, you must know your own personality clearly. For example, do you really love kids? The answer must be “Yes”. Love and patience are the essential characters of a good pediatrician. Also, you must have excellent communication skills. In addition, it usually takes a longer time for a young resident to become an experienced pediatrician. After he/she graduates from the medical college, he/she needs to receive standardized training, and then becomes a general physician; he/she has to receive additional three years of training before being a specialist in the pediatric departments. So, he/she has to face tougher challenges.
DXY.com: CHCMU is a children’s medical center in Southwest China. Are there any specific measures to integrate the regional resources and increase the health-service delivery? In the meeting avenue, actually many doctors mentioned that they had received training in your hospital.
Li: After CHCMU was moved to the current site in the 1950s, it has gained a good reputation for its clinical practices, teaching, and scientific research. In recent years CHCMU has strived to further increase its impact through the following aspects:
First, strengthening the discipline construction. Discipline construction is a multi-faceted task involving the clinical practice, teaching, and scientific research. Scientific research, in particular, is very important for talent training. Successful discipline construction is also helpful for obtaining various resources such as projects supported by the programs including the National Key Discipline, National Excellent Courses, National Teaching Team, and Ministry of Education Key Laboratory. All these honors and resources have vigorously promoted the scientific research in our hospital. Thus, discipline construction is necessary for a good hospital and also has long been one of our priorities. For example, the ranking of the “Best Hospitals” is based on two aspects: (I) the professional reputations of specific departments; and (II) the capacity and achievements of scientific research. It is natural that hospitals with higher ranks have larger impact. Since CHCMU already has a solid foundation in discipline construction, and many doctors are willing to receive further training in our hospital.
Second, talent training. The discipline construction cannot be realized without qualified staff. We have trained a lot of talents by ourselves; meanwhile, we also have recruited many talents from other institutions to further improve the scientific research in CHCMU. Both are equally important.
Third, innovation in clinical techniques. Clinical techniques need to be updated constantly before we can provide training to the trainees. Innovations can also foster the development of hospitals in the surrounding areas.
Fourth, the size of the hospital. A few years ago our hospital was still composed of many small rooms, with patients and their parents crowding the corridors all the day. It was difficult to provide satisfactory services to the patients under such conditions. Then, we spent several years to rebuild the hospital, expanding the construction area from 10,000 square meters to 140,000 square meters. The improvements in the hardware have greatly benefited our patients.
Finally, improvement of management. Any good plan will be invalid without proper execution. Thus, a scientific management method must be available for a hospital. Good management will foster the discipline construction and finally increase the impact of the hospital.
DXY.com: Dr. Li, many thanks for accepting our interview. We wish you further success in your future endeavors.
Disclosure: The author declares no conflict of interest.
(Editor: Xue Zhang, DXY Website, firstname.lastname@example.org)