China’s cabinet announced Tuesday details of medical education reforms aimed at improving the quality and quantity of professionals entering the country’s health care system.

A lack of qualified medical professionals is at the heart of a bottleneck limiting wide-reaching health care reforms, according to the Ministry of Education’s director of higher education, Wu Yan, speaking Wednesday at a press conference held by the Ministry of Education, the National Health and Family Planning Commission (NHFPC), and the State Administration of Traditional Chinese Medicine.

Currently, there are 3.19 million licensed medical practitioners in China, or 22.8 practitioners per 10,000 people — not a far cry from the 28.7 in the U.S., according to figures from 2014, the most recent year for which data is available. Nonetheless, only half of China’s licensed practitioners have a college degree or higher, with many holding vocational degrees or secondary education certificates.

“China has never had a comprehensive strategy for medical education, and that is why there are many problems in our current medical education system,” Hu Shanlian, a professor in the public health department at Fudan University in Shanghai, told Sixth Tone. “The severe lack of qualified doctors, and the uneven and unreasonable allocation of talent between regions — between cities and the countryside, and between different medical departments — have become major problems with the medical system.”

The State Council’s new guidelines seek to combat these problems by requiring prospective doctors entering education in 2020 to complete five years of medical university education and three years of training. Applicants to such education programs will also face stricter admission procedures, with medical universities being required to accept only so-called first-tier students — those who score highest on the gaokao, the country’s university entrance exam.

Speaking at Wednesday’s press conference, Qin Huaijin, chief of the science, technology, and education department at the NHFPC, said the country aims to cultivate 500,000 qualified resident doctors by 2020, a significant rise from the current number of 290,000.

In line with China’s recent round of health care reform, which emphasizes strengthening primary care at the local level, the new guidelines address the need to bolster the country’s qualified doctors and general physicians at community-level medical institutes, particularly in rural and remote regions.

Compared to developed countries, where around 30 to 40 percent of doctors are general physicians, China’s rate is just 6.6 percent, Qin said at Wednesday’s press conference. To encourage more medical university graduates to work at community-level hospitals and remote medical centers, the new policy will allow medical graduates who work in such institutions to compete for the position of chief physician. Graduates who work at big public hospitals will typically only be eligible for such a role after five years.

Hu, who sees the notice as a milestone, remains concerned about the lack of funding in medical education when compared to the financial investment that big public hospitals in cities enjoy. “The gain from investment in medical facilities is much easier to show; investment in education takes years to pay back,” he told Sixth Tone. “But human resources are a crucial part of our health care system.”

A further obstacle to reforms in medical education, believes Hu, is a decline in the desirability of the profession, owing to associations with heavy workloads and strained — even violent — doctor-patient relationships. Tellingly, fewer and fewer medical university students are choosing to become doctors after graduation, he said.

The new education plan will only be effective if it is accompanied by real changes to the rights and treatment of medical professionals, Hu said, adding: “Reasonable payment for doctors’ services, doctors’ power to bargain with hospitals, and respect for medical practitioners are all essential to making the occupation attractive again."

Editor: Owen Churchill.

(Header image: A medical student takes an operating exam at Guilin Medical University, Guangxi Zhuang Autonomous Region, June 2, 2016. VCG)