Background Over the past decade, China's systems of medical education and health care have undergone unprecedented reform. Despite these reforms, a trend of declining interest among medical graduates in pursuing careers in clinical practice has persisted. The aim of this analysis is to examine physician workforce production and attrition rates and use current trends to predict whether an adequate and equitable supply of physicians will exist in the future. MethodsWe analysed data about Chinese medical graduates and physicians in clinical practice between 2005 and 2015 using the Chinese National Health and Family Planning Commission reports and yearbooks published by the government of China and the Peking Union Medical College. These sources covered all of China (31 provinces; Hong-Kong and Macao were not included). The international review board of National Yang-Ming University approved this study. Findings From the beginning of 2005 to the end of 2014, China produced 4 314 791 5-year clinical medical graduates and 413 186 5-plus-2 programme (5-year medical education programme plus 2-year graduate programme) medical graduates: total 4 727 977 clinical medical graduates. However, during this period, there was an increase of only 752 233 (15•91%) in the total number of clinical physicians registered in practice. Using demographic data from this 10-year period, we found that the proportion of physicians aged 25-34 years had decreased from 31•3% to 22•6%, and the proportion of physicians aged 60 years and older had increased from 2•5% to 11•6%. Meanwhile, 5-plus-2 programme graduates increased from 4•3% to 11•2%, and rural areas had a shortfall of over 500 000 physicians. Interpretation This study confi rms the high attrition rate among medical graduates and physicians in China over the past 10 years. If this pattern continues, China will suff er a chronic shortage of medical doctors in certain specialties and in rural areas. China's future appears destined to have the chronic care issues that come with an ageing society and require considerable human resources. High physician attrition rates, low physician production, and rapid population growth will only compound the problem.
Background Chinese medical doctors have experienced unprecedented challenges over the past 10 years, including but not limited to heavy workload and violence against doctors. In the meantime, the National Health and Family Planning Commission issued guidelines for standardised medical training that include an additional 2-4 years of specialist training for junior doctors. Few studies have explored the relationship between burnout and associated factors at Chinese medical schools and hospitals. Methods The study population consisted of 3387 medical students (n=2097) and residents (n=1290) from all over China. In 2016, 85 medical schools and their teaching hospitals participated in this study. We used the following questionnaires: Chinese version of the Maslach Burnout Inventory; Job Content Questionnaire; Professionalism Assessment Scale; Moral Distress Questionnaire; Jefferson Scale of Physician Empathy-Student Version; Chinese version of the General Health Questionnaire; Center for Epidemiologic Studies Depression Scale (CES-D); Professional Role Formation Inventory including sections related to lifelong learning, humanism, social learning, and research advancement; and other social demographic questions to collect cross-sectional data. Statistical analyses were conducted using SPSS 20. Ethical approval was obtained by the Institutional Review Board of the principal investigator's institution.
research on collaborative care might further contribute to clinicians addressing mental disorders as noncommunicable disorders. 8 Finally, neurogenetics research has focused on user perspectives, and is often funded by family advocates. Global mental health is increasingly encouraging user participation in research and advocacy, and can usefully lobby for both discovery and delivery research priorities. 9 Engagement of global mental health and neurogenetics researchers could face impediments. Scale-up of efficacious interventions might have immediate benefits, but the time from genetic discovery to clinical utility is long. Genetic testing is used in neuropsychiatry in resourcerich clinical settings; extension of genetic testing to African populations might be facilitated by combining discovery, clinical genetic testing, return of results, and genetic counselling. 10 Comorbidity of mental disorders is challenging for both global mental health researchers and neurogeneticists. Research in under-resourced countries on interventions for comorbid conditions is at an early stage, and although neurogenetics studies have shown genetic overlap across mental disorders, pleiotropic effects are not well understood. The fields of global mental health and neurogenetics are both cognisant of translation challenges. In global mental health, to go from efficacy trials to scale-up, multiple issues need to be addressed, including buy-in, training and supervision, quality maintenance, monitoring, and finance. There are analogous challenges for the field of neurogenetics in moving from laboratory findings to clinical application. Both fields must emphasise that mental health research is underfunded and that greater investment will substantially pay-off over time.Discovery research has shown that the story of humans begins in Africa and, with population growth, genetic research on the continent will become increasingly crucial. There has, however, been an imbalance in health research with 90% of all research emerging from highincome countries, in which only 10% of the world live. Greater engagement between global mental health and neurogenetics in Africa (figure) might be valuable in redressing this research imbalance.DJS has received research grants, consultancy honoraria, or both from Lundbeck and Sun. All other authors declare no competing interests.
Background Professionalism is a central part of medical practice, and medical organisations worldwide have mandated training on this topic for future medical doctors. In China, national guidelines were developed to make explicit expectations that were once implicit. Medical education reform over the past decade has emphasised topics such as medical humanities, life-long learning, and patient-centered learning in an eff ort to increase the professionalism of future physicians. Although the importance of teaching professionalism has been well recognised, few studies have evaluated its implementation at Chinese medical schools. MethodsWe recruited medical students from three medical schools deemed to be representative of diff erent regions in China (
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