Will Taiwanese Physicians Flock to China?
Chief Surgeon: Those Who are Supposed to Come are Already Here
China drew widespread attention and debate with its February announcement of 31 incentives to attract Taiwanese talent from various sectors, including the audiovisual, education and medical industries. Given that China’s medical profession has been open to Taiwanese physicians for many years, are these additional “economic benefits” likely to make medical personnel leave Taiwan in droves?
Chief Surgeon: Those Who are Supposed to Come are Already HereBy Amber Lin
From CommonWealth Magazine (vol. 645 )
A Taiwanese surgeon shared his experiences practicing in China and spoke about the challenges lying ahead for those who vie for seemingly “lucrative” medical doctor positions in China. The following is a translation of his statements:
“I had served as a surgeon in a private hospital in Taiwan for 15 years when I was invited to establish the surgical department at a Taiwan-funded hospital in China in 2009. I went to Shanghai in 2012, and in 2013 I took the job of chief surgeon at a prestigious hospital in Beijing. So it’s been nine years [in China] altogether.”
“As far as physicians are concerned, the 31 policy incentives don’t make much of a difference. Taiwanese physicians have already been allowed to directly convert their medical licenses into Chinese medical doctor licenses for many years. Moreover, local medical institutions assist in applying for short-term medical practice licenses. Many ‘holiday knife jugglers’ [physicians who fly to China during holidays to conduct surgeries] use this approach.”
“The policy on medical doctors has been around for more than a decade. Those who were supposed to come are all here, and those who didn’t come won’t come specifically for these incentives, so the impact will probably not be very great. Furthermore, whether you can open your own medical office pertains to the policy of the respective local government and is unrelated to your status as a Taiwanese citizen.”
“The Nanning government, for instance, stipulates that you must have been practicing medicine there for five years before you can start your own private practice. Acceptance of Taiwanese healthcare is high in Kunshan because many Taiwanese live there, but it is no longer possible to open a new private practice due to a cap on the total number of practices. In some places you need to have a Chinese identity card. Since the medical practice markets in Beijing, Shanghai, Guangdong and Shenzhen are saturated, the controls are even stricter there. Therefore, most Taiwanese doctors who open a private practice in China pay a local physician for using his or her practice registration.”
"We who have been living in China for a longer time all know that we must regularly watch [China Central Television’s daily news program] Xinwen Lianbo. Before such directives are implemented locally, before enforcement rules are issued locally, central government policy is within sight but out of reach. The 31 incentives, for instance, stipulate that [Taiwanese] nurses can take exams, but how will the examinations be conducted? Which [teaching] units will be part of the exam? None of this has been announced."
"Ordinary medical institutions don’t have any rules; they observe the market situation first. Subsequently, there might be a clearer policy, but in China it often works like this: When the writing is unclear or vague, those in charge would rather do less than more. Unless the central government keeps a close eye on them, the local governments are not necessarily proactive."
Different Organizational Culture, Strong Exclusivity
"The Taiwan policy Xi Jinping announced this time will most likely be implemented quite quickly. The only problem is that hospitals in China are not very likely to systematically open vacancies to Taiwanese physicians."
"Healthcare and higher education differ; higher education is not that exclusive. When a teacher teaches well, it does not mean that the other teachers don’t get students. But exclusivity does exist in the medical profession. In smaller cities, they worry about the competition from Taiwanese doctors. The physicians in Beijing are capable enough...they also see many people, so they are less likely to regard you as a rival."
"There are objective and subjective reasons why Taiwanese physicians here often find it very difficult to adjust. For one thing, the practices and customs in outpatient clinics are very different from those of Taiwan; people here, for instance, do not attach importance to patient privacy, and they are not very polite to doctors. Also, hospital politics is much more intense than in Taiwan."
“I once met a physician from Taiwan who had many patients thanks to her good reputation. When making her ward rounds, the chief physician told her patients that Chinese doctors would not prescribe the kind of medication that she had prescribed. This Taiwanese physician held out for a year and then left. When I had a management position at the Taiwan-funded hospital, I would do my best to come up with some ways of protecting Taiwanese physicians. Yet in the end, 90 percent of the doctors are Chinese physicians, so there can’t be any discrimination, or else the Chinese physicians will band together against you.”
“You asked me whether organizational politics is really that frightening when you come here to develop your career. I will answer with a clear ‘Yes.’ Therefore, resilience when facing challenges is very important.”
“I worked in Taiwan for 15 years and in China for nine years. In Taiwan, I only needed to look after my patients and things were fine, but here it obviously doesn’t stop there; it depends on your attitude. Even now, I still think only about doing the things that ought to be done while also putting up a firewall in places where I could be harmed in order to protect myself.”
“For instance, what approach should I use to prevent adverse effects if a Chinese colleague talks badly about me with my patients? I choose to communicate thoroughly with my patients beforehand. I never intend to harm others but always guard against harm from others.”
“The biggest difference between Taiwan-funded hospitals and Chinese-funded hospitals is that Taiwanese investors more easily bring in Taiwanese healthcare system and concepts, whereas acceptance [of these] is not very high at Chinese-funded hospitals. Taiwanese hospitals attach greater importance to the quality of the doctor-patient relationship, but Chinese hospitals feel that if you do this you will never get the job done.”
“Generally, this is not the case in teaching hospitals, but private hospitals demand good performance, and they will make rules as to which medicines doctors are to prescribe. Also, the medical records here are written in simplified Chinese characters, whereas Taiwan uses English. I guess that the hurdle must be pretty high for frontline nurses.”
Teach Consultation Etiquette
“When opening a private practice in China, consultation habits play a major role in addition to local connections.”
“Since the quality of Chinese clinics is not good, the average person does not trust them. During the recent severe influenza epidemic, Taiwanese patients would go to a clinic, but in Chinese clinics you are often ‘hooked up to an IV drip’ as soon as you walk in, first spending 150 renminbi (about US$24) in a single consultation to obtain medication for three days. People mainly go to the hospital to see doctors.”
“And when the market and [patient] education have nearly reached the [Taiwanese] level, the ‘whales’ will come: The capital-raising capability of local people is very strong, and big fish eating smaller fish is a common occurrence. You need to be very cautious when opening a private practice in China. In Kunshan, for example, a couple of really good clinics are being threatened by large local clinic chains.”
“Over the years, Taiwanese have always been coming here, but not a few have left. Nowadays, cosmetic surgery isn’t that competitive anymore. In the past, Taiwanese doctors went to China because they [the Chinese] didn’t understand [cosmetic surgery]. A classmate of mine flew over every week to give injections for three days over a decade ago. But now the threshold for plastic surgery is low and oversight is lax. Many people get injections directly at the beauty parlor; the market is characterized by cutthroat competition.”
“What has been liberalized is the policy, but whether a practice can survive depends on the market. I am still toying with the idea of starting a private practice, picking a city in the Jiangnan region where more Taiwanese live and acceptance of Taiwanese healthcare is high, but I would not do it alone.”
“What you need to consider here more specifically is that you need to have a team; you can’t fight the battle alone. You also need to do good market research and planning. In your team you definitely need people who have been in China long enough to know the ropes.”
“Relations with the authorities are of course ‘very important’. Many legal clauses are ambiguous; how they are interpreted depends on the officials. If your connections are good, they will allow you to do it; this is a society ruled by man after all. They can either give you a hard time or they can help you.”
“You must not be the least bit foolish or naïve. Using Taiwanese thinking to imagine China is treacherous, and too many people have failed. The Taiwanese are very smart and nimble, but several decades of Chinese reforms and opening have also sharpened the minds of the Chinese.”
“If you simply want to work in a hospital, you won’t have much of a problem, but you need to be tough.”
A Stage to Shine, not Just High Pay
“Many people ask me: If it's so competitive here, why do you stay?” (Further reading: Taiwanese Educators in China: ‘Why Are We Cultivating Talent for China, Not Taiwan?’)
“When I meet with former colleagues over lunch or dinner in Taiwan, they seem to think that I make twice or thrice their salary. This misunderstanding is widespread in Taiwan. High salaries are a thing of the past. Now the salaries are a bit higher at most, but by no means are they a multiple of Taiwanese salaries. Those who come here have their eyes set on the larger market. Moreover, the industry here is market-oriented; why should anyone hire Taiwanese if they aren’t more competent? Chinese physicians aren’t less competent, it’s just that give services that are quite uneven in quality, while those given in Taiwan are.”
“The competitive edge of the Taiwanese is their healthcare philosophy that puts people at the center of care. Although China is making very rapid progress, there are still many areas where Taiwanese concepts could be adopted. For example, although the large hospital where I work in Beijing is second to none, it cannot compare to Taiwan in terms of healthcare concepts, which means I have room to shine.”
“Taiwan’s healthcare ranks third worldwide and is No. 1 in Asia...its success is undisputed. Many Chinese hospital staff come to Taiwan to learn from us, and Taiwanese hospital staff go to China for coaching and training, but this merely scratches the surface without getting to the root of the problem. I’ve found that truly effective reforms must be done from the inside out; they can’t be dependent on the presence of specific individuals. So if I promote reforms from inside, I achieve the best and most lasting effect.”
“For instance, I am now a chief surgeon in charge of a team of nine. I can use a Taiwanese management approach to nurture young physicians and make them think. The Taiwan-funded hospital where I worked previously is still using the work model that we established in the very beginning. Such an inside-out model that changes work through concepts and ideas is more effective than simple training. This sense of achievement made me stay on.”
“I believe our talent pool in the medical profession won’t be depleted. Over the past decade or so, cross-strait exchanges have thrived, so Chinese hospitals are no longer that curious about Taiwan. Since a dynamic equilibrium already exists, fluctuations won’t be that significant.”
“China is indeed a large market, but before you come here you need to make sufficient preparations. You need to be well-prepared mentally since the healthcare ecosystem, hospital requirements, physician-patient relationship and peer relations are all very different from those of Taiwan. Furthermore, fresh med school graduates are not fit to come here; you need a certain skill set to gain leeway for negotiating your salary.”