Cultural Barriers in Building an International Standard Medical Staff in China

One of the most difficult hurdles a new healthcare project has when it gets started in China is recruiting a medical staff.  The ultimate reality is that there isn’t much choice in where you get your doctors.  The private sector is so small that the availability of physicians who are currently working in private facilities and open to recruitment is almost non-existent.  No, you really have no choice but to recruit from the public hospital system. This isn’t all bad as the best physicians from a talent and education standpoint generally are working in the large public hospitals in the major metropolitan areas.  The problem is that they don’t want to work for you; at least in a normal, traditional employer-employee relationship where they resign from their public hospital job and become your employee.  In their public hospital, they have lifetime tenure, a slate of benefits that grows as they advance through the ranks from assistant professor to professor and security – they are never going to get fired or replaced.  Why should they give this up to go work for you?  You’re a start-up with no history and an uncertain future.  A year from now you could be a failure and they would be on street looking for another job.  And good luck going back to their public hospital and asking for their old job back, they are persona non grata there.  You may be able to recruit some very young physicians, early in their career and discouraged by the long road ahead of them in the public system.  But the senior physicians, the ‘famous’ physicians from the public’s perspective, are simply not recruitable in the traditional way.  Many people make the mistake of assuming that if they pay very large salaries in comparison to the public hospital’s that this will be successful in luring physicians away.  Generally, it won’t.  This isn’t a financial issue.  It’s a cultural issue.

 

The only real recourse and the one adopted by virtually every private healthcare facility is a halfway measure of hiring the public hospital physicians on a ‘moonlighting’ basis where they work for you a few days a week or a month.  Originally an illegal practice, this is now officially condoned by new regulations.  But what are the problems with this approach?  Well, if you are trying to introduce international practices into your medical staff, you’re in for an uphill road with these physicians.  They are not your employees.  They have no loyalty to you. They are employed by the public hospital and that’s where their future lies.  The methods of practice they have been taught in the high-volume public hospitals are antithetical to your aspirations of building an international standard facility.  One to two minute examinations, a heavy reliance on prescribing unnecessary drugs, over-utilization of laboratory and imaging procedures and other practices are the foundation of a public hospital physician’s repertoire. Do not for a moment believe that when they walk through your doors for their once a week clinic session that they are going to change their whole method of treating patients.  They won’t, no matter how many educational programs and training sessions you put them through.  They have spent a career learning how to be effective in the high-volume, low-paid world of public hospitals.  To expect them to suddenly abandon everything they have learned and practiced when they go to your facility is naïve.  No, they will continue to treat patients in the same way they do in their public hospital.  And the patients won’t like it.  Chances are your rates are significantly greater than the public hospital.  Why should the patient pay more for essentially the same service they can get at their public hospital?

 

So what can you do?  You could hire all young physicians early in their career who are willing to take a chance with you.  You need to provide solid medical leadership for these young physicians, probably in the form of an expatriate chief medical officer or, if you are fortunate enough, in a Chinese physician who has had extensive international experience.  All of these physicians would ideally have resigned from their public hospital, burned their bridges so to speak, and be employees of your facility.  Their loyalty is to you.  Their future is with you.  In these circumstances, it is possible to build a solid international standard medical staff.  So what’s wrong with this approach?  What’s wrong with this approach is that culturally these physicians will not be accepted by the general public as knowledgeable and ‘expert’.  There is an absolute wall of belief with the public that only very senior physicians have the accumulated wisdom to be an expert.  Never mind that these senior physicians may have not kept up with advances in their field or that their many years of experience are in a public setting with very different standards.  I have known cases where private hospitals had 80 and 85-year old part-time obstetricians doing C-sections and these surgeons had long waiting lists of patients wanting to see them.  Meanwhile, younger and far more talented and up to date surgeons languished with few patients seeking their services.  This environment requires a strong, creative marketing effort to overcome these cultural barriers.

 

The other option is to pragmatically hire a mixed medical staff of public and private physicians; young and old physicians and modern and traditional physicians.  Put them all together with strong leadership and hope for the best.  This is the approach most private facilities in China have taken and this is the reason there are so few hospitals in China that can truly be termed international.

 

FacebookTwitterSina WeiboQQPrintFriendlyGoogle+LinkedInShare
2 replies
  1. Robert Stringham
    Robert Stringham says:

    Very interesting article on the Cultural Barriers in building an International Standard Medical Staff in China. It appears that getting doctors with experience (and fame) from the Public section is difficult and they will unlikely change their way of practicing to meet International Standards. Young doctors have a difficult time attracting the “best patient” as they are perceived as lacking knowledge and experience. Blending the two groups seems like a management nightmare?

    Would bringing in a mix of Mandarin speaking and English speaking, senior consultant level doctors, with US, Canadian or European training and experience be another option? Over the last 20 years we have seen Hospitals around the world bring in older US Board Certified doctors, older Fellows of the Royal College from Canada, Specialists from the UK and Europe. If vetted properly (and vetting is key) these doctors can bring in a wealth of knowledge and experience, act as Department Heads and mentors for younger doctors.

    Having robust systems and processes for assessing the doctors skills and experience is essential to make sure you are only taking the best doctors from one Country to another. Another key aspect of credentialing is understand the doctors motivations for practicing overseas, this helps predict long term placements and satisfaction.

    I would like to explore this further is anyone thinks that this might be a viable option.

    Reply
    • David Wood
      David Wood says:

      Robert,

      Your suggestion of hiring senior level expatriate doctors is certainly a viable solution…a couple of issues though…first, finding the right attitude in the senior physician is very important…many of these senior physicians have had their career in their home country and tend to treat their new job in China as a ‘retirement’ posting where they don’t have to work as hard as they did at home…instead of working industriously in their new job, seeing patients, building solid long-term relationships with their patients, encouraging referrals, all of the things you do to build a practice, they want to play the role of a father figure and let others do the heavy lifting. But, as you say, vetting is key here…you’ve got to dig in and understand their motivations…why does a physician who has worked hard and built a successful practice in their home country give that up to come to China? There are many valid reasons but there are also many reasons that raise red flags: malpractice issues, legal problems, financial issues, etc.

      Reply

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *