I am now in my last week of my 3 week vascular surgery rotation I set up in the First Affiliated Hospital of Zhengzhou University, in Zhengzhou, China. The experience has been eye-opening.
First assisting in CEA, learning about stent grafts and deploying them, and giving presentations in Mandarin are nothing but small gains I made during this trip. The more profound takeaways were the complexity of healthcare in China and the different training path surgeons in China take.
The Chinese citizen pays much more out of pocket for medical expenses, and crowds the big hospitals even for small problems such as a cough. There’s minimal insurance from the government and private companies, so patients pay 70% of the medical cost including the patch of CEA. Whenever there’s a medical problem, no matter how minimal, people rush to the biggest and most well-known hospital in their region because there are few family docs and the quality of care provided in smaller hospitals are inadequate. The result becomes that big hospitals like the one I rotated in end up having 25 people in a single elevator.
One can actually operate independently at age of 23 in China, after a licensing exam. That is because medical school and college are combined into a 5 year program. However, nowadays no decent hospitals would hire you to be an attending right out of medical school, so surgical trainees go on and do 2 years of masters degree and likely 2 years of doctorate degree in order to get a job at a respectable program. However, the surgeons in China are broken into specialties early on during the latter half of medical school, and their technical skills are much superior than their counterparts in the U.S. Their textbook and literature knowledge are lagging, in my opinion.
These are two fundamental differences in my surgical rotation that struck me. There are lots more interesting contrasts in healthcare and surgical care vs. the U.S. I encourage you all to take a global view on surgery. The scope-broadening and networking are simply phenomenal.