A few weeks ago, I had the opportunity to travel through China on business, and one thing stood out in particular: China is a country of massive scale. The vastness of its population, geography, and culture swamp the imagination. This hit me when I was standing in the middle of the 35 million person large city of Chongqing (once known as Chungking).
One of the consequences of this scale is the enormous stress placed on the provision of healthcare. With all of its complexity, the Chinese healthcare system manages to provide access to a population quadruple that of the United States. However, a typical doctor might see a couple hundred patients a day. Results take longer to be obtained. For China, the adoption of digital pathology isn’t an option – it’s a necessity.
Too many people, or too few?
It seems odd to say that a country of over 1 billion people has a manpower shortage, but China truly has a problem when it comes to pathology. The two biggest challenges that pathology faces in China are the enormous supply and demand disparity of pathologists and, more particularly, the insufficient number of specialists.
Again, China is a country of scale, with doctors seeing 200 or more patients every day. It’s typical for a patient to see their doctor for only a couple of minutes at a time and for results to take weeks before they arrive back in the hands of the physician. While I was in China, I had the chance to speak with the Director of Pathology from one of Shanghai’s largest hospitals. She indicated to me that even at one of China’s most-visited hospitals, it was not uncommon for their 40 pathologists to spend very late nights at the hospital working through their caseload.
At the same time, China’s population is growing at a faster pace than new medical professionals can be added. The ratio of pathologists per capita today is estimated to be one for every 75,000 people – about four times fewer than in the U.S. This supply and demand problem is compounded by lifestyle factors, including the fact that a larger percentage of the population smokes. China also faces challenges in providing medical services to broad regions of the country that are more than 100km from the nearest metropolitan hospital.
A lack of specialists
The second broad category of challenges that faces the Chinese healthcare system is the general dearth of specialists. As in the U.S., medical school and specialization may take upwards of seven years or more for completion. However, unlike in the U.S. and many European countries, the compensation and general appreciation for this specialization is not as great in China. As a consequence, there is a significant gap in disease-specific expertise.
Even the subspecialists that do go through the training and gain the expertise expected of them are largely located in major metropolitan areas. While this is not dramatically different from what occurs in other developed nations, the logistical challenges that come with China’s geographic and demographic scale limits the accessibility of these specialists for large swaths of the country. The net result of this is that an already overburdened pathology workforce is expected to make a diagnostic determination for cases which in other countries would be referred to a specialist.
Can digital pathology help?
The problem is not the technology. All-in-all, Chinese hospitals tend to be very well equipped. A radiologist I spoke with in Chongqing told me that his hospital buys equipment before they even have time to train radiologists on the old stuff. While this may have been a joke, the point is that acquiring new technology is not a problem. It is a manpower issue. With that in mind, the question is what role, if any, can digital pathology play in addressing these big challenges in China. I plan to explore this issue in greater detail in future blog posts.
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