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Taiwan suffering acute doctor shortage
Publication Date : 06-08-2012
One hospital in New Taipei City does not have a single surgeon on its roster. Another in Hsinchu city saw its three gynaecologists deliver 250 babies in a month. And all around Taiwan, there is a need for some 1,000 anaesthesiologists.
Taiwan is facing an acute shortage of doctors in the five major fields: surgery, obstetrics and gynaecology, paediatrics, internal medicine, and emergency medicine.
Critics blame poor pay, long working hours and what doctors say is a lack of respect.
"If this continues, Taiwanese will have no more doctors to turn to 20 years down the road," said Professor Chen Ding-Shinn, a distinguished chair professor at the department of internal medicine at National Taiwan University's medical school. "I might have to keep working into my 80s."
Taiwan has 40,000 doctors, but a quarter of them are in aesthetics and other so-called minor disciplines. The number of doctors in the major fields can meet only about half of demand.
In emergency medicine, Chen said only 1,000 out of 1,500 doctors qualified in that field are working in emergency rooms.
Those in the profession say the government-run health insurance system, which Taiwanese tap to pay for most medical treatments in return for a monthly premium, underpays doctors in the major disciplines.
The system prices different treatments at the same rates, often in favour of less critical specialisations, such as aesthetics and ophthalmology.
For example, the reimbursement for an appendectomy is the same as that for cataract surgery.
Simple cosmetic procedures and consultation are covered at the same cost as that for tumours.
But surgeons say the chief cause of the dearth of doctors is the risk of prosecution under criminal law in cases of alleged malpractice leading to injury or death.
It is an occupational hazard for those working in the five major disciplines especially because of the very nature of their work. And the risk is rising: The Department of Health handled just 145 medical dispute cases in 1987, but 547 cases last year.
According to Dr Lin Pyng-jing, a cardiac surgeon and lecturer at Chang Gung University's College of Medicine, 40 per cent of the disputes end up in the criminal courts and the rest go to civil law.
Last year, 10 doctors were convicted, a number proportionately higher than that of Japan, Germany and the United States, he said.
The highest compensation ever imposed in Taiwan's medical history was NT$43million in 1996 - more than S$1.7million at today's exchange rates - which fell on anaesthesiologist Fu Shih-hui and the Taipei City Hospital over a botched surgical anaesthesia which left a patient severely brain-damaged. Fu was also given a suspended six-month jail term.
Dr Chang Wen-kuei, chief anaesthesiologist at Taipei Veterans General Hospital, alluded to the case at a press conference by the profession's association last month to highlight the shortage of anaesthesiologists. "We usually have just two minutes to make snap judgments," he said. "Whenever I fail to insert the tubes, my first thought is 'Oh no, I'm going to be jailed!'"
So, while public hospital doctors earn NT$100,000 to NT$150,000 a month - much higher than the average pay in Taiwan - it comes with shift work, long hours and high stress, said Dr Lin.
"It's not a lot of money, the work is tough and not given the respect it deserves," he said. "Young medical students would rather not risk it."
Indeed, 43 per cent of all townships in Taiwan have no gynaecologist and 60 per cent lack obstetricians, according to a survey by the Taiwan Association of Obstetrics and Gynaecology.
Even in urban centres like Hsinchu, hospitals are struggling. The three obstetricians at the north-western city's Cathay General Hospital deliver 250 babies a month. This breaks down to two to 10 times the average in 11 countries, including Britain, Korea and Singapore, based on a survey by the Japan Medical Association.
The Banqiao district hospital in New Taipei City has been left with no surgeons after an exodus in the past year.
Patients have to be transferred to Sanchong district should they require surgery.
The doctors agree that the best and quickest solution for the doctor shortage is to "stop treating doctors like criminals" and apply just civil law in cases of alleged malpractice.
"Doctors are human beings," said Chen. "They make mistakes too."