US medical student, wanting to work in China - clarification would be appreciated!

[Haru03]

Hello! Just found this site when randomly googling. I am a current US medical student, finishing up my first year of medical school out of four. I've always been planning on eventually practicing in China (mainland or Macau) for family reasons, and since I need to prepare for residency application in the US soon, I would love to have some questions answered. For reference purposes I am a mainland citizen, so I do not need to worry about the visa messes, but I guess I have another set of problems that I need to work around. I also don't have student loans that I need to repay.

 

- Do I even need a US residency ("internship" for Europeans; not an immigration status) or US board certification/license? I have read before that foreign physicians can convert their license to a Chinese one without the need to redo residency, which is great. Yet, my choice of specialties would be limited in the US due to the competitiveness for certain specialties (I'm currently looking at subspecialties of internal medicine which would need me to do residency followed by fellowship; it's a quite competitive process, and the fact that my school isn't ranked very high doesn't really help). On the other hand I wouldn't have this restraint back in China and could finish residency earlier (everything is three years in China versus 3-7 years in the US), so that's a plus. I realize that there might be a pay cut if I don't do US residency altogether, but well... I'd be giving up the US salary, so that probably doesn't hurt as significantly. There is also an option for me to do one year of residency in the US and then quit, which would make me eligible for a GP license but people usually don't do that.

 

- What level of medical Chinese and Chinese clinical exposure do I need? I am a native speaker, but when it comes to medical Chinese I figure I need a lot of work, especially drug names. I don't really expect to be able to speak English only to nurses and patients (unless in one of the larger international clinics?) so it looks like higher level of proficiency is necessary, but if there are some ways to quantify it would be great. I am also planning on scheduling a few away rotations in China, but I am not sure how beneficial they would be for me. 

 

- Are there any ways for me to connect to foreign physicians in China? I've seen a few posts by them (like this one: link) but they rarely have contact info, so it's really a unidirectional info flow. I know the numbers of them aren't high, but it would be great if someone would be able to point me a direction where I could find them. 

 

Thank you all for reading through this wall of text. Any help is appreciated. 

[Flickserve]

You are probably better off completing residency and fellowship in the US to keep your options open. It’s a system you are familiar with and the basic science and language of the exams is in a language that you are used to. It also gives you a backup if you decide you don’t want to be in China at any stage. 
 

If you feel you want to try residency in China, you really need to find out a lot more about the training system, how the exams are structured and what language you need to write exams in. For example, if you did Gaokao and a college science degree in China, before studying in US you could probably adapt (could you imagine learning and writing your US medical school exams in Chinese?). If you did Gaokao and then moved to US, is that deep enough background to write postgrad exams in Chinese? 
 

Since you are already proficient in Chinese, it will just take a few months to pick up the spoken vocabulary in an immersive environment. As for medications, it’s just about familiarising yourself with the names of medications that you usually use. 

 

Before the pandemic, doctors in Hong Kong GPs and specialists would go up to China. They tended to cater towards the expat market or China residents who look for something different. For the usual local china hospitals, I have heard of people who have had ten 2 minute consultations and ten different opinions so yeah, being careful about the validity of your residency teaching is going to be another consideration. 
 

For general comparison, after graduation, and from the start of work, it would take 8 years to get to the end of training and being a specialist in UK, Australia and New Zealand and 7 years in HK. This includes the intern year. 

[大块头]

It's no longer being updated, but you may find the podcast 太医来了 interesting.

[abcdefg]

Welcome to the forum @Haru03.

 

This might be of interest. https://www.youtube.com/watch?v=SgOG1kFg1-8.

 

It's an interview with a doctor who did medical school in China (Taiwan) and specialty training (residency and fellowship) in the US, then later returned to practice (plastic surgery) in Beijing. I suppose it is even possible that you could contact him via the lady who made the video.  

 

I'm a US physician who lived in Mainland China about 10 years following retirement. Did some medical school teaching and consulting in China, but never had a clinical practice, never tried to get licensed. 

 

On 3/30/2022 at 2:09 AM, Haru03 said:

What level of medical Chinese and Chinese clinical exposure do I need? I am a native speaker, but when it comes to medical Chinese I figure I need a lot of work, especially drug names.

 

The aspect of the language that I thought would be more difficult than drug names would be mastering the "soft" elements that are part of any clinical interaction. Having a solid grasp of cultural norms and expectations is so very important. Communication takes place on several levels at the same time, and lot of it is indirect communication. Catching hints and nuances is sometimes critical. At times, a clinician must even tune in to what wasn't said, what might have been purposefully omitted. 

 

On 3/30/2022 at 5:56 AM, Flickserve said:

You are probably better off completing residency and fellowship in the US to keep your options open.

 

I would agree with this completely. 

 

One other point to consider is that it is difficult to know what the China - US relations landscape will look like in 8 or 9 years when you are actually ready to go into practice. 

 

[Haru03]

Just read through the replies. They are all very informative and helpful. 

 

On 3/30/2022 at 8:33 AM, 大块头 said:

It's no longer being updated, but you may find the podcast 太医来了 interesting.

 

On 3/30/2022 at 9:07 AM, abcdefg said:

This might be of interest. https://www.youtube.com/watch?v=SgOG1kFg1-8.

 

 

Will find some time to watch/listen to those!

 

On 3/30/2022 at 9:07 AM, abcdefg said:

One other point to consider is that it is difficult to know what the China - US relations landscape will look like in 8 or 9 years when you are actually ready to go into practice. 

 

 

Yes, that is one of my concerns as well. Age is another; I will be 28 when graduating, adding three to four years to that is 32 and the thought of uprooting everything at that time scares me. But the consistency of doing residency in the US is a very valid argument as well. 

 

On 3/30/2022 at 5:56 AM, Flickserve said:

If you did Gaokao and then moved to US, is that deep enough background to write postgrad exams in Chinese? 

 

Did Gaokao out of completeness' sake, but moved to the US immediately after that. As for knowledge base, that's probably scattered at best: I could explain stuff in Chinese, but I would certainly need a (probably lengthy) dedicated period for reviewing and potentially restudying if I were to take any med school level exam in Chinese. And if I remembered correctly, the eventual licensing exam would be in Chinese, unless I am US certified and go through the conversion process, a thing that I also need to do more research about. 

 

Since I still have a while to think about this (won't be scheduling elective rotations until later next year), I guess I should better focus on coursework/research for now and collect relevant info in the meantime. Thank you all for your recommendations and ideas, I appreciate them very much. 

[abcdefg]

Best of luck to you @Haru03. It goes without saying that the road ahead is long and arduous. I congratulate you on thinking ahead, on trying to gather information to use in making a better-informed decision farther down the road. 

 

As to the overall pros and cons of medical practice in Mainland China, the plastic surgeon in the video I mentioned above talked about the rapid rate of change in first-tier Chinese cities as working in his favor. 

 

For what it's worth, lots of my Chinese physician friends were looking into ways to move overseas to practice. It seemed like their level of job satisfaction was not terribly high. Of course, this could be a distortion, a sampling error, in that maybe those were the only ones who sought me out and the thousands who were happy did not bother.   

[Flickserve]

On 3/30/2022 at 10:07 PM, abcdefg said:

One other point to consider is that it is difficult to know what the China - US relations landscape will look like in 8 or 9 years when you are actually ready to go into practice. 

One further side advantage of doing the residency in US is taking the opportunity to meet any visiting fellows / Masters students who are physicians from China (depending of course where your residency is). These tend to be the middle to senior grade and from bigger hospitals. You can talk to them about the China medical system to get a better idea of what goes on. They usually have a lot more free time compared to their life in China and so happy for the chance to socialise. Furthermore, they probably can help point you to in the right direction if you want to shadow a unit in a hospital. It goes to say, they also tend to come from bigger and more well known hospitals. One physician I worked with came as a visiting fellow and then PhD. I read in the news that he is now director of ICU in a hospital in Wuhan. 

 

On 3/31/2022 at 8:23 PM, abcdefg said:

lots of my Chinese physician friends were looking into ways to move overseas to practice,

 

There are a fair number in Singapore working as physician assistants. They are not eligible for full registration in Singapore (only a few medical schools in China are recognised). I was told as a physician assistant, their salary is already better than in China. 

[Jan Finster]

Unless you are in a hurry and you need to move to China soon, I would definitely finish your degree and do a residency/specialisation in the US. In general, the level of medicine is overall significantly higher in the US. Also, your western degree could be a selling point. In order to get a license to practice you most likely will have to do the Chinese medical exam at some point. This will include TCM (中医). I am sure there are some loopholes to work around it (e.g. working at university hospitals or being a "medical consultant")

[Dawei3]

On 3/31/2022 at 8:23 AM, abcdefg said:

It seemed like their level of job satisfaction was not terribly high.

In the US, Chinese friends who got their medical degree in China, have noted that tensions with patients in China can be high at times.  While in the US, the organization determining whether or no someone gets care is usually a nebulous insurance company (at which it's hard to express your anger), in China often patients see the doctor as playing this role.  If the patient doesn't get the care they think they should get, they may take their frustrations out on the doctors (and other medical staff).  In addition, when medical outcomes aren't positive, patients similarly sometimes take out their frustrations on the medical staff.  

https://www.economist.com/china/2021/04/24/violence-against-doctors-in-china-is-commonplace