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How does a medical student in China become an orthopaedic surgeon?
In China, the first cycle of studies lasts for 5 years, which is equivalent to a Bachelor degree. Some study for 7 years, which is the equivalent of a Master’s degree. Regardless of their initial training, students then have to take 3 years of basic surgery training, after which they can become surgeons and choose a specialization, such as orthopaedics. If you choose orthopaedics, each hospital has its own training system, but typically surgeons have to go through 2 years of specialized training. After these 2 years, they can then choose a sub-specialization, such as pediatric orthopaedics, spine, etc., during which they have to study with a senior surgeon with over 5 years of experience. So in total it typically takes 5 years after an initial medical degree to become an orthopaedic surgeon. Further advanced degrees such as assistant professor or professor take at least 5 years more.
Once you are an orthopaedic surgeon, can you study and practice anywhere in China?
It is a national curriculum, so you can move anywhere in China, there are no geographic restrictions. Each province has its training center, and students are free to choose. When you finish the cycle, you have to find a job by yourself. Those who are very good might stay in the hospital where they trained, but others have to find a smaller hospital or a hospital in their hometown. In small hospitals, as long as you perform good surgery, you can be promoted. In big, university-level hospitals, that is not enough; you have to publish papers and articles, not only in Chinese but also in English, which is why you now see so many research publications in English by Chinese surgeons.
There are no private clinics?
There are, but the private sector is not as developed as, for instance, in the US or in France.
How difficult is it to stay in a university hospital after the end of your studies?
It is not easy, out of 10 students, only 1 or less would be able to stay. As it is very difficult to stay in university-level hospitals many good surgeons have therefore gone to small town or even rural hospitals over the past 10 years, bringing their strong skills and training with them.
In terms of compensation and social status, what does it mean to be a surgeon in a small city hospital?
In terms of compensation, there isn’t much difference between a small hospital and a big one. In rural areas, living conditions and working environments aren’t as good. Children’s education is also a problem, so salaries have to be relatively competitive to attract qualified medical staff. In terms of social status, overall surgeons rank quite high in Chinese society. It is a profession respected by the people.
During the congress, the presentations displayed a very good level of surgery. Does this reflect the overall, average level in China?
People you have seen in the congress come from different regions and different types of hospitals. After over 30 years of reforms, many Chinese have had the opportunity to study abroad, and many foreign experts have come to China to contribute their knowledge. The healthcare and medical sector has also received continued support from the government, resulting in very fast development. China has already caught up with the global best practice in many areas, and there are even some areas where it is possibly already a global leader
China was particularly advanced in the field of microsurgery…
Yes, in hand surgery and finger transplants for instance, I believe that China is a global leader. But there are areas where we have room for improvement. France is a country of innovation and a lot of our techniques originally come from France. In China, people - and not only surgeons, all people - are very hard working and diligent, very assiduous in learning. In the fields of trauma, spine, joint, and such mainstream areas, China is already on par with global standards. However, in some subspecialties, although a few of the larger hospitals are at global level, the smaller ones are still a bit behind. But when it comes to fractures of the four limbs, there are no gaps. Most Chinese surgeons above vice-professor level have studied abroad for a few years and myself I studied in Japan for 2 years.
In the research field, where does funding come from?
It all comes from the government, as private companies are barred by law from supporting medical research. If a company wants to finance a project, it has to go through the government.
What is your family background?
My father was also a doctor, as well as my brother and sister, so it is a family thing. My father was keen on sending me to medical school, but I was already very interested in the field from an early age. However at the beginning I was not focused on surgery. But my father pushed me to choose surgery because he thought that orthopaedics was the best specialization.
Where did you start your training and who where your mentors?
I graduated from the Hebei First University Hospital, and I’ve been there ever since, for the past 42 years. I focused on trauma, and my teachers in this field were very famous in Hebei province. My university had a cooperation program with a Japanese university so I chose to study in Japan. Of course, I had to pass a specific examination to go there, they wouldn’t accept just anyone. When I was studying in Japan, my professor was called Terayama KazuoTanayama, the most famous professor in Japan at the time in the field of joint surgery. I went twice, first sponsored by the Ministry of Education, and then by Hebei province.
How was your time in Japan?
My time in Japan was actually very hard. At the time, I had only 600 dollars per month to live, in spite of the very high costs of living in Japan and had to live with very little. Also, I was alone with no family. But before going there, I studied Japanese for one year, so I could communicate. Over time I got better with the language; actually last year, I gave a speech in Japanese to at the local Orthopaedics Annual Meeting.
Was the level very different compared to China at that time?
At the time, 30 years ago, there was a huge gap. To this day, there is still a gap, as Japanese people do things meticulously and with extreme care. In this respect, I believe Chinese people still need to study the Japanese way. Japan has over 20 Nobel Prize winners in various fields, while China only has 2. And not just in fundamental research. In surgery they are very advanced, although China is closing the gap.
After coming back from Japan, how did you become professor?
I studied very hard, and I was passionate about orthopaedics. While studying abroad and absorbing foreign knowledge, I also noticed some areas of weakness, and brought my own improvements. I now have over 50 invention patents, 10 of which have become products, and 3 of which have been approved by the FDA in the US. I also published a lot, both articles and books. For instance, I invented a traction device which does not require a table and has been selling commercially for 5 years. They now sell over 100 per year. It is already used in Myanmar, Ukraine, the US and I believe that one day, it will be sold in Europe, and will replace existing solutions. Another example is an internal reduction and fixation device for pelvic fractures. These inventions have been a considerable help towards me becoming a professor, gaining the respect of the profession in China, and becoming the President of the Orthopaedic Association of China.
Creativity is essential to be a good professor, but it takes more than that to become President of the Chinese Orthopaedic Association!
Of course! I was hospital vice-director and then director for 24 years. I have been involved in Hebei politics for over 30 years, becoming a member of the standing committee of the Hebei people's Congress,Hebei provi so I know how to handle communication, how to manage organizations and how to implement policies. Actually, all presidents of the Chinese Orthopaedic Association before me were from Beijing - I am the first one from another city. When I became vice-president of the hospital 20 years ago, we were doing 4,000 rather simple surgeries every year. Now we do 40,000, and much more complex ones too.
How long will you be President of the Association?
The tenure is 3 years, and this is my first year. I hope that you’ll be able to come every year!
How many orthopedic surgeons are there in China today?
150,000 registered surgeons, but you have to add about 20,000 to 30,000 on top of that who are not registered. At this meeting here, we have 20,000 registered participants, but I am sure there are more non-registered people.
What is the size of your hospital?
The third hospital of Hebei Medical University has 2300 beds, of which 1100 are for orthopaedics. We have 32 operating theatres, with 230 orthopedic surgeons. This also includes pediatric orthopaedics, with 50 beds.
Your book “Clinical Epidemiology of Orthopaedic Trauma” is very impressive…
The first edition was the first monograph on fracture epidemiology in China and was published in English by Thieme in 2012. It was based on a retrospective review of 65 000 267 fractures treated in our trauma center at Hebei from 2003 to 2007. Based on the first edition, advanced research throughout the nation was carried out. 83 hospitals from 31 provinces were selected and 4310 822000 fractures were included into the study. Thanks to all of the participants, we built an epidemiological database of orthopaedic trauma with the world’s largest sample size to date. The second edition published in 2016 is still dominated by pictures and figures. Age, gender and type distribution of the fractures are displayed by the charts and the injury characteristics of various types of fractures are presented to the readers via the combination of color sketches and X-rays. In addition, our team reported the national incidence, distribution, and risk factors of traumatic fractures based upon a nationally representative population-based study of 512,187 individuals, which has been published in the Lancet Global Health.
So it’s not only about epidemiological characteristics – it’s also about the classification of fractures and overview of diagnosis and treatment…
We wanted a practical, well-illustrated book to be an essential reference for experienced surgeons as well as residents and medical students. Besides the AO classification, which is recognized worldwide, other special classifications are used to comprehensively reflect the features of different fractures. I do hope that this huge work will contribute to orthopaedic science globally, not only in China.
What were the main teachings of this 12th congress?
The 12th congress contains 38 parallel sessions, which covers all subspecialties of orthopaedics including traumatic fracture, joint surgery, spine surgery, orthopaedic oncology, sports medicine, microsurgery and imaging navigation, osteoporosis, ankle surgery, paediatric orthopedics and basic research etc. The main teaching of each session includes new and advanced techniques, research results which aim to address current challenges, and practical experience in the management of complex cases.