诊断: 症结就在于 pathology as an important medical discipline is misclassified in China。

I agree with many points made by  “不能考执业医师的病理研究生们都来看看”.  In fact, “病理研究生无法报考执医而从业” is only one of the major challenges facing pathology and pathologists in China.  There are several other related issues and serious challenges.

I.   症结就在于 pathology is misclassified in China。In most part of the world, including U.S.A, pathology service belongs to one of key clinical disciplines! But pathology diagnostic service in China is classified as “second class, auxiliary” clinical discipline. 

The inappropriate classification of pathology in clinical disciplines determines the social-economic status of pathology and pathologists.  As a result, the misclassification of pathology causes subsequently three key problems, among others:

(1)    The status of pathology service is not well respected by other “major” clinical services. 病理学科在疾病的诊断和治疗中的关键作用有目共睹. Pathology diagnosis is the gold standard! But in China, only when a malpractice happens, people (the CEOs, presidents of the hospitals) realize the importance of pathology. Otherwise, not much attention is paid to pathology. 病理科是不讨好的科室. Pathologists are just humble “grandchildren” in the hospital. 病理科 often time has  small work spaces, unfavorable locations, and very limited resource allocations of the hospital budget.

(2)    病理医生低收入. In USA, pathology is very competitive medical discipline, and pathologists in USA are paid reasonably well compared to other clinical disciplines! One of the main reasons is that the pathology diagnostic service fees in USA consist of “professional component (about 70%), and material/instrument component (about 30%)”. But in China, the services fees consist mainly of material/instrument component. We need to change this: pathologists in China need to get higher salaries!

(3)    Because of the above 1 and 2,  中国病理人才越来越少，病理学科的发展停滞不前. A lot of young students with interest and knowledge of pathology are ending up doing something else!

I have visited more than 80 Chinese hospitals/university medical centers since I practiced pathology in U.S.A in 1999. There are significant shortages of good dedicated pathologists in China. Many places re-hired retired pathologists/professors since talent young medical students want to do other medical disciplines rather than pathology because the above problems. As a matter of fact, the situation was not the same when I was studying pathology in China in early 1980. At that time,  pathology service was still considered as a clinical discipline as other major medical disciplines and many dedicated medical graduates chose pathology as a career.

II.  In summary,  new policy should be considered to address problems of pathology in China.  New policy should be discussed, planned, tested, and implemented based on three major aspects, namely professional input, international standards, and the demands from the society!!

(1). Professional input, as stated in the above, is already very clear.

(2). International standards are also easy to check via web, international pathology organizations, and international pathologists including myself.

(3). The demands from the society, from the patients, are very high. China has transformed significantly during the past 30 years.  For example, China now has the best 5 star hotels, best high-speed trains, and best shopping malls. That is wonderful. But pathology services have not been improved during the same period of time. In fact, they are becoming worse.  China, and Chinese people need the best pathologists!! Chinese patients need to enjoy the best quality of pathology diagnosis services!!

III. We need to work together to solve the problems. Each and everyone of the pathology community have the responsibility and duty to respond to the problems. We need every 病理医生积极主动参与的热情. The following are major suggestions:

            (1). To mobilize all national and local pathology organizations. It is very important to act as a massive group, with a stronger voice! To mobilize the media: newspapers, websites, radio and TV stations. Huaxia Pathology website is a very useful platform. To unite organizations of other medical disciplines, which are relied on pathology services.

            (2) To address the issues one by one directly: namely RECLASSIFY PATHOLOGY DIAGNOSTIC SERVICE AS A MAJOR CLINICAL MEDICAL DISCIPLINE!! SO IT WILL promote the social-economic status of pathology service and pathologists among the professional field of medicine.

            By doing this, the whole landscape of pathology will change: more and more people will do pathology, more and more resources will be allocated to pathology services and pathology research. The final mission of medicine, serving the patients well, will be accomplished. However, these all need the involvement of pathology organizations and every pathologist. Everyone can make a contribution to this effort.

            To address the problem of 病理研究生无法报考从业,  it also needs to 制定一个严格的完善的准入、管理体系, 准许病理研究生直接参加医师考试. But 病理研究生 still needs to be trained for additional years before being allowed to sign out pathology diagnosis report.

为发展中国的病理事业, 为病理学科后继有人，Let’s work together！

I certainly will try my best to contribute to this long-term project.

谈东风   May 27, 2010 from Houston.

谢谢谈老师所做的倡议；如果真要做这个事情对中国病理学的是一次“辛亥革命”。需要有严格的组织和分工，并需要长期的曲折的“斗争”。

呵呵、、、、、

尽力而为！！

 谈教授从多个层面分析的很透彻，中肯，热望为中国病理事业的发展和进步做贡献。感谢谈教授！

从源头上解决问题至关重要。机制、设置、准入和培训的问题迫在眉睫！

在国内，很久以前有高师班（2年制）、病理诊断培训班（2年制）、研究生班（2-3年制），脱产（离开原单位）专门进行病理专业的的培训（而不是进修），当代国内的中坚力量基本上是那个时期培养的（有的后来出国学习和培训），培训内容涵盖各个系统各个病种。中间很长一段时间被遗忘（顶多搞一年的进修）。现在又有了病理住院医师培训机制（博士毕业后1年、硕士2年，本科3年），但这个机制还不完善，还存在很多的问题。这和美国、法国、英国、德国相比差距甚远。

我非常赞同谈教授的建议：为发展中国的病理事业，为病理学科后继有人，让我们共同奋斗！

这个贴太好了！！！！深刻！！！！这就是中国的现状！！！！

 谈教授对国内病理现状分析的很透彻，切中命脉。

一方面经过专业学习的病理医生不能考证；一方面临床紧缺病理医生。

长期以来始终没能招聘到合适的病理医生，真的很为难。

退休的病理医生也忙的不可开交。

不知制定政策或有能力改变政策的机构是否了解，病理人才的问题已迫在眉睫了。

基层病理科太需要有热情有知识的病理学生了，强烈建议变更病理学科设置，强烈建议准许病理研究生直接参加医师考试，并于适当的培训，让有志学子补充到病理队伍中去，这样病理学科才有希望人才济济.蓬勃发展。倘若病理硕士博士毕业证不能作为行业入门的依据，其价值还会高吗？想学的人还会多吗？

 感谢谈老师！！说出了病理人的心声。

感谢谈老师，身在海外心系祖国！

我会将各位专家和网友的意见转发给病理高管

只有想不到，没有做不到！关键是我们病理人要上下齐心，才能有望改变现状。

要相信并坚信病理人的未来一定会很美好。

国内病理的地位和收入没有改善的迹象。不知道大家还能忍受多久？既然现状无法改变，就适应社会发展吧。如果有机会，我就改行，到公司去打工。

       谈博士此文本人看后很受感动，亦对海外的病理同行能如此关心国内同行甚为敬仰。

       但谈博士可能久居美国，不了解中国现在的国情，没有就中国的现状，剖析中国的病理人才越来越少关键。中国现在是一个急功近利的市场，包括每个人择业到就业阶段，是经济，不是兴趣。医院老板是院长，换一个角度，如果你是老板，你会给一个不赚钱的部门高报酬吗，绝对不会！老板只会给赚钱的部门高收入！你何时见过医院对外宣传医院病理科的诊断水平是如何的高超，如何有保证，他只会宣传老百姓崇拜的所谓的临床医生，因为他们能从病人身上赚钱。

      病理从业人员，尤其是医生，要想获得高报酬，在现今的中国，必须把现有的病理收费，包括活检、细胞和尸体解剖总体收费提高5到10倍，才有可能提高病理科在医院收入重要性，从而提高各位同仁的地位，提高病理在中国医学界的位置！扩大病理科的地盘，改善病理窘迫的工作环境。可悲的是，我们没能在新出台的病理试行方案中看到任何这方面苗头，方案认为病理科重要，为何不提高病理的收费，嘴巴能留住人才吗，否！

      不从现今经济天平上进行调节，想改善中国大部分医院病理在医院中的地位，那只是一纸空文！恶性循环，人才流失！

       愿国内外同行携手合作，共同改变现状！