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.

 哈哈，这个帖子的本意是好的。

1、首先不要闹内部矛盾，还没有开始就闹内部矛盾；“革命”就没有办法开始了。

2、一个出色的病理学家一定要具备一个出色哲学家的的素质；因为病理需要认识疾病的本质；跟哲学家一样一个认识事物的本质。首先我们要了解的是我们上面说的是导致病理学科的本质吗？

3、所有我们上面讨论的只是一些事物的表象而已；本质是孔孟文化的：“中庸之道和明哲保身”。中国的所有各行各业的问题都相似，不只病理科一个学科。

4、中国真不缺人才，但是缺乏高素质人才；病理科也如此。高素质人才如何培养是一个哲学、社会和文化问题。

5、中美文化差别：中国：“神呀，保佑我吧！”，美国：“GOD BLESS  YOU ！”

6、如果我们在这争论能改变这个现象的话，我每天来争论。

7、最后说一句：要想解决这个问题，学习毛泽东和华盛顿或许有所帮助。

我想问考试是干嘛用的，是检验一个人的能力的吗，如果是，那么那些通过研究生考试的学生就应该是具备相应的能力的，那么执业医师考试也是一样，如果他没有这么能力他根本就通不过相应的考试，既然通不过，那根本就不用限制了；如果否，那么就是国家的研究生入学考试和执业医师考试的问题了，是不是应该在研究生入学考试中也加一条：禁止任何跨专业考试的考生报名！可惜现在很多学校反而很喜欢跨专业的考生，他们认为别的专业考进来的考生更能胜任，因为长期从事同一专业的人容易形成思维定势，反而不利于学科发展，为什么中西医结合治疗比单纯用中药或者西药效果好呢，原因就在于此！我想说西医临床毕业的人干临床或者病理不一定就能比非临床出身的做得更好，这没有事实依据，同样，有翅膀的不一定是天使，也有可能是鸟人！谢谢！

 还有一大悲哀：病理医生工作环境的恶劣，长期在有毒有害试剂、气体的场所工作

（很少有医院能提供排毒防害的工作环境，能装个通风柜已经不错了）。

稍稍扳下手指，就发现上海各院病理科人员肿瘤发病特高，估计全国情况相似；

工作年限稍长的，几乎人人都前额脱发（甲醛熏的）。

常见为一套家具内甲醛超标打官司，又见谁想到病理科的高浓度甲醛和二甲苯。

享受不到放射科的待遇（如：年假、营养费、提高退休待遇等），也没普通工人（接触有害气体物质）福利。

对此，我已经提了三十年了。期望年轻的病理医生能改变我们的工作环境，保护好自己。健康平安做到老。

确实这样，说说我现在看到的研究生培养吧，

1、全日制的研究生培养还是好的，虽然大家都是科研实验，没有过多的临床的技能培训。这确实是个现实。大家研究生毕业之后，临床病理能力确实没有多少，目前上海的培训制度非常好，也是必须的。

2、还有一些在职的研究生，那真是……，

所以说，目前这种情况的出现是国家的培养制度的制定出了问题！

 看到谈老师和各位同行对现有病理体制的剖析，感慨颇多。绝大多数基层医院对病理科的重视程度以及人员配置具有相当大的随意性，甚至有些医院将其病理部门视为一个人情部门，将不具有任何从业资格及经验的人员安置在其中，这样的人员他们的精力不是放在学术上，常常不能作出令临床医师信服的诊断，医院领导就更不重视这样的科室了，长此以往会形成一个恶性循环。

在这样的体制下，个人的力量与声音显得多么渺小，作为一个病理新人，我多么希望依靠自己对病理的这份热忱能继续走下去，能够很好的走下去，再坚持一下就能看见一丝希望的阳光。谈老师和各位前辈都是我学习的榜样

         我认为病理人价值的提高应该两方面：一是严格病理医师准入制度，关键是培训制度的建立与完善。病理科需要真才实学的病理学家；二是患者生命价值的提高，维权意识的增强。病理医师真正的职责是为各种医疗行为保驾护航，而不是为医院挣钱！试问：当因医生诊断不正确，频频出医疗事故，而患者几万、几十万索赔时，医院领导仍不重视病理吗！

        西方国家患者生命比较值钱，人们维权意识普遍较强，医疗事故索赔数目巨大。所以，西方国家医院管理层特别重视病理医师。当然，是高水平的病理医师。

I agree with you! You make good points: "一个团队一个集体，只有团结了才能发挥他的力量。"  "病理医生的地位, 最重要的原因就是要看带头人就是科领导的态度！"

"重视不重视，在于自己，自己去努力争取." "我们做病理的，应该让大家知道病理，知道病理的重要性！当然这是个很大的工程，需要大家的努力！医院不宣传我们，我们应该要自我宣传，不能关起门来做病理，这样谁都不认识你！还如何谈地位？"

I think you are doing well. Argument makes things clearer. Thank you.

You asked a good question "大家都知道不能考执业医师的病理研究生是什么人？那是原来大学本科中不是学临床医学的人".   But Why??  What is the reason??  Why 大学本科学临床医学 don't choose pathology as a career??!!

You may be right: "我觉得目前中国最不缺乏人才！".  But 中国缺病理人才.

My points are very clear:

事实上，“病理研究生无法报考执医而从业”只是在中国病理学和病理学家的所面临的重大挑战中的一个。还有其他一些相关的问题和严峻的挑战。

关键症结就在于：在中国病理专业被错误地分类。在世界大多数地方，包括美国，病理专业服务都属于临床学科的重点之一！

Do you think it is right to put 的病理诊断服务在中国被列为“第二类，辅助性”的科室??

Your argument may be right. "大家觉得在中国这个十几亿的泱泱大国，会缺乏人才吗？在中国什么都缺，就是不缺人才！人才有得是!"  But my point is  that the number of 中国病理人才 does not match to 十几亿的泱泱大国!

I did not 为病理研究生抱不平. We should encourage and help everyone who would like take pathology as his/her professional career. 为了解决病理研究生无法报考从业的问题，I suggested 需要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。但病理研究生仍然需要several years 的训练，然后才获准发出病理诊断报告。

What is 中国的病理人才越来越少关键??

As I mentioned, 关键症结就在于：在中国病理专业被错误地分类, 在于中国的病理诊断服务被列为“第二类，辅助性”的科室。由于医院分科中不恰当的病理学分科决定了不适当的病理学和病理学家的社会和经济地位。作为结果，导致随后的三个关键问题，其中包括：

（1）病理诊断服务（或病理科）得不到其他“主要”临床服务科室的尊重。病医院CEO，院长）不关注病理学的重要性, 病理在医院的预算仅有非常有限的资源分配, because 病理诊断服务收费主要只包括耗材部分.

（2）由于上述(1), 病理医生才低收入。

（3）由于上述(1)和(2)，中国病理人才越来越少

You are right: "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！"  But, this happens not only in China, but also in U.S.A, Russia, virtually everywhere. Therefore, the problem still is 关键症结就在于：在中国病理专业被错误地分类, 在于中国的病理诊断服务被列为“第二类，辅助性”的科室。由于医院分科中不恰当的病理学分科决定了不适当的病理学和病理学家的社会和经济地位。If we can solve this 关键症结, 医院院长 and other leaders will change their attitude, the life of pathologists will change, the social-economic status of pathology and pathologists will change, and finally 中国病理人才越来越多!