China’s doctor training system is broken
Behind the suicide of a 25-year-old trainee doctor
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This week we explore the tragic story of a trainee doctor, Cáo Lìpíng 曹丽萍.
Cao Liping was born in 1998 into a rural family in Luxi County (泸溪 lú xī) in Hunan, a land-locked province in southern China.
She was one of four daughters; the third oldest.
Her family was poor when she was growing up. Her parents worked in the construction industry so were often away from home for long periods.
Liping worked part-time to bring in extra income for the family, and helped with the housework when her parents were away.
She studied hard too, securing a place in the county’s top high school and then going on to study medicine at university.
After she graduated, Cao Liping started her training as a resident doctor at Hunan People’s Hospital (湖南省人民医院), the top hospital in the province.
By the summer of 2024, after nearly seven years, she would complete her training and become a fully qualified doctor.
Just another six months to go.
But in the early hours of Saturday February 24, she was found dead in the doctors' duty room of the hospital where she worked.
She had taken her own life hours before.
Hospital security footage shows Liping last seen walking into the doctor's duty room at 20:47. Hospital digital records show she submitted her last patient discharge medical records three hours later.
At 23:59, a suicide note was automatically published on her QQ Space, a blog-like social platform.
"I'm really tired and want to go back and rest... The world is not fair in the first place. I only have myself to blame for being an inadequate workhorse. I can't take it any more. Mom and dad, I'm sorry. Thank you for bringing me up and I will repay you in my next life."
“我真的好累，想回去休息了……世上本就没有公平，怪我自己是不合格的牛马，熬不下去了。对不起爸妈，生养之恩，来世再报。”[3]
As a trainee doctor (规培医生), Liping had an exhausting work schedule. She was expected to work at least six-days a-week. On one recent shift during Chinese New Year, she worked for over 30 hours straight, with no break.
According to WeChat records made public by her family after her death, she repeatedly asked her supervising doctor for time off, complaining of symptoms of rapid heartbeat and high blood pressure.
She asked to reduce her shifts, but her supervisor replied:
We are really short-staffed this month. Next month, you can be the back-up doctor.
实在这个月缺人，下个月你就可以当副班了。
But next month never came for Cao Liping.
Her death has sparked debate in China on how the system for training doctors is broken.
Trainee doctors like Liping are expected to work long hours for very little pay (Liping’s monthly salary was around 2,000 yuan ($296)).
Trainees are often treated badly by their superiors, who expect them to complete menial tasks such as updating patient history records, on top of working as a full-time doctor, and while writing their thesis.
They are the lowest level staff in hospitals, and are technically not formal employees:
There are strict hierarchies in the department from the chief physician, deputy chief physician, attending physician, resident physician, and then the lowest level of "three students" - trainee doctors, advanced trainees, and graduate students.
科室里有严格的层级，主任医师、副主任医师、主治医师、住院医师，然后才是最底层“三生”——规培生、进修生、研究生。[1]
A social media post by another trainee doctor, and a friend of Cao Liping, shares her experience of how trainee doctors are treated under the current system:
I thought the main purpose of residency training was to learn how to apply theory into clinical practice.
Turns out, it's to be a free workhorse for the department.
我以为规培的主要目的是学习，是把知识和临床结合，原来是给科室当免费的牛马。
In other words it’s a system which treats trainee doctors just like livestock, expendable human resources, or “huminerals” (人矿 rénkuàng), to use another popular internet phrase of 2023 explained by eminent Sinologist, Geremie Barme.
So, that’s what we’re exploring this week.
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Favourite Five
1. 牛马 niú mǎ
workhorse
世上本就没有公平，怪我自己是不合格的牛马，熬不下去了 - The world is not fair in the first place, so I only have myself to blame for being an inadequate workhorse. I can't take it anymore. [3]
More: Read more about the background in this phrase tomorrow in the Sinica Phrase of the Week.
Related:
人矿 rén kuàng - “huminerals”
社畜 shè chù - "social livestock"
打工人 dǎ gōng rén - working people
2. 压榨 yā zhà
to squeeze dry, exploit
带教还有点压榨她，一个人干两个人的活 - She was also exploited by her supervisor, who made her do the work that should have been done by two. [1]
Related:
压垮 yā kuǎ - overwhelm, crush
3. 感同身受 gǎn tóng shēn shòu
to empathise, feel as if it were happening to oneself
李珂也曾在湖南省人民医院做过规培生，看到曹丽萍的遗书后，非常感同身受 - Li Ke had also worked as a trainee doctor at Hunan People's Hospital, so she could totally relate after reading Cao Liping's suicide note. [1]
4. 付诸东流 fù zhū dōng liú
to come to nothing
也就是说，八年努力付诸东流 - In other words, eight years of effort has gone down the drain. [4]
5. 廉价劳动力 lián jià láo dòng lì
cheap labour
在医疗论坛丁香园的规培话题下，“免费的牛马”、“廉价劳动力”是频繁被提到的热门词汇 - In the discussion about doctor training programmes in the DXY forum, "free workhorses" and "cheap labour" are frequently mentioned. [1]
Consuming the Conversations
Useful words
6. 苦闷 kǔ mèn
gloominess, grievances
曹丽萍一反常态地在上班时间给她打电话，试图倾诉工作的苦闷 - Cao Liping called her during working hours - which was highly unusual - trying to complain to her about work. [1]
Related:
沉闷感 chén mèn gǎn - sense of heaviness, feeling of dullness
7. 心悸 xīn jì
palpitations
曹丽萍从去年12月至今，在医院4次看诊心悸、胸闷的问题 - Since last December, Cao Liping has visited the hospital four times due to issues of palpitations and chest tightness. [1]
8. 猝死 cù sǐ
sudden death
病历还是没写完……既然早晚要猝死，那就让我自己选择方式吧 - I haven't finished the medical records yet… Since I'll work until I drop dead, at least allow me to choose how I die. [1]
Related:
遗书 yí shū - suicide note
9. 委屈 wěi qu
to feel wronged, to suffer unfair treatment
在外工作遇到了委屈，曹丽萍几乎从不会和家人提起 - Cao Liping encountered unfair treatment at work, but she almost never mentioned it to her family. [1]
10. 规培 guī péi
residency training
但如果不能通过规培，则拿不到证、毕不了业，更无法执业 - But if trainees can’t complete their residency training, they won’t be able to receive their qualifications and diploma, let alone working as a doctor. [1]
Related:
退培 tuì péi - withdrawal from residency training program
11. 折磨 zhé mó
to torment, to torture
除了低薪资和超长劳动时间，最折磨人的还是无意义感 - Besides low wages and excessively long working hours, what tortures her the most is the sense of meaninglessness. [1]
Related:
吃苦 chī kǔ - to endure hardship
熬日子 áo rì zi - to get through tough times
12. 刺痛 cì tòng
sting, hurt
曝光的遗书内容，有这么一段话深深地刺痛着大众的心 - The published suicide note contains a passage that breaks the hearts of the public. [4]
13. 残酷 cán kù
cruel
这一个个悲剧事件，都在昭示着某些单位对员工的压榨是有多残酷 - Each tragedy shows how cruel the exploitation of employees by certain organizations can be. [4]
Three-character phrases
14. 死循环 sǐ xún huán
vicious circle, dead end
我以为熬过这几天就好了，可这就是个死循环 - I thought it would be better once I got through those days, but it's just a vicious cycle with no way out. [1]
15. 连轴转 lián zhóu zhuàn
to work around the clock, to work continuously without rest
她长期处于高强度加班且“连轴转”的状态 - She constantly worked tight schedules and long hours without rest. [1]
16. 留后路 liú hòu lù
to leave oneself a way out, to leave room for manoeuvre
选择这种方式说明曹丽萍完全没给自己留后路 - Choosing this way (to end her own life) indicates that Cao Liping didn't leave herself any chance to survive. [3]
Idioms
17. 没日没夜 méi rì méi yè
day and night, round the clock
没日没夜的加班，既然早晚要猝死，那就让我自己选择方式吧 - I work day and night. Since I'll work until I drop dead, at least allow me to choose how I die. [3]
18. 悲痛欲绝 bēi tòng yù jué
to be overwhelmed with grief
事情发生后，曹丽萍的家人悲痛欲绝 - After this happened, Cao Liping's family was overwhelmed with grief. [4]
19. 兔死狐悲 tù sǐ hú bēi
even the fox is saddened by the hare's death, a sad event that evokes sympathy
他说，兔死狐悲，令人叹惋 - He said that her suicide saddens many people in the same profession. [4]
20. 三头六臂 sān tóu liù bì
having three heads and six arms; omnipotent
你只是个凡人，没有三头六臂，不会七十二般变化，你不可能什么都能 - You're just an earthling. You don't have three heads and six arms; you can't transform yourself into seventy-two creatures. You can't do everything. [4]
21. 灰飞烟灭 huī fēi yān miè
to vanish into thin air, to disappear completely
被科室发现后退培，即将展开的职业生涯, 弹指间灰飞烟灭- A trainee was removed from the residency training programme (after breaking the rules), so his budding career is gone in the blink of an eye. [1]
Phrases
22. 不眠不休 bù mián bù xiū
without rest, without sleep
大年初六起，连上三十多个小时班，不眠不休 - Starting from the sixth day of the lunar new year, she worked for over thirty hours straight without any rest. [3]
23. 饱受诟病 bǎo shòu gòu bìng
to be widely criticised, to come under heavy criticism
规培生工作强度大、待遇差等问题，也一直饱受诟病 - The intense workload and poor treatment of resident trainees have also been widely criticized. [2]
24. 倒在了黎明前 dǎo zài le lí míng qián
to fall before the dawn, to fail or collapse before reaching a goal
甚至毕业在即她却不愿再多等3个月，她倒在了黎明前 - Even though graduation was imminent, she was unwilling to wait another three months. She fell before the dawn. [4]
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