Two major developments relating to medical education have recently made headlines. The first was an announcement that National Yang-Ming University and National Chiao Tung University plan to merge. The other was that four domestic universities — National Tsing Hua University, National Sun Yat-sen University, National Chung Hsing University and Yuan Ze University — have announced the establishment of new postgraduate colleges of medicine.
This raises the question: Are there really too few doctors in Taiwan, or is it a problem of uneven distribution? Or perhaps the problem is really a poor working environment, which either causes doctors to emigrate in search of better conditions, or leave the profession. If a shortage of doctors is not caused by too few medical graduates, then building more medical colleges would fail to solve the problem.
Due to people living longer, advances in medical technology and improved treatments and care, it is easy to understand why there would be a need for more doctors now and in the future.
There is also the COVID-19 factor: With the entire population wearing masks in public spaces, the number of people catching either the common cold or influenza this year has fallen substantially. If mask-wearing in public spaces is kept up by the majority of the population in the years ahead, will it be necessary to restrict the number of doctors who specialize in pediatrics and ear, nose and throat medicine?
Additionally, due to advances in artificial intelligence, would the number of doctors specializing in medical imaging, pathology — and even some clinicians — need to be reduced at an increased rate than is already happening?
The authorities in charge of medical education and policymaking as well as specialist medical associations need to discuss these factors in detail.
Taiwan has more than 50,000 doctors trained in Western medicine, yet there are only 7,000 to 8,000 qualified Chinese medicine doctors, who provide an important source of alternative medical treatment for many people. If the national person-to-doctor ratio is calculated excluding Chinese medicine doctors, the figure would be out of touch with reality.
The medical equipment used in colleges of medicine is extremely expensive, while tuition fees have been steadily decreasing over the long term. If they rely on tuition fees as their only source of funding, medical colleges would not be able to make ends meet.
Why, then, are these four universities rushing to build new medical colleges? The answer is that there is a high employment rate for medicine-related academic disciplines. Enrolling more of these students is an easy way for universities to counter the declining birthrate and the consequent overall decline in student enrollments.
There is another reason: Submitting more medical research papers, due to their high impact coefficient, can greatly improve a university’s position in international university rankings.
Furthermore, if a hospital is attached to a university’s medical college, this would provide an additional revenue stream for the university.
According to the government’s budget for the next fiscal year, the second largest area of allocated expenditure after defense is education, on which the government is to spend more than NT$100 billion (US$3.45 billion).
As the defense budget would likely need to increase in the coming years, it is reasonable to assume that education funding would become stretched.
Given this probable outcome, is it wise to continue expanding medical colleges at this time? Taiwan is a relatively small nation. It already has 13 medical universities or medical colleges housed within universities. It seems the nation might be set to repeat the mistakes of the past by setting up more academic institutions than the market can support.
At the beginning of this century, then-Chinese president Jiang Zemin (江澤民) instructed China’s universities to undergo mergers to enhance their international competitiveness.
Taking Shanghai as an example, Shanghai First Medical College merged with Fudan University to create the Shanghai Medical College of Fudan University. Shanghai Second Medical College merged with Shanghai Jiao Tong University to create Shanghai Jiao Tong University School of Medicine.
Both universities ended up with two prestigious medical colleges under their names. This resulted in a doubling in the number of academic papers published by each of the universities. Due to the high impact coefficient of medical papers, both universities were able to rise up international university rankings.
An added bonus was the increased interaction between the medical colleges and other academic departments within their new university homes, which opened up new avenues for research, including research papers and the development of spin-off products.
This also had the additional benefit of providing students with a greater variety of courses.
National Sun Yat-sen University has indicated an intention to merge with Kaohsiung Medical University for at least 10 years; likewise National Chung Hsing University and Chung Shan Medical University have also signaled a strong desire to join forces.
However, this would require the Ministry of Education to ease restrictions on mergers between public and private academic institutions. In both cases, once conditions are ripe, success would surely follow, as the merged institutions would be greater than the sum of their parts.
National Tsing Hua University and Yuan Ze University could also try to find a medical university with which to merge. Post-merger, the world rankings of these top universities would undoubtedly be further enhanced.
If it is determined that the nation does need more doctors, then the best-performing universities could increase the number of admission places by approximately 10.
At present, teaching hospitals, including those run by the Tzu Chi Medical Foundation, Mackay Memorial Hospital, Fu Jen Catholic University Hospital, E-Da Hospital and Kaohsiung Medical University Hospital, only accept 40 to 50 postgraduate medical students per year into their medical colleges.
If each institution were to accept an additional 10 to 20 students per year, with an appropriate amount of subsidy provided by the education ministry, this would be a simple and effective alternative to establishing new medical schools.
Jeng Cherng-jye is an executive superintendent of Taipei Show Chwan Hospital and a member of Chung Shan Medical University’s board of directors.
Translated by Edward Jones
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