Data show that dentistry programs at universities have better enrolment than programs for physicians. This issue has less to do with specific departments or medical specializations than it has to do with social attitudes toward medical professionals.
In the past, doctors were accorded high social status and looked up to for the role they play in society. They not only protect people and save lives, but have also stepped up at critical moments, speaking out on social injustices.
The father of Taiwan literature and doctor Loa Ho (賴和) did just that, as did the renowned pharmacologist Tu Tsung-ming (杜聰明), activist and politician Chen Yung-hsing (陳永興) and President William Lai (賴清德) — all of whom were doctors and medical professionals.
From the Japanese colonial period through the democratization movement, doctors were not only found in their clinical practices and hospital wards, but oftentimes, they were active as intellectuals working toward the public good.
However, these days medical professionals are finding themselves increasingly put upon. With the National Health Insurance system’s global budget system and low point-value payments, doctors are laboring under considerable workloads and long hours, yet they are inadequately recompensed and receive little support.
To address the pressure from the points-value system, hospitals across Taiwan are cutting down on human resources, increasing work hours and requiring doctors to become little more than diagnostic automatons. Increasingly, doctors are becoming physically and mentally exhausted. Beginning with the completion of their residencies, a substantial number of junior doctors are being overworked. They do not have the time or energy to stand up for their own rights, much less play a role in social reform.
How can an environment like this produce the next Loa Ho? How is such a system going to lead to medical professionals’ willingness to stand up for the public good?
Moreover, there are fewer incentives for joining this professional field. The kinds of people needed to enter the field are being pushed away. Based on a National Taiwan University Hospital internal survey, about 30 percent of medical students regret going into medicine. Many plan on switching careers or going overseas for career development opportunities. This is not just an issue of personal choice, but a system-wide exhaustion of the younger generation’s idealism.
Taiwan used to say with pride that doctors were the most responsible, social reform-oriented group of professionals. If today’s system is causing doctors to be drowned in work and pushed to the brink, then having a good conscience alone would do them little good. Taiwan would not only be losing talent and expertise, but a considerable force for social progress.
One reason medical professionals have given so much back is due less to professional training or the taking of the Hippocratic oath, it is because of the respect and support that they have been accorded.
If doctors are to speak out again and become protectors of social good, the first step would be to rebuild the system with a proper focus on respecting medical work. The respect and humanity with which doctors have been treated has allowed them to see the humanity in others and instills in them the will to be a voice for social progress.
Lu Chun-wei is a dermatologist and an assistant professor at Chang Gung Memorial Hospital.
Translated by Tim Smith
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