Re: “Chinese TCM Renaissance and the Global Movement for Integrative Health and Medicine” by Weeks (J Altern Complement Med 2017;23:79–81)

Dear Editor:

We write with an addendum to your editorial from February 2017, “Chinese TCM Renaissance and the Global Movement for Integrative Health and Medicine.” ¹ Although Chinese medicine (CM) has been supported by the Chinese central government since the 1950s, not until last year did China adopt its first CM law, effective July 1, 2017, to promote its growth and development. County-level governments and above are required to set up CM institutes at publicly funded hospitals, maternity wards, and pediatric clinics. All practitioners must pass qualifying examinations. Meanwhile, the government would expand research and development centers for CM. It encourages CM doctors and researchers in China to collaborate with practitioners from around the world to place CM on a more equal footing with Western medicine. ^2,3

Historically, all CM doctors in China have been restricted in practice by the government, for instance most of them had to work in hospitals. A law from over 20 years ago states that a CM doctor had to meet these very specific requirements to open a clinic: have space >600 sq. ft. (in some provinces, this law even required 3,000 sq. ft. ⁴ ), have more than two employees, and the owner had to have >$8,000 dollars. ⁵ In addition, new clinics were required to pass a very restrictive application and inspection process. If there were hospitals in that area, clinics would not be approved. ^4,5

Ironically, although there are >25 CM schools, with 4,000 graduates each year, few had opportunities to actually practice. It was a “buyer's market” with so many CM graduates. Most tertiary hospitals required prospective employees to have PhD degrees after their medical education. In China, the learning of CM is commonly a 5- to 7-year college level education, with the degree of Bachelor in Medicine or Bachelor plus Master in Medicine, which is equivalent to MD in Western countries. Some of the graduates are employed by the hospitals and get 5–6 years' residency before they become attending physicians in a specific specialty. Other graduates may get jobs in educational or research institutions or other fields. Also, a certain number of graduates look for further academic training and get Master or PhD degree in Medical Science after an additional 3–5 years of studies. As a clinical doctor, attending continuing education courses are required each year, which is very similar to that in the United States for medical doctors.

These and other restrictions limited the growth of the profession. Even though there are many CM graduates each year, there has been no significant increase in the number of CM doctors compared with the 1950s. ⁴ Apparently, many CM graduates had to choose other professions or go abroad as Chinese hospitals were unable to hire most of them. Potential CM practitioners missed the opportunity to become a CM doctor, losing the possibility to serve people in the healthcare system. ⁴

In recent years, some organizations and medical schools have been allowed to register and open clinics, whereas doctors have been allowed to register for two practice locations. Now with this new rule, ³ practice opportunities will grow. As restrictive requirements have been completely removed, CM doctors can now register with the local government for opening an institution or a clinic. The adoption of the new rule ³ will allow potential CM doctors to open their own clinics as long as they pass the physician title assessment. The new rule ³ will allow CM doctors to open clinics more easily and practice based on their own plan. They must just register the clinic information with a public official, similar to that in the United States. The new rule ³ also allows potential CM practitioners who even do not have formal CM college education, but training through apprenticeships, to attend a special physician assessment to get a license and then become a CM doctor. The government's steps should advance CM development and allow more patients in China to have care from CM professionals. It will be interesting to observe the effects from this liberation of CM doctors.