• Selina S Lien, Russell O Kosik, Angela P Fan, Lei Huang, Xudong Zhao, Xiaojie Chang, Yuhwa Wang, and Qi Chen.
• School of Medicine, National Yang-Ming University, Taiwan.
• Lancet. 2016 Oct 1; 388 Suppl 1: S11.

BackgroundOver the past decade, China's systems of medical education and health care have undergone unprecedented reform. Despite these reforms, a trend of declining interest among medical graduates in pursuing careers in clinical practice has persisted. The aim of this analysis is to examine physician workforce production and attrition rates and use current trends to predict whether an adequate and equitable supply of physicians will exist in the future.MethodsWe analysed data about Chinese medical graduates and physicians in clinical practice between 2005 and 2015 using the Chinese National Health and Family Planning Commission reports and yearbooks published by the government of China and the Peking Union Medical College. These sources covered all of China (31 provinces; Hong-Kong and Macao were not included). The international review board of National Yang-Ming University approved this study.FindingsFrom the beginning of 2005 to the end of 2014, China produced 4 314 791 5-year clinical medical graduates and 413 186 5-plus-2 programme (5-year medical education programme plus 2-year graduate programme) medical graduates: total 4 727 977 clinical medical graduates. However, during this period, there was an increase of only 752 233 (15·91%) in the total number of clinical physicians registered in practice. Using demographic data from this 10-year period, we found that the proportion of physicians aged 25-34 years had decreased from 31·3% to 22·6%, and the proportion of physicians aged 60 years and older had increased from 2·5% to 11·6%. Meanwhile, 5-plus-2 programme graduates increased from 4·3% to 11·2%, and rural areas had a shortfall of over 500 000 physicians.InterpretationThis study confirms the high attrition rate among medical graduates and physicians in China over the past 10 years. If this pattern continues, China will suffer a chronic shortage of medical doctors in certain specialties and in rural areas. China's future appears destined to have the chronic care issues that come with an ageing society and require considerable human resources. High physician attrition rates, low physician production, and rapid population growth will only compound the problem.FundingThis study was supported by the ROC Ministry of Science and Technology GrantMOST104-2511-S-010-003. The funding source had no involvement in study design, data collection and analysis, interpretation of the results, writing of the report, and the decision to submit the paper for publication.Copyright © 2016 Elsevier Ltd. All rights reserved.

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