Who are rural China’s village clinicians?

Purpose - The purpose of this paper is to measure the turnover (or stability in employment) of village clinicians in rural China over the past decade. The authors also want to provide quantitative evidence on the individual characteristics of the clinicians who provide health care to villagers in rural China and whether we should expect these individuals to be interested in continuing to supply quality health care in China’s villages in the coming years. Design/methodology/approach - This paper uses data from a survey of rural China’s village clinicians conducted in five provinces, 25 counties, and 101 villages in 2005 and 2012. This paper also uses qualitative data from interviews with 31 village clinicians. Using a mixed methods approach, this study describes the turnover of village clinicians and the main factors that impact the career decisions of clinicians. Findings - Turnover of China’s village doctors, while not trivial (about 25 percent of village doctors exited their field between 2005 and 2012), is still not overly high. Only five out of 101 villages did not have village clinicians in 2012. Of those that lost village doctors between 2005 and 2012, nearly all of them still had a village doctor in 2012 (either taken over by another local clinician or the position was taken by a newcomer). The authors find that three main sets of factors are correlated with the career decisions of village clinicians: village clinicians’ opportunity cost, the profitability of running a village clinic, and commitment to the field of medicine. In general, clinicians who left the village faced a much higher opportunity cost, had been running a clinic that was not profitable, and had fewer ties to the field of medicine. Newcomers over the same period had higher levels of education, went to higher profit clinics between 2005 and 2012, and had a stronger commitment to the field. Originality/value - This study makes use of a data set with a large and nationally representative sample to provide a new perspective to better understand clinician turnover at village clinics, the career decisions of clinicians, and the implied trends for the quality and access to rural health care services in the future.