The dilemma and hope of Traditional Chinese Medicine practitioners in China.

On November 1, 2019, the World Federation for Medical Education (WFME) deleted 8 universities of Traditional Chinese Medicine (TCM) from the World Directory of Medical Schools. Coincidentally, just a year earlier in 2018, Oriental Medical Schools in Korea were rejected from being listed on the directory. The Korean Medical Association has stated that the WFME's decision clearly shows that the global medical community recognizes neither TCM nor Korean Medicine as modern medicine. As a consequence, this incident has had a certain negative effect on the internationalization and globalization of Chinese medicine. Graduates of these institutions will now be hindered from obtaining medical licenses abroad, which will not only affect students’ employment abroad but also their enrollment to medical schools abroad. Although the purpose of the WFME's decision was to internationalize medical education, it will only create additional challenges for TCM practitioners and TCM college graduates in China. The problem associate with this delisting seems to be the information asymmetry (also known as asymmetric information) of TCM within China and outside China.

In China's current medical system, physicians’ qualifications are divided into 4 categories: clinical (Western medicine), dental, TCM, and public health. When medical practitioners run a business, they must run in accordance with their own registered professional scope of practice and cannot overstep the bounds of their registered scope of practice. Thus, the question remains; can TCM practitioners prescribe prescription medications of Western medicine? Graduates from TCM colleges and universities in China have gone through a systematic and integrated set of study program including Western medicine diagnostics, physiology, anatomy, internal medicine, and pharmacology, to name a few. TCM practitioners who have obtained a medical license in China through formal course of study can generally prescribe Western medicine. In the mainland Chinese hospitals, TCM practitioners in reality can adopt various modern diagnoses and treatment methods according to clinical needs, which is equivalent to clinical (Western medicine) specialty.

Another problem associate with this delisting involves the insufficient communication between physicians of TCM and Western medicine. Due to the overlap of diseases treated by Chinese and Western medicine, there may be a long-term, competitive relationship between TCM and Western medicine in China. The good news is that the value of complementary and alternative medicine (CAM) is increasingly valued by scientific research. A systematic review showed that in different regions of the world, CAM usage was between 9% and 65%. Some Western medicine doctors may have negative impressions of TCM; considering the different concepts and forms of the two types of medicine, the integration and balance of TCM and Western medicine is complex. This bias against TCM is not only recognized among Western medicine doctors in China but also among international Western medicine doctors. For example, a recent comment suggests that, after decades of research, the underlying mechanism of acupuncture is still not clarified, and there is not enough evidence for clinically valuable benefits and possible harm. Therefore, Western medicine doctors would not recommend acupuncture for the treatment of pain.

In addition, TCM practitioners in China have few opportunities to participate in international exchanges and cooperation. For example, in a multicenter randomized controlled clinical trial, each center required at least one responsible researcher. However, in China, in general, only the first or corresponding authors of the paper have actual responsibility for the paper, and it is only effective when promoted a professional title. The number of first authors and corresponding authors of a paper is limited, which may cause Chinese researchers to become less enthusiastic about participating in international multicenter researches.

Finally, students of TCM universities accept both TCM education and modern medical education. However, the employment rate of graduates has been low in recent years. While most of the physicians in TCM hospitals and in the TCM department of Western medicine hospitals graduated from TCM universities, there are relatively few TCM hospitals and TCM departments in hospitals. Moreover, since most Chinese hospitals specifically request for graduates majoring in clinical medicine of Western medicine in their recruitment information, most students majoring in TCM may face difficulties finding employment. On the other hand, due to the relatively low cost of TCM treatments, hospitals are not willing to invest much in the development of the TCM discipline, leading to slow development or even atrophy of the TCM department.

In conclusion, TCM colleges should be recognized internationally as medical colleges. TCM colleges and universities provide comprehensive basic and clinical education of TCM and Western medicine for students. The communication between TCM, Western medicine, and international educational organizations should be strengthened to eliminate prejudice. Graduates can then decide to become doctors that integrate TCM and Western medicine or Western medicine doctors. Medical institutions and universities of TCM should establish a scientific and reasonable professional title evaluation system and encourage international cooperation. In addition, the states should improve upon and formulate policies to encourage employment of graduates from TCM colleges and universities.

Author contributions

KZ contributed to the conception and design of the work. KZ drafted the manuscript and QT revised the manuscript. Both authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Funding

No funding was received.

Ethical statement

No ethical approval was required for this manuscript as this study did not involve human subjects or laboratory animals.

Data availability

Not applicable.