When doctors earn 3,000 RMB: China’s healthcare pay squeeze
After years of training, some Chinese doctors now earn as little as 3,000 RMB a month. Pay cuts, rising pressure, and bleak prospects are forcing many to rethink a once-secure profession. Lianhe Zaobao correspondent Li Kang finds out more.
Wave after wave of pay cuts made over the past year have been especially tough for doctors in China.
Dr Li from Guangdong told me that at the public hospital in her prefecture-level city, as a junior doctor within the official establishment, her current monthly salary is just over 3,000 RMB (US$429.57).
Pay cuts, shrinking earnings
The pay cuts began in 2023. It started with a reduction in performance pay, which was halved, followed by the cancellation of allowances, and finally, even basic salary was decreased. At the same time, personal social security contributions have gone up. This mix of pay cuts and rising deductions reduced Li’s take-home pay from already less than half of its former level to under one-third today.
To support her family, Li has little choice but to keep her hospital job while taking on part-time online consultations, earning about 10 RMB per session on average. In a month, the extra income amounts to only a few hundred RMB — just enough to cover the utility bills.
Li’s situation is not unique. According to the 2024 Healthcare Talent Salary and Employment Survey Report released by HuayiNet last June, among the nearly 30,000 medical staff who took part in the survey, as many as 57.9% saw their pay fall in 2024, an increase of 20 percentage points compared with the previous year.
“I’ve worked for 17 years and never received a year‑end bonus. Recently, they can’t even pay our wages.” — a medical staff member
On Chinese social media, posts about pay cuts for doctors are everywhere; from major hospitals in first‑tier cities to community and township hospitals, and from junior doctors to attending physicians, nearly everyone has been affected. In recent months, this wave of pay cuts has intensified: in some hospitals, it is not just about decreased pay; even paying salaries on time has become a problem.
Under one post discussing year-end bonuses for 2025, a medical staff member lamented helplessly: “I’ve worked for 17 years and never received a year‑end bonus. Recently, they can’t even pay our wages.” Another medical worker tried to comfort him: “Being able to get your pay is already pretty good”.
The continued deterioration in pay has also pushed some doctors who can no longer cope to resign, resulting in a “doctors exodus”. At Dr Li’s hospital, more than a dozen doctors resigned over the past two years, including some of the hospital’s key employees. Jiangsu’s Dr Guo told me that the resignation rate at his 3A tertiary hospital was as high as 20%.
Doctors’ performance is in turn closely tied to hospital revenue.
Hospital revenue suffering, performance-based salaries not ideal
The pay for doctors in China’s public hospitals mainly consists of basic salary, allowances and performance-based pay. Fixed pay accounts for roughly 40%; in first‑tier cities, this proportion is even lower at only 29%. In other words, for Chinese doctors, half or more of their income now depends on performance appraisals.
Doctors’ performance is in turn closely tied to hospital revenue. Prior to 2017, public hospitals in China derived their income from three main sources: medical services, government funding and mark‑ups on medicines and medical consumables.
Of these, government funding comes mainly from local authorities, accounting for a relatively small but fairly stable share. Mark‑ups on medicines and consumables once made up more than 40% of public hospital revenue. But since 2017, the Chinese authorities have abolished mark-ups on medicines and then on consumables, depriving hospitals of a major source of revenue. At that time, medical staff went through a round of pay cuts.
Medical service income has long been the main source of hospital revenue, but it is also strictly constrained by the health insurance system. One salient point of contention is the DRG/DIP payment reform (payment by diagnosis-related groups or diagnosis intervention packet) rolled out nationwide in recent years.
Under this reform, hospitals charge a fixed “package price” for each type of disease or procedure, and any amount beyond that must be borne by the hospital itself. Some commentators argued that this payment method is a key reason behind the severe financial losses hospitals faced.
However, China’s official position does not accept this view. In 2024, the National Healthcare Security Administration stated in an official document that the reduction in hospitals’ medical income should not be blamed on DRG; the more crucial issue lies instead in unreasonable hospital expansion and development.
In China however, performance-based pay makes up a relatively larger share of public hospital doctors’ income, making it easy for doctors to chase performance indicators and engage in overtreatment, among other problems.
Another view is that the root of the problem is not just the health insurance payment method, but the fact that a doctor’s salary is too tightly bound to the income of public hospitals, making doctors the direct bearers of hospitals’ operational pressures. In a paper published last October, Ying Xiaohua, director of the Health Economics Teaching and Research Department at Fudan University’s School of Public Health, pointed out that there were structural imbalances in the current pay system for public hospitals.
Ying’s comparative research revealed that internationally, doctors in public hospitals are mainly paid fixed salaries. Such a system is more conducive to preserving the public-interest nature of healthcare and, at the level of institutional design, prevents short‑term profit‑seeking behaviour driven by performance incentives. In China however, performance-based pay makes up a relatively larger share of public hospital doctors’ income, making it easy for doctors to chase performance indicators and engage in overtreatment, among other problems.
High turnover
Even more concerning is that when current pay levels are no longer enough to retain doctors, those who remain would have to shoulder even more work. With staff continually leaving and workloads constantly increasing, in the long run, a decline in the quality of care is almost inevitable. The resulting pressure would further squeeze the doctors who stay, forming a vicious circle.
At Li’s hospital, several young doctors secured positions soon after graduation, yet many would now rather break their contracts than stay.
Guo, a clinical practitioner of ten years, has already been promoted to attending physician. He is not considering a career change — his sunk costs are too high and the hospital feels like home. Yet he is certain that the current chill in the healthcare system is unlikely to lift over the next five to ten years.
This chill has already begun to affect the career choices of the next generation. At Li’s hospital, several young doctors secured positions soon after graduation, yet many would now rather break their contracts than stay. After years of gruelling study, they finally “made it” only to turn away the moment they set foot in the hospital. This is no longer merely an economic issue — it reflects a rational choice by the next generation of doctors, looking ahead at what lies before them.
This article was first published in Lianhe Zaobao as “中国医生月薪跌回3000人民币？”.
