As my research into China’s senior care market has continued, one of the questions I have been eager to explore is how Western providers should come to understand the geriatric training that already exists for doctors, nurses and vocational bed-side staff within China. Senior care would not be the first industry to peer into China, see immense opportunities, only to have a series of high-profile failures follow, all because basic assumptions about access to trained personnel were made incorrectly. Western models, in particular those that emphasize franchises and licenses as their operating model, will need to pay particular attention to how staff is identified, trained and retained if the senior care market is to successfully evolve. Obviously, a critical part of this happening is learning more about how the market currently approaches geriatrics in general, a question I wanted to speak with Dr. Sean Leng about at length. Recently, Dr. Leng was kind enough to spend time speaking with me in detail about these and related questions.
Few people are better positioned academically, professionally or personally to speak to the question of geriatric care standards in China. As an academic geriatrician, Dr. Leng is a Professor of Geriatric Medicine & Gerontology at John Hopkins University School of Medicine. He holds a M.D. from Jiangxi Medical College with subsequent medical training at the Peking Union Medical College (PUMC). His PhD is in immunology and molecular virology at Texas A&M with additional postdoctoral fellowships at Yale and John Hopkins along with residency training at Columbia University. Professionally, Dr. Leng is affiliated with China Senior Care, the Hangzhou operation spear-headed by Mark Spitalnik. He has also received a grant from the prestigious China Medical Board to work with PUMC in helping develop their geriatric training regimen. But all of these accomplishments aside, Dr. Leng’s personal experience may be the most important. Upon one of his returns to China during his studies, he saw first-hand the impact Alzheimer’s was having on his father. As Dr. Leng put it to me last week, “it was heart-breaking to go back and see him in China, but for him to not be able to recognize me.”
Geriatrics remain a field that is in need of extensive development in China, a point that simply cannot be over-stated as Western operators begin to more aggressively expand in the country. Dr. Leng shared “The problem there is no standard training curriculum for geriatricians.” As a discipline, geriatrics in China is not well organized. A doctor in China would have the opportunity to specialize in a particular field that would be identified as a geriatric area; the example Dr. Leng offered was cardiology. The problem with this is that most cardiologists see older patients anyway, so while the Chinese medical system may think it is educating people in the field of geriatrics, the sub-specialty of cardiology actually predominates. Consequently, as Dr. Leng said “the functional aspects of falls, dementia, frailty and other age-related specific syndromes are not really addressed.”
This has created a number of problems, not least of which is the paucity of good research in the field of geriatrics within China’s medical and academic institutions. The little geriatric care that does exist tends to be that provided for former high-ranking Party and PLA officials. Dr. Leng commented on this “[because of this] there is no real scholarly exchange because all the medical records or clinical data is confidential.” In order to address this problem, Dr. Leng has been working since late 2010 with the China Medical Tribune to publish a special geriatrics series, as well as hosting a conference by John Hopkins and the China Geriatric Society late last year, all of which is designed to get across the basic principles of geriatrics to China’s medical community.
Our conversation naturally transitioned to what Dr. Leng sees as the key challenges facing developers and operators who are eager to expand into China. His answer on this point is worth quoting at length:
“Number one, the geriatric work force is not there. Physicians, but physical and occupational therapists, dietitians, social workers, nursing aids – we just don’t have that in China. When we had the project funded by the China Medical Board in 2006, we included 12 doctors at the hospital plus 4 nurses. We need both in terms of the workforce if we are to provide quality senior care in China. Those ‘nursing homes’ [I see being built around China] are really disturbing to me. When I went to Beijing and saw all the high rise senior housing being built – you can name quite a few of them – the problem is you don’t even see a clinic near-by. The people move in there, and when they do they are physically just fine – they are highly functional – they don’t need much. But within 10, 20, and 30 years, when they are in their 70s, 80s, or 90s, how are these people going to get their healthcare support? Obviously, the whole thing is not set up right. They do not have a good healthcare management or provider or training or even source of healthcare providers for the system. Tailoring to the high end, is there a big enough market? Simply copying [what worked in the West for developers] will not work. My vision is getting to the grass roots in the community and formulating a network there. From the hospital care, and outpatient clinical care, answering the question of how do you train the geriatric workforce? The model in the US – we train, we get the geriatric principles to the doctors – but also training the nursing aid and the nurses and promote some of the novel geriatric care models.”
None of what Dr. Leng had to say suggests the China senior care industry is not a compelling opportunity, but developers and operators are going to have to be increasingly mindful of the wide gaps that exist between how China trains its doctors and nurses in geriatrics versus how this is handled in more developed economies. I know from my own research that many early entrants into China have incorrectly assumed they can access a basic pool of skilled healthcare and semi-skilled vocational workers in the senior care space; the unfortunate reality is that in both areas, China’s geriatric workforce needs major improvements, a realization that might well suggest where even more exciting and lucrative business opportunities might exist.