Authors: Liang Ge, Jian Lu, Chu-Hui Zeng
Interviewer: Patrick Lee
Editors: Justin Guan, Marco Ertreo

China’s fast-paced economic growth has fueled a scientific renaissance in the country with an increasing presence in the world of Interventional Radiology (IR) (1). This presence can be felt in the United States as well, with an entire section in the Journal of Vascular and Interventional Radiology website dedicated to Chinese translations. In 2016, there were almost a thousand English journal IR publications by Chinese physicians compared with just thirteen a decade ago (2).

First established in the 1980s, IR is a still relatively young field in China with only 3000-5000 IR physicians in 2008 (3). To gain a better understanding of IR’s place in China and its training models, we spoke with Dr. Liang Ge, an attending physician at Huashan Hospital (an academic and tertiary hospital in Shanghai) and Dr. Jian Lu, a 3rd year trainee at the Southeast University at Zhongda Hospital.

Currently, to become an Interventional Radiologist in China, a student needs to first complete 5-years of undergraduate studies in medicine and general radiology. For example, Dr. Ge is an alumnus of the Fudan University’s Medical Imaging Institution, where he was almost expected to become a Radiologist. If the student wants further education, they can apply for a master’s degree in a certain subspecialty, such as IR. There are two types of master’s degree, research and clinical. Just as their names imply, a research master’s focuses on research in IR, while a clinical master’s focuses on gaining hands-on clinical skills during the training period. Both programs take three years to complete, however, only the clinical master’s program will provide a Certificate of Standardized Training in Residency, which is mandatory for a trainee to become an attending physician. For research master’s, trainees will still have to complete an additional three years of standardized clinical training before they can obtain the Certificate of Standardized Training. Despite the added effort, becoming an IR is worth it for many. Dr. Ge believes “IR is more challenging than diagnostic radiology” since you can not only diagnose, but also clinically treat patients.

Much like in the US, the training paradigm for IR is rapidly evolving in China. When asked about the new training program in the US and the divergence with diagnostic radiology, Dr. Ge says “I totally agree with the split: IR and DR are two totally different groups of doctors. However, IR is still not fully independent of DR in China. In most tertiary hospitals, IRs are clinical doctors [unlike DR] who admit their own patients.”

Unfortunately, trainees are sometimes caught in this transition. While only an undergraduate and a master’s degree are required to practice as an IR, doctoral degrees can make candidates look more attractive for future employment. Nevertheless, Dr. Jian Lu feels tired and depressed. He completed his PhD in 2018, but the required duration of subsequent clinical training following his PhD was increased was recently increased from one to three years. Thus, his total training time before becoming an attending physician dramatically increased to 14 years: 5 years bachelor’s degree, 3 years master’s degree, 3 years of research PhD and, finally, 3 years of standardized clinical training. Recently, the National Health Commission of the People’s Republic of China announced plans to add an additional three-year “Professional IR Training” requirement after the three years of standardized clinical training. Understandably, this has generated a great deal of controversy among the Chinese IR physicians, as this change will extend the duration of training even further and lead to reduced physician compensation.

Despite the long training, as an attending physician Dr. Ge has had a very fulfilling career. Focused mostly on neurointerventions, his daily practice includes “aneurysm coiling, intracranial stenting, carotid stenting, mechanical thrombectomy, and peripheral IR.” In China, neurointerventions are part of basic IR training and physicians can choose to specialize without a formal fellowship. Finally, he adds that “in our hospital the IR department shares [procedures] with the neurosurgery department, but I believe we are more skillful because IR has better diagnostic imaging skills. That is why I am an IR.”

References:

1. Tollefson, Jeff. “China Declared World’s Largest Producer of Scientific Articles.” Nature News. Nature Publishing Group, 18 Jan. 2018. Web. 28 May 2018.

2. Zhao H, Tsauo JW, Zhang XW, Li X. Interventional Radiology in China : Current Status and Future Prospects. 2017;130(11):1371-1375. doi:10.4103/0366-6999.206355.

3. Teng GJ, Xu K, Ni CF, Li LS. Interventional radiology in China. Cardiovasc Intervent Radiol. 2008;31(2):233-237. doi:10.1007/s00270-007-9266-4.