title: Aging village doctors in five counties in rural China: situation and implications.
abstract: BACKGROUND
  The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former "barefoot doctors") who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors' aging situation and its implications in rural China.
  
  
  METHODS
  The data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.
  
  
  RESULTS
  The average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.
  
  
  CONCLUSIONS
  Aging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.
authors: Huiwen
authors: H
authors: Xu
authors: Weijun
authors: W
authors: Zhang
authors: Linni
authors: L
authors: Gu
authors: Zhiyong
authors: Z
authors: Qu
authors: Zhihong
authors: Z
authors: Sa
authors: Xiulan
authors: X
authors: Zhang
authors: China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China. tian65216@hotmail.com.
authors: Donghua
authors: D
authors: Tian
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D002681:China; D003150:Community Health Workers; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010415:Pensions; D010820:Physicians; D019035:Rural Health Services; D012424:Rural Population; D011795:Surveys and Questionnaires; D000078329:Workforce