Taiwan offers few opportunities to those who wish to pursue a career in Chinese medicine. Students rejected by local med schools often end up studying on the mainland--only to be rejected again after returning to Taiwan.
Acupuncture, or inserting fine needles into designated points on the body to cure illness or relieve pain, is one of the oldest and most commonly used therapeutic techniques in Chinese medicine. It antedates written Chinese history, and many people believe that acupuncture was used by the Yellow Emperor, legendary ancestor of the Chinese people. The technique came to fruition in the Han dynasty (206 B.C.--A.D. 220), and has been popular ever since, being relatively simple to administer, with few side effects and numerous applications.
Most Chinese probably know very little about the history or theory of acupuncture, but they are quite accustomed to seeing people with fine needles stuck into their torsos, heads, or even their eyelids. In fact, acupuncture has become so popular and so widespread that many foreigners are now interested in its uses, and Western medical researchers have started to experiment with it--some because they think acupuncture works, others because they believe they can explain its effects in terms recognized by Western science.
But not all traditional Chinese therapies are considered scientifically valid in the West. Putting three fingers on some one's wrist to diagnose illness, for example, makes little sense to most practitioners of Western-style medicine, and saying that illness is caused by a blockage of chi , or "life energy," is perhaps even less acceptable. Westerners who detect no scientific basis for Chinese medicine can be forgiven for rejecting it. But when even the ROC government discriminates against its practice--an attitude reflected in many official policies--that is indeed cause for comment.
Take health insurance, for example. It was not until 1975, or twenty-five years after its promulgation in 1950, that labor insurance was extended to cover Chinese medicine. Civil servants had to wait even longer--thirty years from 1958 to 1988 --for their special government employees' insurance scheme to cover Chinese medicine. This alone put a serious damper on the development of traditional Chinese medical facilities.
According to the Department of Health (DOH), Taiwan now has seventy-nine hospitals and more than two thousand clinics specializing in Chinese medicine, or approximately one-tenth of the number of institutions practicing Western medicine. Last year, only 5 percent of national insurance payments were allocated to Chinese medicine. "The government doesn't really regard Chinese medicine as scientific, and so thinks it shouldn't be covered by insurance," says Lee I-hung (李一宏), the director of the Means Polyclinic and a licensed doctor of Chinese medicine. "It wasn't that people didn't want Chinese medical treatment, but when it came down to money, it was only natural that many of them should turn to Western medicine, which was covered by insurance."
The lowly status accorded Chinese medicine becomes even clearer in the field of education. This dates back to 1912, when the education minister explicitly forbade the establishment of Chinese medical schools. "Westernization was thought to be the key to developing the country, so modern Western science was the only thing students should study," says Yun-tson Tsao (曹永昌), chief of the Chinese Medicine Division of the DOH's Committee on Chinese Medicine and Pharmacology. "In light of government policies, Chinese medicine was officially ruled out of court before it even had a chance to get in."
Despite that, however, Chinese medicine continued to flourish, because there was a tradition of passing down its healing arts to the next generation through informal education programs. The ban on the establishment of schools of traditional Chinese medicine was lifted in 1930, but it was not until 1966 that the China Medical College set up Taiwan's first department of Chinese medicine, and only in 1983 did the school devise a post-graduate program. This college is still the island's only source of formal education in Chinese medicine. Each year, 120 graduates who have completed the seven-year college program and another 100 who have completed the five-year post-B.A. program take the national examination in the hope of becoming licensed doctors of Chinese medicine.
Successful examinees who have finished the seven-year course can then take a further examination to become licensed doctors of Western medicine, since their training also covers that. (This is not true of post-baccalaureate students.) But there is a catch--a graduate who has passed both exams may opt to practice either Chinese or Western Medicine, but not both.
Graduates who have formally studied only Western medicine, on the other hand, may accumulate an additional forty -five credits in Chinese medicine and then take an examination to become licensed practitioners of Chinese medicine. The intention behind these rules is undoubtedly sound: let Chinese and Western techniques mutually support and help each other. The results, however, have not been beneficial for Chinese medicine, because doctors tend not to stay confined to that field when they have the chance to become licensed M.D.s.
Yun-tson Tsao points out that as a result of years of government emphasis on Western medicine, licensed M.D.s are paid better, enjoy higher status, and have access to better research facilities and promotion opportunities. "In a Western medicine teaching hospital, people know they can build up their knowledge and advance their careers," Tsao says. "But with Chinese medicine, you stay in the same position from the day you hang out your plate until you retire." It is thus hardly surprising that more than 80 percent of the college's Chinese medical department's graduates choose to practice as doctors of Western medicine. Up to last March, the latest date for which figures are available, just nine of the more than two hundred Western -medicine graduates who amassed the extra forty-five Chinese medicine credits succeeded in passing the examination to become licensed practitioners of Chinese medicine.
At various times, legislators, Western-trained doctors, and the Chinese medicine fraternity have all talked about setting up more departments of Chinese medicine, or even a Chinese medical university, but little has been done. Yun-tson Tsao explains that in the past, when the Ministry of Education exercised total control over what departments a university could set up, the excuse for not creating a Chinese medicine faculty was always "lack of qualified teachers." But now that individual universities can decide on their own departments, the situation seems no better. Any proposal to create a new department has to be approved by the university faculty but, with the exception of the China Medical College, the decision-makers inevitably come from departments of Western medicine. It is a Catch-22 situation: because as yet there are no other Chinese medicine departments, therefore, none can be created. "With people like that making all the big decisions, what chance is there of them agreeing to spend a whole slew of money on a new Chinese medicine department?" Tsao rhetorically asks. "Even the chances of getting such a proposal on to the agenda are negligible."
Only one-third of Taiwan's 3,300-odd traditional Chinese practitioners have received any formal medical education. An irony of the situation is that those who pass the college entrance examination and spend seven years in the department of Chinese medicine do not want to end up practicing it, while those who want to be traditional Chinese medicine doctors often fail the college entrance examination. For such people, the only way of making their dreams come true is by passing professional exams. They pick up medical knowledge from attending hospitals run by friends or relatives, self-study, or whatever other sources may be at hand. Then they take a qualifying examination, held once every three years, followed by a special examination for would-be doctors of Chinese medicine. Many cram schools offer help with these exams, but passing them is as difficult as winning admission to med school via the college entrance examination, perhaps more so, and makeup tests in subsequent years are a common event.
Frustrated by the difficulties they face locally, many residents who wish to pursue a career in Chinese medicine turn their thoughts to mainland China. Large numbers of the older generation of traditional Chinese medics visited the mainland for short-term study lasting from weeks to months. "It was mostly out of an anti-government mindset," Lee I-hung says. "The government here didn't respect Chinese medicine, but the government over there did. It allocated resources to it and welcomed Taiwanese, so there seemed to be no reason not to check it out."
Lee points out that most of these older-generation students were already licensed as Chinese medicine doctors in Tai wan, so they went to mainland China for purely academic purposes. They gave no thought to whether the Taiwan government would allow them course credits for what they learned there. But students who have gone to the mainland over the past decade have done so with a very different set of attitudes. "These young people study Chinese medicine because they want a share of the local market," Yun-tson Tsao says. "When the route to that market is closed, they detour."
The bypass seems to be getting both wider and shorter. There are few barriers in the way of Taiwan citizens who want to visit the mainland now, and admission to one of its Chinese medical universities usually depends on money, pure and simple. Currently, Taiwan citizens who wish to go to the mainland to study are not even required to register with any of Taiwan's government agencies.
There is, however, one serious drawback. The political realities of cross-strait relations have ensnared a draft law governing recognition of mainland diplomas, which is stalled for the foreseeable future, and the government has yet to draw up a definitive list of mainland schools that it will accredit. As far as Chinese medical studies are concerned, however, the government has announced tentative plans to accredit graduate degrees of the Chinese medical colleges in Beijing, Shanghai, and Guangzhou.
According to Tsao, one major difficulty in accrediting mainland schools is the different system over there. Mainland medical college programs in general require five years to complete, with three years for graduate programs. Both programs include about six months of "political" courses. Because of this shorter school time, and in light of the different admission standards, local Chinese medicine practitioners are suggesting that the government devise strict criteria for investigating the adequacy of mainland graduates' medical knowledge and skills.
In the eyes of some of Taiwan's traditional practitioners, however, shorter school time is not necessarily to be equated with inferior training. Lee I-hung has visited most of these mainland schools, and he believes that the quality of the education on offer there, along with the facilities, are superior to those in Taiwan. "The two governments' differing education policies on Chinese medicine explain everything," he says. "Whereas the mainland has established several public Chinese medical universities, Taiwan only has one department --and that's at a private college."
On the other hand, Tsao is also familiar with mainland universities and facilities, but he thinks that quantity is not necessarily the same as quality. He argues that the mainland has more research manpower because of its much larger population base, so the chance of their making medical breakthroughs is higher. But on average, and giving due regard to the whole spectrum of medical development, the mainland is ten to twenty years behind Taiwan. Tsao says that many mainland practitioners of traditional Chinese medicine become professors on the strength of their strong political affiliations, rather than their academic achievements. "The best mainland doctors are assigned to take care of high-ranking government officials," he says. "They don't have the time to teach at schools, and most of them have not the slightest wish to do so."
On one issue at least there is general agreement: Mainland schools do offer Taiwan students easier access to Chinese medical education. Over the past four or five years, many young people have completed their studies on the mainland and returned to Taiwan. There are no formal statistics on how many residents have visited mainland China to study Chinese medicine and then come back home, but Tsao estimates their numbers at between three and five thousand. Their mainland diplomas have not yet been recognized by the Taiwan government, however, so their experiences have done nothing to make their becoming licensed traditional doctors any easier. For them, the rule is the same as for everyone else who is not a local Chinese medicine major: They must pass the qualifying examination and the special examination for doctors of Chinese medicine.
It is, perhaps, an inevitable fact of life that some of them start to practice before passing the examinations. "It's like the situation several years ago, when local hospitals were hiring doctors who'd graduated from Filipino medical schools that weren't accredited by the government here," Tsao says. "The new generation think that because they've completed a college -level course of med training they're qualified to practice. Whether they've got a license is neither here nor there."
At present, the market works in favor of such "non-licentiates." People go to illegal doctors because there are simply not enough licensed doctors of Chinese medicine to go round. According to the DOH's most recent survey, Taiwan needs about 4,600 doctors of Chinese medicine, or 2.2 for every 10,000 of the population. In light of this, some observers question whether Taiwan can absorb another few thousand mainland-trained traditional Chinese medicine doctors, once the government agrees to accredit mainland schools, but Lee I-hung believes that market mechanisms will decide the issue. "From a selfish point of view, the best thing is for me to be Taiwan's only doctor, so that all patients have to come to me," he says. "But for the good of all-round medical development, it's best if there are more doctors than the market needs. Let competition stimulate quality and eradicate the no-hopers."
But at present, Lee sees no signs that either the government or the local Chinese medical fraternity are ready to let market forces dictate. When it comes to government efficiency and society's mindsets, neither acupuncture nor modern surgery seems to be of much help.