In Jiong Tu and colleagues' introduction and discussion about the internet hospitals emerging in China (August, 2015), The internet hospital: an emerging innovation in China. we are disappointed to see little recognition of, or discussion about, the fact that skilled doctors in top-level (tertiary) hospitals in China are already overworked. These doctors have no additional time or energy to deal with internet diagnoses and prescriptions. In China's health-care system, primary health care is generally weak, with an insufficient number of skilled and experienced health professionals. Harnessing the privatisation of China's fragmented health-care delivery. Most patients in China prefer to visit tertiary hospitals even for common and minor illnesses since they can freely choose which doctors and medical institutions to visit. According to statistics from the National Health and Family Planning Commission of the People's Republic of China, in January–November, 2014, there were 2·6 billion patient visits to Chinese hospitals, 46% of which were visits to tertiary hospitals. National Health and Family Planning Commission of the People's Republic of ChinaThe situation of national medical service delivery in China in 2014. Therefore, tertiary hospitals in China are often overcrowded and the doctors in these top-level hospitals are generally overworked and overloaded. A 2014 national survey shows that 92% of doctors in tertiary hospitals need to work overtime, and 72% of doctors who have worked more than 60 h a week on average are in tertiary hospitals in China. Chinese Medical Doctor AssociationChinese doctors practicing white paper. In Tu and colleagues' introduction The internet hospital: an emerging innovation in China. of internet hospitals in China, skilled doctors in top-level hospitals are trained to meet patients and provide diagnoses and prescriptions via the internet. This approach seems to increase the accessibility of patients to high-quality medical services. However, with the consideration of overwork of skilled doctors in tertiary hospitals in China, its effects and sustainability are in doubt. We think that the key solution to the poor access to high-quality medical services in China is to provide enough skilled doctors or general practitioners in primary care institutions. If this situation is not fundamentally improved, the overcrowding and long waiting times experienced by outpatients will soon also become a problem in internet hospitals. To increase the supply of skilled doctors or general practitioners in primary care institutions in China, policies and programmes to encourage these health professionals to work in primary care institutions and reform of the medical education curriculum will be significant. Meanwhile, strengthening of the continuing professional training and development China's primary health-care reform. for health professionals in primary care institutions and improvements to their working conditions are also important. We declare no competing interests. The internet hospital: an emerging innovation in China. Harnessing the privatisation of China's fragmented health-care delivery. The situation of national medical service delivery in China in 2014. Chinese doctors practicing white paper. China's primary health-care reform. © 2015 Hu and Zhang. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.
China's trial of "Internet hospitals", which has grown rapidly since its initial launch in late 2014 to over 1000 sites in Guangdong province, is in serious danger of failing, unless the health service addresses the overworking of doctors in hospitals, according to correspondence in top medical journal, The Lancet. Doctors simply have no time or energy to deal with the demands of the internet hospital, on top of their regular workload according to Yinhuan Hu and Zixia Zhang, citing figures that claim 72% of doctors in Chinese hospitals work overtime and 92% work over 60 hours per week on average. If the overworking is not rectified soon, the same overcrowding and delays that afflict regular hospitals will come to affect the Internet hospitals too.