view my work in Japan.”

Medicine transcends biology; it embodies organization. Each nation develops its healthcare system influenced by its culture, economy, and priorities. In Japan, where I have spent several years, healthcare seems to merge seamlessly with the social rhythm: precise, intentional, and subtly compassionate. In the United States, where I received my training, there is a strong focus on innovation and specialization, often undermining coordination in the process. As I prepare to teach medicine and global health at Fudan University in Shanghai in the spring of 2026, my studies have led me to understand how China has fashioned its unique model—not dictated by philosophy or tradition, but rather by scale, structure, and pace.

China’s most notable feature is its ability to scale. With a population of 1.4 billion, its healthcare cannot rely on minor efficiencies; it must function as a comprehensive ecosystem. The country operates a three-tiered system consisting of community clinics, county hospitals, and large tertiary facilities, all interconnected through national policy. In reality, many patients opt to skip the lower levels, heading straight to major urban hospitals. A leading hospital in Shanghai might receive over 10,000 outpatients in just one day.

This density has fostered a distinctive clinical approach: quick, targeted, and algorithmic. Consultations are short, documentation is simplified, and imaging and lab testing are impressively rapid. The system values throughput out of necessity. For an American or Japanese physician accustomed to more prolonged interactions, this speed can be disorienting. Yet, there is a kind of elegance in this method: decisions rely on data, protocols are uniform, and the overall workflow is designed to efficiently transition patients from symptoms to solutions.

My colleague and co-author, Dr. Myriam Diabangouaya, experiences this rhythm firsthand. Hailing from Africa, she trained at Fudan University and now works at Juntendo University Hospital in Tokyo. “Chinese hospitals teach you to think in systems,” she shared with me. “With so many patients awaiting care, you quickly learn to identify patterns, triage smartly, and act decisively. This experience compels you to balance empathy with efficiency.” She describes her training as thorough and intensely practical: long shifts on busy wards, early engagement with real patients, and continuous feedback from residents and faculty who operate in teams that often transcend departmental boundaries.

This sense of practicality carries into medical education itself. China’s national standard, the “5 + 3” model, comprises five years of undergraduate medical education followed by three years of standardized residency training. Certain universities, including Fudan and Peking Union Medical College, also provide eight-year integrated MD-PhD programs for exceptional students. In contrast to the U.S. model, where medical school follows an undergraduate degree, or Japan’s largely uniform curriculum, China’s system is vertically integrated and centrally coordinated. The Ministry of Education and the National Health Commission collaborate to oversee curricula, ensuring connections between academic objectives and national health policies.

This synchronization is what sets Chinese medical education apart. When governmental focus shifts to rural primary care, universities enhance community-medicine rotations. When public health concerns pivot towards chronic disease management or aging populations, curricula evolve within a single academic year. Few countries can align medical education and healthcare reform at this magnitude. The outcome is a workforce prepared not only for hospitals but also for the nation’s changing epidemiological and demographic challenges.

The system’s adaptability was prominently displayed during the COVID-19 pandemic. Hospitals underwent reorganization within weeks, telemedicine platforms were launched nationally, and students were rallied as part of emergency response units. Medical education intertwined with public service. For many Chinese trainees, the pandemic represented both a crisis and a field practice in collective medicine, demonstrating that clinical expertise and civic duty can flourish alongside one another.

In comparison to Japan, where hospital hierarchies are rigid and advancement relies on seniority, Chinese institutions resemble more technical hubs, where competence and outcomes frequently overshadow age or title. Compared to the United States, where decentralization promotes innovation yet fragments care, China’s structure benefits from state-driven unity, allowing for swift and uniform implementation of reforms. This organization facilitates large-scale initiatives: standardizing residency training across the nation, creating interoperability for electronic medical records, and broadening national health insurance to encompass nearly the entire populace.

Naturally, this scale introduces challenges. Disparities between urban and rural areas endure, specialist shortages continue, and physician burnout is an escalating issue. The doctor-patient relationship can be tested by sheer volume and expectations. Nevertheless, even these difficulties are addressed through structural strategies: investment in community hospitals, digitization of referrals, and performance metrics designed to balance equity with efficiency. In China, reform tends to be iterative rather than rhetorical, refined through feedback, data, and substantial administrative momentum.

For Dr. Diabangouaya, that practicality was transformative. “At Fudan, you’re constantly reminded that medicine is integral to national development,” she remarked. “Every lecture connects clinical practice to population health. You observe how education, research, and policy collaborate. That lens remains influential in how I view my work in Japan.”