Why Are Chinese Medical Students Taking Their Own Lives Before Saving Others?

(This post was originally published on April 21, 2025.)

It was a spring night last year. Cao, just three months shy of finishing her gruelling three-year medical residency, made a tragic decision.

The medical trainee was supposed to be on leave that day, but only found herself back at the hospital in central Hunan, checking on her patients.

About 9 pm, she walked into the physicians’ lounge, filed the last of her medical records in three hours, took a scalpel into the bathroom, and cut her own throat behind the locked door.

The aspiring doctor took her own life at age 25.

“I’m so tired. I just want to rest…” read her timed suicide note, as reported by the state-linked Beijing Youth Daily. “It’s my fault for being an incompetent workhorse – I just can’t take it anymore,”

Cao’s death is far from an isolated incident.

Last spring alone, at least three other medical trainee students – from China’s metropolitan Shanghai to Nanning city in southwestern Guangxi, according to Chinese state broadcaster – chose the same escape as Cao, overwhelmed by endless paperwork, unreasonable hours, and repetitive tasks that felt far removed from real training.

The string of tragedies sparked public outrage back then, with many medical students echoing their struggles online. They’re calling for an overhaul of the residency training program, pointing to the system that exploits them as little more than cheap labor.

“Sometimes I feel the despair doesn’t come from a lack of awareness, but from the realization that even if you do see the issues, you just can't change the system.” Ren, a pediatrics trainee at a top-tier hospital in Eastern Jiangsu province, told me last March, just a month after Cao’s death.

“No one cares about us – and that’s what truly feels hopeless.”

A year after all the social uproar, have things fared any better for these medical trainees?

“My work is actually more intense,” Ren told me in a recent message. “As I work longer, I’ve gradually become used to this unreasonable system.”

“I’m now a mature workhorse LOL” She DM'd me on WeChat, the Chinese equivalent of WhatsApp.

Ren’s jotted notes on her patients’ treatment status.

The Elephant Room is giving our interviewees’ surnames to protect their privacy.

Physical and Mental Toll

Being a doctor demands rigorous training worldwide. However, in China, the challenge is compounded by a system that has become a means for major public hospitals to exploit cheap labor. This life-saving career takes a heavy toll on those in the field.

Launched in 2014, the “standardized residency training” program has sent around 1.1 million trainees to hospitals nationwide, according to data cited by the Chinese state-owned news agency Xinhua.

Those trainees are mainly medical students pursuing clinical master’s degrees; graduates with medical degrees entering residency separately, and doctors sent by their home hospitals to train at larger medical centers.

“Those master’s students have it really tough – they’re worked to the bone, far beyond reasonable limits...” Dr. An, 34, now a cancer researcher at a top-tier hospital in Southern Guangdong province, shared his observation.

Ren, like many of her peers who have tragically taken their own lives, falls into this category and is expected to juggle the demands of finishing her studies while working tirelessly to obtain a license for “standardized training” for future job hunting.

The 24-year-old works six days a week, with five daytime shifts of about nine hours each, from 7:45 AM to 5 PM, and one overnight shift that ideally runs from 5 PM to 7:30 AM. However, she often logs off no earlier than 10:30 AM the next day, totaling about 17.5 hours of work.

“We have a hidden rule – even after pulling a night shift, we have to finish rounds on all your patients, writing up their medical orders, and filing their medical records before clocking out in the morning,” Ren said her longest working record is a staggering 20.5 hours – working straight from 5 PM until 1:30 PM the next day.

A stack of medical records for the patients Ren’s responsible for.

Qiao, a former medical trainee in pediatrics, said last March “staying up all night and working for 15 hours straight is just part of daily life.”

She trained during the COVID-19 pandemic from 2019 to 2022, but after three exhausting years, she ultimately gave up her childhood dream of becoming a clinic doctor – an ambition she had invested eight years of hard work in – and chose to take on an administrative role instead.

“I was just too tired to go on, both physically and mentally, ” Qiao told me last year.

Liu Jin, the advocates and implementer of China’s standardized training of residents, argued that “the issue of working hours is something that doctors everywhere have to deal with,” according to his interview with a state-backed Chinese media in the wake of the suicide of Cao.

“They must accept that kind of pressure when they start practicing on their own,” said Liu, citing that no patients or families would be happy to see a surgeon clocking out while an operation is still in progress.

He also added that he doesn’t mean doctors should be expected to work themselves to the bone, and systems must be in place to ensure reasonable working conditions.

Yet, for many trainees, including Ren, the idea of a protective system feels like a distant dream. In the current climate, even requesting a sick day feels like too much to ask.

In December 2023, just three months into her residency, Ren ran high fever during her night shift. Sensing it wasn’t too busy that night, she requested sick leave from the attending doctor. But the young trainee, feeling too dizzy to stand, was told she could only leave if she found someone to cover her shift.

“I was desperate at that moment and ended up crying my heart out – of course not in front of them.” Ren recounted a year later, calling it the incident that hurt her the most.

Eventually, she managed to secure a four-day sick leave – after calling her university mentor, the education ministry at her hospital, and her university teaching secretary to get their greenlights in respectively.

On top of all the strains, Ren and Qiao, both working in pediatrics, frequently dealt with frustrated families of their young patients – babies and kids who couldn’t articulate their ailments.

Tensions between doctors and patients are a perennial problem in China. In this “dumb” division, according to Ren and Qiao, worried parents often lash out at them over everything from medication choices to when their child should get a Magnetic Resonance Imaging.

Lopsided Input-Gain Ratio

The physical and mental toll weighs heavily on most medical trainees, but the mantra of “eat bitter first” doesn’t guarantee sweetness later.

Like Ren and Qiao, medical trainees from postgraduate programs are juggling dual roles: they’re master’s students expected to maintain decent academic standings while also being resident trainees forced to work around the clock to fill staffing shortages.

“They call you a full-time doctor when assigning tasks, but when it’s time to pay up, you’re just a trainee student,” said Qiao, whose take-home monthly salary was 4,900 yuan (USD 670) at most, on which she could barely get by during her training period.

Ren’s situation is even more challenging – she earns only about 1,000 yuan ($137) monthly.

Unequal pay for equal work is a shared pain point for all medical trainees nationwide. In 2014, the state announced it would allocate 20,000 yuan (USD 2739) per year to medical trainees as a financial subsidy. However, in reality, 30% of 3000 Chinese medical trainees surveyed in 2020 were paid no more than 1,000 yuan (USD 137) per month, and 8% had no income at all.

Beyond financial struggles, balancing the demands of training and research is nearly impossible for many, including Ren.

The second-year postgraduate student was meant to finish a decent SCI paper before graduation to qualify for a job at a reputable hospital in her hometown in Western China. But the daily grind left her with no time for her own experiments and research.

“I probably won’t even be able to produce a graduation thesis, let alone publish an SCI paper,” she said.

In addition, Ren feels that the greatest loss in this program has been the lack of systematic clinical training, which is exactly what the “Standardized Residency Program” is all about—cultivating competent clinical doctors.

“They taught us nothing but just allowed us to trail behind them and expected us to figure things out independently,” Ren said. “I think this is very dangerous for our patients… It’s a matter of medical safety.”

Dr. An, from a top hospital in Guangzhou, echoed that “there are only a few medical mentors who are both competent and willing to teach.” As a result, medical trainees often have to pick up what they should have learned during training in their future medical practices, he said.

Futile Resistance against the System

Faced with immense pressure and a demanding work schedule, Ren, like many other trainees, said she dared not risk her future by protesting. The hospital has complete control over her “training license,” which is essential for her future job search as a doctor.

However, some resistance was brewing among Ren’s juniors, though it ultimately led nowhere.

Last month, a fresh trainee reached her breaking point and protested to the school, earning all the pediatrics trainees a chance to sit down and voice their daily hardships to their teachers.

“After hearing her, all the teachers were left speechless,” recounted Ren.

“They knew we were struggling, but there was nothing they could do about it,” Ren added. “It all boils down to the system.”