Survey Reveals Burnout Crisis Among China’s Pediatric Trainees Despite Strong Clinical Teaching

China is running out of pediatricians, and a new survey of doctors in training suggests the pipeline is under strain at its most vulnerable point. With only about 118,000 pediatricians caring for a population of 1.4 billion, the country’s pediatric workforce shortage has become a public health emergency in slow motion. Now, researchers at the Children’s Hospital of Chongqing Medical University have taken a close look at the people who are supposed to fill that gap: the residents themselves. Their findings, published in BMC Medical Education, paint a picture of a training system that teaches well but fails to keep its trainees emotionally and financially afloat.

The study, led by Di Hu and colleagues, surveyed 203 pediatric residents at a single tertiary teaching hospital in 2026 using a structured questionnaire covering demographics, training motivation, training quality, professional identity, work stress, psychological status, and social support. Nearly three quarters of the respondents, 72.91 percent, were women, reflecting the heavily female composition of China’s pediatric trainee population. The researchers analyzed the responses with descriptive statistics and used logistic regression to identify which factors were independently associated with negative emotional states, a methodological choice that allows them to separate real predictors of distress from mere correlations.

On the surface, the training itself looks solid. A striking 94.09 percent of residents reported having adequate opportunities for clinical practice, and 93.11 percent said they were satisfied with the quality of teaching they received. For a training program cranking out the next generation of children’s doctors, those are encouraging numbers. The technical machinery of residency, the ward rotations, the supervised procedures, the didactic teaching, appears to be functioning largely as designed. If the goal were simply to teach residents how to practice pediatrics, the system would seem to be succeeding.

But the numbers underneath tell a far darker story. Only 23.65 percent of residents said they felt proud of their pediatric career, and just 55.66 percent were willing to commit to pediatrics long term. Most alarmingly, 74.38 percent had considered leaving the profession or changing careers altogether. In other words, three out of every four trainees in this cohort had seriously weighed walking away from pediatric medicine, the very field China desperately needs them to enter and stay in.

The mental health data help explain why. Seventy point nine four percent of residents reported experiencing negative emotions over the preceding three months. Anxiety was the most common, affecting 57.64 percent of respondents, followed by burnout at 42.86 percent and depression at 18.72 percent. These are not trivial rates. Burnout at nearly 43 percent among trainees who have not yet even entered independent practice suggests that the stressors are baked into the training environment itself, not merely a byproduct of seniority or caseload accumulation over years.

When the researchers asked residents what was driving this distress, three stressors dominated. High workload was cited by 76.35 percent of respondents. Tense patient-physician relationships, a well-documented problem in Chinese healthcare where distrust and occasional violence against clinicians have eroded the doctor-patient relationship, affected 69.95 percent. And 67 percent pointed to a mismatch between their income and their effort, a complaint that carries particular weight in pediatrics, historically one of the lowest-paying specialties in Chinese hospitals.

The logistic regression analysis sharpened the picture by identifying which factors independently predicted negative emotions after adjusting for other variables. Residents who perceived insufficient social recognition of their profession had 2.89 times the odds of reporting negative emotions compared with those who did not, a finding that was statistically significant at p equals 0.012. Low professional pride more than doubled the odds, with an adjusted odds ratio of 2.44 at p equals 0.030. High workload raised the odds by 2.34 times at p equals 0.027. The pattern is coherent: residents who feel unseen, undervalued, and overworked are the ones drowning emotionally, and these three drivers reinforce one another in a feedback loop that erodes both identity and wellbeing.

What residents themselves want changed is telling. Compensation and benefits topped the list, with 77.34 percent naming it as a priority for improvement. Training content optimization came second at 60.59 percent, and psychological support was third at 46.31 percent. The ranking makes intuitive sense: you cannot fix burnout with mindfulness workshops when the underlying grievances are financial and structural. The authors argue that urgent interventions are needed on multiple fronts, including salary reform, psychological support infrastructure, optimization of training content, career development services, and enhanced social recognition of pediatricians as a profession.

The findings carry implications well beyond a single training base in Chongqing. Pediatric workforce shortages are a global phenomenon, driven in many countries by low pay relative to other specialties, high emotional demands, and litigious or strained family interactions. The Chinese data add a specific warning: even when the educational quality of training is high, a program can fail at retention if it ignores professional identity and mental health. A resident who learns excellent pediatric medicine but graduates feeling underpaid, unrecognized, and emotionally exhausted is not a success story for the health system.

The study has limitations worth noting. It is a cross-sectional survey from a single center, so the 203 respondents represent one snapshot at one institution rather than a nationally representative sample, and the design cannot establish causation between the identified factors and psychological distress. The authors also note that the study was reviewed by the Institutional Review Board of the Children’s Hospital of Chongqing Medical University, which granted an exemption from formal ethical review because the survey was anonymous, low-risk, and involved no clinical intervention or patient data. Still, the scale of the reported distress, three quarters of trainees considering career exit, is hard to dismiss as an artifact. If China wants more pediatricians, the survey’s message is blunt: better teaching will not be enough. The country will have to make pediatric careers worth staying in, with pay that matches the workload, psychological support that trainees actually use, and a society that treats children’s doctors as the essential professionals they are.

Subject of Research: Mental health, professional identity, and training quality among pediatric residents in China

Article Title: Current status and recommendations for pediatric residency training: a cross-sectional survey of 203 residents from a single training base in China

Article References: Hu, D., Hu, Y., Fan, Y., Yang, Z., Tang, X., Li, M., & Pan, B. (2026). Current status and recommendations for pediatric residency training: a cross-sectional survey of 203 residents from a single training base in China. BMC Medical Education. https://doi.org/10.1186/s12909-026-10632-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10632-w

Keywords: pediatrics, residency training, burnout, mental health, professional identity, physician workforce, China, medical education, social support, workforce shortage, anxiety, compensation