The research team, led by Xinke Liu and Mingqing Wei of Dongzhimen Hospital at Beijing University of Chinese Medicine, together with colleagues including Jing Shi and Jinzhou Tian, conducted a cross-sectional online survey of physicians in January 2025. The final analytic sample comprised 393 physicians drawn from 27 provincial-level regions of China, a geographic spread that gives the results unusually broad coverage for a study of this kind. Rather than simply asking doctors for general impressions, the investigators built a dedicated measurement instrument called the Chinese Medicine Service Quality scale, or CMSQ, which integrates general service-quality principles familiar from mainstream health services research, the philosophy of patient-centered care, and service characteristics that are specific to traditional Chinese medicine, such as herbal decoction services and the evaluation of TCM clinical practice.

The technical rigor of the scale’s validation is a central feature of the study. The six-domain CMSQ demonstrated high internal consistency, with a total Cronbach’s alpha of 0.945 and domain-level alphas ranging from 0.784 to 0.896, values that indicate the items within each domain reliably measure a coherent underlying construct. Confirmatory factor analysis supported the proposed six-factor structure, with a comparative fit index of 0.946, a Tucker-Lewis index of 0.938, a root mean square error of approximation of 0.056, and a standardized root mean square residual of 0.053, all of which fall within conventional thresholds for acceptable model fit. Importantly, the authors also tested measurement invariance and found it supported across hospital levels and hospital types, meaning the instrument measures the same constructs in tertiary referral centers and smaller community institutions alike, a prerequisite for fair comparisons between different tiers of the Chinese health system.

When the scores themselves were examined, a clear pattern emerged. Physicians rated pre-visit responsiveness most favorably, with a domain mean of 4.31 on the scale, followed closely by appointment service accessibility at 4.30. These findings suggest that the front end of the TCM care pathway, the scheduling systems and the way institutions respond to patient inquiries before an appointment, has improved considerably and is now seen by providers as a relative strength. At the other end of the ranking, medication supply services received the lowest domain rating at 3.96, and within that domain, the waiting time for herbal decoctions stood out as the single lowest-rated item in the entire survey, with a mean of 3.61 and a standard deviation of 1.22. For a system in which individually prepared herbal formulas are a cornerstone of treatment, a bottleneck at the decoction stage represents a tangible friction point that patients experience directly.

The subgroup analyses added a geographic and institutional dimension to the picture. Among the physician and institutional characteristics examined, city tier showed the most consistent differences in service-quality ratings, indicating that the level of urban development of a physician’s location is more strongly associated with perceived service quality than factors such as hospital level or hospital type. This pattern echoes well-known disparities in Chinese healthcare more broadly, where megacities concentrate resources, specialist expertise, and modern infrastructure, while smaller cities often struggle to match the same operational standards. The fact that such disparities appear even in physicians’ assessments of their own institutions underscores how deeply structural these differences are.

Perhaps the most consequential analysis concerned the link between service quality and physicians’ willingness to recommend their institutions, a proxy for institutional loyalty and confidence that has parallels in patient recommendation metrics used worldwide. Using ordinal logistic regression with adjustment for covariates, the researchers found that higher recommendation intention was associated with three domains in particular: pre-visit responsiveness, with an adjusted odds ratio of 1.278 and a 95 percent confidence interval of 1.112 to 1.469 and a p value below 0.001; medication supply services, with an adjusted odds ratio of 1.132 and a confidence interval of 1.036 to 1.237 and a p value of 0.006; and TCM practice evaluation, with an adjusted odds ratio of 1.144 and a confidence interval of 1.019 to 1.284 and a p value of 0.022. In plain terms, physicians who felt their institutions were responsive before visits, reliable in supplying medications, and supportive of quality TCM clinical practice were significantly more likely to speak well of those institutions.

To capture the physicians’ own priorities in their own words, the team also collected open-ended suggestions and analyzed 283 substantive responses using latent Dirichlet allocation, a topic-modeling technique that identifies recurring themes in large text corpora without imposing predefined categories. The modeling surfaced three broad clusters of priorities. The first concerned institutional capacity and clinical standardization, reflecting a desire for stronger organizational foundations and more consistent clinical protocols. The second centered on clinical quality, affordability, and the care experience, linking the technical excellence of TCM practice to the financial accessibility of services and the overall patient journey. The third cluster addressed operational management, workforce development, and service accessibility, pointing to the everyday machinery of scheduling, staffing, training, and logistics that determines whether a well-designed service model actually functions in practice.

Taken together, the results sketch a system in which the visible, patient-facing elements of TCM care have advanced faster than the back-office operations that support them. Physicians clearly appreciate improvements in responsiveness and appointment access, but the weak ratings for medication supply and decoction waiting times suggest that the supply chain for herbal medicines, from procurement through preparation to dispensing, has become the limiting factor in perceived service quality. The regression findings reinforce this interpretation, because medication supply services emerged as one of only three domains independently associated with recommendation intention. An institution that cannot reliably deliver the medicines its physicians prescribe undermines both clinical trust and staff morale, regardless of how skilled its practitioners may be.

The study also carries methodological significance for the broader field of complementary and integrative medicine research. Service-quality assessment in TCM has long been hampered by the absence of validated, provider-centered instruments that respect the modality’s distinctive features, from individualized herbal formulations to the integration of traditional diagnostic methods with modern clinical workflows. By demonstrating strong reliability, acceptable confirmatory factor fit, and measurement invariance across institutional strata, the CMSQ offers researchers and administrators a reusable framework that can be deployed in future surveys, quality-improvement programs, and policy evaluations. The authors position it as a preliminary but psychometrically supported, physician-centered instrument, and its open-access publication means that other teams can scrutinize, replicate, and extend the validation work.

The authors, whose work was supported by the Strategic Research and Consulting Project of the Chinese Academy of Engineering and several provincial and national research programs, emphasize that strengthening operational reliability must go hand in hand with enhancing TCM-specific clinical quality and organizational support. The study was approved by the Institutional Review Board of Dongzhimen Hospital and conducted in accordance with the Declaration of Helsinki. As traditional Chinese medicine continues to expand within China’s integrated health system and attracts growing international interest, this survey provides a rare quantitative baseline from the people best placed to judge where the system works and where it strains: the physicians on the front line. Their message is consistent and actionable, celebrating genuine gains in accessibility and responsiveness while demanding focused investment in the medication supply chain, workforce development, and the standardization of clinical practice that will determine whether the next generation of TCM services can match the expectations of both providers and patients.

Subject of Research: Physician-assessed service quality of traditional Chinese medicine healthcare in China

Article Title: Assessing traditional Chinese medicine service quality from physicians’ perspectives: a nationwide survey in China

Article References: Assessing traditional Chinese medicine service quality from physicians’ perspectives: a nationwide survey in China. (n.d.). https://doi.org/10.1186/s12906-026-05549-2

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05549-2

Keywords: traditional Chinese medicine, service quality, physician survey, health services research, CMSQ scale, psychometric validation, medication supply, herbal decoction, patient-centered care, China, ordinal logistic regression, topic modeling