Physician Extenders

The term physician extenders refers to individuals (such as nurse practi- tioners and physician assistants in the United States) who can substitute for doctors in certain circumstances. China’s unique use of physician extenders began in 1965 with the development of barefoot doctors (now known as village doctors). These workers came from rural backgrounds and received around three months of training supplemented by continuing education. After their training, they alternated between working in health care and in agriculture. The government supported this development as a way to improve health in rural areas and reduce the power of the doctors from the pre-Communist elite. Assistant doctors (who receive three years of postsecondary training) were later added to the mix to provide minor surgery as well as primary care. Similarly, in urban areas, street doctors were trained to perform a similar role, offering both primary care and basic emergency care, as well as health education, immunization, and assistance with birth control. Street doctors have little formal training and work in outpatient clinics under doctors’ supervision.