Switching to Medicine Mid-Career and the Routes by Which Adults Can Take the National College Entrance Exam

I have wanted to write this article for a long time but never found the time. Today I settle down to organize the experience I have groped out over these years of practice, as a reference for friends who are thinking about this question.

I myself switched to medicine mid-career. In the 1998 gaokao, my first-choice preferences were all medical schools, but that year I underperformed, was not admitted to my first choice, and was reassigned to a decent engineering university. At that time my family's economic situation was very poor; in 1998 my hometown also flooded, my older brother was in his junior year, and my parents were heavily burdened. So I gave up repeating the exam, and later gave up the university and chose to drop out. After dropping out, I spent my time both teaching myself at the National Library and making a living.

I am quite capable of making a living; by age thirty I had gone from nothing to buying a home and settling down in Beijing through my own efforts. But unfortunately, around that time my mother successively suffered cerebral hemorrhage and gastric cancer. To help her recover, while taking her to seek medical treatment, I re-taught myself both Chinese and Western medicine.

I had worked in cross-border e-commerce for a long time with a high income, but after my mother died of illness in 2012, I suffered a blow like never before, and my life's ideal nearly collapsed. Before my mother died, I ran a small company on Zhongguancun South Street, with the office rented in the Jiulong Business Center directly opposite the National Library and more than a dozen employees. The staff were capable, so I could act like an absent-minded boss, handling the big and leaving the small, working few hours a day and spending most of my time reading in the library. After my mother died, I was in a state of mental collapse and had no heart to keep running the business, losing nearly a hundred thousand yuan a month. If I had not stopped the loss in time, I would have bankrupted the family.

Seeing me distracted, immersed all day in pain and medical books and unable to extricate myself, my wife suggested I retake the gaokao, get into a medical school, and revive my old dream. But at that time my child had just started primary school, and I knew I could not abandon my family. It was then that I learned there was still a legal route to switch to medicine mid-career: the traditional-apprenticeship (shicheng) pathway in Chinese medicine.

The only shortcoming of this path is that one can only learn TCM, not Western medicine. With a science and engineering background—I was a math-physics-chemistry Olympiad competitor in high school and won awards—under the influence of modern scientific thinking, deep down I might have preferred to study Western medicine. But fate is so coincidental that it arranged for me to choose a path I had not previously favored.

In the 1980s the Ministry of Health once issued a regulation stipulating that those without a medical degree who wished to study TCM could establish a traditional-medicine apprenticeship relationship; after following a master for three full years, they could take the apprenticeship-graduation exam. One year after passing that exam, they could take the assistant TCM physician qualification exam. After working as an assistant TCM physician in a medical institution for two years, they could take the TCM physician qualification exam.

To take this path, one must first find a TCM physician qualified to take on apprentices (preferably at the level of associate chief physician or above). Master and apprentice must sign a "Traditional Medicine Apprenticeship Relationship Contract," in triplicate, and have it sealed at the notary office of the Justice Bureau; the notary office keeps one copy, and the master and apprentice each keep one.

I established my traditional-medicine apprenticeship relationship in August 2012, about three months after my mother's death. Strictly following the health department's requirements, through the introduction of my high-school teacher and his wife, I apprenticed myself to the vice president of our local TCM hospital—my master was already an associate chief physician at the time. After performing the apprentice-bowing ceremony and signing and notarizing the apprenticeship contract, I formally began my TCM apprenticeship. My master was very good to me; he liked my intelligence and diligence, taught his medical skills without holding anything back, and very much hoped I would inherit his legacy. Even now he still hopes that when I have time, I will organize his family's ancestral clinical experience into a book for publication.

It should be noted that after the new TCMPharmacy Law was promulgated, the traditional apprenticeship model was adjusted somewhat. In the past an apprentice needed six years to sit the physician qualification exam; after 2023 this was changed to ten years. After an apprentice passes the assistant physician qualification, they must work clinically in a hospital for five years before applying for the TCM physician qualification. So if you take this path now, you must be mentally prepared that it takes ten years to obtain the TCM physician certificate.

Besides the traditional TCM apprenticeship model, non-specialist-background people who wish to study TCM have another route: signing up for the TCM "verified-specialty" (que you zhuanchang) assessment. The verified-specialty assessment and the traditional apprenticeship graduation exam are usually organized together, both by the provincial TCM administration. In the past, after passing the verified-specialty assessment, one could take the assistant physician qualification after one year, and the TCM physician certificate after two years working at a medical institution. Now, like the apprenticeship track, after passing the assistant physician qualification one must work in a hospital for five full years before taking the TCM physician certificate. The verified-specialty route has conditions: specifically, a recommendation from a physician of associate-chief rank or above is needed, as well as letters of recommendation from patients; details can be inquired at the TCM section of the local Health Commission, where you also register.

Here is a pitfall to avoid: some provinces never organize this exam. Our Hubei province is like this. Starting in 2015, I called the provincial TCM administration every year, even went to the bureau to ask the director in person, and always got the reply that for various reasons (the real reason being a lack of funding) the exam could not be organized that year. But some provinces organize it every year; Beijing, Shandong, and Shanxi, for example, hold such assessments at fixed times annually. The apprenticeship graduation exam and the verified-specialty exam follow the principle of territorial administration: wherever you registered the apprenticeship and signed up, you take the exam there; the examinee's household registration need not be in that locality.

However, TCM physicians produced through either route are extremely rare in every province. I have met friends who established apprenticeships in Beijing: one graduated from Peking University, another from Beijing University of Chemical Technology, and some even crossed disciplines to do a master's in TCM at Beijing University of Chinese Medicine, but none finished the path—they all stopped halfway.

The reason is simple: this is a long process requiring too much energy and time. For an adult, five or six years is an extravagance beyond extravagance. Now it takes ten years, so taking this path requires careful consideration. Ten years is too long and too variable; I feel this path now suits only high-school graduates.

In 2018 the state introduced a new policy: besides the old apprenticeship and verified-specialty routes, non-specialist-background TCM enthusiasts with a special skill can also take the TCM Specialty Physician Qualification Exam. This requires recommendation letters from two or more associate chief physicians and ten or more patients, plus complete medical cases of treated patients and various examination reports. With these materials and identification, you register at the TCM section of the local Health Commission; after review and approval, you may sit the TCM Specialty Physician Qualification Exam.

I was among the first cohort in Hubei province to take this exam. The pass rate is extremely low: the first cohort in Guangdong province had a pass rate of only about one in ten thousand or two. Pass rates in various provinces are now basically around 10-20%. Many training institutions promise guaranteed passes, but they are in fact deceiving candidates; they exaggerate and overstate the role of the TCM specialty physician certificate, and should not be believed.

The pass rates for TCM apprenticeship, verified-specialty, and the TCM specialty physician exam are all very low. The TCM specialty physician certificate has many restrictions: the scope of practice is confined to the very narrow disease category applied for, and, unlike the TCM physician certificate, it cannot be practiced freely nationwide. But after five years, a TCM specialty physician may apply for the TCM physician certificate; the first holders of this certificate to sit that exam will not appear until 2028, and no one knows what will happen by then.

By the way, the traditional apprenticeship model now includes both three-year and five-year apprenticeships. After completing five years, a five-year apprentice takes this TCM specialty physician qualification exam. The Beijing TCM Administration is very standardized in this regard: once the apprenticeship relationship is established, it must immediately be registered on the Beijing TCM Administration website. The apprentice must have annual electronic clock-in records at the teaching hospital, as well as study notes and medical cases.

No matter which route a non-specialist TCM practitioner takes, obtaining certificates is far harder than for specialists, and the certificates obtained are mostly "castrated" versions of physician licenses; most cannot work as general practitioners, are bound by many restrictions, and sit at the bottom of the medical system's pecking order. This is why, after taking this non-specialist path myself, I chose to retake the gaokao and take the specialist route.

But in fact, apprenticeship education is far more practical than school education. I have met many TCM practitioners who graduated from TCM universities and hold TCM physician certificates, yet they have almost no clinical experience. The reason is none other than this: under the apprenticeship model, the master soon requires the apprentice to do clinical work to lighten their own clinical load, whereas the academic type may reach a doctorate and still be unable to practice independently.

The most important thing in studying medicine is clinical practice. I have apprenticed under several masters, and they were all good; though some were strict and even beat my board when guiding my clinical work, they all took me by the hand in clinical practice and required me to practice, which greatly helped my clinical level. Nowadays TCM physicians who graduated from university are also looking for masters and follow a master clinically for years before they can practice independently. So everyone's learning cycle is actually about the same length.

But it is much more convenient for specialist-background Chinese-Western practitioners to take physician qualification exams. Holders of a medical associate degree may take the assistant physician exam one year after graduation; two years after obtaining assistant physician qualification, they may take the physician qualification exam. A TCM assistant physician who has studied Western medicine for two years may take the integrated Chinese-Western physician exam; a Western-medicine assistant physician who has studied TCM for two years may also take the integrated Chinese-Western physician exam. Holders of a medical bachelor's degree may take the physician qualification exam directly one year after graduation. Specialist-background practitioners, whether in TCM, Western medicine, or integrated Chinese-Western medicine, hold physician certificates that can be practiced nationwide with no restriction on scope.

Except for a few medical schools that recruit "4+4" medical doctor students to train clinicians directly across disciplines, the overwhelming majority of medical schools do not yet have such qualification to train physicians. Therefore, graduates of other majors who cross over to a medical master's program are not eligible to sit the licensed physician qualification exam. The licensed physician exam also does not recognize self-study-exam or adult-gaokao degrees; the only recognized medical degree is one obtained through the national unified gaokao.

So, if we switch to medicine mid-career and want to become unrestricted general practitioners, there is really only one true shortcut: retake the national unified gaokao, get into a full-time medical junior college or undergraduate program, study full-time for a few years, and take the specialist route. All other routes may look like shortcuts but are actually just side paths that cannot fully realize one's medical dream.

So how does an adult take the national unified gaokao? First, we must have a high-school diploma or an equivalent-education credential; without such a credential one is not eligible. We take the high-school diploma and household register to the admissions office of the Education Bureau at the place of household registration to register for the gaokao as a social candidate. Registration is usually in November of the preceding year, and the national unified gaokao takes place the following June. Under Chinese law, any citizen of the People's Republic of China with a high-school education or equivalent has the right to register for the gaokao, no matter how many times they take it.

Most provinces implement the policy that the household registration at the time of registration review prevails. Once a candidate has successfully registered, migrating household registration to another province does not affect taking the gaokao at the place of registration the following year. But Beijing and Shanghai are exceptions: Beijing requires that household registration not be migrated until the gaokao and admission are complete.

The registration procedures for retaking the gaokao are not complicated; after signing up, the admissions office will notify candidates step by step to have photos taken, undergo physical examination, and collect the admission ticket—all procedural work. When I took the gaokao twice in 2024 and 2025, the Education Bureau notified me of the next steps whenever the time came, and nothing went wrong.

But preparing for the gaokao as an adult is extremely hard. Less than half a month after I registered in November 2023, I was in a car accident and suffered a brain injury, which directly undermined my preparation that year. In 2024 I basically took the exam cold; when I sat in the exam room, I not only forgot many formulas but no longer recognized even logarithm and trigonometry symbols.

Yet even taking the 2024 exam cold I scored 350—not too low, since over a hundred thousand candidates in our province scored lower than me, and I could still get into a junior college. Only, at admission my major was reassigned to nursing; switching to TCM would have cost 80,000 yuan. For one thing I hated to spend that money, and for another I felt it was irregular and worried about problems, so I decided to take it again in 2025.

In 2025 I worked, fought the traffic-accident lawsuit, prepared for the exam, cared for my family, and updated my official account every day—the process was grueling. My body really could not bear it; I spent too long at the desk and often had dizziness and lower-back pain. My work pressure was not small either, though this year I tried tactfully to decline new patients—here I owe an apology to many friends: this year I may indeed have put the gaokao first and blocked out some friends who liked to disturb me. But I have hundreds of patients who have followed me for over five years, and some for over ten; I know their conditions best, their lives depend on me, and I cannot completely cut myself off from the world, nor can I ignore my family.

So for an adult taking the gaokao, setting too high a goal is unrealistic. I prepared for a year and scored only 50 more points this year than last. Of course, this year's gaokao was harder; the undergraduate cutoff lines across provinces for the new Gaokao Paper I were mostly falling, and ours dropped 11 points year-on-year. Among Hubei's 340,000 physics-track candidates, I ranked between 166,000 and 7,000 (improving my percentile). Last year I was only three to five points short of being admitted to TCM; this score should be smooth admission, so this year's hard work was not in vain.

But I should explain: my foundation is very good. Twenty-eight years ago in high school I ranked first in the whole school; on my best exam, the second-place student trailed me by over a hundred points in total. In my first year, in the county-wide general-high-school unified exam, I placed first among all county general high schools; that same year my older brother took the gaokao and became our local top scorer, and the two of us caused a sensation across the county. In my second year, in the provincial general-high-school joint exam, I ranked in the top ten-plus province-wide. I also won awards in Olympiads in high school.

Back in high school, my teachers cultivated me as a Tsinghua-Peking-Oxford-Caliber prospect. So even after so many years, retaking the gaokao, I still had some foundation to draw on. Yet even someone with my solid foundation, taking the gaokao at 46, still could not score well, which shows how hard the gaokao is now. So those whose high-school foundation was weak in the past should be cautious about choosing the retake route.

By my plan, finishing this route of mine requires at least seven more years. Adding the thirteen years of apprenticeship I have already walked, my entire journey of studying medicine will have taken exactly twenty years. I do not think many people have the perseverance to finish this winding mid-career path. I myself am extremely resolute, can endure hardship, never take shortcuts, and have always pursued steady, solid progress. I also hold myself to high standards; although many publishers have long had their eyes on me, wanting me to publish with them, and many readers have for years hoped I would publish a monograph they would buy, I have always felt my level has not yet reached a state that satisfies me, so I keep sharpening myself. I am a rare kind of person who can persist in a long-term goal; I started writing my blog in 2015 and have kept it up to today, ten years, and I will probably never stop in this life.

On this path I have met too many people with the same idea, but to date, apart from myself, not a single one has persisted to the end; the others basically all had only three-minute enthusiasm. At the end of this article, I want to urge readers with the same intention to act according to their ability.

Walking such a path requires coordinating family relations, balancing study, life, and work, and having a certain intellectual and economic foundation, as well as the character to endure hardship and persevere. One must be mentally prepared that even after finishing the path, one may still not find a medical job matching one's training. If all this is not enough to stop you from going forward, then you truly love medicine and are suited to take it as a lifelong career. To such a person, no difficulty is to be feared. I believe that where there's a will there's a way; you, who can endure such hardship, will surely persevere until the day you see the rainbow.