Policy makers clash with doctors on addressing doctor shortage

Following protests by Hospital Authority (HA) staff in January against excessive overtime and a lack of manpower, there have been calls by non-medical professionals to make it easier for foreign doctors to practice in Hong Kong and address a persistent shortage of medical human resources.

Political concerns have led to questions about the feasibility of shrinking out in this direction.

During the winter flu season in January, the bed occupancy rate in most public hospitals topped 100 percent, meaning extra beds are placed in the corridors and other open spaces. Doctors and nurses took to the streets to voice their frustration with the insufficient human resources.

By 2017, Hong Kong’s population of more than seven million people was served by 14,290 registered doctors, about 1.91 for every 1,000 people, an average much lower than other OECD countries such as South Korea (2.3), Canada (2.7) and France (3.4). One way to raise the ratio would be to allow more foreign doctors, but the Medical Registration Ordinance sets an unusually high bar for such imports.

Camel through the eye of a needle

There are currently two pathways for foreign doctors to practice in Hong Kong, but neither one has helped bring in new blood to a strained healthcare system.

The first pathway is to pass the three-part licensing examination administered by the Medical Council of Hong Kong (MCHK). Non-locally trained doctors must then complete a 12-month internship with the HA. The passing rate of the examination is meager. In 2016, the passing rate of the first part of the examination was only 11 percent and just 60 new doctors were registered this way.

“Even for experienced foreign doctors that have passed the exam, it is insulting to require them to be an intern,” said Mr Cheung Yu-yan, a lawmaker.

The second pathway for non-locally trained doctors to practice in Hong Kong is to get a job with the HA or the medical schools at Hong Kong University or Chinese University of Hong Kong, which allows them to skip the licensing examination and acquire a limited registration. As of 2016, only 134 doctors entered Hong Kong’s healthcare system this way, and only 24 worked for the HA.

What frontline health practitioners want is for regulators to do away with the licensing examination and make it easier to enlarge the medical workforce.

Drawing Commonwealth peers

Dr Alfred Wong Yam-hong, a member of local doctor group Médecins Inspirés, suggested using a reciprocal recognition programme for doctors from the Commonwealth countries that Hong Kong adopted before the 1997 handover.

“It is feasible and convenient. The reciprocal recognition programme can attract Hong Kong doctors who received their medical training in the UK, Canada, Australia and New Zealand to return to serve Hong Kongers,” he added.

After the programme was scrapped, the number of new doctors registered annually dropped from 523 from 1990 to 1996 to 316 between 2004 and 2010, according to pathologist Dr Feng Chi-shun.

But many argue that bringing back this programme could be difficult.

“First is political concerns, given that Hong Kong is part of China now. Second is that many doctors worry their mainland counterparts would demand the same treatment,” Prof Felice Lieh Mak, former chairwoman of the Medical Council Professor, told the media last Saturday.

The Singapore model

Some are now looking to Singapore, which allows foreign doctors to practice there without a licensing examination.

Singapore grants conditional registration to doctors with a degree from universities specified in the Medical Registration Act. It recognizes 158 qualifications from 28 jurisdictions, with two from Hong Kong and eight from China. After these doctors have gone through a specified period of clinical practice under supervision, they can be fully registered in Singapore.

“We can adopt this model and improve it,” said Mr Cheung. “Medical graduates from renowned institutions can be granted limited registration with the HA and the medical schools at HKU and CUHK. They then can be fully registered with MCHK after five years of practice.”

But medical sector lawmaker Dr Pierre Chan said Hong Kong is only a special administrative region and not a country like Singapore, which could create difficulties in formulating a national policy.

“If we were to follow suit, could we just recognize eight qualifications from China and ignore the rest of them?” Dr Chan asked.

He also noted it is difficult to assess the quality of the institutions (ignoring Singapore’s success) and the QS World University Rankings are not enough to serve as a benchmark. He insisted that a licensing examination for all is the fairest way.