Understaffing has plagued Hong Kong’s public health system for decades, and the repercussions of new legislation intending to countervail this have yet to unfold.
Photo: Dssoobgh Rremyoo on Wikimedia Commons
The chronic and persistent shortage of manpower has lasted for decades. More recently, between 2008 and 2017, Hong Kong’s per capita doctor ratio displayed an incremental increase from 1.8 to 1.9 physicians per 1,000 people. According to the World Bank, this falls behind other developed countries such as Singapore (2.3) and Australia (3.7).
LegCo statistics display that while the number of registered nurses increased by 45% in the same time frame, the percentage of those working for the Hospital Authority dropped by 4%, causing a shortage of about 400 nurses in 2017 and 2018. The ageing population exacerbates this acute deficit, as hospital admission rates remain high.
In January 2019’s particularly heavy flu season, public hospitals were well over capacity and medics’ frustration erupted in protests to address understaffing.
The South China Morning Post reports that 17 representatives from the Public Doctors’ Association and Frontline Doctors’ Union met with Chief Executive Carrie Lam to simplify the management system, as the sheer volume of paperwork required of medical staff motivates some to pursue administrative work rather than practicing medicine.
The Medical Registration Amendment Bill – approved by Chief Executive Carrie Lam and sent to the Legislative Council on 2 June – seeks to confront the existing shortage by allowing overseas-trained doctors to practice in Hong Kong.
However, local medics say this presents a superficial solution to a longstanding problem. Since the amendment would allow applicants to register without completing a decades-old licensing exam, some doctors challenge that it would not necessarily improve the quality of healthcare available.
Furthermore, Dr Arisina Ma Chung-yee, president of the Hong Kong Public Doctors’ Association, worries that even if an influx of overseas-trained staff would improve local medical standards, the government has “never considered whether there are enough wards, nurses, therapists and other services” to support the incoming doctors.
Nurses, for instance, are patients’ go-to sources for immediate and ongoing care. Nurses are already overworked and underpaid; yet, the bill does not delineate any plans to tackle Hong Kong’s nursing shortage.
A multifaceted struggle
Even considering the aforementioned attempts at reducing the administrative red tape, the foundations of this issue are manifold and doctors must also be incentivised to continue serving in public hospitals. Dr Gabriel Choi Kin (president of the Medical Association) notes that many shift to the private sector after meeting the requirements. Similarly, analysts believe the bill is more likely to draw overseas-trained doctors into private work.
Despite doctors’ feedback that the Amendment Bill is incomprehensive, it is expected to be passed before 2022.
Pro-establishment lawmaker Tommy Cheung was the bill’s original supporter before it was proposed in government.
This issue is often coupled with the concern that China is gradually replacing local elements with Mainland equivalents.
Chief Executive Carrie Lam denounced this criticism – as well as those related to the Sinovac vaccine and the government’s overall COVID-19 responses – as overly politicising government strategies.
The problem, medics contend, is not solely centered on the fact that overseas doctors may not qualify for the same standards; rather, that the bill is insufficient and fails to address shortages at their root causes. While it may inject a certain number of physicians into public hospitals, other medical students are still being discouraged from studying medicine.
Where are we now?
The political aspect of these tensions also span over the anti-government protests in 2019; many medical staffers supported pro-democracy demonstrators by aiding the injured and condemning officers’ use of tear gas to disperse crowds.
Since then, the government has delayed consulting medics for policymaking, depriving them of a voice in the decisions that would affect them most. The Hong Kong Medical Association and similar representative bodies were not informed of the Medical Registration Amendment Bill before it was announced to the public.
Progress cannot be achieved without the input of those who are directly impacted. The myriad of complications associated with this issue will not be simplified overnight, but whether Hong Kong can effectively commit to long-term solutions remains to be seen.