Don't shut out bright young medics

PUBLISHED : Thursday, 04 May, 1995, 12:00am
UPDATED : Thursday, 04 May, 1995, 12:00am

I REFER to the letter from Dr David Fang, Honorary Secretary, of the Hong Kong Academy of Medicine (South China Morning Post, April 24).

Dr Fang said the academy's admission requirements were 'reasonable' and had been decided after 'extensive consultation'.

I am very doubtful that there was adequate consultation.

How thorough was the consultation? Almost all American specialist qualifications demand only four to five years' training. But their standards are so high, that their level of competence is recognised throughout North America.

It is therefore absurd to deny North American specialist qualification holders the right to become fellow members of the Hong Kong academy, because they fall short of the 'time rule' requirements, that is, have not had a total of six years' training.

Let me give some concrete facts and some examples.

The American Board of Certified Surgeons requires five years of training.

The American Board of Internal Medicine requires three years' training and a further two years of sub-specialty training (in, for example, nephrology, endocrinology, rheumatology, haemotology), making a total of five years' intensive and comprehensive training.

The American Board of Obstetrics and Gynaecology requires four years' intensive training only.

The Canadian College of Surgeons requires five years' training in general surgery.

To put the whole thing in perspective, a good example to use, would be general surgery.

The training process in Hong Kong even in the busiest hospital, affords surgeons the opportunity to perform less than 800 operations over a six-year training period, including pre and post-qualification residency.

In the US, I know of no newly-qualified, board-certified surgeons who have performed less than 1,200 operations during a five-year residency period. Take the case of kidney transplants in the US.

In Pittsburgh University Hospital alone, no less than 200 transplants are performed annually and yet their nephrology surgeons are trained for two years after the three years required to qualify for membership of the board of certified internal medicine. This makes a total of five years.

They are then recognised as specialists and do not need to do any further training.

The Hong Kong Academy of Medicine should evaluate overseas specialist qualifications with care.

Such qualifications should be the subject of objective and thorough investigation. Only after such an investigation should an overseas qualification be accepted or refused.

If the time period to be used as a yardstick is not to be revised, then only a few lucky ones will get into the academy. This means that many young, but bright doctors, will find themselves left out in the cold.

It seems to me that the present sets of rules for academy admission requirements, are structured along the lines of the systems in some European countries, where it is obvious that there are not many cases to be handled during the training period.

In order to compensate for this shortfall in the handling of clinical cases, training periods take longer.

There is nothing wrong with countries structuring their training in this way, but we should also look at other countries and their training periods.

I look forward to a reply from the academy and from the College of Surgeons and the College of Physicians, to hear what they think.

It is important that we look at this issue objectively.

W. M. CHOW Central