Long training, short planning key problems
A factor that makes manpower planning for doctors so difficult is the long time it takes to train a doctor, seven years, which means there is often a big gap between a current shortage and a possible future surplus.
It takes six years for a medical student to finish university. Graduates then need to complete a one-year internship before they can register as a medical practitioner.
Another problem is the lack of a long-term funding arrangement between the government and the Hospital Authority - the government approves its funding on an annual basis. This means planning of staffing levels is only done in the short term.
Medical legislator Dr Leung Ka-lau said that because the authority could not guarantee what its funding would be for five to 10 years, it could not decide on the number of doctors it could employ beyond the year for which it had a definite funding figure.
'As a result, the number of public doctors hired each year is decided by the finances of the Hospital Authority rather than the real need of society,' Leung said. 'In the several years after 1997, the authority had trouble hiring all the medical graduates because of financial difficulties, and now we have a shortage.'
The authority loses 5 per cent of its doctors per year, while individual departments such as internal medicine and obstetrics and gynaecology have turnovers of more than 11 per cent.
The authority is keen to hire part-time doctors from the private sector and is introducing measures to stop the brain drain from the public sector, such as creating more senior posts and providing more clerical support for doctors.
The situation was very different seven years ago, when the cash-strapped authority encouraged doctors to consider voluntary departure in late 2002 and early 2003.
That exercise saw 78 doctors with more than 10 years' experience leave, something the authority would not have allowed to happen if the present shortage could have been predicted.
In May last year, an internal authority paper highlighted a doctor shortage in the next decade. It projected that the number of public doctors needed to increase from more than 5,000 to 6,749 in 2026, representing average annual growth of 1.6 per cent, compared with 0.8 per cent growth in the population. The average annual shortfall of doctors will be 33, with a cumulative total shortfall of 229 doctors by 2016.
The cumulative shortfall would amount to 371 by 2016 if the expected addition of 2,880 beds in private hospitals is also taken into account.