Public hospitals have come up with an innovative remedy for the shortage of doctors: bringing in overseas doctors without asking them to sit for a Hong Kong licensing exam. But some doctor groups oppose the plan, cautioning that the quality of medical care may suffer.
But is their opposition merely driven by self-interest?
The plan has divided the medical community, as the Hospital Authority moves to hire about 20 overseas doctors - Cantonese-speaking Hongkongers who received their medical training overseas.
'The authority should not go around the examination system; it is the gatekeeper of doctors' standards,' says Dr Samuel Kwok Po-yin, who convened a group of private specialists called The Concern Group on the Medical Service Standards.
But Tim Pang Hung-cheong, spokesman for the Patients' Rights Association, says doctors are putting their interests before the public's.
'Private doctors may worry that overseas doctors may eventually enter the private market and take away their business. They do not think much about the needs of the public,' Pang says. 'If the public does not bring in overseas doctors now, their waiting time will continue to be very long and doctors cannot have their work hours cut.'
No one doubts that Hong Kong is short of doctors in the public sector, as many are shifting to more lucrative private practice. In the past year, 262 public doctors quit, equal to 22 each month. The Hospital Authority needs to hire more than 500 doctors this financial year to cover the loss of staff and develop new services. But because of insufficient supply, it is able to hire only 330. The city's medical schools, meanwhile, are turning out only 260 doctors each year. The schools intend to boost that to 320 graduates a year - but not until 2015.
The shortage has plunged public health care into a crisis. Doctors who stay are burdened with heavy workloads. Waiting times for patients are long. The exodus of obstetricians to the private sector has undermined public services so seriously that the government had to recently cap the number of deliveries by mainland mothers who choose to give birth in the city.
The authority views hiring overseas doctors as a quick way of beefing up the thinning ranks. They would be hired through 'limited registrations', meaning they would not have to take the Hong Kong Medical Council's licensing examination and would be exempted from the usual one-year internship. Their practice would be limited to public hospitals and clinics. The applicants would need at least three years of work experience and to pass an intermediate specialist examination recognised by the Hong Kong Medical Council.
The Concern Group on the Medical Service Standards, formed by a group of private specialists, said the authority can not guarantee the standard of the overseas doctors without better assessment.
'If the authority does not want to ask the doctors to sit for the medical council licensing examination because of the timing issue, it should consider asking the council to provide a special session of examination for these doctors,' said Kwok, the convener.
The concern group fears a precedent may be created: that people in power can bring in overseas doctors, creating a privileged group. Some frontline doctors also worry that the authority might someday use the overseas doctors to dilute their bargaining power. 'If frontline doctors threaten to take industrial actions for better work conditions, the authority can simply ignore their calls and turn to a supply of doctors from overseas,' one public doctor said.
Dr Choi Kin, president of the Hong Kong Medical Association, said it was wrong to accuse the medical profession of protective their interests. 'Hong Kong enjoys an extremely free market. Doctors from anywhere in the world can sit for the Hong Kong licensing examination, and they can practice here if they pass it. Some countries only allow people with residency rights to sit for the examination.'
But Pang, of the Patients' Rights Association, said the authority's assessment of the overseas candidates was good enough. 'First, the potential candidates have to pass the intermediate specialists examination - this is a safeguard of standards. Second, they must speak Cantonese so they won't have communication problems with patients,' Pang said.
The authority is set to face a political battle when it files applications for limited registration to the Medical Council. Fourteen out of the watchdog's 28 members have indicated that they will reject the applications - though chairwoman Professor Felice Lieh Mak has said the 'public interest' would be the top consideration for the council in making a decision.
Neither are public doctors united in their views on the plan. Practitioners in internal medicine generally welcome the extra manpower, but surgeons do not, because overseas doctors would eat into their training opportunities. Trainees need to perform at least 100 operations every six months in order to be qualified as a specialist. 'If we have more overseas doctors, they would share the cases and there will be fewer operations for each surgeon,' said Dr Kenneth Fu Kam-fung, president of the 300-strong Public Surgeons United. 'Our training is different from physicians as they do not have to achieve a quota of consultations in their training.'
Small surgical departments in highly specialised areas are the most concerned as they want to keep their small number of training posts for local doctors. 'We understand that patients have to wait for a long time for a consultation and operation,' Fu said. 'We have asked the authority to bring in some family doctors to help at outpatients clinics.'
The controversy has also alerted the government, as it is keen to boost manpower as it introduces its coming health care reform - a voluntary medical-insurance plan by 2015 in hopes more patients will use private medical services. The government will soon launch a review to look at local and overseas supply of doctors.
The number of doctors in the city, or 1 for every 645 people
- In 1995, the ratio was 1:782
- In 1988, the ratio was 1:1,000