A dying profession
Young doctors are increasingly turning away from the more important fields of medical science to embrace the easier and more lucrative areas of plastic surgery and anaesthesiology.
Their senior colleagues find the trend disturbing.
Ten years ago, general surgery and internal medicine (the prevention, diagnosis and treatment of diseases) were among the most popular fields but for some doctors-to-be, the attraction of these life-saving disciplines has faded.
'These are now being seen as hard work, low pay,' said a specialist in internal medicine, who works in a public hospital.
The Hospital Authority says it has vacancies for medical staff in all fields of specialisation, but that shortages are particularly serious for emergency medicine, internal medicine, family medicine, psychiatry and radiology.
According to the Medical Council's list of specialists, only one doctor registered as a specialist in internal medicine in the past two years.
General surgery is only slightly better, with six doctors registering as specialists in the past two years, increasing the number by 1.5 per cent. By contrast, 20 doctors have chosen to specialise in anaesthesiology, adding 6 per cent to the number of these specialists in just two years. Although the list may not offer comprehensive data for the entire sector, it can still offer a picture on the trend which is now acknowledged by both old and young generations.
A 25-year-old medical student said younger doctors were determined to choose a lighter burden when making career choices.
'Take anaesthesiology as an example. It is comparatively less stressful compared with other fields such as surgery,' he said. 'A surgeon can claim a human life if he makes a wrong cut in an operation. That means he is constantly working under a lot of pressure.
'Sometimes he may face complaints from the patient or relatives, and then the hospital will also be after you. And then there's the media, always suspicious of a medical blunder even if the doctor has made no mistake.
'Being a doctor in Hong Kong is already a crazy life. Who would want a career like that?'
In comparison, anaesthesiology, the field he has now decided upon, offers relatively stable work and a reasonable income.
The market value for an anaesthesiologist was also good, he said, meaning that both public and private hospitals were constantly complaining of a shortage of specialists in this field.
The older generation of doctors sees the trend as well.
'During my years [as a medical student], we all wanted to specialise in fields such as internal medicine and surgery,' said Professor Joseph Sung Jao-yiu, vice chancellor of Chinese University, and a hero of the fight against the 2003 outbreak of severe acute respiratory syndrome (Sars).
'It is because these subjects are life-saving. A student chooses to study medicine with a vision to save lives. It can be very satisfying when a doctor sees patients recovering after illness or surgery', Sung said.
Being a professor of medicine himself, Sung said, he had noticed that 'the social values of young doctors have changed'. He appealed to them not to be afraid of hardship, long working hours and low income.
'Never forget your vision for being a doctor,' he said.
Sung acknowledged that the stressful working environment in public hospitals was a big factor behind the trend.
Both internal medicine and surgery are ranked among the five fields which saw the largest turnover rate in recent years, with obstetrics and gynaecology topping the list, followed by paediatrics and ophthalmology.
In order to become a specialist, doctors need several years' experience as a general practitioner, depending on which field they choose. Specialists with several years of experience may then be promoted as a consultant by a hospital, depending on their performance - but it may be up to 20 years, if the hospitals do not have any vacancies.
Dr Seamus Siu Yuk-leung, a specialist in internal medicine, said 'the workload in internal medicine is not in proportion with the pay in public hospitals'.
He said doctors were better paid in the private sector than in the public one, and that a surgeon could two or three times as much in a private hospital as in a public one.
He thinks a doctor is more likely to leave the public sector as a result of the pressure and hardship, and the fact that they usually work more than 70 hours a week in an understaffed environment. As a result, public hospitals were facing a loss of talent, said Siu, who is also chairman of the Frontline Doctors' Union.
Adding to concerns is the difficulty in finding experienced doctors - the result of a policy to reduce the number of medical graduates during the Sars outbreak. The situation only changed in 2007 when the number of medical students was increased by 20 per cent.
Each doctor needed at least seven years in the field to gain experience and now the medical sector was having to deal with the consequences of that short-sighted policy, said Dr Ho Pak-leung, former president of the Public Doctors' Association.
'When there are not enough experienced trainers for training new doctors, how can we feel confident about the quality of medical service?' Ho said.
'The understaffing problem is making conditions even more difficult, which encourages even more people to leave. Even if they are enthusiastic doctors, they become discouraged after a few years and their health and spirits deteriorate. It is a vicious cycle.'
Former senior Hospital Authority executive Dr Ko Wing-man, who resigned in the aftermath of the Sars outbreak, said a booming market for private medical care over the past decade had worsened the trend.
There are about 11,500 doctors in Hong Kong - 60 per cent of which are employed in the private sector, where they provide services that are used by only 10 per cent of all patients. Public hospitals employ 40 per cent of doctors, who care for up to 90 per cent of the city's patients.
Ko said he left the authority after 'feeling a little bit discouraged' by this fact.
A Hospital Authority spokesman said it would manage the manpower shortage by recruiting part-time doctors and non-local doctors under limited registration, as well as retaining existing staff through an improvement in working conditions. This would be achieved by strengthening clerical support for doctors and providing better training and promotion opportunities.
Regarding the allocation of new medical graduates, the authority would evaluate the relative need of individual specialties and allocate trainee places according to principles agreed among specialists.
Clinical departments would go through the selection process based on applicants' preferences and the availability of posts.
The Hospital Authority last year lost this number of doctors in general medicine. It also lost 23 surgeons