Government must break Hong Kong doctors' protectionist barrier

C.K. Yeung says foreign-trained medics are a clear solution to staff shortages at public hospitals

PUBLISHED : Monday, 16 December, 2013, 3:45am
UPDATED : Monday, 16 December, 2013, 3:45am

How would you rate a public health system that asks its elderly citizens to wait up to three years for cataract treatment or two years for surgery on an enlarged prostate?

Judging by treatment quality, Hong Kong's health care system is world-class. Judging by the accessibility of services at our public hospitals, Hong Kong is almost third-world. Why this discrepancy? Blame it on the all-powerful medical lobby that keeps foreign-trained doctors from coming to Hong Kong to serve our patients.

Hong Kong has only 1.7 doctors per 1,000 people, against an average of three per 1,000 in developed countries. The government pours enormous resources into health care, but its hands are tied by the Medical Council and local doctors' union that resolutely keep out much-needed doctors from abroad. Our public hospitals are chronically short-staffed, severely affecting the quality of patient care. But the problem isn't a budgetary shortfall; it is allowing the medical profession to dictate things on its own terms.

Medical doctors are expensive to train. Its costs our taxpayers about HK$3.5 million to train a physician with basic qualifications at our two university medical schools. Limited teaching resources keep the total intake of medical students at around 250 to 320 a year, although plans are afoot to increase it to 400 over the next few years.

But the acute shortage can be corrected with a simple solution: importing qualified doctors. Some countries are doing it with great success.

Take Singapore. Like Hong Kong, Singapore is short of doctors. But, unlike Hong Kong, Singapore's Medical Council, which decides who can and cannot practise medicine, does not require foreign medical graduates to pass any licensing exams to work in a hospital. Instead, it allows international medical graduates to practise in its approved health care institutions, provided they come from a list of recognised medical schools.

Currently, this list contains 158 medical schools across the world, including eight from mainland China. The careful screening of the world's top medical schools ensures the standard of medical practice. Under this system, Singapore now attracts more than 400 international medical graduates a year, with most of them serving in public hospitals.

By contrast, Hong Kong imposes a mandatory licensing exam on all non-local medical graduates who want to practise here. An average of just 11 international medical graduates got through this way each year between 2007 and 2011 - a laughable figure when we consider that our population is bigger than Singapore's by two million.

There is something else Singapore is doing that is worth copying: in 2010, Singapore introduced a cash subsidy for its citizens studying medicine abroad to offset the cost of their final two years of study in order to lure them back to the Lion City.

Here in Hong Kong, we keep out our talented young who have gone abroad for their medical degree, preventing their return to practise medicine, and permanently separating them from their Hong Kong families unless they give up their overseas practice. This is a waste of local talent and does an utter disservice to the city.

Britain has a two-part licensing exam for foreign medical graduates. But pass rates over the past 12 years, up to last year, have averaged 51 per cent and 75 per cent respectively, attracting an average of 4,400 overseas medical graduates per year.

This is no longer just an internal matter of a professional body regulating itself. It is a social and population policy matter that goes to the heart of our quality of life and the duty of providing proper health care for our people.

Our patients are powerless to protest. The government can no longer stand idly by and let the medical profession's protectionist interests override that of the public.

How can we explain the behaviour of local doctors who proudly display their Royal College of Physicians certificates and other foreign credentials in their clinic's waiting room, and yet fight tooth and nail to keep out foreign doctors trained by these same medical establishments?

Individually, doctors take the Hippocratic oath. The medical profession, collectively, should also take the social Hippocratic oath to cater to the public health interests of the community.

The public is fed up with property hegemony. Now the medical profession stands accused of practising medical hegemony.

Our life expectancy is among the world's highest. But with the shortage of doctors and the long waiting list at public hospitals, our senior citizens' sunset years are likely to be miserable rather than glorious.

The government is talking up health care reform through a medical insurance scheme. But if we remain undersupplied with doctors, medical insurance will only boost doctors' earnings, not patients' well-being.

C.K. Yeung teaches in the School of Journalism and Communication at the Chinese University of Hong Kong