The government should take a serious look at developing the family doctor system
There is a need to address reform of health-care financing and delivery to match it with changing needs
The prospect of years of post-graduate training tends to focus attention on future earning potential. New doctors who have already completed six years as undergraduates are no exception. Specialisation in narrow areas of surgery usually appeals more than the role of family doctor. That is a pity, because the latter are increasingly important gatekeepers of medical care for an ageing population.
It does not help that the specialist training course for family doctors takes six years, the longest curriculum in the world according to Dr Donald Li Kwok-tung, president of the Academy of Medicine. As a result, the academy is considering shortening specialist training for family doctors to four years, in line with international trends. The US and Britain take three years to train family doctors and Canada only two in an effort to shift the medical burden of ageing populations from hospitals to the community by enhancing their role. Li said the government’s failure to strengthen the role of family medicine, leaving a stressed public hospital system to continue to meet the bulk of the city’s medical needs, showed a lack of vision. With 90 per cent of patients relying on public hospitals, he called for more support for preventive medicine and basic diagnosis over the need for specialist care. Hospitals where doctors had only a few minutes with a patient were not good training grounds and he suggested trainees should be allowed sessions in private clinics for experience while being paid a minimum wage.
Of the 13,000 doctors in Hong Kong, only about 450 are trained in family medicine. The government set up a register of primary care doctors five years ago, but not all those who joined it have the training. College of Family Physicians president Angus Chan Ming-wai has a point when he says it should be required for registration. Ultimately, we must address reform of health-care financing and delivery to match it with changing needs. Meanwhile, the government should consider the issues raised by Li and Chan.