Should doctors who provide the first level of medical care for patients be required to go back to school - or at least hospital - for retraining?
This is the debate now rumbling in the medical profession as the government prepares to publish Hong Kong's first directory of primary-care doctors.
The Food and Health Bureau will put the directory on the internet in early April, aiming to provide easy-to-read information about doctors' qualifications and experience so that patients can choose practitioners according to their needs.
Primary-care doctors are those who provide services to patients as the first point of contact, before specialist care or hospitals. They are mostly general practitioners but also include some paediatricians, family medicine specialists and those dealing with the elderly.
Unlike specialists, they are not required to have any continuing medical education after qualifying. But once the list is published they will have to do so if they want to stay on it.
The vice-president of the Hong Kong Academy of Medicine and a specialist in family medicine, Dr Donald Li Kwok-tung, believes that most of the 2,000-odd primary-care doctors in the city will want to be listed in the directory.
Li, also a member of a government-appointed task force designing the directory, said it should be made accessible to all doctors during the setting-up stage. 'But by evolution, the requirements for doctors to enter and stay on the list should be tightened. We should not make it too difficult in the initial stage because doctors in the past did not have much training opportunities, we should not punish them.'
But the Hong Kong College of Family Physicians, responsible for specialist training in family medicine, says it should be mandatory for all listed primary-care doctors to receive retraining at hospitals.
'It is, of course, better to have a directory than not having one ... but the current design is inadequate because the government does not require doctors to take any specific training,' college council member and immediate past president Dr Gene Tsoi Wai-wang said.
For example, doctors should take supervised training at accident and emergency departments to refresh first aid skills and cardio-pulmonary resuscitation.
'Education is different from training,' he said. 'Most continuous medical education involves attending seminars or talks, but this is not enough. Primary-care doctors should refresh their knowledge through more structured training.'
The new directory will be open first to all doctors and dentists before expanding to other professionals including nurses, Chinese medicine practitioners and allied health practitioners. They will have to take continuing education to stay on the list, and the entry requirements will be tightened in five to six years, with only doctors with postgraduate qualifications, such as specialists or diploma holders, being listed.
Currently, only specialists have to take continuing medical education, in which they are required to achieve 90 marks in three years to keep their specialist registration. The marks are awarded for hours of training, self-study or attendance at a seminar.
Tsoi said some countries regularly tested their primary-care doctors in cardio-pulmonary resuscitation, but there was no such requirement in Hong Kong.
President of the Hong Kong Medical Association Dr Choi Kin said there was no need to make first aid training mandatory for primary-care doctors. 'Let's be practical, one should really know what a primary-care doctor needs to know. It is very rare for a doctor to come across a patient collapsing at the clinic. It is of course good to keep learning, but I don't think it is necessary to make such training mandatory,' he said.