I REFER to the controversies surrounding the rules and regulations for admission to the fellowship of the Hong Kong Academy of Medicine (HKAM). One of the rules demands three years of post qualification experience before admission is allowed to the academy. This rule is grossly unfair and there is no justification for it. To impose a time condition on applicants after they have achieved a higher qualification is nothing but a recognition of the age of the applicants; it does not relate to their actual competence. Take, for example, surgery. In the US or Canada, those who hold qualifications such as Fellow of the Royal College of Surgeons (Canada) or American Board Certified Surgery from the US must have performed over 1,300 operations in their five-year period of residency training before any higher qualification is granted. In Hong Kong it would take eight to 10 years after having achieved a higher qualification, to have completed the same number of operations. We should follow the example of the US and Canada and specify the number of operations that must be performed before an applicant is eligible to qualify for the academy. In the case of internal medicine, the same principle should apply. For instance, in the US or Canada, some specialties require less than three years of post qualification experience. But their two years of highly structured post-qualification training in the most reputable hospitals would equip them with such a vast scope of experience, that it would probably require those who are trained in Hong Kong not three but many more years of experience to obtain the same level of competence. It would be unfair to demand rigidly three years of post qualification experience without having regard to the depth of experience, for example, the number of cases handled prior to their application for admission to the academy. I would therefore recommend that the admission requirements for the HKAM be based upon some quantifiable factors and quantitative elements rather than purely on the number of years of experience. The academy must accept that competence is more a more important factor than age. If the academy's rule is not changed, it would lead to the situation whereby the older but less competent would get in, while the young but bright and competent would not. It would be wrong to ask those who have, say, the FRCS from Canada, or who are members of the Board of Certified American Surgeons, or who hold an Internal Medicine Diploma from the US, to do another three years before they are entitled to become members of the Hong Kong academy. W.M. CHOW Central