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It all adds up for a top doctor

HIS field is far from glamorous. It involves studying and slicing up the large bowels of people who have been ill for some time, almost half of whom will die of their cancer.

But slightly more will live, and it is Chu Kin-wah's skill with a scalpel and decades of training which allows 60 per cent to check out of his wards and go home.

Above his desk hangs a picture of his sons, seven-year-old Samuel and five-year-old Lomond. The two boys smile proudly as they wear green promotional sashes and brandish small pink cards; the photo was taken at an organ donation drive last year.

Dr Chu is one of Hong Kong's top colorectal surgeons. He is not famous, except to his own family and those of his patients, and is paid on a par with a government architect and assistant government chemist, a package of about $150,000 a month.

He worked for the old Medical and Health Department through the 80s and was among thousands of staff who agreed to switch to a new salary package under the Hospital Authority, established in December 1991.

But as Queen Mary Hospital's chief of service of colorectal surgery, he and his fellow consultants find themselves at the heart of a row over their salaries.

Dr Chu is arguably one of the most deeply involved. His wife and former high school sweetheart, Chan Ka-foon, was promoted to consultant rank at Queen Elizabeth Hospital just this year. Now their family receives double benefits, a phrase which has incensed some politicians and government number-crunchers.

Legislators on the Public Accounts Committee are now deliberating whether to slash the housing benefits paid to senior doctors. Director of Audit Dominic Chan Yin-tat set the cat among the pigeons when he tabled his first review early this month.

Mr Chan has recommended that housing benefits be paid to doctors for a maximum of 10 years each, instead of for the duration of their employment, and that married couples who work for the Hospital Authority should be able to claim only one set of benefits - in this case cash allowances - between them.

The auditor also pronounced it unfair to peg doctors' cash allowances as a percentage of their basic salary, allowing the sum to creep up at the same rate as annual pay adjustments. 'The resultant excess housing benefits are enormous,' he said.

'I have estimated that over a 20-year period, the total housing benefits payable to them in excess of comparable benefits in the civil service would be about $6,700 million,' he reported.

But his calculations are hotly disputed and the row has become an emotive one, whipping up a storm over the normally calm pond of the Hospital Authority. A survey conducted by the Public Doctors Association, of which Dr Chu is a council member and immediate past president, found one-in-six were willing to quit their jobs rather than stomach an unkind cut.

The dispute is rooted in a deal struck four years ago.

When the Government's Hospital Services Department sank quietly into its grave in 1991, and the modern Hospital Authority arose in its place, administrators knew its success depended on whether doctors would make the swap.

Doctors in public hospitals and clinics had always been government civil servants, and took the long holidays, pensions, education allowances and expensive quarters which came with their status.

To woo them into switching from the Civil Service to the new government-funded body, a new remuneration package was offered. They would receive the same salary as before, but the value of their government benefits would be weighed up and handed over in the form of a monthly cash allowance.

In return, holidays were slashed back to a maximum 28 days a year, pensions were ditched in favour of the provident fund and medics moved their families out of large government quarters and scouted for their own homes.

'It was a bitter battle,' Dr Chu recalled. 'Staff were negotiating with the Government over the pay packages.

'Looking back, the public, the administrators, the doctors, nurses, paramedics; everybody was not satisfied with the Medical and Health Department. There was very great pressure from all walks of life to improve the service. The media and everybody said the Hospital Authority had to be established to bring about reform in the medical services.

'At that time, among staff there was resistance to Hospital Authority terms. We were very sceptical. Once you accepted Hospital Authority terms, there was a possibility that your package would be cut in the future.' Few doctors remain in government employment until retirement age, when they can collect their pensions. Most gain experience in public hospitals then resign and set up in private practice while they are still young.

'In the Medical and Health Department, very few doctors stayed more than 10 years. At that time it was a joke that doctors who remained in the government service were no good. All the bright young guys went into private practice, where they could earn more,' Dr Chu said.

Many government doctors decided they might as well opt for the new Hospital Authority package, attracted by the monthly cash allowance which compensated for the loss of pension and other benefits. They wanted to work in public hospitals, but not until retirement.

'The reason I changed was because it is more flexible; you don't have to wait until you retire to get your pension,' Dr Chu said.

'But look at the nurses and paramedics: very few of them swapped to the Hospital Authority terms because they planned to work for the government until they retired. For the new staff, they had no choice.' Dr Chu joined the Medical and Health Department immediately after graduating from the University of Hong Kong - where he now tutors young medical students - in 1980.

He trained in the specialties of neurosurgery and orthopaedics before going to London for training in his chosen field: colorectal surgery.

'In 1989 I got my promotion from medical officer to senior medical officer and in 1992 I was promoted to consultant. I've been in this position for three years, and I'm now 40 years old,' Dr Chu said.

'I'm a junior consultant, a D2 [directorate grade 2]. A consultant can be from D2 to D4. My basic salary is just less than $1.1 million a year. I get a 60 per cent cash allowance and 15 per cent in the provident fund each year.

'I also entered the HLISS [Housing Loan Interest Subsidy Scheme], which adds five per cent.' The authority's HLISS subsidises half of the interest payable if a senior employee wishes to take a mortgage and buy a home.

When Dr Chu agreed to move to the Hospital Authority in 1991, his holidays had been 41 days a year and his government benefits as a senior medical officer were considerable.

'I was entitled to departmental quarters. It was a lovely flat, more than 2,400 square feet, within the Queen Mary hospital complex. It was within walking distance,' he said.

'The balcony was 400 square feet - I'm not joking - then you had sitting room, living room, kitchen, a very big store room, utility area, a servant's room and three toilets.

'Now I live in Fu Lam Gardens, a mile from here. It's 1,750 square feet. Because I found our flat relatively early, I was lucky.

'At that time we were negotiating the pay package. We knew we would not be given quarters; we would have a cash allowance. So I thought it was a good time to buy.' He moved into his first departmental flat, in Tsuen Wan, as a second-year medical officer earning little more than $7,000 a month. Later he moved to quarters at Chai Wan and then Pokfulam. The smallest was 1,700 square feet.

He and his wife notch up 11-to-12-hour days from Monday to Friday, work Saturday mornings, every second Sunday morning and consider themselves 'on call' at all times.

'We were classmates at Tsuen Wan Government Secondary School and then at the University of Hong Kong. She underwent roughly the same training as myself, but mainly in the Queen Elizabeth and spent some time in Oxford,' Dr Chu said.

Last week Dr Chu was responsible for 40 patients in his Queen Mary Ward and another 20 to 30 in Kwong Wah; he has a team of seven doctors beneath him.

'I've been working in this hospital for 15 years. The changes I've seen in the last four, compared to the first 11, are dramatic,' he said.

'One of the most important things, to my mind, is the attitude of the staff. Most people, when they enter the profession, have the intention to care for their patients. But you need a boss to credit them, to say: 'You're going in the right direction'.

'I had a boss here, when I was junior. He was a very good boss, but sometimes he would grumble to us that any suggestions he made for improvements met with bureaucracy, were turned down by the administration and blocked.

'Now it's very much different. There are more senior people staying and the quality has improved.

'We work much harder than before . . . the philosophy of patient care has changed. You can't calculate that with money.'

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