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Hong Kong needs to increase the number of specialists in family medicine by five times to strengthen primary care, a study has found.

The Academy of Medicine, the top training and accreditation body for specialists, recently launched a study to project the demand for doctors in the city.

The academy's 15 colleges will also assess needs in their own areas of specialisation to help the government to plan long-term health care policies and reforms.

The study was commissioned by the health minister, York Chow Yat-ngok, to ensure an adequate supply of doctors. Hong Kong has 10,000 doctors, half working in the private sector.

According to the College of Family Physicians, Hong Kong needs more than 1,000 specialists in family medicine to meet an 'optimum level of primary care'.

Many legislators have pointed to the need to improve primary health care to reduce reliance on expensive hospital treatment.

The president of the college, John Chung Tze-nang, said Hong Kong has about 200 specialists in family medicine and it would take 10 years to meet the manpower target recommended in the survey.

Every year the Hospital Authority provides 100 new training posts for specialists in family medicine.

'The projection is the best scenario. It is always difficult to determine how many doctors we need. It all depends on what standard of care people want,' Dr Chung said. 'For example, we have to take into account the length of consultation.

'We think a doctor should spend about 10 minutes on each patient to carefully listen to their problems and provide some health education. Now, not all doctors can provide such time to patients.'

Dr Chung said he was pleased that the government was promoting family medicine as part of its health-care reform.

'Family doctors are important health gatekeepers by providing appropriate care at the primary level. They can reduce the burden on hospitals and help promote preventive medicine.'

The dean of medicine at Chinese University, Fok Tai-fai, called on the government to increase the supply of doctors as soon as possible. In the past two years, the student intake at Hong Kong's two medical schools has been cut from 320 to 250 a year.

Professor Fok said he worried that Hong Kong would suffer the same problems as a number of other countries, such as Singapore, Australia and Britain, where a shortage of doctors has hampered the development of health services.

'In Hong Kong there is a trend to shorten doctors' working hours and it means a bigger demand on doctors in the future.'

He said training a doctor who could practice independently was a long process, involving five years in medical school followed by six years of specialist training. 'Some private doctors argue there is an oversupply of doctors in the private sector, which is not good for business, and that public hospitals cannot recruit all medical students. But these arguments are not sound. We are not talking about doctors' business here, but about how many doctors people need.'

Activity:

In groups of four or five, select one of the following questions and  come up with an answer.

1. 'Family doctors are important health gatekeepers by providing appropriate care at the primary level. They can reduce the burden on hospitals and help promote preventive medicine.' Discuss how this system can work efficiently and effectively.  (Hints: think about consultation fees, cost of prescriptions, consultation time, waiting time, facilities and location of clinics etc.)

2. Some people believe that the length of consultation is the only factor to be taken into account when we  assess the standard of family doctors. What other factors should we also consider?

3. Do you think that shortening doctors' working hours is fair to the public even when there is a shortage of doctors? Think of at least three reasons to support your point of view.



Five-fold increase in family doctors sought