The biggest group of specialists in Hong Kong's public hospitals are angry at their poor career prospects, with Hospital Authority figures showing the lowest-ranking doctors have to wait an average of 16 years for promotion. The doctors - specialists in internal medicine, also known as physicians or internists - say their morale is at an all-time low and complain that the authority has done nothing to retain talent in the public hospital system. A panel under the authority formed by top physicians has urged the government to act at once to restore confidence. Otherwise, they say, there could be 'a collapse in public services'. An authority committee overseeing the training of physicians - doctors who diagnose and treat illnesses in patients, as opposed to surgeons - recently completed an analysis of promotion prospects. It shows that some specialists take 16 years to rise to the rank of associate consultant. Doctors in other specialities, such as radiology and obstetrics, can become consultants within 10 to 15 years. The authority says doctors in the departments of medicine and clinical oncology wait the longest for promotion because of low staff turnover. The four specialities with the fastest promotion tracks are obstetrics and gynaecology, psychiatry, radiology and anaesthesia. Turnover among obstetricians was 9 per cent in the first 10 months of the financial year, to the end of January, but less than 5 per cent in departments of medicine. The poor prospects have not only affected the morale of physicians at public hospitals but may mean fewer medical students choose this speciality. That could have long-term ramifications for hospital services. Professor Daniel Chan Tak-mao, chief of the department of medicine for hospitals in the western half of Hong Kong Island and a member of the training committee, said internal medicine used to be one of the top choices for new doctors but had lost popularity in recent years because of the slow career advancement. Chan said one in 10 of the 70 trainee posts in medicine offered last year at public hospitals went unfilled. 'It is difficult for us to retain talent and attract new blood because the doctors cannot see a future. The trend is certainly worrying,' Chan said. 'Physicians play a very important role in public health care. They take care of most of the chronic illnesses, [something] which will become even more commonplace in an ageing population.' The authority's central co-ordinating committee for internal medicine, comprising its top experts in the field, is seeking meetings with management on the issue. Committee chairman Dr Patrick Li Chung-ki said: 'We are losing some middle-level doctors - some have switched to other specialities. The authority should do something about it before the services collapse.' The Hospital Authority predicts that the turnover of doctors will rise from 4.4 per cent in the last financial year to 6.8 per cent this financial year, a five-year high. The starting rank for public doctors is medical officer. Next in the hierarchy is senior medical officer or associate consultant. The highest rank is consultant. In the early 1990s it took about six years for most medical officers to get promoted to senior medical officer and 10 years to go from medical officer to consultant. The president of the Public Doctors' Association, Dr Loletta So Kit-ying, said many physicians were 'very angry' that their demand for more senior posts had fallen on deaf ears and morale was at an all-time low. So, a senior medical officer in the department of medicine at Pamela Youde Nethersole Eastern Hospital in Chai Wan, said at least four medical officer posts in her department were vacant and at least six doctors would leave before the summer. Dr Ching Wai-kuen, the Hospital Authority's chief manager for doctor grades, said the authority would create more senior posts for physicians in the coming financial year. 'We have 14 specialities and it is difficult to make sure doctors have the same promotion path in each of them. We cannot fulfil the expectations of every doctor,' Ching said. Dr Paul Shea Tat-ming, a former physician at Queen Elizabeth Hospital in Yau Ma Tei who is in private practice, said the lack of promotion for physicians had created a 'shoe-shining' culture within departments. 'The chief of services has the absolute power in deciding on promotions, so many staff have to flatter them. The authority should break this culture by rotating the chief of services among different hospitals.' Distant goal A medical officer is paid, in HK dollars, between $49,359 and $102,959. A senior officer earns $108,227 to: +$124,684