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Fewer than 10 per cent of foreign doctors who sit the Hong Kong Medical Council examination go on to get a licence, raising concerns that the local medical profession is putting up barriers to fend off competition.
The concerns have prompted the head of the council's licentiate committee, Dr Cheung Hon-ming,  to call for a review of the test, which he says is 'too difficult'. 
But the city's medical association rejected claims the test was a barrier to foreign doctors, saying Hong Kong has a very free market.
Cheung said the pass rate for the exam dropped from an average 15 per cent between 1977 and 1996, to 8.9 per cent between 1996 and 2009. In 2008, only nine out of 138 people who sat the exam got licences. There were 12 out of 158 in 2009. 
'The very low pass rate shows that the standards for the examination could be too high,' he said.
'Some overseas doctors, including those with specialist qualifications, have failed. We need a review.'
Overseas and mainland doctors who want to practise in Hong Kong have to pass the exam to get a licence and qualify for an internship. 
But graduates from the city's two medical schools - at the University of Hong Kong  and Chinese University - do not have to sit the test. 
They can start a 12-month internship immediately after passing the schools' internal exams. 
The Medical Council says the standard of the universal examination is comparable to the local medical schools' internal tests.
Before the handover in 1997, doctors from commonwealth countries were exempted from the exam. But the exemption was lifted after the handover. 
Cheung said there should be one licensing examination for all, including local medical students.
He said that while the medical schools' examinations mostly covered the final year's curriculum, the council's examination covered almost all subjects in a five-year medical course.
Candidates can only sit the examination five times, a rule Cheung said should be lifted. 'Why don't we give more opportunities to people who want to keep trying?'
Cheung, who trained in Guangzhou, is also president of the Association of Licentiates of the Medical Council,  formed by about 500 doctors who passed the licensing exam to practise in Hong Kong. 
Hong Kong Medical Association president Dr Choi Kin agreed it would be better if all doctors, including local medical students, sat the same exam. 
'That can at least make the system look fairer to all and stop all the argument,' Choi said.
But Choi rejected claims that the council examination was a obstacle to foreign doctors. 
He said Hong Kong doctors from all over the world could sit the test and practise here if they passed. In contrast, some countries only allowed people with residency to sit licensing tests. 
The annual examination has three parts: written papers on professional knowledge, a test of proficiency in medical English and an assessment of clinical skills. 
The syllabus and the examination papers are prepared by the Medical Council's examination sub-committee, comprising academics from the two medical schools.
'To ensure that the level of the licensing examination is comparable to the examinations of the local medical schools, the examiners are requested and required to make reference to the questions used in the examinations of the local undergraduates,' a council spokesman said. 
The council said that apart from the local examiners, four overseas examiners were invited to oversee the conduct of the clinical assessments. They gave comments and feedback on the examination. But the 'syllabus' of the examination only lists the subjects covered and does not give details of content. 
One university doctor who practises in Hong Kong with limited registration - referring to doctors hired by universities who do not have to take the licensing examination - said the council exam was a 'political examination' instead of about  standards.
He questioned why the final exams for the two local medical schools had a pass rate of over 90 per cent, nine times the success rate for candidates sitting the council's tests.
'Are the exams comparable? The views I am given is that they are not,' the doctor said.
154
The number of foreign doctors registered with the Medical Council under limited registrations as of the end of June



Foreign doctors' test 'too tough'