Why Singapore is more attractive to overseas doctors than Hong Kong

Hardly a week goes by these days without another story about long wait times or doctor shortages in the public sector. A particularly striking recent example is the report of a new paediatric hospital being unable to open at full capacity due to its inability to recruit staff. Overseas doctors, especially those with personal ties to Hong Kong, have been intermittently touted by politicians and commentators as a potential solution to the territory’s medical staffing crisis.

Yet, like me, many overseas doctors do not believe returning to the city is a viable career move. To understand this reluctance, one must consider the two main pathways to gain a medical licence in Hong Kong and the opportunity costs associated with each.

The first route is to take the medical council licentiate examinations. In the medical field, it is well known that months of revision are required to pass these notorious exams, even for those lucky enough to have the financial means not to need to hold down full-time employment while preparing. Now imagine being asked to sit these tests, held in Hong Kong, while working full time as a practising doctor with long hours in the UK or Canada. No wonder many are put off by the idea of attempting the exams. 

Contrast this with Singapore, where as long as the Singaporean government deems one’s primary medical qualification to be from a medical school of a satisfactory international standard, registration without any examination is possible. Is it any surprise that many doctors of Hong Kong origin with Western qualifications choose to practise there instead? Singapore is only four hours away from Hong Kong, with an environment full of Asian familiarity and a health care system of international repute.

The second way back to Hong Kong is to apply for a one-to-three-year contract job after qualifying as a specialist overseas. If successful, the Hospital Authority will grant you limited registration, but only for the length of the contract.

Surely this is a more attractive option? Not so, as advanced medical training can often last five to 10 years post medical school, during which time, these doctors are likely to have laid down roots and have young families. Furthermore, specialists are often in demand where they trained, with the best opportunities for progression becoming available at this very stage of their careers. Uprooting oneself for a contract that is considered relatively short in the medical sphere is simply too unappealing for some, especially if it involves foregoing a tenure-type permanent position with guaranteed, stable career progression.

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Those with some insight into medical recruitment would point out that certain international territories have successfully recruited high-quality specialists with similar three-year contracts. However, the remuneration on offer in Hong Kong is simply not competitive enough for those considering a short-term career move.

Several Middle Eastern countries offer Western-trained specialist doctors tax-free packages in excess of HK$2 million a year with free accommodation, free private education for their children, generous annual leave and training budgets, and business-class flight tickets for their entire families to wherever they deem home to be. 

Any attempt to change the current system will be fraught with political difficulty. However, it is also undeniable that there is a medical staffing crisis in Hong Kong, compounded by the fact that medical students take five years to train before they can even practise under close supervision, let alone provide specialist level expertise. No clear immediate solution is therefore in sight, and it is ultimately the people who will suffer.

Recruiting suitable qualified overseas doctors could indeed, at least in part, provide short-to-medium-term relief. Sadly, Hong Kong currently cannot seem to even effectively attract its own sons and daughters to return. The whole situation is truly Kafkaesque.

Dr Daniel Poon gained his medical degree in the UK after moving from Hong Kong. He is currently receiving higher specialist training in diagnostic radiology at St Thomas’ Hospital and Evelina London Children’s Hospital, both in London