Foreign-trained doctors can only be a temporary cure for Hong Kong’s chronic staff shortage

The problem is a mismatch in numbers between Hongkongers seeking to use the public health service and the doctors and nurses in the sector. Opening the door to overseas doctors is necessary, but not sufficient to ease the overcrowding

Eugene Kin-Keung Chan

Published: 7:00am, 8 May 2019

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Judging by the number of doctors in a given population, Hong Kong does not appear to fare as well as the advanced countries in the Organisation of Economic Cooperation and Development. According to Hong Kong’s Department of Health, we have 1.9 physicians per 1,000 population, a ratio lower than the OECD countries, including Denmark (4.4 per 1,000); Australia (3.6); the UK (2.8); Japan (2.4) and; Singapore (2.3).

Of course, Hong Kong’s ratio is higher than many other places in the world. Perhaps it can also be argued that the ratio does not accurately reflect the situation here because quite a number of locals choose traditional Chinese medicine doctors over Western doctors, or rely on Chinese herbal medicines and over-the-counter drugs.

There is no universally agreed optimal number of doctors required in a society. The general opinion is that the more, the better, especially in an ageing society.

The challenge faced by every health care system is unique and complex, influenced by many factors such as history, demographics and the level of public health awareness. In the US, where health care is largely provided by private institutions, doctors and hospitals are known to turn away those who do not have insurance. By contrast, in the UK, citizens largely enjoy universal health care under the National Health Service, but it is overstretched and has increasingly been criticised for falling short.

Hong Kong’s health care system is a combination of the US and UK models; public and private medical facilities function alongside each other, but they are not in harmony. The disparities in demand for both systems lie at the root of the shortfall of doctors in the public health system.

Medical professionals in the public health system protest against their overwhelming workload during the winter flu season in January this year. Photo: Felix Wong

The public system comprises a network of publicly funded hospitals and numerous outpatient clinics, which are managed by the Hospital Authority, similar to the UK’s NHS. Hong Kong residents are charged a fraction of the regular fee for all sorts of medical services.

We also have 12 private hospitals with numerous private clinics, which charge a much higher fee for their premium services. These hospitals offer doctors attractive compensation packages – one reason that’s driving doctors from the public system to private hospitals.

Doctors’ group says paying patients to go private could solve health crisis

Most Hongkongers use the cheaper public system, but doctors gravitate towards the private system. In consequence, the public system is overcrowded, with too many patients and too few doctors and nurses. It is feared that this problem will only worsen as our population ages.

Currently, there is a debate on how to encourage more foreign-trained doctors to work in Hong Kong’s public hospitals.

In colonial times, foreign-trained doctors from Commonwealth countries such as the UK, Canada and Australia were able to come to Hong Kong to practise without needing to take part in a three-part local licensing exam. In anticipation of Hong Kong’s return to Chinese sovereignty in 1997, the Medical Council changed the rule in the 1990s, requiring foreign doctors and medical school graduates from these countries to also take the exam and undergo an internship, on the grounds of maintaining standards for public health and safety.

Failure to reform Medical Council boils down to one thing: doctors’ self-interest

These requirements have deterred foreign doctors and foreign-trained Hongkongers from coming back to work in Hong Kong. Many Hongkongers wonder why the Medical Council is making it difficult for experienced doctors from Commonwealth countries to register in Hong Kong while our local medical practitioners often proudly display at their offices and clinics their specialist diplomas or training certificates from the medical schools of these same countries.

However, bringing in doctors from the Commonwealth countries is just an interim solution. In the long run, to resolve our doctor shortage and ease the pressure on public hospitals, we must expand our medical school enrolment, reinforce primary health care services, and launch public education campaigns on the benefits of maintaining a healthy lifestyle and wholesome diet.

In the meantime, let’s hope that the just-started Voluntary Health Insurance Scheme will encourage more people to seek private health care and take some of the workload off our public system.

Dr Eugene Kin-Keung Chan is president of the Association of Hong Kong Professionals

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