The closed shop of the local medical profession is finally being prised open, with lawmakers voting to allow more graduates of foreign medical schools to practise here to meet a severe shortage of public hospital doctors. This does not signal a dramatic cut in queues and waiting times for treatment any time soon. The vote has triggered a cautious step-by-step process that reflects opposition by the medical profession, which remains unconvinced that standards of medical treatment will be maintained. Their concerns go to the heart of a problem the government has to solve – near third-world waiting times for world-class treatment. It has adopted an approach followed successfully by Singapore, but we are unlikely to see any more doctors until late next year. Health minister Sophia Chan Siu-chee says the amendment to the Medical Registration Ordinance is not to replace Hong Kong’s rigorous licensing exam system. It is to add a new pathway for eligible non-locally trained doctors, including mainlanders and specialists without permanent residence, to serve in the public health sector without compromising quality. “Exams are not the only way to prove the ability of doctors with overseas experience,” Chan said. The quality assurance may be subjective but it is the bottom line. It is fundamental to the reforms and should be tested by an exact performance audit of public health services from time to time. Chan said membership of a 10-strong committee responsible for drafting a list of recognised medical schools, whose graduates may be exempted from the licensing exam, will be announced soon. The list of up to 100 schools of “comparable” quality with the two local teaching universities, will be revealed in the second half of next year. Hong Kong’s exam exemption for overseas doctors won’t ‘ruin the system’: health chief The bill passed by 39 votes to one, with medical sector lawmaker Dr Pierre Chan lamenting damage to a “fair examination system” and professional autonomy. Medical Association president Dr Gabriel Choi Kin regretted the loss of “the standard in monitoring” doctors through exams, while qualification to practise could be decided “by a few people”. Patients’ rights activists sounded a welcome, if cautious note. This newspaper has long argued that queues and waiting times and overworked doctors do nothing for patient welfare. The combination can lead to distressing outcomes and feelings of helplessness and neglect for patients and families. It remains to be seen how attractive this change makes Hong Kong to foreign-trained doctors. Most important is the assurance that lowering the bar to doctors and improving access to health care will not compromise quality. The health minister has already left a mark with her role in fighting the Covid-19 pandemic. If she can deliver on that assurance she will cement it.