The row has been years, if not decades, in the making, and the city’s leader has previously said she was prepared to “go to war” on the subject. Here, the Post examines why the matter is so contentious, what the future holds for the city’s doctors and whether the new proposals can finally plug the long-standing service gap and meet patients’ needs.

What exactly has been proposed?

According to the proposal submitted by the government, there would be three main requirements for applicants under the new scheme: they must be permanent residents; graduates of recognised foreign medical schools already registered as doctors or holders of specialist qualifications outside Hong Kong; and willing to work in the city’s public health care system for five years after obtaining their specialist qualifications.

After five years, the doctor could obtain full registration in Hong Kong, without the need to pass the city’s licensing exam, and would have the option to work in the private sector.

Plan to allow doctors trained overseas to work freely in Hong Kong sparks anger

The government also proposed that a committee, comprising health officials and medical educators, be set up to draft a list of recognised medical schools, which should be of “quality comparable” to their two local counterparts. The number of schools on the list, which would be reviewed every three years, would be capped at 100.

The proposed bill is expected to be submitted to Legco in the second quarter this year.

“On the premise of ensuring quality of health care and alleviating the problem of doctor shortages in the public health care system, setting up this new arrangement could allow more qualified overseas-trained doctors to practise in Hong Kong,” Lam said.

What’s wrong with the current system?

Currently, there are two ways for foreign-trained doctors to apply to practise in Hong Kong. Those who hope to obtain full registration and be free to work in either the public or private sectors must pass the licensing exam and complete an internship, normally of six months to a year.

The other option is the limited registration scheme, under which overseas-trained doctors can skip the licensing exam but must work in the public sector, under the Hospital Authority, Department of Health or the two medical schools at the University of Hong Kong and Chinese University.

A move to the private sector would still entail taking the licensing exam. They also need to renew their local registration every three years.

According to the Medical Council registry, more than 120 doctors currently have limited registration.

Dr Lam Ching-choi, a member of the Executive Council, said the city had experienced a long-standing shortage in some areas, such as paediatricians specialising in developmental assessment.

The limited registration scheme, he said, had not been effective in filling the gap with talent. The government has said public hospitals were short by about 660 doctors.

What’s the history of the row?

The shortage of doctors is nothing new for the city. Two years ago, the matter came to a head when the government pushed for proposals to remove internship requirements for foreign-trained practitioners, and clashed with local doctors’ groups such as the Hong Kong Medical Association, which said it feared a dumbing-down of standards and was in turn accused of protectionism.

The city’s independent medical regulator, the Medical Council – composed of government representatives, private doctors’ groups, medical school heads and patient rights’ advocates – shot down four proposals to reform the rule before eventually agreeing in May 2019 that overseas specialists could be exempted from internship requirements if they worked in local public hospitals or medical schools for three years and passed the licensing exam.

Hong Kong can hire overseas doctors without watchdog’s backing, says source

Last year, the council cited coronavirus concerns in cancelling several sittings of the licensing exam, drawing backlash from foreign doctors aspiring to return to Hong Kong to work.

The political tug of war erupted again in November last year after Liberal Party lawmaker and Executive Council member Tommy Cheung Yu-yan, whose daughter and son-in-law are overseas doctors, raised the issue in Legco.

The legislature – almost totally devoid of opposition members after they resigned en masse in protest against a controversial resolution from Beijing – passed Cheung’s non-binding motion calling on the government to set up a “new mechanism” to bring in “experienced and quality non-locally trained doctors” to relieve the personnel shortage in the public sector.

At the time, Chief Executive Lam raised the stakes by declaring that the reform was “a war that must be fought, but hopefully it will be a peaceful, gun smoke-free war, which will depend on how our medical friends deal with this”.

Why is the latest proposal so contentious?

Answering questions from pro-establishment lawmakers in the Legislative Council, Lam again resorted to bellicose tones on Thursday, asserting that her administration’s determination to push forward the latest reform was “very great”, and that the government would not “kneel” to pressure.

But the proposal drew immediate criticisms, not just from the usual suspects in the local medical field, but also from an overseas doctors’ group, as well as from some loyalist legislators and patients’ rights organisations, who attacked the plan as too timid and wanted it to go further.

Dr Gabriel Choi Kin, president of the Medical Association, was quick out of the blocks to characterise the scheme as the “wrong step”, one that would “remove the minimum standard for registration”.

President of the Public Doctors’ Association Dr Arisina Ma Chung-yee expressed worries about foreign doctors’ language skills, saying some might not be familiar with the predominantly English terminology used locally.

Others have raised concerns about an influx of doctors trained in mainland China, though whether that will come to pass will depend on how many Chinese institutions make it onto the list of recognised schools. Singapore, for instance, has a list of more than 100 recognised foreign medical schools, five of which are from the mainland.

But perhaps surprisingly, the Medical Licentiate Society of Hong Kong, which represents overseas doctors in the city, also argued in favour of keeping the licensing exam to maintain standards, citing a survey it conducted in 2019 that found 84 per cent of the 302 non-locally trained doctors it polled wanted the current test to stay.

On the other side of the divide, Elizabeth Quat and Leung Che-cheung, from the Democratic Alliance for the Betterment and Progress of Hong Kong, want the government to include qualified doctors who are not permanent residents, such as those from the mainland.

Will the plan fill the chronic staffing shortage?

Chief Executive Lam on Thursday said public hospitals needed an additional 660 doctors, with vacancies as high as 40 per cent in some fields.

Lawmaker Tommy Cheung said, on average, there were 1.9 doctors for every 1,000 Hongkongers, fewer than in many comparable jurisdictions.

That ratio was higher in Singapore, with 2.5 doctors serving every 1,000 residents. Cheung estimated Hong Kong needed to recruit about 3,400 doctors to catch up with the city state.

But Dr Arisina Ma questioned whether shortages in the public sector were as serious as described by officials, given there had been an increase in local medical graduates in recent years and a recent contraction in the private health care market.

She also disputed that the plan would solve the shortages.

“Naturally, people would leave [the public sector] after getting full registration. The amendment this time is not aiming to solve the shortage problem,” she said, while declining to speculate on its purpose.

The government, however, maintains its new process would mean up to 12 years of work in the public sector for fresh graduates.