Physician Heal Thyself

Hong Kong has a shortage of doctors. With a population of about 7.4 million, we have some 14,000 doctors. That’s a ratio of 1.9 doctors per 1,000 people. Compare that to Singapore, which has 2.4.

To meet that figure we’d need another 3,000 doctors. Another report suggests Hong Kong is down by 11,000 doctors. The shortage is acute in particular specialities. Child development assessment is 40 per cent down on the required number of doctors.

None of this is a surprise to the public lining up for treatment. Long waits are the norm. And yet Hong Kong is sitting on massive reserves of cash. Why isn’t that money used to invest in better medical care for the community? Well, several barriers are preventing movement on that issue. 

As a consequence of obstruction by some and blindness by others, we see massive waiting times at public hospitals. Patients with a stable condition are waiting for up to 3½ years to see a specialist. If you have private medical care, there are no such delays. But that comes at a cost. And there is the nub of the issue.

Our two medical schools, funded by the taxpayer, do not produce enough doctors to meet needs. Allied to that is the poor working conditions in public hospitals run by the Hospital Authority.

Doctors and other staff put in long hours while facing a heavy workload for pay that doesn’t match the private sector — anyone who can jump ship.

So why not import doctors? Well, blocking the gate is the Medical Council. This professional body is acting like a militant trade union to prevent overseas doctors from coming through. Of course, it puts forth arguments about maintaining professional standards, dropping dark hints about doctors from certain places.

The places are not named, but we all get the point. As a control, it puts in place restrictive entry requirements, designed to keep them out. Did I mention local doctors run the Medical Council? Get the picture?

Ultimately, our government is not beyond blame. With the Medical Council hindering the import of doctors, officials adopted their usual passive attitude and obfuscated. This situation has gone on for years.

It’s worth pointing out that officials are mostly immune to the consequences of the shortage. With specialised clinics designated for civil servants, long waits are not something they suffer. Besides, most can afford private medical care given the packages of senior officials. 

Matters came to a head during the recent flu season. Signs of strain in the Hospital Authority broke to the surface. 

Staff discontent at their appalling workload and lack of manpower caused the government to react finally. They adopted the usual ‘knee-jerk’ reaction of a cash injection. ​

No long-term solution, nor a comprehensive strategy, with a lifetime commitment. Only a quick bit of cash. Then, business as usual. Move on, nothing to see here!

In summary, we have a Medical Council working against the public interest, a dithering government, and to boot, loads of money in the bank. 

One pundit suggested the only way is to open up the flood gates, to swamp the market. Without the ability to make a reasonable living in the private sector, force doctors to stay in the public system. It’s a tad radical, but a sign of the sentiment building in the community. 

Politicians on all sides are right to be displeased. As a consequence, the Medical Council has taken a well-deserved beating in the court of public opinion. Operating behind closed doors, the public has little insight into its workings.

Let’s talk briefly about social responsibility. I wouldn’t mind so much if doctors paid the full cost of their training and then went into the private sector to make huge salaries. Fair enough. But if they don’t pay, they then owe the community a return on the money we invested in their training. 

It usually takes six years to complete a medical degree. The fees are about HK$43,000 per year. The fact is the public subsidises medical courses because, without such an investment, few could afford to become doctors. 

Mind you; this doesn’t mean doctors don’t have a responsibility to serve the community that paid for their training.  As taxpayers, we fork out HK$3.7 million per doctor in basic-training costs. Then add-on the specialist training that comes later to reach an amount nearing HK10 million. 

That doctors from reputable overseas institutions need to pass local exams appears restrictive. Surely, it’s a simple matter of drawing up a list of recognised accredited foreign institutions. 

​After that, and verification of individual qualifications, let them in.  
Moreover, since we’ve got the money, invest in a long-term approach. 

We have an ageing population — the people that built this great city — and they deserve care in their twilight years.

​A new medical school and a Medical Council that works in the public interest would be an excellent start. ​