Sick of Procrastination

Almost exactly three years ago, I wrote in these columns about the fierce resistance being put up by local medical professionals to proposals to reform composition of the Medical Council. The ostensible reason being put forward for opposing change was to prevent the government being in a position to nominate or influence a majority of the members, thereby undermining the principle of the profession governing itself.

In fact the Council had for a long time been doing a very poor job of managing its affairs in particular in respect of handling complaints against doctors. Even relatively simple cases were taking many years to investigate and bring to a conclusion, in one notorious case almost a decade.

But the doctors were prepared to defy common sense, ignore public interest and seek to defend the indefensible, because lurking behind the management issues was something even more fundamental: naked self interest. Doctors knew that the community wanted a much more liberal policy with respect to admission of foreign-trained doctors. Under the prevailing arrangements at the time, graduates of the top medical schools in the world – even if they had been born in Hong Kong and were the sons and daughters of Hongkongers – had in effect to undergo a completely fresh evaluation of their knowledge and skills, and sit an examination, in order to gain a licence to practice here. Diluting doctors’ control of the council could, some of them feared, lead to a change of policy.

What had brought the issue to the fore four years ago was the effort led by Legislative Councillor Tommy Cheung Yu-yan (Cheung has since been appointed to Exco) to secure changes to the policy on admission of foreign-trained professionals. His own family had been directly affected because his children had qualified in the United Kingdom. Despite being bona fide Hongkongers, and despite their mastery of Cantonese which logically should have been a big plus in treating local patients, they were in effect being treated as foreigners.

A Bill to amend the composition of the Medical Council was successfully filibustered by Dr Leung Ka-lau, the Legco member representing the medical functional constituency, and it lapsed at the end of the 2016 session. A revised bill was finally enacted in 2018, but only after the terms had been softened to weaken lay representation. The reformed council has yet to address the subject of how to facilitate entry of foreign-trained doctors.

The issue has arisen again in the context of the current flu season. The sight of overworked, exhausted doctors and nurses struggling to cope with the influx of local people seeking treatment in hospitals and clinics has come as a shock to the whole community. Some hospitals were reporting bed occupancy rates of over 100 per cent because extra beds were being squeezed in. Bearing in mind that staffing levels in some wards were already below approved standards, that meant the doctors and nurses – particularly the latter -- were seriously overworked. When the staff concerned were driven to hold a public demonstration to draw attention to the situation, it was clear we had reached crisis point. Once again, calls began to ring out calling for easier entry. Chief Executive Carrie Lam Cheng Yuet-ngoh said it was not the right time to introduce changes. Possibly she meant we should not distract staff from their duties while they were under such pressure, and instead we should take up the cudgels when the situation eased. Even with that generous interpretation, I’m not sure I agree. There is also an argument for striking while the iron is hot.

We all know the best long term solution is to train more doctors and nurses here in Hong Kong. Plans have been drawn up to increase intake at both medical schools to train more doctors, and at local nurse training establishments to boost their numbers. But these measures will take time to produce results. To plug the gap in the interim we should take a long hard look at how to make it easier for foreign-trained professionals to practice. Let us be clear: no-one is suggesting any relaxation of standards. We should only be looking to bring in professionals as good as or better than those we train ourselves. Various methods of achieving this have been mooted, perhaps the simplest would be to draw up a list of those teaching institutions recognised as being among the best in the world. Applications in respect of their graduates could be automatically approved, applications from graduates of other institutions could continue to be considered on their merits. But whatever we decide to do, we need to press ahead without further delay.

After the original article appeared, one doctor wrote to tell me I had misunderstood the situation: the key issue in his mind was not protectionism but reciprocity. In other words, he was only prepared to consider entry by doctors from other countries if those countries regimes were amended to make it possible for him to automatically practice there. Why should an American doctor, even one who had studied at one of the best hospitals in the world, be allowed to practice in Hong Kong unless he (the writer) could practice in the USA on the basis of his Hong Kong qualifications. At a superficial level, reciprocity seems a reasonable argument. But on a closer look, the case completely collapses because it totally ignores the position of Hong Kong patients queueing for treatment here. They should be our priority. It is disappointing that some professionals apparently see their first priority as their own status.

Physician, heal thyself.