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iv. There has been a distinct uptrend of health insurance expenditures over the past decade, hinting at the general growth and the potentially increasing attractiveness of working
in the private sector. Among many other indicators, expenditures via privately purchased and employer-based insurance schemes increased 335% from HKD 5.3 billion in 2001-02
to HKD 23.3 billion in 2016-17. However, over the same period, the ratio of inpatients taken care of by public and private hospitals stayed roughly unchanged, which implies that
even though there are more financial resources available in private sector, the workload of public hospitals has not lessened. As ‘pull factors’ from the private sector increase and
public hospitals continue to be overloaded, an ever-worsening doctor shortage situation, particularly in the public sector, becomes likely.

v. Further worsening the crisis is the increase in attrition of public hospital doctors that is fast catching up with the intake of doctors in public hospitals. In 2016-17, an intake of
467 full-time and part-time doctors in public hospitals was observed and 337 were lost to attrition in the same period. Among the doctors lost to attrition, some were lost due to
retirement (and this retirement wave has just begun), while others were potentially lost to attrition to the private sector. If attrition of public hospital doctors continues to increase
due to factors such as work overload, stress and other ‘pull factors’ that may attract them to practice in the private sector, then even a greater intake of doctors would amount to
no, or slow net increase of doctors in public hospitals. This vicious cycle would mean that the chronic shortage of public hospital doctors will remain unresolved and would get
worse very quickly as our population ages and chronic diseases become more prevalent.

4. There is an urgent need to become more receptive towards augmenting the role of foreign-trained doctors

i. To stand a chance at ameliorating this undesirable and unsustainable reality, evaluating the supply of doctors is a must. Scattered e orts have been made to address the shortage
in doctors, albeit evidently, with limited e ectiveness since the shortage of doctors are in the thousands, not the hundreds. For instance, the Government increased the number
of University Grants Committee-funded medical training spaces by 90% from 250 in 2005-06 to 470 in 2016-17. The number will further increase by 60 each year in the 2019-20
to 2021-22 UGC triennium. Meanwhile, the Medical Council of Hong Kong (MCHK) increased the frequency of the Licensing Examination from one to two sittings in 2014, and in
2016 introduced flexible arrangements for the post-Licensing Examination internship requirement. In 2018, the Government extended the validity and renewal period of limited
registration from not exceeding 1 year to not exceeding 3 years. In e ort to specifically address the shortage of doctors in our public healthcare system, the Hospital Authority
st
(HA) introduced the ‘Special Retired and Rehire Scheme’ in 2015-16 to rehire healthcare professionals after their retirement. As of 31 December 2018, 61 doctors continued to
work under the scheme at the HA. The HA also set a higher retirement age for new recruits employed from June 2015 onwards, and increased the Special Honorarium Scheme
(SHS) allowance by 10% for frontline medical sta in January 2019. Still, despite all these e orts, we continue to face a doctor shortage crisis.

ii. System-level changes to the distribution and skill-mix of our healthcare workforce are fundamental in moving towards a primary care-led, integrated, person-centred health
system and will contribute to relieving the doctor shortage crisis. Still, these changes will only happen over an extended period of time while immediate action needs to be taken
to address our doctor shortage crisis. Thus, it is our view that due consideration needs to be given to augmenting the role of foreign-trained doctors in our public healthcare
system.