Demystifying the myths around doctor shortage
This article appeared originally in the China Daily Hong Kong Edition on 15 March, 2021.
Author: Pamela Tin, Head of Healthcare and Social Development at Our Hong Kong Foundation.
The discussion on Hong Kong's doctor shortage crisis was renewed recently when the government announced a proposal to create a new pathway for the admission of non-locally trained doctors. The initiative, which borrows heavily from major policy recommendations put forward in Our Hong Kong Foundation's advocacy study "Health System Capacity Constraints — The Severe Shortage of Doctors in Hong Kong Public Hospitals" in 2019 is the culmination of substantial advocacy in the public policy arena. A small but important step forward to address Hong Kong's long-standing doctor supply shortage, the proposed pathway would allow those registered as medical practitioners or with specialist qualifications from recognised non-local institutions to gain Full Registration after serving our public sector for a set amount of time. This initiative foreseeably provides at least some relief to our overworked healthcare workforce and promises timely healthcare service provisions.
Though necessary and timely, the proposal has been met with criticism and significant pushback that has often been based on misconceptions surrounding the proposal. These misconceptions must be clarified to allow all to stand on fairer common ground when forming opinions toward the new proposal.
The relaxation of Licensing Examination requirements to attain Full Registration has been met with opposition that positions the exam as key to ensuring the provision of high-quality medical services in Hong Kong. This narrative alleges that a new pathway to Full Registration may allow the entry of poorer performing doctors. However, it should be known that the quality of these non-locally trained physicians we look to admit are already safeguarded by multiple layers of quality control. At the very least, graduation assessment at recognised medical institutions, registration requirements by medical authorities, and employment assessment by Hong Kong public sector institutions will serve as the first level of checks for work quality. Furthermore, the proposal creates a gatekeeping function against doctors with subpar performances through mandating practice in the public sector. This requirement not only allows new recruits to showcase their assimilation into the local health system, but will also allow supervisors and peers to review physicians' competency. Moreover, we should not forget that many non-locally trained physicians are currently already providing training to our own local medical students.
Separately, concerns have been raised on the selection of non-local medical schools to be classified as "recognized" and whether selected schools provide the same high-quality education delivered in Hong Kong's medical schools. In reality, the proposal proactively puts forward the creation of a subcommittee comprising cross-sector experts to objectively review and select institutions to be recognised. Notably, Our Hong Kong Foundation's 2019 advocacy study revealed that a number of non-local medical schools fare just as well as, if not better than, Hong Kong's medical schools according to global rankings. Rankings should not be the only measure but may serve as a useful navigator for where to recruit top-quality talent.
Many are also apprehensive that non-locally trained doctors will face a language hurdle upon beginning their practice in Hong Kong. However, we must not let this narrative distract us from hiring top quality talent to serve our fast-collapsing health system. Public institutions, including the Hospital Authority and Department of Health, perceivably have set hiring criteria on language standards that must be met to be considered for a position. Many non-locally trained doctors already providing services in Hong Kong today have no issues in delivering their services to our citizens. Importantly, when Hong Kong is already losing in the global competition for top medical talent, flexibility must be exercised. For example, returning doctors who are uncomfortable practicing in Cantonese can use translation services or be matched with patients who prefer medical care in English. Receiving top-quality care in a timely manner should arguably outweigh the importance of the language such care is delivered in.
Even with the implementation of the proposal, many worry about Hong Kong's attractiveness to non-locally trained doctors and the possibility that the proposal will have a limited impact on our local doctor supply. It is reasonable to speculate that this opportunity to return home and, in many cases, reunite with family and friends will be sufficiently attractive to eligible permanent residents. Even if few physicians immediately benefit from this proposal, its enactment opens possibilities for future students of non-local medical schools and provides an option for practicing medicine in Hong Kong that did not previously exist. Additionally, this proposal is just one of many solutions aimed at expanding the doctor supply in the public sector that together should substantially ease our doctor shortage crisis.
The proposed amendments are good first steps in the right direction. Yet Our Hong Kong Foundation's 2019 advocacy study showed that Hong Kong already lags behind its international peers in its doctor supply. In the midst of a growing global shortage of doctors, we continue to hold onto outdated policies that put restrictions on the extent high quality non-locally trained doctors can contribute to our fast collapsing system. And so, while boosting our healthcare workforce robustness requires multifaceted long-term systemwide solutions, Hong Kong's emerging healthcare needs must also be resolved in the short term. Continuous consideration should be given to measures that stretch beyond the proposed amendments to attract and, importantly, retain well-qualified non-locally trained doctors to practice in Hong Kong.