Time for our city to address its doctor shortage

This article appeared originally in the SCMP on 29 April, 2021.
Author:  Pamela Tin, Head of Healthcare and Social Development at Our Hong Kong Foundation

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As demand for health care in Hong Kong continues to rise, with challenges ranging from the Covid-19 pandemic to an ageing population and the increasing prevalence of chronic diseases, the city’s doctor shortage is becoming more acute.

According to the most recent health care manpower projections released by the government, the shortage is worse than three years ago.

While such a situation is not unique to Hong Kong, the city is unique in adopting relatively passive measures when it comes to attracting qualified doctors from around the world to fill the gap.

In contrast to Singapore, Britain and Australia, Hong Kong has required non-locally trained doctors to pass a local licensing exam before they can register as medical practitioners, since the exam exemption for doctors trained in recognised Commonwealth countries was scrapped in September 1996.

This has resulted in a startling trend. From 2016 to 2020, non-locally trained doctors accounted for about 11 per cent of newly registered doctors in Hong Kong, far lower than the average 56 per cent recorded between 1992 and 1996.

Overall, non-locally trained doctors who work under full or limited registration make up about 10 per cent of Hong Kong’s doctor supply. If we include those foreign-trained doctors who benefited from the exam-free entry before 1996, their share comes to about 25 per cent. In contrast, the share of foreign-trained doctors in Singapore, Britain and Australia ranges from 30 per cent to up to 40 per cent.

In practical terms, Hong Kong has two doctors for every 1,000 people, in comparison with Singapore (about 2.5), Britain (three) and Australia (four). A consequence of this is long waiting times.

The World Health Organization notes there is a shortage of doctors worldwide, and governments everywhere are trying to resolve the issue.

Why has Hong Kong been so slow to solve the problem? We believe that suitable adjustments must be made to the existing system to augment the role of non-locally trained doctors in Hong Kong.

In plugging the gap in the supply, public concerns must also be addressed. These include maintaining the quality of health care in Hong Kong and prioritising the manpower crunch in public hospitals.

Different economies have implemented different policies with regard to assessing the quality of doctors and safeguarding the quality of care. Frequently, a local licensing exam is not the only yardstick.

In Singapore and Australia, foreign-trained doctors can practise under supervision for a period of time (two to four years in Singapore; 12 months in Australia). In Britain, foreign-trained doctors can submit recognised test certificates as proof of language proficiency. These examples of alternative medical registration systems may be worth considering.

After years of discussion in Hong Kong, the government recently announced a proposed legislative framework for bringing in more non-locally trained doctors. Under the framework, non-locally trained doctors who are permanent residents (and who are, presumably, from a local cultural background and have the relevant language skills) will gain full registration – provided they are graduates of recognised medical schools and registered as medical practitioners outside Hong Kong, or are holders of specialist qualifications, and they will work in local public institutions for a set period (the government is proposing at least five years).

The government is currently consulting different segments of the community about the proposed framework and plans to submit the bill to the Legislative Council in the second quarter of this year. Some people fear that the proposal would allow the entry of poorer-performing doctors, while others may be concerned about how the recognised non-local medical schools are chosen. These concerns are reasonable.

But if we look at how other economies have dealt with such issues, it is clear that these worries are not insurmountable obstacles, as long as key stakeholders including the government, medical professionals, and civil society keep an open mind and work on the policy details. Otherwise, if we keep avoiding the elephant in the room, Hong Kong will never have enough doctors to cope with the ever-increasing health care challenges.