Tuesday, 26 November 2013

Mainland medical graduates should be used to overcome Hong Kong doctor shortages


by Dr Feng Chi-sun
There is a serious shortage of doctors in Hong Kong and it affects mainly public hospitals. Based on the frequently cited figures, more than 90% of inpatient services are performed in public hospitals, where fewer than 50% of our doctors work.
Since it takes years to train a doctor, the obvious quick remedy is to hire overseas doctors. When Hong Kong was a British colony, all Commonwealth doctors are eligible to practice in Hong Kong; non-Commonwealth ones had to take a qualifying exam. After the handover, all foreign medical graduates have to take the exam, which is notorious for its level of difficulty, with a pass rate of 10% or less.
It's no wonder we continue not to have enough doctors in public hospitals, and waiting time for elective surgeries takes months and years.
To solve the shortage problem, Hong Kong's Hospital Authority has come up with a solution that some argue is flawed. It is giving limited license to selective non-local medical graduates so that they can practice in public hospitals without taking the exam. The candidates must speak Cantonese and hold a valid medical degree. Fair enough. But that's where the transparency and accountability of the selection process ends. By picking candidates based on their paper credentials and not by a more objective method, such as test scores, the authority is inclined to admit only medical graduates from world-renowned schools from Western countries, and exclude those from less prestigious ones, especially those from the mainland.
The difference between an ethnic Chinese from a Canadian medical school and one from a Chinese medical school is the family background. But, unlike family wealth and prestige, medical knowledge is acquired and not inherited. Regardless of their undergraduate medical education, all doctors have an equal chance of being nurtured into a highly competent healer. Doctors learn most of their skills at the postgraduate stage.
Perhaps, a better way for the Hospital Authority to deal with the shortage crisis is to recruit Cantonese-speaking non-local medical graduates from around the world, and lower the entry bar for them to start working in Hong Kong by easing the exam to a level at which the pass rate is at least 50%. The way the current exam is structured, it is suitable only for fresh graduates, but is counter-productive to our goal of recruiting competent doctors. Many of the candidates have already had a few years of practice experience in their own fields, and might have forgotten many didactic facts in other areas. Is there really any need for a future ophthalmologist to also have indepth knowledge of gynecology?
And like in the US, they could start work as an intern, and are allowed a full license only after years of training and passing a more advanced exam in their specialty.
The approach used by the Hospital Authority in picking candidates to work for them is problematic because it is whimsical and non-transparent, and easily perceived to be discriminatory or having a hidden agenda. It invites criticism and possibly lawsuits.
Most of all, the pool of potential medical geniuses is much bigger on the mainland than the small group of Cantonese-speaking doctors who graduated from Western countries. Hong Kong will lose out if this valuable human resource is not tapped.
The author was a consultant pathologist for the Hong Kong government and St. Paul's Hospital before his recent retirement. He was a lecturer at the Medical Faculty of the Chinese University of Hong Kong and a diplomate of the American Board of Pathologists.
Source: China Daily

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