Overseas Physicians Best Medicine for Doctors’s Shortage?

Local doctors oppose scheme to make it easier to recruit overseas doctors
Reporters: Sabrina Poh & Viola Yeh

She starts her work day at 9 a.m., spending the morning checking up on and chit-chatting with patients on her ward rounds. Then she has a working lunch or talks to her supervisor at noon. In the afternoon, she has to rush to fit in more patients. Technically, she finishes work at 5 p.m., but she rarely gets to wrap up her work before 7 p.m. When she is assigned to be on-call, which usually happens one to two times per week, she needs to stick around until 1 a.m. the next day. By the time she gets home, she is exhausted; she eats, talks a little to her family and goes to bed.

Dr Vinci Ma, who is in her early 30s, studied and practised medicine in the United Kingdom (UK). She returned to Hong Kong to be with her family. As a result, she has had to adapt to the long working hours and frenetic pace of Hong Kong’s public hospitals. Here, she works 60 to 70 hours per week, compared to 48 hours in the UK.

Ma has been working in the Queen Elizabeth Hospital since 2009. Like other doctors who qualified outside of Hong Kong, she had to sit a re-qualification exam and jump through other hurdles to be granted a partial licence. “We can only practise under limited registration, which means we are restricted to working in public hospitals, in a specific department under a contract,” Ma explains.

Ma earned her medical degree from the University of Nottingham and worked in the UK as a pediatrician for three years before coming back to Hong Kong.

She spent half a year to prepare for the licensing exam set by the Medical Council of Hong Kong (MCHK). “There aren’t any [sample] exam materials. There is a syllabus but it is not very helpful,” she recalls. As a result, Ma had to go through all the materials she studied while at medical school.

She passed the examinations, which have long been criticised as difficult by other overseas-qualified doctors, on her first try. However, she still had to repeat half of her basic training before she could practise.

One of her colleagues had to repeat his entire training and the intermediate exam, all of which he had already completed in the UK. The intermediate exam is a stepping stone towards become a specialist in a specific field of medicine.

If Ma had waited a few years before returning to Hong Kong to practise medicine, things would be different. Earlier this year, the MCHK gave the go-ahead for the Hospital Authority (HA) to hire nine overseas doctors to work in public hospitals without first taking the MCHK’s usual licensing examination and one year internship. The HA says all of the nine were born in Hong Kong but educated and trained overseas.

Their employment is part of the HA’s New Overseas Doctor Recruitment Scheme aimed at addressing the shortage of doctors in Hong Kong’s public hospitals. Under the scheme, a panel of experienced doctors and professors from local medical schools will vet overseas applicants. Overseas-qualified doctors with at least three years’ experience can apply.
In 2011, the HA needed to recruit 500 doctors to develop new services and to replace the 300 who left to work in the private sector. The ever-expanding private sector offers doctors higher pay and a lighter workload. But the HA was only able to hire 330 doctors due to a lack of qualified local recruits. Hong Kong’s medical schools produce just 260 graduates each year.

But the idea of recruiting more overseas doctors has drawn criticism from local doctors’ groups such as the Hong Kong Medical Association (HKMA), the Association of Private Medical Specialists of Hong Kong and the Hong Kong Public Doctors’ Association. These critics say that bringing in overseas-qualified doctors, especially without requiring them to take the licensing exam, will affect the quality of service.

In a statement in response to the scheme, the Allied Concern Group on the Standard of Medical Services in Hong Kong wrote: “Who will evade an examination to get a job?…The doctor we are looking for cannot be the one who evades challenges as benign as an examination.”

Dr Choi Kin, the president of HKMA and member of the Medical Council, says the licensing exam is supposed to be on a par with the final Bachelor of Medicine exam of both the Chinese University of Hong Kong (CUHK) and University of Hong Kong to ensure all overseas doctors meet a basic standard to safeguard the health care of the public.

Choi is strongly opposed to the employment of the nine overseas-qualified doctors who avoided the licensing examination. He points to licensing examinations and other hurdles other countries, such as the United States and Canada, set before they will allow overseas-qualified doctors to practise there.

Choi believes the hiring of overseas-qualified doctors in general will have a detrimental effect on the health of local citizens. He gives a hypothetical example of a young medical graduate from Ireland who has only worked as a radiation oncology doctor being thrown into the Accident and Emergency Department of Tseung Kwan O Hospital.
“Blunders are bound to be made. I only hope life will not be lost,” he says. “Local doctors do not want to babysit these foreign graduates for their mistakes.”

Choi also disputes the HA’s statement that the nine recruits are all locally-born Cantonese speakers. The HA does not want to disclose the identity of the doctors concerned for reasons of privacy and the sensitivity of the issue.
Not all concerned parties are critical of the scheme, however. The Hong Kong Patients’ Rights Association told Varsity it felt the HA’s “stringent and lengthy employment procedure can safeguard the public patients’ interest”.

However, UK-trained Vinci Ma feels the new arrangements do not go far enough and are still unfair to overseas doctors. “Training needs to get accredited,” she says. “[The MCHK] does not recognise all the training in the UK.”
When Hong Kong was under British rule, there was a reciprocal arrangement under which doctors from the British Commonwealth were allowed to get registered and practise here. The rule was abolished upon the handover.

Professor Enders Ng Kwok-wai, associate dean (development) of the Faculty of Medicine at CUHK, gives a conditional view on whether recruiting overseas doctors can help alleviate the heavy workload in public hospitals.

Ng says that bringing in specialists could be beneficial as they could help train Hong Kong’s younger doctors. In contrast, junior doctors coming from overseas would dilute existing training opportunities for local doctors.
“They become a burden to our system because we have to provide training for them and they would also take away the training opportunities of our local medical graduates,” he says.
Regardless of the types of overseas doctors brought in, Ng believes they should all have to take the exams. “We have to make sure that the quality and the standard of the overseas doctors meets the local standards,” he says. “We know very well that the standards of medical schools from around the world are not equal. We need to make sure the qualities of these overseas doctors are good enough to serve the local population.”

Professor Tony Mok Shu-kam specialises in clinical oncology at CUHK and is a well-known television doctor who was trained in Canada. He worked there before returning to work in Hong Kong under limited registration. He says the recruitment of overseas-qualified doctors will only be of minimal help to the problem of the shortage of doctors in Hong Kong’s public hospitals. “The demand is always there,” says Mok who believes the shortage is due to the government’s failure in long-term planning.

He explains the government reduced the number of medical students during the economic decline in the early 2000s. “When you cut back on the number of medical students, five years later, the flow of younger doctors into the public system starts to decrease. And we see the shortage of doctors these years.”
Hong Kong’s two medical schools intend to increase the number of graduates from 260 to 320, but that will not boost the number of graduates till 2015.

As a recent graduate from CUHK’s medical school, 24-year-old Dr Will Leung Lok-hang is positive about the recruitment of overseas-qualified doctors. Leung, who is now a fully registered medical practitioner working at the Caritas Medical Centre says: “I welcome them coming, if they come and do good to patients, because we all should put the patients’ benefit first.”
Setting aside the rising tensions between those who support the Overseas Doctor Recruitment Scheme and those who oppose it, Leung says the fundamental value of a good doctor lies in their attitude. “He should be collaborative, cooperative, of good character and listen.”

Regardless of where they have been trained, Leung believes that, “to be a good doctor, you should not just have a cure, but to comfort always. We have this kind of mission.”