Following is a question by the Dr Hon Pierre Chan and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (March 22):

Question:

     If any person has been awarded a medical degree by the University of Hong Kong (HKU) or The Chinese University of Hong Kong (CUHK) and has completed a year of internship at the Hospital Authority (HA), that person is qualified to be registered as a medical practitioner. Non-locally trained medical practitioners are required to pass the Licensing Examination administered by the Medical Council of Hong Kong (MCHK) and to complete a period of internship at HA before they may be registered as medical practitioners. In addition, non-locally trained medical practitioners with acceptable qualifications and relevant experience, if employed by specified institutions (including the Department of Health, HA and the medical schools of HKU and CUHK) for the purposes of teaching, conducting research or performing clinical work, may apply to MCHK for limited registration with a time limit. Regarding matters relating to the registration and employment of non-locally trained medical practitioners in Hong Kong, will the Government inform this Council whether it knows:

(1) the number of local medical graduates registered as medical practitioners in each of the past five years; among them, the respective numbers of those who were and were not offered appointment by HA after registration; the general reasons why HA did not offer appointment to some of them (if any);

(2) the number of non-locally trained medical practitioners who passed the Licensing Examination in each of the past five years, with a breakdown by the country/region where they received medical training; among them, the respective numbers of those who were and were not offered appointment by HA after registration; the general reasons why HA did not offer appointment to some of them (if any);

(3) in each of the past five years, (i) the number of job applications received by HA from non-locally trained medical practitioners and (ii) the number of such medical practitioners employed by HA; among the medical practitioners employed, (iii) the number of those whose applications for limited registration were approved by MCHK, with a breakdown by the country/region where they received medical training;

(4) in each of the past five years, (i) the respective numbers of job applications received by HKU, CUHK and the Department of Health from non-locally trained medical practitioners and (ii) the respective numbers of such medical practitioners employed by those institutions; among the medical practitioners employed, (iii) the number of those whose applications for limited registration were approved by MCHK, with a breakdown by their grades and ranks as well as by the country/region where they received medical training;

(5) the respective numbers of non-locally trained medical practitioners whose applications for renewal of limited registration were approved and rejected by MCHK in each of the past five years; the general reasons why MCHK rejected some of the applications (if any); and

(6) regarding the 136 non-locally trained medical practitioners with limited registration in Hong Kong as at the end of last year, of a breakdown of that number by the number of years of working in Hong Kong (set out in the table below)?
 

Number of years of working in Hong Kong	Number of people
Over 20 years
Over 15 to 20 years
Over 10 to 15 years
Over five to 10 years
Five years or less

Reply:

President,

     Operating under the principle of professional autonomy, the Medical Council of Hong Kong (MCHK) is an independent statutory body established under the Medical Registration Ordinance (MRO). It is responsible for handling matters relating to the registration and regulation of doctors in Hong Kong.

     In addition, according to sections 8 and 14 of MRO, a person may be registered as a doctor with full registration if he/she:

(a) has been awarded a degree of medicine and surgery by the University of Hong Kong (HKU) or The Chinese University of Hong Kong (CUHK) and has attained a certificate of experience of employment in a resident medical capacity in approved hospitals for a period of not less than 12 months under section 9 of MRO; or

(b) has passed the Licensing Examination and completed a period of assessment in approved hospitals as determined by MCHK under section 10A of MRO.

     According to section 14A of MRO, a person may be registered as a doctor with limited registration if he/she satisfies MCHK that:

(a) he/she has been selected for an employment or for a type of employment determined and promulgated by MCHK;
(b) he/she has obtained an acceptable overseas qualification;
(c) he/she has had adequate and relevant full-time post-qualification clinical experience;
(d) he/she is registered with a medical authority outside Hong Kong; and
(e) he/she is of good character.

     So far, MCHK has published 12 promulgations of limited registration in the Government Gazette. At present, there is no registration under promulgations no. 1, 5, 6, 7, 8 and 11 as the types of employment described in those promulgations no longer exist. Currently, application for limited registration can be made under the following six promulgations:
 

Promulgation No.	Employment
No. 2	For the following types of full-time employment: (a) Employment as a medical practitioner by the Government for the purpose of research work or for such clinical practice of medicine or special health care services, as specified by the Director of Health; (b) Employment as a medical practitioner by the Hospital Authority (HA) for the purpose of research work or for such clinical practice of medicine or hospital work, as specified by HA; (c) Employment as a medical practitioner by HKU or CUHK for the purpose of teaching, research or performing hospital work, in the Faculty of Medicine.
No. 3	Being such persons (whose names were entered prior to the end of 1964 into a list maintained by the Registrar of Clinics, Department of Health (DH)) appointed for the provision of primary healthcare, and to be responsible for the medical management of those clinics exempted from the provisions of section 7 of the Medical Clinics Ordinance (Cap 343).
No. 4	Being such persons (whose names were entered prior to the end of 1964 into a list maintained by the Registrar of Clinics, DH and who are or who have been registered under Promulgation No. 3 of the MCHK on Limited Registration) appointed for the provision of primary healthcare, and to be responsible for the medical management of those clinics registered under the Medical Clinics Ordinance (Cap 343).
No. 9	Employment for supervising the medical matters which may arise in connexion with the construction work in compressed air for the Tuen Mun - Chek Lap Kok Link - Northern Connection Sub-sea Tunnel Section project under Highways Department's contract number HY/2012/08.
No. 10	Employment by a firm of solicitors registered by the Law Society of Hong Kong to carry out a medical examination of a person in Hong Kong for the sole purpose of preparing a medical expert report on that person for use in a pending court proceedings in Hong Kong.
No. 12	Employment for the purposes of the annual rugby event Sevens World Series.

     Doctors with limited registration may carry out medical practice including teaching, research and hospital work etc. subject to specified restrictions and conditions. The maximum duration of limited registration is one year. Upon expiry of the registration, the person may apply for renewal for up to another year. 

     As at end 2016, there were a total of 134 doctors with limited registration in Hong Kong.  They were employed by the medical faculties of HKU and CUHK (79 persons), HA (14 persons), clinics that have been exempted from the provisions of section 7 of the Medical Clinics Ordinance (27 persons), clinics registered under the Medical Clinics Ordinance (12 persons), and works contractor commissioned by the Highways Department (two persons). DH has not employed any doctor with limited registration. The breakdown of doctors with limited registration under the promulgations in the past five years (i.e. from 2012 to 2016) is at Annex 1. 

     My consolidated reply to the six questions raised by the Dr Hon Pierre Chan is as follows.

(1) and (2) In the past five years, the average number of doctors newly granted full registration was about 320 each year, of which about 280 possessed qualifications awarded by the two medical schools, and about 40 passed the Licensing Examination and completed internship assessment. Detailed figures are set out at Annex 2.

     The number of candidates who sat and passed the Licensing Examination of MCHK in the past five years by the jurisdictions of qualification held by candidates is set out at Annex 3.

     At present, there are about 5 800 doctors in HA. HA assesses the manpower situation of doctors annually and recruits doctors taking into account factors including service demand, service development needs, staff turnover and market supply.

     Locally trained medical graduates are the most important source of doctors serving in the public sector. As far as Resident Trainees are concerned, HA employs most of the local medical graduates. In the past five years, for applicants who were graduates from the two medical schools and newly granted full registration, on average about 96 per cent joined HA each year.  In addition, HA also employs other qualified doctors to meet service demand. In the past five years, for applicants who were newly granted full registration after passing the Licensing Examination and completing the internship assessment, on average about 72 per cent joined HA each year. For applicants who were not newly registered, an average of about 54 per cent joined HA each year in the past five years. Detailed figures are set out at Annex 4. Looking ahead, the growth in healthcare services will be able to absorb new medical graduates.

     The main reason for applicants not joining HA eventually is that they chose not to accept HA's offers. It is understood that a small number of graduates joined the private healthcare sector or were employed by other institutions such as DH and the two universities.

(3) Although HA has employed most of the local medical graduates and other qualified doctors, there was still a shortfall of about 300 doctors as at end 2016. From January 2012 to end 2016, MCHK approved a total of 29 applications for limited registration from non-locally trained doctors who were employed by HA to address manpower shortage. All of them were employed as Service Residents. All applicants are non-locally registered doctors and have at least three years' clinical experience in hospitals after completion of internship, and possess a specialist qualification comparable to the Intermediate Examinations of the constituent Colleges of the Hong Kong Academy of Medicine (HKAM). As at end 2016, there were 12 doctors with limited registration working in HA to address manpower shortage. They served in the anaesthesiology, emergency medicine, family medicine, internal medicine, paediatrics and radiology departments respectively. 

     At present, doctors with limited registration serving in HA represent only a small proportion of the overall number of HA doctors and a stringent mechanism has been put in place for recruitment of such doctors. HA conducts regular manpower assessment in each specialty in consultation with the relevant departments and organisations, including the specialties with severe staff shortage, frontline doctors, doctors unions and the Doctors Staff Group Consultative Committee. Upon requests from departments and with consent of the Central Co-ordinating Committees (COCs) of the respective specialties, HA will initiate the recruitment process for doctors under limited registration.

     The Selection Panel of HA is responsible for recruitment and selection of doctors with limited registration. It consists of representatives from the relevant constituent Colleges of the HKAM and HA's COCs of the respective specialties. HA will ensure that the applicants meet the qualification requirements before submitting applications for limited registration to MCHK. It will also provide relevant information to assist MCHK in considering the applications.

     HA has set up a Task Force on Limited Registration Scheme, which is responsible for monitoring the employment of doctors under limited registration. It consists of the deans of the two medical faculties, the President of HKAM, representatives of HA Board and the Chief Executive of HA. HA will report the recruitment progress and results on a regular basis at the Administrative and Operational Meetings and Directors' Meetings of HA.

     Locally trained doctors will continue to be HA's main source of manpower supply, while doctors with limited registration will only be employed when necessary in order to address short-term manpower shortage. The information on doctors with limited registration in HA is at Annex 5.

(4) The information on the employment of doctors with limited registration by HKU, CUHK and DH is at Annex 6.

(5) The information on doctors with limited registration applying for renewal of registration in each of the past five years is at Annex 7.

(6) The number of years that doctors with limited registration have worked in Hong Kong is set out at Annex 8.

Ends/Wednesday, March 22, 2017
Issued at HKT 19:58

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