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LCQ3: Non-local doctors recruitment scheme

     Following is a question by the Hon Fred Li and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (November 9):


     In view of the serious wastage problem of doctors in public hospitals in recent years, the Hospital Authority (HA), in addition to increasing promotion opportunities and recruiting part-time local doctors, also plans to recruit overseas doctors to practise with limited registration in Hong Kong, but the Allied Concern Group on the Standard of Medical Services in Hong Kong, which consists of doctors' associations such as the Hong Kong Medical Association, the Association of Private Medical Specialists of Hong Kong and the Hong Kong Public Doctors' Association, has jointly signed a submission to the Medical Council of Hong Kong (MCHK) to voice opposition.  In this connection, will the Government inform this Council:

(a) whether it knows the impact of non-Hong Kong residents using medical services in Hong Kong on the demand for doctors in private hospitals and specialists, and on the recruitment and retention of specialists by public hospitals; the current percentage of the number of attendances of non-Hong Kong residents in the total number of attendances of private hospitals per annum; whether the authorities will consider including a provision to prescribe the percentage of the number of attendances of non-Hong Kong residents of private hospitals when they apply for licence renewal; further, the number of doctors who have returned to the Mainland to set up clinics and hospitals or practise under the Mainland and Hong Kong Closer Economic Partnership Arrangement; the impact on the supply of doctors in Hong Kong; how the doctor-to-population ratio in Hong Kong compares to that in other advanced countries which provide medical services for a large number of non-nationals;

(b) whether it knows the criteria adopted by HA for the initial screening of the applicants for the overseas doctor posts; the number of doctors HA intends to recruit in this way, as well as their specialties and ranks; the wastage rates of such posts in the past two years and the number of current vacancies; whether it will continue to recruit more overseas doctors to fill such posts; how the authorities will address the dissenting views of local doctors' associations and ensure that the overseas doctors recruited by HA and their local counterparts can whole-heartedly work together in the future; whether, under the existing legislation or the Professional Code and Conduct for the Guidance of Registered Medical Practitioners in Hong Kong, doctors' associations are allowed to attempt to influence the decision of MCHK regarding the vetting and approval of applications for limited registration; and

(c) whether the authorities have reviewed the causes of the low passing rate of overseas doctors attending MCHK's Licensing Examinations; whether it knows if MCHK has a statutory obligation to make improvements to attract more quality medical personnel, having regard to safeguarding the public's health and interests?



     With an ageing population and advances in medical technology, there is an increasing demand for healthcare services in the community, and the manpower requirement for healthcare personnel grows commensurately.  In the past few years, the Hospital Authority (HA) has implemented a series of measures to address manpower issues.  In 2011-2012, HA will continue to recruit additional healthcare staff, including about 330 doctors and 1,720 nurses, to meet the service demand.  To increase doctor manpower in the short-term, HA has enhanced the remuneration package and allowed greater flexibility for employments of part-time doctors early this year.  Without affecting the promotion of other young doctors, HA has taken proactive efforts to retain some of the doctors who have retired or left HA.  By now, some 60 senior doctors remain serving in the public hospitals on a part-time basis.  In addition, HA has, in recent years, created additional promotion posts, strengthened professional training and relieved the workload of its frontline healthcare workers by re-engineering the work processes and streamlining work procedures with a view to boosting staff morale and improving staff retention.  Since there will only be some 250 local medical graduates each year up to 2014, it is anticipated that the problem of shortage of doctors in public hospitals will persist in the next few years even after the implementation of such measures.  Under such circumstances, the employment of non-local doctors with limited registration is necessary.

     The Government supports HA's recruitment of non-local doctors to practise with limited registration as one of the additional and immediate measures to address the manpower problem.  In tandem with recruiting non-local doctors to practise with limited registration, the Government has also taken steps to tackle the healthcare manpower shortage problem at source by a number of measures, including allocation of an additional $200 million to increase the number of training places for healthcare personnel.  To ensure a sufficient supply of healthcare manpower in the long run, the Government will, on the basis of the outcomes of the Second Stage Public Consultation on Healthcare Reform, set up a high-level steering committee to conduct a strategic review on healthcare manpower planning and professional development.  The steering committee will put forward recommendations in the first half of 2013 with a view to ensuring the healthy and sustainable development of our healthcare system.

     My reply to the various parts of the question is as follows:

(a) With Hong Kong being an international city, there have always been non-local residents using the healthcare services of Hong Kong.  Based on the number of hospital discharges and deaths, the percentage of non-local residents using public healthcare services is about 1.2%.  In general, the demand of non-local residents for some specialist services, such as obstetric services, is higher.  Private hospitals are regulated by the Department of Health under the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (the Ordinance).  At present, there are 12 private hospitals registered in accordance with the Ordinance in Hong Kong.  They are required to meet the conditions relating to accommodation, staffing and equipment.  No restriction on these hospitals' service scope and target clients has been laid down in the Ordinance.

     Under the liberalisation measures of Mainland and Hong Kong Closer Economic Partnership Arrangement (CEPA) and its seven Supplements, the Department of Health of Guangdong Province has approved 10 certificates to the Hong Kong service suppliers for setting up clinics/outpatient clinics in Guangdong Province and 10 specialist doctors have obtained the Mainland's certificate of qualification as doctors through accreditation.  Besides, according to information available to the Department of Health, a total of 23 registered western medical practitioners sat for the National qualification examinations for doctors and obtained the certificate of qualification as doctors from the Ministry of Health.  With more than 12,000 registered doctors in Hong Kong, the impact of CEPA on the supply of doctors in Hong Kong is minimal.

     As for the doctor-to-population ratio, there were about 12,800 doctors registered with the Medical Council of Hong Kong as at end October 2011, equivalent to 1.8 doctors per thousand population.  According to information from the Organisation for Economic Cooperation and Development and the countries concerned, the respective ratios of doctors per thousand population in other advanced countries in 2008 were, for example, 2.6 in the United Kingdom, 3.1 in the United States, 2.2 in Japan, 2.3 in South Korea, and 2.2 in Singapore.

(b) When taking forward the non-local doctors recruitment scheme on this occasion, HA has attached great importance to the quality of doctors and set up a Task Force of Limited Registration Scheme (the Task Force) specifically for scrutinising the qualifications and eligibility of the applicants.  To ensure that the recruited doctors have attained the required medical standard, all applicants have to be overseas medical graduates with at least three years' working experiences in hospitals after completion of their internship, and possess a specialist qualification comparable to the Intermediate Examinations of the constituent Colleges of the Hong Kong Academy of Medicine.

     As at September 2011, HA received a total of 160 applications, of which 29 were assessed to be eligible for further processing.  The Task Force will first process applications from certain specialties which are with acute manpower shortage, including the specialties of medicine, anaesthesia, and accident and emergency.  HA already set up a selection board in late October 2011 to conduct interviews with the 15 shortlisted applicants who have met the requirements for the above three specialties.  Subject to Medical Council's approval of their limited registration applications, the selected non-local doctors will be employed as resident doctors (equivalent to entry rank doctors in HA) and only be allowed to work in HA public hospitals.  In 2009-10 and 2010-11, the turnover rates of doctors were respectively 5.2% and 5% in the specialty of medicine, 6% and 4% in the specialty of anaesthesia, and 3% and 5.7% in the specialty of accident and emergency. Members of the professional team of the concerned departments in HA will continue to work in a cooperative manner and will offer appropriate support and guidance as and when necessary.

(c) The Medical Council, established under the Medical Registration Ordinance, is empowered to handle registration and disciplinary regulation of medical practitioners in Hong Kong.  One of the main functions of the Medical Council is to administer and conduct the Licensing Examination for medical graduates from non-local medical schools.  The Licensing Examination of the Medical Council aims to ensure that those who wish to register as medical practitioners in Hong Kong after having received medical training outside Hong Kong have attained a professional standard comparable to that of local medical graduates.  This is to safeguard the quality of our medical services and public health.  Hence, the Medical Council will ensure that the standard of the Licensing Examination is consistent with that adopted by the two faculties of medicine in Hong Kong for assessing their medical graduates.  Papers of the Licensing Examination are also prepared by the teaching staff appointed by the two faculties of medicine and vetted by the Examination Sub-Committee of the Licentiate Committee under the Medical Council.

     Under the principle of professional autonomy, the Government respects the arrangements made by the Medical Council regarding the registration of medical practitioners and its Licensing Examination.  It is believed that the Medical Council will, as before, handle the registration of medical practitioners in Hong Kong on the premise of safeguarding public interest and protecting public health.

     Thank you, President.

Ends/Wednesday, November 9, 2011
Issued at HKT 16:25


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