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Editorial : Doctors' professional autonomy

【明報專訊】WITH public hospitals facing a shortage of doctors, the government was hoping to relax the requirements for residency applicable to specialists from overseas countries so as to encourage them to practise in Hong Kong. What was unexpected, however, was that all of the four proposals would be defeated in the Medical Council. That has renewed scepticism about whether the medical industry is dominated by protectionist forces and the self-interest of a few has been prioritised over the public interest.

There is a serious shortage of medical professionals in Hong Kong. There are only 1.9 doctors per 1,000 people, a ratio much lower than the 3.3 in the United States and 3.7 in the UK. It is an undisputed fact that Hong Kong's public healthcare system is bursting at the seams and frontline doctors are overwhelmed. It takes a long time to increase the number of people training to be doctors. "While the grass grows, the horse starves," as the saying goes. Bringing in an appropriate number of qualified doctors from overseas can help mitigate the urgent problem. Local organisations of doctors, however, remain steadfast in the argument that the proportion of doctors is already higher than at the turn of the century. They argue that the problem is not so much "the lack of doctors" as an imbalance between public and private healthcare services.

Currently qualified doctors have to overcome many barriers before they can practise in Hong Kong. Some people who have been through the process describe some of the requirements as unreasonably harsh. In recent years, there have been voices in society critical of rampant protectionism of the medical industry. They demand that the industry allow more overseas doctors with the right credentials and professional standards to practise in Hong Kong, especially descendants of Hong Kong people who studied medicine abroad. At the end of last year, the Medical Council established a task force that began looking into the issue with a proposal to relax the requirements for residency with the hope of reducing unnecessary thresholds.

Compared with a change to the requirement of a licensing examination or a mechanism adopted in places like Singapore that allows graduates of prestigious universities around the world to practise without taking a licensing examination, the proposal put forward by the task force was actually very limited in scope. The medical industry said that doctors had reached a basic consensus on the relaxation of the residency requirement. Surveys also show that most doctors agree that overseas specialists who have passed the licensing examination should be exempted from the residency requirement. All sides thought that the proposal would be adopted by the Medical Council. The outcome turned out to go against their wish.

In recent years there has been ceaseless disagreement over the reform of the Medical Council. The medical industry insists that doctors should make up half of the commissioners to ensure "professional autonomy". Although a reform package was at last adopted last year and the number of commissioners outside the industry increased from four to eight as a result, representatives of doctors remain in a dominant position. Representatives from inside and outside the medical industry have both expressed shock and disappointment at the Medical Council's rejection of the relaxation of the residency requirement. One representative of the industry even says that most commissioners have reached a consensus on the exemption, and those against it "can be counted on one hand". The problem is the arrangement and mechanism for the way the votes were held. There should not have been separate votes on the four proposals, he said, implying that the sector did not obstruct the passage of the proposals.

The government should not turn a blind eye if self-interest is prioritised over the needs of society in the name of professional autonomy. The biggest goal of the reform of the Medical Council is to make the medical profession serve citizens better. The result of the vote shows that the reform of the Medical Council has not been strong enough, and protectionism remains a problem. The government must step up intervention — it cannot just merely say it is disappointed about the result.

明報社評2019.04.05:醫生專業自主 不能凌駕公眾

公立醫院醫生短缺,政府希望放寬海外專科醫生申請註冊所需的實習期,吸引他們來港執業,未料4個方案全遭醫委會否決,再度令人質疑醫生業界保護主義當道,小撮人私利凌駕公眾利益。

本港醫護人手嚴重不足,醫生與人口比例是每1000人只有1.9名醫生,較諸美國的3.3、英國的3.7等低很多。公營醫療系統爆煲,前線醫生疲於奔命,已是鐵一般的事實。增加培訓本地醫生需時甚久,遠水難救近火,適量輸入合資格海外醫生,有助紓緩燃眉之急,可是本地醫生組織卻堅持,現今香港醫生比例已比本世紀初為高,問題「不是醫生不足」,只是公私營醫療服務失衡,云云。

現時合資格海外醫生來港執業,需要通過不少關卡,有過來人形容,部分要求嚴苛得不合理。近年社會有聲音批評醫生業界保護主義強烈,要求業界容許更多合資格夠水平的海外醫生,特別是負笈海外學醫的港人子弟回流執業。去年底,醫委會終成立專責小組,從放寬實習要求入手,希望減少不必要的門檻。

比起改變執業試要求,又或仿效新加坡等地採取國際著名大學醫科畢業免試執業等機制,小組提出的方案,其實只是很有限的改動。醫生業界表示,他們對放寬實習有基本共識,問卷調查亦顯示,多數醫生贊同通過執業資格試的海外專科醫生可免除實習期,各方都以為醫委會定會通過方案,豈料事與願違。

近年醫委會改革紛爭不休,醫生業界堅持醫生委員需佔一半,才可確保「專業自主」。雖然醫委會改革方案去年終獲通過,業外委員由4人增至8人,然而醫生專業代表實際仍佔主導地位。今次醫委會否決放寬實習要求,業界與業外代表均表意外和失望,有業界代表還說,大部分委員都有共識豁免實習期,反對者「一隻手都數得晒」,問題出在投票機制安排,不應將4個方案獨立投票,言下之意是業界沒有阻撓通過方案。

倘若專業自主變成私利先行、凌駕社會需要,政府便不能坐視。醫委會改革最大目標,是令到醫生專業能夠更好地服務市民,今次投票結果反映醫委會改革力度不足,業界保護主義問題並未掃除,政府必須加強介入,不能僅僅說句對投票結果失望便了事。

■Glossary

practise : to work as a doctor, lawyer, etc.

renew sth : to begin sth again after a pause or an interruption

mitigate sth : to make sth less harmful, serious, etc.

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