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








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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