Editorial : Public Dental Services : Boost Staffing and Reform

【明報專訊】Tackling a shortage of manpower in the public healthcare system, the government has taken a multi-pronged approach. This includes ramping up the introduction of non-locally trained doctors and nurses and stipulating that locally trained doctors and nurses must stay in the public healthcare system for a certain period. The suggested amendments to the Dentists Registration Ordinance now under consultation are also aimed at these two targets.

In Hong Kong, almost 90% of specialist services are provided by public hospitals. However, doctors in public hospitals account for less than half of the total number of doctors in Hong Kong. Before the COVID-19 pandemic, the public healthcare system was already facing a manpower shortage. Due to burnout and the poor working conditions in public hospitals, many doctors and nurses have left their posts. The wave of emigration further exacerbates the shortage.

While stepping up the training of local doctors and nurses is a measure that will root out the problem, it takes years to train professional medical personnel. "While the grass grows, the horse starves," as the saying goes. At the same time, tertiary institutions are constrained by objective conditions such as limited equipment and supporting facilities. Greatly augmenting the number of training places in the short term is easier said than done. To relieve the manpower pressure of public hospitals as soon as possible, a new approach must be taken.

The new stipulations the authorities are proposing will require locally trained non-specialist dentists to serve in the public healthcare system or other specified organisations for a certain number of years, with the initial goal set at two years. As for local dentists who will have acquired specialist qualifications under the Department of Health's supervision, through administrative methods, they will be mandated to serve under the Department for two to five years. The government is also considering introducing qualified non-locally trained dentists. Strong reactions from the dental industry include describing the government proposal as "turning things upside down", and the restrictions over the number of years to serve under specified institutions as "harsh" as well as a discouragement to the younger generation from studying dentistry.

At present, local dental graduates can practise in Hong Kong after registration without an internship. In the consultation document, it is proposed that local dental graduates be required to do a one-year internship in organisations such as the Department of Health or the Hospital Authority. This requirement is about improving the clinical standards of dentists and is different in nature from the requirement of working for a designated organisation for two years. These two requirements must not be conflated. Whether the proposed amendments are "harsh" is a matter of opinion. Strictly speaking, the notion that the amendments will "scare away students who intend to enrol" is a conjecture almost uncorroborated.

In contrast, the issue that deserves more attention is that public dental services are mainly used by civil servants, while grassroots citizens have to wait in long queues at government dental clinics for things such as tooth extractions. Unless this is changed, bolstering dental manpower in public healthcare only offers limited benefits to the general public.

In recent years, the government has emphasised the development of primary healthcare. This presents exactly an opportunity to reform public dental services. Of course, from the point of view of the private dental industry, either the scaling up of public dental services or the introduction of non-locally trained dentists may mean "more business competition". It cannot be ruled out that some industry participants view the issue of "bolstering public dentist supply" from this perspective. Any reform that affects vested interests will always provoke a backlash, but the government must put the interests of society first. Apart from expanding public dental services, the authorities can also consider promoting public-private partnerships so that the industry understands that we are all in the same boat.

明報社評2023.03.10:公營牙醫服務須改革 充實人手僅屬第一步










augment : to increase the amount, value, size, etc. of sth

conflate : to put two or more things or ideas together to make one new thing or idea, esp. in a way that is inaccurate or harmful because the two are not really the same

uncorroborated : (of a statement or claim) not supported by any other evidence

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