【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
公營醫療系統人手短缺，政府多管齊下應對，包括加強引入非本地培訓醫護，以及規定本地培訓醫護須留任公營系統服務一定年期，現正進行諮詢的《牙醫註冊條例》修訂建議，主要亦是朝這兩個方向推進。
全港近九成專科服務由公立醫院提供，但公院醫生佔全港醫生人數卻不足一半。早於新冠疫情之前，公營醫療系統已面對人手不足問題，醫護疲於奔命，公院工作環境惡劣，流失不少醫護，移民潮進一步加劇人手荒。
增加培訓本地醫護，雖說是治本之策，但培訓專業醫療人員需時多年，遠水難救近火，各大院校也受硬件配套有限等客觀條件制約，短期內大幅增加培訓學額知易行難，為了盡快紓緩公院人手壓力，必須另闢蹊徑。
當局建議立法要求本地培訓的非專科牙醫，須在公營系統或指定機構服務一定年期，初步目標為兩年，至於在衛生署監督下考獲專科資格的本地牙醫，則以行政方式，規定要在該署服務2至5年。另外，引入合資格非本地培訓牙醫，也是政府考慮之列。牙醫業界對修例反應強烈，形容政府的建議屬「翻天覆地」，又指任職指定機構年期限制「嚴苛」，將減低年輕一輩讀牙醫意欲。
現時本地牙科畢業生註冊後，毋須實習即可在港執業。諮詢文件建議要求本地牙科畢業生須於衛生署、醫管局等機構實習1年，乃是提升牙醫臨牀水平要求，性質跟必須效力指定機構2年有別，兩者不能混為一談，修例建議「嚴苛」與否，見仁見智；所謂「嚇走有意報讀的學生」，嚴格來說只屬推測，並無太多實據。
相比之下，更加需要關心的問題，是目前公營牙醫服務主要供公務員享用，基層市民卻要在政府牙科診所排長龍「等剝牙」，若不改變這一情况，就算充實公營牙醫人手，普羅大眾得益也有限。
近年政府強調發展基層醫療，這正是改革公營牙醫服務的契機。當然，對私營牙醫業界而言，公營牙醫服務規模擴大也好，引入非本地培訓牙醫也罷，都可能意味「搶生意」，不排除業界有人以此角度看待「充實公營牙醫人手」問題。任何牽動既得利益的改革，總會惹來反彈，但政府必須以社會利益為先。當局在擴大公營牙醫服務之餘，亦可考慮推動公私營合作，令業界明白大家同坐一條船。
■Glossary
生字
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