Mal-distribution of Patient Load the root
for Manpower Problem

(Keywords: oversupply, workload, medical financing, health care reform, dual medical system)

          Last Sunday, the editorial of the Hongkong Standard calls for the training of more doctors in Hong Kong. Ironically, in the past years, there were counter calls, in particular from the medical profession, that the two local medical schools should cut student intake. Even the Education and Manpower Bureau is looking into the medical manpower need. Who then is right and who is wrong?

          As a start, there is no denial that our doctors in the public sector, in particular the Hospital Authority, are grossly overworked. Stories abound. Many are working on a 90-hour week, others probably more. A continuous working cycle of over 30 hours is the norm rather than the exception. The more unfortunate who happen to be on call in public holidays often times are not properly compensated.

          Worse the scenario is heading for deterioration. With the decree of "enhanced productivity" despite forever increase in patient load, it would be foolhardy to expect any proportional increase in staff to soothe the pressure. Little wonder that strong voices abound calling for more doctors to ease the public hospital workload.

          Yet, the reality is that in recent years, many medical graduates were reported to be unable to secure jobs after repeated attempts. Some are reported having to work as a pharmaceutical representative, insurance agent, etc, inadvertently not putting public money into its expected use! Private clinics are lamenting to be running at a much lower market share compared to previous volumes. Some of the private hospitals are reported to have to struggle to stay afloat. Is there then a doctor shortage?

          With some 9,000 doctors working in Hong Kong serving a 7 million population, giving a ratio of 1 doctor to some 780 people, Hong Kong has an adequate doctor number to work with by any standard. Yet, about 40% of them are working in the public sector, looking after some 95% of the population that need hospital admission.

          The problem, therefore, is not a general medical manpower shortage but rather a mal-distribution of patients. We have no defined policy of what heavily subsidised public medical services are for and for whom. We have the pledge that for a mere $68, any Hong Kong citizen can get the best medical care with a good "hotel type" of hospital environment to boost. Little wonder few, irrespective of wealth, can resist the temptation of shifting to the public sector for whatever ailment.

          Unless and until we have a properly defined policy that public medical cost should be a shared responsibility between the users and public coffer, and that those who can afford should pay, our health care system will hardly be sustainable but heading for a disaster.

          We look forward to such a political determination in the forthcoming long awaited Health Care Reform Green Paper.

          The proponents for further increasing medical student intake, and for allocating more funds to employ more doctors in the public sector, resemble "watching the world through a tiny hole".

          Superficially, to the uninformed public, this suggestion must be welcome. After all, who would not favour a next to free medical system? Yet, where can "extra" funding be coming from when Government budget has to be well proportioned between the different areas of societal needs?

          Furthermore, with no change to the current policy, increase in staff, though no doubt will cut down the workload of public hospitals in a short time, will invariably attract an even more shift from the private sector. The medical system of Hong Kong has flourished on a dual basis, under which the private and public sectors working side by side, ever since the early colonial days. This culture must be preserved.

          Societal leaders must, therefore, look beyond the populist culture of trying to please all. Rather, they should stand up to lead the populace onto the proper path for Hong Kong.

(Hongkong Standard)