Policy makers should give further consideration
to Medical Grade Reform

(Keywords: two-tier, professional accountability, remuneration, HA Board, service quality)

          After some two years of intense discussion between the public doctors and the Hospital Authority (HA) management, much public debate and many rounds of staff consultation, the "Medical Grade Reform" for public doctors was passed this week by the HA Board lock, stock and barrel, albeit an eleventh hour signature campaign where over 1,500 staff signed up in opposition.

          Surprising enough, few Board Members realise exactly the grievances nor the request of the medical staff.

          What then is the commotion? There are basically two issues.

          The HA, in an attempt to increase professional accountability to the patients, introduces a two-tier system where any medical problem will be the responsibility of a specialist, whilst providing training for the "trainee" (a qualified doctor who has yet to obtain specialist status). This must be an honourable task and is practised by most if not all medical teams. Regrettably, taking the issue to the letter could well be interpreted as every patient for any condition must be seen by a trainee together with a specialist without fail. Such defies common sense, is unnecessary and could only be carried out when the number of specialists be increased many folds to equate that of trainees.

          On this worry, the management have clarified the issue, stating that any supervision could be "direct or indirect"; and that such measures will only "be achieved over time" rather than pushing for a blanket implementation overnight.

          The second matter at issue is the introduction of a new staffing structure and corresponding remuneration package. It is decided that existing staff would not be forced to take up the new package. More, they would be allowed to retain whatever in their existing remuneration ladder, even upon promotion.

          On such basis, some may argue that any employer should have the autonomy to alter remuneration benefits for new recruits. Yet, any organisation with staff doing the same work but with different benefits would certainly affect morale.

          More, under the "new" package, the staring salary of specialists -- by definition of supervisory rank -- is lower than that of other professions in the public sector and even within the HA. Such not only denigrates the medical profession, but could also lead to less top quality people joining the profession, thereby affecting quality of medical care.

          Furthermore, even under the current remuneration structure, the two-tier accountability concept could still be delivered and the principle of cost neutrality -- costing HA no more and no less -- be contained.

          It may be argued that the "new" package could create openings for more "new" specialists. Needless to say, such would still have to depend on the availability of funds. The possibility of more specialist posts must be weighed against the inevitable lowering of staff morale.

          Yes, the unionists have repeatedly aired their opposition against implementing two-tier system overnight -- which the HA management had assured of not the case. Yet, it was only at the last minute that they submitted staff's views on the second issue -- the new remuneration structure -- to the Board Members, leaving little time for lobbying or further explanation.

          It is regretful that the Board Members are not willing to give further considerations to the over 1,500 signature from public doctors in opposition. It is equally disappointing that messages relayed by unionists were too vague and too late. Both sides have this much to learn.

          Now that the Medical Grade Reform proposal has been passed, the Board, the staff and the management should put their heads together to work for the betterment of our public health care.

(Hongkong Standard)