Politicians and public figures from a range of backgrounds take turns to have their say on important matters of the day in this personal view programme.
Catch it live: Sunday 8:15am - 8:25am
Podcast: Updated weekly and available after broadcast.
My Dear Sons,
The Government recently proposed to amend the Medical Registration Ordinance to allow non-Hongkong medical graduates full registration to practise without examination. The proposal is limited to Hong Kong citizens graduating from approved outside medical schools, who have served in the public sector for 5 years.
Many people are still not aware that doctors graduating outside Hong Kong do not need to take any examination to practise medicine here. All they need is to find employment with the Hospital Authority, Department of Health, or the 2 Universities. They are granted a licence to practise in public institutions (limited registration), which will be renewed every 3 years. If they wish to practise independently in private, then they have to pass an examination which is set at the medical school graduation level.
The Medical Council has been criticised for setting protectionist examination with a very low pass rate. During the period 2012-16 the part 1 (professional knowledge) pass rate for graduates from USA, Canada, UK, Germany and Australia averaged 40%, from Mainland China 16%, and belt and road countries 11%. For part two (use of English) the pass rates were 100%, 70%, and 99% respectively. The part 3 (clinical exam) pass rates were 53%, 28% and 17%. Examinations are held twice yearly and candidates can have 5 attempts before any review.
You all know that I myself have failed many examinations in medical school, and at the specialist level. I have never blamed anyone for setting a high standard but only myself for inadequate preparation and inaptitude. When I passed my fellowship examination in Edinburgh in 1978 the overall pass rate was 25%. Nowadays of course we strive for a much higher pass rate, but with medical graduates from many different countries, that may be difficult to achieve.
The Medical Council has the duty to ensure a safe standard of practice with general registration because it allows practice without supervision. To say that the Council purposely designs an examination to keep out foreign graduates is unfair and groundless.
The Hospital Authority (HA) provides well over 90 percent of inpatient and outpatient services in Hong Kong at little or no cost to users. It is no surprise that there is a long waiting list for everything. The problem is attributable to the overall lack of sustainable healthcare financing. The present system has clearly proven unsustainable.
There has been a rapid increase of annual medical student intake by the two medical schools in recent years, which today stand at 530 but if government approves will soon reach 590.
So far, any health manpower planning has proven sadly disappointing.
In 1997,130 of the 270 graduating interns could not find jobs. HA hurriedly created 70 medical posts based on 3-year contracts. Despite strenuous objection from the deans, the medical student intake was cut from 300 to 250. Then, in 2002-3, HA cut 1067 of its medical, nursing and allied health professional staff through a voluntary early retirement scheme in 2 rounds. Yet now it tells us that there are 660 vacant posts for doctors.
Adding doctors alone will do little to alleviate the shortfall of public medical services. Every time you send a patient for elective MRI scanning you are told that the waiting time is at least one year. You want to admit a patient for treatment now but there is no bed available for 3 weeks. Your patient needs surgery for severe knee pain but the queue is 2 years.
To make full use of existing medical staff, funding must be made available for additional nurses, allied health professionals, supporting staff, beds, operation theatres, imaging scanners, office space, inpatient and outpatient facilities. We need a primary care system that effectively reduces dependence on hospitals. Much more can be gained through an improved public-private healthcare interface.
The plight of frontline public doctors is well recognised, but the attraction to move to private practice is not due to a much-glorified swollen income. Young doctors leave HA because of frustration with their work. They feel helpless and see little chance for promotion to consultant level. Even so I don’t want any of you to leave the HA.
In February this year, the Medical Licentiate Society of Hong Kong, after surveying 302 members who are non-local medical graduates, published their strong opinion regarding the fairness, necessity and importance of the licencing examination. They stress that the examination is essential for a safe standard of practice, and 12% of them have yet to pass it.
Hong Kong citizens graduating from reputable outside medical schools should be welcome to receive on-the-job specialist training here, but they will be competing with local graduates for training posts. There has always been a shortage of training posts due to lack of funding, and the Academy of Medicine Colleges have testified to this. Approved trainees go through 6 years of structured training, sit a basic specialist exam at 2 years, and an exit exam at the end. Having completed the training and examinations, local and non-local medical graduates become Fellows of the Academy of Medicine.
I see no need for overseas medical graduates to get on the general registry if they qualify as Academy Fellows. They should be registered as specialists and allowed to practise in their own field.
Some Hong Kong citizens who have completed specialist training abroad may have private practice as their main reason to come back. If so, why not allow them to take the specialist examination together with local trainees? Examination at the medical school level may be unfair to them, as the Hon Mr Tommy Cheung alluded to, but they should feel comfortable to be examined in their own specialty.
My main objection is the government’s proposal to set up a committee to vet a list of medical schools for approval of exemption. This committee bypasses the Medical Council and tramples our professional autonomy, which is an infringement of the Basic Law (Article 142). At best the government will create another committee within the Medical Council, but this alters the structure of the Council and equally negates the long-established principle of one objective standard fair to all.
Furthermore, the proposed committee will face much political pressure, including from non-English speaking influences, which will change the practice and teaching of medicine here forever. And what if, as you all suspect, there are insufficient graduates coming back to take up the offer? Your worst suspicions will probably come true. The door will be open to non-HK citizens.
Ultimately, it is the Hong Kong people who will pay with their health.
My dear Sons, ask your friends who are in the other professions to take heed. Their professional autonomy may be the next target.
I am delighted that you and your sons like my song “Beat the Virus”, which I wrote to boost the morale of Hong Kongers in the pandemic. As your mentor, I applaud your wise parenting, spending time with your children amidst your busy schedule as a front line doctor; and I appreciate your sense of humour to laugh along with your colleagues watching the video together.
Indeed, stressful doctors and nurses in the pandemic have to keep mentally healthy and happy, in the face of daily challenges. We need to relax often when we face excessive expectations, demands and frustrations. While no health workers were infected in the first and second waves, many doctors and nurses were infected in the fourth wave. A doctor was even admitted to the ICU. In the third and fourth waves, more than 150 citizens died, as compared to 8 deaths in the first and second waves.
It is really high time for the Government to classify Covid-19 as an “occupational disease” for those who got infected through their work.
It is worrying that despite restrictive social distancing measures since November, the number of daily confirmed cases failed to return to single digits, with many cases of unknown origin.
Hong Kongers must continue to be vigilant in masking, social distancing, staying home, avoiding social gatherings, and washing hands with soap water or disinfecting them with alcohol sanitizers for 20 seconds after touching objects or before touching face, eyes, nose and mouth.
However, I observe that many people don’t wear masks properly, failing to cover the nostrils; many touch their masks frequently and do not sanitize their hands after touching the polluted masks; some pull the masks down to the neck when they drink, eat or smoke, thus contaminating the inside of the masks by the droplets on the exposed neck and when they pull the masks up again, the contaminated inside of the mask would touch the nose and mouth.
I know your husband John is a smoker. As smokers are more vulnerable to Covid-19 infection, he is endangered especially if he, like many others who smoke in the streets, pull their masks down; and the pedestrians around him would also be at risk.
These loopholes could account for the cases with unknown origin.
To end this pandemic nightmare, mass vaccination is now hailed as light at the end of the tunnel; and in many countries, vaccination has already begun. The Hong Kong Medical Association has liaison with medical associations around the world. The President of the Israel Medical Association told me that Israel has already vaccinated 2 million, that is 22% of its 9.3 million population.
Our Government has ordered 7.5 million doses each of the three chosen types of Covid 19 vaccines : Sinovac, Pfizer-BioNTech and AstraZeneca-Oxford; and it is announced that vaccination will begin around the Lunar New Year, in Community centers, Government and private clinics, and elderly homes.
For mass vaccination to succeed, the Government must try its best to educate the public about the need for vaccination; and to fend off misconceptions and false messages, especially the fallacies wrapped in pseudoscience, denouncing the vaccines.
The choice of vaccines , should of course be based on published peer reviewed scientific research data , rather than emotional or political considerations.
For herd immunity to develop, we should vaccinate at least 80% of the population, or over 2/3 of the population within this year, i.e. 5 million of our 7.5 million people, with 2 injections for each person, amounting to 28,000 injections per day.
So this is a daunting task which requires resolute leadership, with seamless inter-departmental cooperation and collaboration of different bureaus. The Government needs well-planned user-friendly logistics. Transparency builds confidence. People need “informed choices”, with pre-vaccination consent, and 15-30 minutes’ rest time after vaccination. Resuscitation equipment should also be available at each vaccination centre, although severe allergic reaction is extremely rare. Israel has only one reported case of anaphylaxis in the 2 million vaccinees, and the person had recovered without complications.
As a doctor, you know vaccines take weeks to develop immunity. As the elderly were more susceptible to Covid-19 infection, all elderly citizens and all staff working in the elderly homes should be vaccinated as early as possible.
Scientific researches have found Vitamin D supplement useful in the prevention and management of Covid-19 infection; and in the reduction of mortality of Covid-19 patients, though there is still ongoing debate, pending randomized controlled trials. As citizens are advised to stay home due to Covid-19 pandemic, many Asians with coloured skin cannot produce sufficient Vitamin D in the winter. Vitamin D is not only vital for our bones but also important for our immune system. 4000 iu of Vitamin D per day has been advised for adults to maintain a serum level of 50 nmol/litre of 25 OH Vit D. Overweight people are suggested to take 1.5 times more the usual dosage.
As the elderly are prone to Vitamin D deficiency, I urge the Government to provide Vitamin D for all elderly over 65 years of age for the potential protective benefit. Daily Vitamin D fortifications could be given to residents in the elderly homes. In fact, mandatory Vitamin D fortification of milk products has already been implemented in Canada and Sweden.
As incentives for the mass vaccination programme, the Government could consider giving out Vitamin D supplement for all Covid-19 vaccinees when they leave the venues, together with educational materials on the vital role of Vitamin D in our immune system, and a vaccination certificate or code, good for job applications, travelling, reopening of restaurants, gyms, theatres and businesses alike.
Vaccination is not 100% protection. We need to continue proper masking, social distancing, hand hygiene, and daily Vitamin D fortification.
Jane, keep up your morale with good mood while working hard with dignity and passion in the frontline, especially during this difficult time when doctors are often misunderstood and unfortunately, even demonized in Hong Kong.
Thank you for encouraging me to stand for the Medical Council election last autumn. With your support I was elected again. The Medical Council, made up of both doctors and non-medical members representing the benefits of patients, plays the important role of upholding the standard of Hong Kong’s doctors, safeguarding the health of all citizens and serving the interests of all people in Hong Kong.
In closing, I pray that God will bless your family and all Hong Kongers with good physical, mental and spiritual health in the New Year!
Yours sincerely, Uncle Alvin