Medical Registration (Amendment) Bill 2021 (2021/10/21)

Medical Registration (Amendment) Bill 2021 (2021/10/21)

MR YIU SI-WING (in Cantonese):

President, the average life expectancy of Hong Kong people is among the highest in the world. One of the reasons is the sound foundation of our public and private healthcare systems. However, having regard to the actual needs of the community, Hong Kong still has a long way to go in addressing the challenges posed by the ageing population in the future. The Government has the duty to review the current policy and continue to allocate more resources, so as to further enhance our medical services.


In recent years, the waiting situation for Accident and Emergency services and outpatient services at public hospitals has been far from satisfactory. Patients have to wait for more than five to six hours during the peak time. The waiting time for specialist outpatient services is even more difficult for the community to accept as it may take as long as several years for some specialist services.


There are many reasons leading to the excessively long waiting time for healthcare services, and one of the major reasons is the shortage of doctors. Hong Kong has been plagued by the shortage of doctors for many years. According to the Healthcare Manpower Projection 2020 promulgated earlier by the Food and Health Bureau, the shortage of doctors will remain in the years to come, with the projected shortfall of doctors reaching 1 610 and 1 949 in 2030 and 2040 respectively. Currently, the per capita doctor ratio in Hong Kong is 2 doctors per 1 000 population, obviously lagging behind that in other advanced economies. For instance, the per capita doctor ratio in Singapore and Japan is 2.5 doctors per 1 000 population; and it is 2.6 in the United States; 3.0 in the United Kingdom; and 3.8 in Australia. I therefore support the Government's legislative amendment exercise to create a reasonable pathway for admission of non-locally trained doctors ("NLTDs").


President, in scrutinizing this bill, my major concerns lie in the following aspects. First, upon passage of the legislation, the Government still has to conduct timely review on the effectiveness. There are many reasons for the shortage of doctors. While the purpose of the Government's legislative amendment exercise is to attract overseas doctors and medical graduates to come and practise in Hong Kong, thereby alleviating our shortage of doctors, it remains unknown whether they are willing to come to Hong Kong. Therefore, the Government should not assume that the problem of shortage of doctors will be solved with the passage of the legislation; rather, it should take the initiative to conduct regular review on the effectiveness of the legislation and make timely adjustments.


According to the Government's projection, following the current legislative amendment exercise, the target of 2.5 doctors per 1 000 population can be achieved by 2040, but compared with the per capita doctor ratio of the United Kingdom and Australia, this target is not aggressive and there is still a certain gap. With the changes in population, doctor attrition rate and medical needs, I have proposed at the Bills Committee meeting that the Government should timely adjust the growth rate in a phased manner before 2040, and consider alternative approaches if it falls short of the target. These approaches include making reference to the reputation and achievements of overseas medical institutions, considering the admission of outstanding doctors or Hong Kong students who are studying in medical schools run by local universities established in the Mainland, and other feasible options. The ultimate goal is to have sufficient qualified doctors in Hong Kong, so as to meet the basic medical needs of the community.


Secondly, a scientific and fair assessment system should be put in place, so that more overseas medical schools can be recognized. The current Medical Registration (Amendment) Bill 2021 ("the Bill") seeks to create a new pathway for NLTDs to practise in Hong Kong. The applicant must hold a recognized medical qualification awarded by a specified medical school outside Hong Kong and possess medical registration in any place where the medical schools concerned are located. The list of specified medical schools will be determined by the Special Registration Committee ("SRC").


In the future, the success or otherwise of this legislative amendment exercise will largely depend on whether there will be adequate specified overseas medical schools. I consider that the future SRC should adopt an open, fair and scientific attitude in drawing up this list of recognized medical qualifications, so as to avoid affecting the effectiveness. Before the return of sovereignty, many registered doctors in Hong Kong came from Commonwealth countries, and basically, they could obtain recognized qualifications without taking any examination. With the growing access to education and information, the medical and education standards of many countries (including the Mainland) will continuously improve, and more medical schools will meet the required standards in Hong Kong. SRC should adopt an objective attitude and establish a scientific and fair assessment system for selecting more qualified medical schools based on the actual circumstances, so as to bring in sufficient number of overseas doctors to Hong Kong. To streamline the legislative process of this legislative amendment exercise, I support the Government's proposal to add specified institutions pursuant to the negative vetting procedure. 


Thirdly, a reasonable mechanism should be put in place to retain existing healthcare workers. In the past three years, the attrition rate of doctors in the Hospital Authority ("HA") ranged from 4% to 6%. In 2019-2020, there was an attrition rate of 5.4%, or 322 full-time doctors in equivalent, in HA. The unreasonable wastage will only exert extra pressure on existing frontline healthcare workers. At present, healthcare workers in Accident and Emergency Department and medical wards are overburdened with excessive pressure. Doctors and nurses are human beings. When they are under constant physical and mental stress, they will of course consider changing jobs for better pay and more comfortable working environment.


Globally, various countries are facing a shortage of healthcare workers. The situation is especially severe owing to the spread of the novel coronavirus epidemic in the recent two years. Various countries are competing for medical talents. For instance, the United Kingdom, the United States and Australia are competing for doctors by adopting an examination-free admission policy; Singapore has 40% of its doctors being overseas doctors exempted from examinations; the private healthcare system in Hong Kong also keeps recruiting healthcare workers from the public sector. Under such circumstances, the public healthcare system should take corresponding measures to avoid massive wastage of existing doctors; otherwise, even with the admission of NLTDs, we cannot overcome the current problem of inadequate healthcare services.


Therefore, the Government has the duty to keep reviewing the working environment, remuneration package and promotion prospects of existing healthcare workers, and make reasonable manpower deployment so that healthcare workers can work at ease. Moreover, upon passage of the Bill, some local doctors may not understand the intention of the Bill and may even feel dissatisfied. The Government has the duty to give an adequate explanation so that the community will understand that the new legislation only seeks to alleviate the pressure on doctors in the public healthcare system, and shall not bring any adverse impact to their career development or promotion prospects.


President, the current Bill is just a means to an end, but not an end in itself. In the future, the Government should adopt a multi-pronged approach. Apart from making good use of the existing public and private healthcare resources, the Government should continue to build more hospitals and set up more primary care clinics and day care centres, so as to alleviate the existing pressure on the public healthcare system. To address the excessively long waiting time for patients and improve medical services, this is a systemic project, and the Government is duty-bound to make an all-out effort to implement it.


With these remarks, President, I support the Bill and the Government's amendments.