Hong Kong passes contentious bill allowing more overseas-trained doctors to practise in city, with applications ‘likely to open in third quarter next year’

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More doctors from overseas and mainland China can apply to work in Hong Kong as early as next year, the Post has learned, after the legislature passed a contentious bill paving the way for them to practise in the city and help plug a medical manpower shortage.

The Legislative Council on Thursday voted 39-1 to approve the government’s amendment to the Medical Registration Ordinance, ending months of bickering stemming from fierce opposition by the health care sector over concerns that an influx of doctors unfamiliar with the local system would lower standards.

Now that the bill had cleared the final hurdle to become law, a source said, doctors hoping to join the new scheme were likely to be able to apply starting from the end of the third quarter of 2022.

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The bill had faced stiff resistance from doctors’ representatives. Photo: Nora Tam
The bill had faced stiff resistance from doctors’ representatives. Photo: Nora Tam

Health minister Sophia Chan Siu-chee told lawmakers the legislation would not replace existing processes.

“The bill is not to replace the system of the licensing exam, but to add a new pathway to let eligible non-locally trained doctors serve in the city’s public health care sector, while ensuring the doctors’ quality,” she said.

Chan said membership of a 10-strong Special Registration Committee, which would be responsible for drafting a list of recognised medical schools whose graduates could be exempted from the city’s licensing exam after meeting certain criteria, could be announced next week.

The committee, comprising health officials and medical educators, would hold its first meeting next month. The list, containing no more than 100 recognised schools of “comparable” quality with the two local teaching universities, would be formulated in the second half of next year.

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The Hospital Authority, Department of Health and Academy of Medicine would also set up a platform to discuss training matters for specialists, Chan said.

City leader Carrie Lam Cheng Yuet-ngor first floated the plan to attract overseas-trained practitioners in February, saying she was prepared to “go to war” to bring in more doctors.

The government’s original proposal, introduced in Legco in June, centred on waiving local licensing exam requirements for overseas-trained doctors, provided they met certain conditions.

Following calls from pro-reform advocates to open the door even wider, the government further amended its proposal in late August and agreed that non-permanent residents who were specialists would also be eligible to join the scheme, along with permanent residents.

But they must be graduates of recognised foreign medical schools and already registered to practise. They should also serve the city’s public health care system for at least five years after obtaining their specialist qualifications.

The government hopes the rule changes will help alleviate a chronic staffing crunch. Photo: Sam Tsang
The government hopes the rule changes will help alleviate a chronic staffing crunch. Photo: Sam Tsang

Under the revised plan, permanent residents who graduated from foreign medical schools will also be able to take local licensing exams without the need to intern overseas beforehand. They will then be able to intern locally if they pass.

The plan also allows foreign doctors working in the city under a limited registration scheme to become fully registered after 10 years in the public sector.

Lawmaker Elizabeth Quat, from the Democratic Alliance for the Betterment and Progress of Hong Kong, said she supported the bill but more work needed to be done to tackle problems in the public health care system.

“I’m worried that even with the passing of this bill, how many doctors can we attract?” she said, listing overcrowded hospitals, heavy workloads and poor management as some of the sector’s pressing problems.

Medical sector lawmaker Dr Pierre Chan, the only member to vote against the bill in a legislature with no opposition camp, criticised the legislation, saying it infringed on the profession’s ability to regulate itself.

“[The bill] damaged a fair examination system, and professional autonomy,” he said, calling it a “political move” by the government to put forward the bill in February, when medical workers were in the middle of a fight against Covid-19.

He added that most doctors who responded to a poll he conducted in June also opposed the proposal.

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But Sophia Chan said doctors recruited through the special registration scheme would be subject to regular assessments in areas such as medical knowledge application, clinical performance, personal integrity and team spirit.

Doctors’ groups remained critical of the plan, while patients’ rights advocates sounded a welcome if cautious note.

Medical Association president Dr Gabriel Choi Kin called the bill’s passage “regrettable”.

“The standard in monitoring the profession is gone, or worse,” Choi said. “In the past, as long as you met a certain standard and passed [the exam], you could then practise. Under the special registration scheme, [your practising qualification] could be decided by a few people.”

Choi said the Medical Council, which handles the registration of doctors, was trying to draft its own reference list of recognised medical schools based on passing rates of graduates in the local licensing exam.

The Academy of Medicine, which hoped the new pathway could help alleviate manpower shortages, said it would continue to discuss details on implementing the law with the government and other stakeholders.

Alex Lam Chi-yau of advocacy group Hong Kong Patients’ Voices welcomed the idea of allowing capable and experienced doctors trained overseas to work in the city, but said he doubted whether the plan could truly address manpower shortages in public hospitals.

“The special registration scheme will also allow doctors to work in public institutions apart from the Hospital Authority … it is not truly tackling the manpower issue in public hospitals,” Lam said.

Tim Pang Hung-cheong of the Society for Community Organisation said time was needed to assess how effective the plan would be in attracting people but a generally unwelcoming attitude by local doctors would not help.

Health secretary Sophia Chan. Photo: Nora Tam
Health secretary Sophia Chan. Photo: Nora Tam

The political row over the thorny issue of how to tackle a shortage of public sector doctors has been years, if not decades, in the making.

In 2016, the government attempted to attract more doctors trained overseas by extending their registration period under the limited-registration system from one year to three, part of a controversial set of measures aimed at reforming the Medical Council. But lawmakers only passed the move in 2018.

A year later, the council passed a plan to exempt an internship of non-local medical specialists who have already passed the city’s licensing exam, given they had worked for three years in the public health care sector. It also aimed to remove hurdles for overseas-trained doctors to work in the city.

Officials had argued the overhaul was needed to ease a chronic staffing crunch, noting the city had just two doctors for every 1,000 residents – significantly fewer than Australia’s 3.8 and Sweden’s 4.3. A failure to adopt the new framework, they warned, would result in the city having 1,610 fewer doctors than it needed by 2030, with that figure rising to 1,949 by 2040. It remained unclear, however, exactly how many doctors the changes would attract.

Before the changes, foreign-trained doctors either had to pass the local licensing exam and complete an internship, normally of six months to a year, or take a job in the public sector, which would allow them to skip the test but only grant them limited registration.

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