The first shocking news of the medical profession in 2016 was the
announcement, interestingly via news media, of proposed reform of the Medical
Council by the government through introduction of an Amendment Bill to the
Medical Registration Ordinance (MRO). In
this issue of the News, you must read the page from Lai Eve. She had nicely summarized the content of the
reform proposal and divided them into “controversial” and “straight-forward”
categories. The most ingenious was the
title she coined this reform proposal:
The Medical Council Deform.
You might say that it was exaggeration to describe the proposal as
deforming the Medical Council. Or some
might argue that it is necessary to deform the Medical Council if there is a
need to do so, so as to serve the public better. I shall high-light a few points before going
into discussion.
- It was stated that this proposed Amendment Bill was only an interim action. More thorough reform might be introduced after the review from the Steering Committee on Strategic Review on Healthcare Manpower Planning and Profession Development in Hong Kong.
- This interim action was called for because there was a recent High Court case in which the judge severely criticized the delay by the Medical Council in handling complaints, and there had been mounting public pressure for urgent improvements.
- Another immediate concern was that the Medical Council needed more flexibility in approving a longer period of up to 3 years for application for limited registration of non-locally trained doctors to practice in Hong Kong.
- In the proposed Amendment Bill, the most controversial item is to increase the number of appointed lay members in the Medical Council from 4 to 8.
I am not going to argue whether there are urgent needs to introduce
reform while the report of the Steering Committee is due to complete. I have to point out that the increase in
appointed lay members from 4 to 8 vastly disturbed the balance in the
composition of the Medical Council, while serving no actual purpose in
addressing the 2 stated objectives.
Complaint handling is but one important function of the Medical
Council. Complaints are first screened
by the Preliminary Investigation Committee (PIC). The PIC would refer the case for an inquiry
if a decision on whether the doctor is guilty is needed. It is statutory requirement for a lay member
to form the quorum both in a PIC meeting and in an inquiry. Therefore, there seems a need to increase the
number of lay members in the Medical Council if more PIC meetings and inquiries
are to be held. However, this complaint
handling function is purposely segregated from the other functions of the
Medical Council for fairness and for the guarantee of independent decision
making by individual members. PIC cases
and inquiry details are never discussed in policy meetings or among
members. Therefore the issue of needing
more lay members to meet PIC and inquiry quorums can be addressed by adjusting
the role of assessors.
Assessors are persons who can take part in an inquiry. They will not take part in any other meetings
or decision making of the Medical Council.
One of the purposes of such design is to relieve the workload of members
of the Medical Council. In the proposed
reform, there are important modifications to the numbers and roles of
assessors. A lay assessor can replace the
lay member in a PIC meeting or an inquiry to form the quorum. The number of lay assessors appointed would
be raised from 4 to 14. All these
changes can in fact address the issue of lay persons in complaint handling
without disturbing the composition of the Medical Council.
Another often proclaimed problem about complaint handling not
mentioned in the reasons for reform is “doctors protecting doctors”. It is argued and propagandized that
increasing the number of lay members is important and useful to address this
issue. However, the proposed reform
keeps the majority of doctors in both PIC meetings and inquiries. Therefore, increasing the number of lay members
is irrelevant in this respect.
Increasing the number of lay members from 4 to 8 changes the ratio
of lay members to doctor members from 4:24 to 8:24 (1/6 to 1/3). Lay members are still the minority. However, one should not overlook the fact
that all lay members are appointed by the government. Within the Medical Council, there exists a
delicate balance of appointed member to elected member of 14:14. When the number of lay members is increased
by 4, the ratio of appointed members to elected members would be 18:14, with
clear majority votes by appointed members.
It has been hinted by some, and overtly expressed by many, that
elected members in the Medical Council tend to protect the interest of doctors
rather than the public. A too often
quoted example is that non-locally trained doctors are not allowed to practice
in Hong Kong without sitting for an examination because of oppositions from
doctors in the Medical Council. This is
frankly inaccurate and the example is inappropriate. The power of the Medical Council originates
from the MRO. The Medical Council simply
does not have the power to allow non-locally trained doctors to practice in
Hong Kong without sitting for an examination and fulfilling certain requirements. In certain situations, such as the
applications for limited registration, the Medical Council can approve
non-locally trained doctors to practice in the 2 Universities and Hospital
Authority (HA) without sitting for an examination. In the past few years, the HA has used this
mechanism (with objections from a significant number of Hong Kong doctors)
to employ non-locally trained doctors to
work in various departments. So far, the
Medical Council has posted practically no resistance to the applications. The non-locally trained doctors are also able
to successfully renew their limited registrations yearly.
While it certainly undermines the wisdom of doctor voters, it is to
a certain extend true to say that elected members have an inclination to take
interests of the profession more seriously.
However, by the same token, members appointed by the government will
incline to support government proposals.
It is this delicate balance in power of difference stake-holders that
decisions acceptable to all parties can be negotiated. Having a clear majority of appointed members
will distort the Medical Council to the extent that professional autonomy is
affected.
Adding lay members to the Medical Council does not address the
“urgent” needs stated in the proposal.
However, the HKMA is not against adding more lay members. We have a deeper understanding of the
proposal. To safe-guard professional
autonomy, we insist that the ratio of appointed members to elected members be
maintained. One simple method is to add
4 elected doctor members together with the addition of 4 appointed lay members.
(Source: HKMA News January 2016)
