All hell broke loose when the Medical Council announced the results
of voting on the proposal for “exemption from internship assessment for
non-locally trained doctors who have passed the Licensing Examination” after
its policy meeting on April 3, 2019. The
results were that all 4 options from the proposal were voted down upon.
This mess could be traced back to June 2017, when the Steering
Committee on Strategic Review on Healthcare Manpower Planning and Professional
Development issued its review report. In
July 2018, the Food and Health Bureau invited the Medical Council to consider
plans to take forward the recommendations in Chapter 5 of the review report. One of the key recommendations was the
“facilitation for qualified non-locally trained doctors in taking Licensing
Examination and internship assessment”. The
Medical Council then set up a Task Force to look into these matters.
There was general agreement among the Task Force members that the
internship assessment period could be shortened. At present, the assessment period after a
candidate passes the Licensing Examination is 12 months, after which he can get
his full registration. However,
candidates can apply for exemption up to 6 months if he has a specialist
qualification comparable to a Fellowship of the College of the Hong Kong
Academy of Medicine. So, practically we
were talking about whether to shorten the assessment period of another 6 months
only.
It was also agreed by Task Force members that candidates who applied
for the exemption of the remaining 6 months should have worked for a certain
period in institutions in Hong Kong. This
was in line with the principle for the requirement of internship. After practicing in Hong Kong, the doctor
should be familiar with the local scenarios including the healthcare system,
epidemiology and culture.
There were 2 areas not in agreement:
- The period that the candidate was required to work in Hong Kong. This covered both the length of the period, and whether the candidate needed to work for a further fixed period after he passed the Licensing Examination.
- The institutions concerned. The disagreement was whether it should only be the Hospital Authority, or it should cover all 4 institutions including the Hospital Authority, the 2 Universities and the Department of Health.
So, there came up with 4 options for the full Council to consider
and to vote upon during the policy meeting on April 3, 2019. Basically, all 4 options included that the
candidate should have passed the Licensing Examination; and should hold a
specialist qualification. The
differences were:
- A. A total of 3 years’ experience (including the period before he passed the Licensing Examination) in any of the 4 institutions under limited registration.
- B. After passing the Licensing Examination, he had to work for another 3 years in any of the 4 institutions under limited registration.
- C. A total of 3 years’ experience in the Hospital Authority under limited registration.
- D. After passing the Licensing Examination, he had to work for another 3 years in the Hospital Authority under limited registration.
Actually the 4 options were in pairs. They differed mainly by the period of
experience, and where the candidate was to work. It was like an “chicken or egg first?”
argument for the period to work before a candidate could apply for the further
exemption. Obviously 3 years might be
enough to gain his local experience. A
shorter period might help to attract more candidates to apply. However, he might leave the public institutions
immediately when he got his full license. That did not serve the purpose of alleviating
the shortage of manpower in the public institutions. For the same token, allowing the candidate to
work in any of the 4 institutions might defect the purpose of attracting
overseas doctors to work in the Hospital Authority. It is common knowledge that the working
environment in the Hospital Authority cannot be described as attractive
compared to the other 3 institutions.
There had been diligent lobbying by government related persons, and
among the Medical Council itself. It was
debatable whether one should concede when matters concerned important
principles. However, in this matter, the
number at stake was estimated to be a handful of candidates a year. It might not be a good time to drag on when
there was so much sentiment orchestrated in the public.
Before the voting, there had already been common consensus reached. Whichever of the 4 options came out, there was
unlikely to be vigorous action of opposition. However, it messed up. It was described as “the worst show-hand”
where the player messed up with the best cards he had ever got. A new set of voting rules was used. Although there was no problem with the set of
rules, when applied in these particular conditions, all it did was to foul up. The procedure of the meeting did not reflect
the opinions of members present. The
voting did not aim at problem solving and decision making. The consensus was ignored, and all 4 options
were defected by the dividing of votes because of fine details.
After that, all hell broke loose. There were press releases, there were
finger-pointings, there were words of regret from the government, there were
open accusations, there were open letters, there were demonstrations. And of course, there were back-stabbing. And there were more orchestrated sentiments.
The newest progress as on April 12, 2019 was another press release
from the Medical Council Chairman. It
stated that “in view of the importance of the subject issue”, he was going to
propose to suspend the operation of the Standing Order of the Medical Council
“so that the Medical Council may reconsider and decide the various matters on
exemption of internship assessment for non-locally trained doctors by a voting
arrangement to be agreed.”
It was not common when consensus could be reached by all stack-holders,
and an even rarer occasion that it then got all messed up.
(Source: HKMA News Apr 2019)
