After the Medical Council Saga on April 3, 2019, the “facilitation
for qualified non-locally trained doctors in taking Licensing Examination and
internship assessment” issue had escalated to receive the attention of the
Chief Executive of Hong Kong. The
discussion had shifted from “facilitation in taking” to total abolishment of
the internship assessment. Even the
Licensing Examination was deemed obsolete and dispensable. I am not going into anti-intellectual
arguments of whether all Hong Kong citizens should be able to have GOPC
appointments whenever they like to, or to have their cataracts done immediately
at $100. Even if Hong Kong is flooded
with doctors, these objectives are unattainable for obvious reasons. Rather, as a doctor who has seriously thought
about practicing abroad, I analyze below whether exemption of the Licensing
Examination would be a crucial factor in the decision making.
Doctors are all specialists in examinations. We are selected by examinations and then
trained to tackle and to pass various examinations. This is part of our skills. Of course, it would be a merit if there is no
need to sit for and pass an examination before one can practice. However, it is unlikely a major concern.
To practice in Hong Kong means to migrate to Hong Kong. Few doctors would act like domestic helpers. We do not expect them to earn a living here to
support their family abroad, or to work for several years, save some money and
return to their homeland. The decision
is whether to live and to work in Hong Kong, not just to work here.
We are not supposed to provide basic specialist training to attract
non-local doctors. Front-line doctors
and medical students are already foreseeing shortage in training opportunities.
In addition, it is hard to prevent a
doctor from leaving Hong Kong immediately after he finishes his training. We are talking about increasing the supply of
manpower, and not promoting training centers. However, to attract doctors who have finished
their trainings and have establishment in their careers is more difficult. The working environment in our public
hospitals under the Hospital Authority is by no means pleasant. It is true that some of the private specialists
in Hong Kong are earning incomes even envied by the rich Legislative
Councilors. But they are the lucky few
and they still need to face long working hours and the stress of private
practice. To most non-local people,
living is much more than turning precious lifetime into clinic and surgery
hours and money.
The living standard in Hong Kong is notoriously high worldwide. A 3-bedroom 1000 square feet flat in non-rural
area easily costs $30 million. A balcony
is a luxury. Backyards are for tycoons. A car park space costs $3 million and you
still need to walk with an umbrella in a rainy day to get your car. Unless the doctor is from a comparable city,
it is not easy to adapt to such cramped living environment.
The next generation is likely to complain more. The curriculum of local schools is uniquely
designed for the DSE. Immigrant doctors might
need to explain to their kids what “learning” means here. Starting from kindergarten, seats for good
schools are sacred. Seats for
international schools are not only sacred, but also expensive. Doctors in Hong Kong work hard so as to send
their kids to study in UK, USA, Australia, New Zealand and everywhere. It would be soul searching if immigrant
doctors need to send their kids to universities back in their homeland.
Living is not just working or going to school. Other factors that need to be considered
include: language, culture and leisure facilities, air pollution, attitude of
citizens towards foreigners, freedom and political stability. The list is never exhaustive. It is also highly individualized. I am not saying that Hong Kong is not good and
no one wants to migrate to Hong Kong. But it is a fact that Hong Kong people
are always enthusiastic in emigration, or to secure a foreign passport even in
Vanuatu. It is an important decision to
uproot a family and move to another country. With so many factors at stack, it is hardly
likely that an examination, which doctors are trained to handle, serves as a
significant determining factor. Some Legislators
suggest that we should attract Hong Kong citizens who are practicing abroad. If family reunification is not a strong enough
urge, there must be factors other than an examination that deter the doctor
from coming back.
It is thus improper to dispense of the Licensing Examination as an
important and fair means to assess the standard of non-local doctors. It is tedious and it needs some hard work to
prepare for the Licensing Examination. However, medical work is tedious. It needs some practice to spell the word
“chloramphenicol” correct. It is tedious
to follow standard procedures in performing surgeries. It needs some hard work to stay updated with
new medications for the treatment of cancers. Are we really looking for doctors who would
jump to Hong Kong just because they are exempted from taking an examination?
(Source: HKMA News May 2019)
