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About HKCFP > President’s Message

April 2018

I just spent my Easter break at Nanning for the 5th Cross-Straits Medicine Exchange Association Conference. Nanning is the capital city of Guangxi in southern China. It is known as the "Green City" because of its abundance of lush subtropical foliage. Our delegates were headed by Prof. Donald Li and Prof. Cindy Lam who are the Chairman and Vice-Chairlady of the Exchange Association respectively. Prof. William Wong, Drs. Jun Liang, Edwin Chan, Alex Zhang were all there to support. Dr. Dao Man Chi represented our Young Doctors Committee and Dr. Chiang Lap Kin received the best paper award. We had witnessed the second batch of three recipients of HKCFP Donald Li Scholarship. They were from Henan, Shanghai and Beijing and had previously attended the training course organized by the College. They will have the opportunity to attend the Family Medicine clinics at university, public and private sectors in Hong Kong for exchange of knowledge and ideas.

China has well recognised that Family Medicine will improve the health of population, lower the cost and result in less heath inequality. The latest important China policy is to enhance the training of family doctors, speed up the infrastructure building of primary healthcare and promote the contract services of family doctors.

The gatekeeper role and the importance of family doctor in dealing with episodic, chronic diseases, preventive care and the whole person healthcare management are highlighted. The training at the moment is 5+3+X. 5 is the basic medical school training. 3 is a Master degree in clinical medicine or postgraduate training in Family Medicine but unfortunately the trainees are mainly spending time in hospital training with very little community exposure! “X” is yet the undetermined future training to become a specialist FM doctor. Continuing medical education CME and continuing profession development are encouraged.

I was most impressed when the senior official from the National Health and Family Planning Commission openly highlighted the problems with uneven distribution of resources, training standard and quality, low wages, lack of promotion and professional development that the primary healthcare system is facing. The government understands the problems and is changing its policy to fulfil the primary healthcare need of the most populated country in the world. Not an easy task! At this very moment, China has 209,000 family doctors. By 2020, the ratio is 2-3 family doctors per 10,000 people and by 2030, the ratio is 5 per 10,000 people meaning there will be 650,000 family doctors.

To put a figure on how many trained Family Physicians is needed in Hong Kong, I have taken a leaf from the National policy of one family doctor per 2000 people. Hong Kong with a population of about 7.5 million requires 3750 trained Family Physicians to sustain the primary healthcare system. If the average working life of a doctor is 40 years, we need to train at least 94 Family Physicians per annum. The actual figure is much higher as some doctors may have a shorter working life, or are doing part-time job!

When we talk about the manpower, I don’t know what the fuss is about regarding the proposed limited registration increasing to 3 years in order to attract more talent coming to work in Hong Kong. All those that voiced out Hong Kong had over supply of doctors 15 years ago have all gone submerged! I remember 4 years ago I had dinner with the Chief Executive of Hospital Authority, Controller for Centre for Health Protection, Dean of Faculty of Medicine HKU, a Professor in Dermatology and we were all non-Hong Kong graduates. A shy Director of Department of Health at the same table mentioned she was transferred to HKU after a first year medical school in UK. I was a Glasgow graduate from a very traditional medical school and Glasgow is home to one of the Royal Colleges in postgraduate training in UK. In the 1980s and 1990s, the National Health Services was staffed by a lot of overseas doctor to work at junior doctor level in order to sustain the UK health services. The attraction to Glasgow was to provide decent postgraduate training and these overseas doctors all planned to achieve UK postgraduate qualification. When I was working as senior house officer at the Glasgow Royal Infirmary, there was always an “international football team” with doctors from Australia, Malaysia, Africa, India and the now war torn countries like Iraq, Libya, Syria at the ward round. I did not just learn from the Scottish system but these overseas doctors had taught me to become a better doctor. I learnt from their goodies and their mistakes.

Hong Kong has a very high standard in Medicine and there is no doubt postgraduate training can be offered to attract overseas graduates to come here for training and services. A lot of overseas graduates are Hong Kong SAR citizens and have achieved postgraduate intermediate qualification as recognised by the 15 academic Colleges of the Hong Kong Academy of Medicine. These are the ones the Hospital Authority should target for and if in doubt seek the opinion from Education Committee of the Academy. Ultimately if these doctors opt to work beyond their limited registration, they still have to sit for the licentiate examination but exemption can be given to the specialty they have previously contributed in part of the clinical examination and the internship year. We all know in breeding from two origins will increase genetic disorder. Genetic diversity is good for a healthy clan and healthcare system!

Dr. Angus MW CHAN President