Hong Kong College of Family Physicians

I was in London during the first two weeks of July when the saga of the Medical Registration Ordinance (Amendment) Bill unfolded. The Council was supposed to have a recess in July 2016 but was recalled on 21 July 2016 to discuss the aftermath of the blockage of this Bill.

The current total number of members of the Medical Council, Hong Kong (MCHK) stands at 28. 14 elected members consist of 7 members elected by all medical practitioners and 7 representatives of the Hong Kong Medical Association (HKMA) by open nomination followed by election within the HKMA Council. Of the 14 appointed members, 2 representatives each are from the University of Hong Kong, Chinese University of Hong Kong, Department of Health, Hospital Authority, and Hong Kong Academy of Medicine (HKAM) and there are 4 lay members. The Government proposed that the lay members increased from 4 to 8. 2 representatives of HKAM would be elected members and this would balance the number of elected to appointed members at 16 each. The other proposals included increasing the number of lay members in the Health Committee from 1 to 2. An additional Preliminary Investigation Committee would be set up with 2 lay members instead of 1. There were amendments to the quorum requirement of Medical Council proceedings and an increase in the number of lay assessors. These suggestions along with enhanced secretariat support could speed up the proceedings of the Medical Council.

Back in 2012 a steering committee was set up to review the healthcare manpower planning and professional development. This committee reviewed the functions of statutory regulatory body, its lay membership, admission of non-locally trained healthcare professionals, complaint investigation and disciplinary inquiries. There is an international trend towards more public participation, greater transparency and accountability in the discharge of self–regulatory functions by healthcare professional bodies. For example, doctors to laypersons ratio in the Medical Councils in Canada, Australia and New Zealand are 2:1. In United Kingdom, the ratio is 1:1 and members are appointed following an independent appointment process. The ratio is currently 24:4 in MCHK. Even after the amendment, the ratio will be 24:8 and the percentage of medical doctors is still relatively high and more than enough to safeguard the rights of medical doctors.

I had explained in the May 2016 FP Links the representation of the College within MCHK was through HKAM. At that time the storm was already brewing. Our College is unique in that we have both HKAM fellows and non-HKAM members and fellows. Since January 2016, the HKAM Council had been discussing the Bill without much controversy. HKAM embraces 15 constituent Colleges which are equally represented at the HKAM Council and I am one of the members of the current Council. It means one College one vote. Colleges are of different sizes and HKCFP is ranked sixth in size within the Academy. A general election from all AM fellows for representation at MCHK is unfair to those Colleges with fewer fellows, otherwise the two biggest Colleges namely the Physicians and the Surgeons will always be represented at MCHK.

The Government proposed that the 2 existing appointed members nominated by HKAM be converted to 2 members directly elected by the HKAM Council to serve on the MCHK. This was similar to the arrangement for the election of the 7 members of HKMA. This proposal did not alter what the Academy was practicing except it no longer required the appointment by Chief Executive. The conversion from “appointed” to “elected” was to keep the ratio of elected to appointed members within the MCHK at 1:1 after the addition of 4 lay members and to facilitate the Amendment Bill to pass. The conversion was discussed and supported by the HKAM Council meetings in February and April. Those nominated or elected by the HKAM Council to sit on MCHK needed to have the necessary experience, qualification, reputation and respect of the medical profession. There was a suggestion if the process of electing fellows through HKAM Council needed to be abolished and opened to general election amongst all registered medical specialists, then the 9 seats allocated to HKAM (currently 2) and HKMA (currently 7) ought to be redistributed. This sounded very fair even when the Bill was blocked.

On 29 June, HKAM issued Position Statement on The Amendment Bill to justify its position in the MCHK and to support the Government’s proposal to add 4 lay members. I have explained the reasons behind HKAM’s decision as above. There was no underhand dealings and the legal advisor of HKAM confirmed the Position Statement did not lead to any procedural irregularity as the HKAM Council had the mandate to serve its constitutional objectives. Subsequently there was an EGM on 16 July 2016 for the AM President to make the stance clear and avoid further fragmentation within the Academy.

Another rumour was MCHK would relax its rule on limited registration and brought in less qualified doctors. The government was facilitating non-locally trained doctors to practice in Hong Kong through limited registration valid from not exceeding one year to not exceeding three years with the new proposal in order to solve the manpower shortage especially in the Hospital Authority. The MCHK will normally ask the Education Committee of HKAM to vet through the training and qualification of the applicants before approval and there is no relaxation on MCHK or HKAM of the requirement for practicing in Hong Kong. I have been a member of the Education Committee for 5 years and I honestly have no worry over the quality of overseas trained doctors admitted to Hong Kong through limited registration.

Medicine and politics do not mix. If one starts this chemical reaction, the end result is entropy (everything in the universe moves from order to disorder). It was unfortunate the Bill was suddenly politicized. Unfounded rumours were spread solely to block this Bill in order to defeat the Government. The result was no winner and the reputation of doctors was severely damaged! I sincerely hope the new Legco lawmakers will engage in sensible discussion after the September election and find a win win situation for the doctors, patients and politicians.

I must admit I am not sensitive enough to this political storm. I will certainly inform our members and fellows of any latest development especially from the HKAM.

Dr. Angus M W CHAN
President

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