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Plan to cut training for Hong Kong family doctors by two years to boost role of primary care

by October 17, 2016 General

Hong Kong’s specialist medical training school plans to slash two years off the course for family doctors to attract more students.

These new recruits would strengthen the role of preventative primary care in the city, easing the burden on overstretched public hospitals that are a drain on taxpayers.

Dr Donald Li Kwok-tung, president of the Academy of Medicine, said many young doctors shunned family medicine for more lucrative branches of the profession and the government had failed to enhance the sector’s place in the system.
Li revealed the school was considering shortening the specialist training for family medicine doctors by two years to four years – on a par with international standards – as the current six-year curriculum was the longest in the world.

Trainees have already spent six years as undergraduates at medical school.

There is an international trend for countries where the population is ageing rapidly, for example Singapore, to shift the medical burden from hospitals to the community by enhancing the role of family doctors. Hong Kong is also experiencing such a demographic shift.

In the United States and United Kingdom it takes three years to train to be a family doctor, and just two in Canada.

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Li hoped the Hospital Authority would allow trainees to work part-time in private clinics to gain further experience.

“Public hospitals are not good training grounds. How can you learn to be a good and caring family doctor if you only have three minutes to a patient? [Public hospitals] should pay the trainees a minimum wage and allow them some sessions to work in private clinics.”

Where is the support for primary care services which can help prevent sickness and hospitalisation in the first place?

Dr Donald Li Kwok-tung

Li said the government lacked vision in planning ahead and had failed to strengthen the role of family medicine. Relying on public hospitals to meet the bulk of the city’s medical needs would soon be unaffordable, he warned.

Some 90 per cent of patients rely on public hospitals, which are heavily funded by the government and are short of about 300 doctors at all times.

“While the government is giving an extra HK$1 billion to build public hospitals, where is the support for primary care services which can help prevent sickness and hospitalisation in the first place?”

Li stressed that family doctors had an important role to play in providing regular care for patients, such as monitoring their blood pressure and preventing complications.

Of 13,000 registered doctors in Hong Kong, only around 450 are specialists trained in family medicine to serve a population of over seven million.

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The latest data from the Hospital Authority showed that family medicine was among the least popular specialities for young doctors. Some 26 resident trainee posts left vacant after recruitment in July were from family medicine, along with areas such as obstetrics and gynaecology, internal medicine and accident and emergency.
Li said being a family doctor was not as lucrative as working in areas such as surgery and that the public lacked appreciation of their role. Many family doctors worked in clinics run by big medical chains to secure a stable income, but their relationship with patients gave them little sense of satisfaction.

Li, who steps down in December, hoped his successor would carry on his idea to reform the training curriculum to better meet the needs of the community.

He also called on the Hospital Authority to disclose how much was invested into educating new doctors every year in its annual budget and promise not to cut back on the expenditure.
In the long term, the government should make health insurance mandatory for Hongkongers so that more patients would use private services and free public space for urgent cases.

“This is the way we should go and I must say it even if it is unpopular,” he said.