Replies to LegCo questions

LCQ9: Specialist training in family medicine

Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (November 24):

Question:

It is learnt that due to the actual demand and supply of medical manpower and the Government's development of family medicine into a focal point of medical service in the future, most medical graduates will become family doctors. Since last year, however, the Hospital Authority (HA) has not been able to provide sufficient specialist training posts in family medicine to young doctors who have completed internship. As a result, 81 doctors are filling "non-specialist training" posts so far. Although these doctors take up the same clinical duties as other doctors receiving specialist training, they do not receive recognised specialist training. In this connection, will the Government inform this Council:

(a) how the policy bureau(x) responsible for the demand and supply of medical manpower and HA address the current situation of insufficient resources and training posts when determining the size of intake for specialist trainees in family medicine;

(b) whether the policy bureau(x) concerned and HA will formulate policies to improve the situation and provide assistance to the affected doctors; if they will, of the timetable for doing so; and

Reply:

Madam President,

a) The Government and the Hospital Authority (HA) work closely with the Hong Kong Academy of Medicine (HKAM) and its Colleges in determining the number of new Residents to be admitted for specialist training. The factors to be considered include the Government's healthcare policies, projected specialist requirements of the HA, the projected supply of specialists for the public and private sectors in the light of the number of trainees completing training, the turnover rates, HA's plan on service development, the training capacities in HA hospitals and the applicants' suitability for specialist training.

HA supports the Government of building up the number of Family Medicine (FM) specialist in Hong Kong and has stepped up its training on family medicine over the past few years. The number FM specialist training places offered by HA in the 2002-03, 2003-04 and 2004-05 intakes were 92, 98 and 81 respectively. However, there are practical limitations on the training capacity primarily relating to the rules laid down by the Hong Kong College of Family Physicians (one of the Colleges under the HKAM that sets out the specialist training requirements for FM). The limiting factor is the number of trainers available to supervise the trainees according to the rules set by the College, given the relatively small pool of FM specialists in Hong Kong. The HA has already tried to maximize whatever trainer resources available while striving to maintain the quality of training.

b) Starting from two years ago, there has been a number of new graduates who cannot be absorbed by the various specialist training programmes each year after the number of new Residents to be admitted for specialist training has been worked out taking into consideration the factors mentioned above, including the limitations placed on HA's FM training capacity. Recognising that primary healthcare needs in Hong Kong are met by a pluralistic system of providers including General Practitioners and specialists in Internal Medicine, FM, Paediatrics and other fields, HA introduced a two-year General Practitioner training programme in 2002-03. The objective is to provide new graduates who cannot be absorbed by the various specialist training programmes with additional general practitioner training and clinical exposure before they eventually work in the community as generalists.

c) The number of new graduates who cannot be admitted into specialist training programmes differs from year to year. Since last year, there has been higher staff turnover in various clinical specialties of the HA because of the Voluntary Early Retirement Programme and a recovering private market. HA has also obtained additional resources that can be used to support the employment of more trainees in various clinical specialties. Therefore, while the number of intake for the FM specialty will still be limited for the reason mentioned above, the residual number of new graduates who will not be admitted to specialist training and have to join the General Practitioner training programme will be smaller, unless the graduates themselves prefer generalist to specialist training. Nonetheless, the HA will regularly review the effectiveness of this programme and take improvement measures as and when necessary to ensure that the General Practitioners emerging from this programme are well-equipped to play their role in Hong Kong's primary healthcare.

Ends/Wednesday, November 24, 2004

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