Following is a question by the Hon Tommy Cheung and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (April 21):
Question:
A non-locally trained medical practitioner is required to pass the Licensing Examination administered by the Medical Council of Hong Kong (MCHK) and work as an intern and undergo a period of assessment of normally 12 months in an approved hospital before he/she may apply to be a registered medical practitioner. The Licentiate Committee of the MCHK is responsible for conducting the Licensing Examination, while the Internship Sub-committee under the Licentiate Committee makes internship arrangements in collaboration with the Central Internship Committee of the Hospital Authority (HA) as well as supervises and assesses the performance of interns. In this connection, will the Government inform this Council:
(1) given that some Hong Kong people who studied medicine in overseas places and graduated with flying colours are not eligible for taking the Licensing Examination as they have not completed medical training in such places, whether the Government will amend the Medical Registration Ordinance (Cap. 161) to permit non-locally trained medical graduates who have not completed medical training to take the Licensing Examination; if so, of the details and timetable; if not, the reasons for that;
(2) as the Singapore authorities have stipulated that fresh graduates of overseas medical schools recognised by them may apply for provisional registration in Singapore after one year of internship in the public hospitals in Singapore, whether the Government will follow such practice and require that such graduates must serve in the public hospitals for a specified period of time, so as to increase the manpower of medical practitioners in the public hospitals; if so, of the details; if not, the reasons for that;
(3) whether the channels for locally trained and non-locally trained medical graduates to apply for internships are the same; if not, of the reasons for that;
(4) of the terms of reference and membership list of HA's Central Internship Committee;
(5) of the mechanism and criteria for selecting medical graduates to work as interns, and whether locally and non-locally trained medical graduates are treated equally; if not, of the reasons for that;
(6) of the respective numbers of internship places offered to locally and non-locally trained medical graduates by (i) the HA, (ii) the Department of Health and (iii) the faculties of medicine of the two universities in each of the past five years; the criteria for setting the quotas of such places;
(7) of the mechanism for assessing the performance of interns; and
(8) of the medium and long term measures in place to further facilitate non-locally trained medical graduates and medical practitioners to come to Hong Kong to practise?
Reply:
President,
My reply to the question raised by the Hon Tommy Cheung is as follows:
(1), (2) and (8) The Government has adopted a multi-pronged strategy to tackle the severe shortage of doctors in the public healthcare system by, inter alia, increasing the number of medical training places, providing funding for universities to upgrade and increase their healthcare training facilities, as well as supporting the manpower initiatives of the Hospital Authority (HA).
To attract non-locally trained doctors to practise in Hong Kong, the Medical Council of Hong Kong (MCHK) has, since August 2019, shortened the period of assessment from six months to two days for non-locally trained specialists who have passed the Licensing Examination and have already worked full-time in the public healthcare sector for three years. Besides, several Colleges of the Hong Kong Academy of Medicine (HKAM) have agreed to admit non-locally trained doctors with qualifications at the pre-intermediate level for continuation of their specialist training in Hong Kong on the premise that the specialist training opportunities for locally trained doctors will not be compromised.
Upon relaxation of the threshold for non-locally trained doctors to practise in Hong Kong, their number and percentage among all newly registered doctors during the same period have slightly increased. However, they are far from sufficient to fill the shortfall. The Government hence considers it necessary to create a new pathway (i.e. special registration) under the existing Medical Registration Ordinance (Cap. 161) (MRO) to allow more qualified non-locally trained Hong Kong doctors to practise in our public healthcare sector so as to increase the supply of doctors in Hong Kong.
We propose that a non-locally trained doctor may apply for special registration subject to the following criteria being met:
(i) he/she is a Hong Kong Permanent Resident;
(ii) he/she is a graduate of a recognised medical school outside Hong Kong, and has been registered as a medical practitioner or has obtained a specialist qualification in any country or region where the recognised medical schools are located; and
(iii) he/she has been engaged in full-time employment in any of the local public healthcare institutions (i.e. the HA, the Department of Health, the University of Hong Kong (HKU) and the Chinese University of Hong Kong (CUHK)).
The proposed requirement for an applicant to have been registered as a medical practitioner or obtained a specialist qualification in the country or region where the recognised medical schools are located is meant to ensure that his/her standard of practice has been recognised.
A non-locally trained doctor who has been registered as a specialist in the country or region of practising medicine and whose qualifications are recognised by the HKAM may apply for full registration after working in the public healthcare institutions for a specified period and passing the on-the-job assessment. For those who have yet to receive specialist training in the country or region of practising medicine, they will have to complete the entire specialist training in Hong Kong, which normally lasts for at least six years. As for those who have attained a qualification comparable to the pre-intermediate/intermediate examinations of constituent Colleges of the HKAM, they will have to continue the remaining specialist training (for a period of at least three to five years) in Hong Kong. After obtaining a recognised specialist qualification from the HKAM, they are required to work in the public healthcare institutions for a specified period and pass the on-the-job assessment before they can apply for full registration.
The Government will introduce the relevant bill into the Legislative Council in the second quarter of this year to take forward the above-mentioned proposal.
(3), (5) and (6) The HA has been collaborating with the MCHK and the faculties of medicine of the two local universities in promoting internship training opportunities for local medical graduates and non-locally trained doctors who have passed the Licensing Examination and upgrading their standards.
Under section 12 of the MRO, a person who has passed the Licensing Examination or a qualifying examination administered by HKU or CUHK leading to the award of a degree of medicine and surgery may apply to the MCHK for provisional registration for internship purpose. At present, the HA is the sole provider of internship training places while the MCHK and the two local universities are responsible for ensuring the training standards and levels. Those who meet the internship training requirements under the MRO are treated equally and will be offered internship training places by the HA.
The numbers of medical interns working in the HA in the financial years from 2015-16 to 2019-20 are as follows:
| Financial Year | Number of Interns |
| 2015-16 | 368 |
| 2016-17 | 373 |
| 2017-18 | 470 |
| 2018-19 | 469 |
| 2019-20 | 475 |
(Note: The statistics for 2020-21 are still under compilation.)
The HA does not maintain information on the respective internship places for local medical graduates and non-locally trained doctors who have passed the Licensing Examination.
(4) The Central Internship Committee (CIC) set up by the HA is responsible for overseeing matters relating to internship training, which include monitoring and improving the quality of internship training. Members of the CIC include the Chairman of the Internship Sub-committee under the Licentiate Committee of the MCHK, representatives of the medical schools of the two local universities, the HA executives and senior doctors in public hospitals. The current membership of the CIC is at Annex.
To ensure that internship training meets the standards of medical training, the CIC monitors the working and training arrangements of interns on a regular basis, and advises the HA and the two local medical schools on changes that need to be made to those arrangements. In addition, the CIC is responsible for drawing up the eligibility criteria for intern training sites. These criteria form the basis on which all hospitals and hospital departments are assessed for the purpose of training post accreditation. The CIC also maintains close communication with training hospitals and collects feedback from interns regularly, so as to ensure compliance with the standards and requirements of internship training.
(7) Medical interns will be deployed to various specialties of different hospitals during the training period. They will be assessed by each specialty according to relevant standards and levels. They are required to pass the assessment in order to complete the internship training and obtain a certificate of experience from the MCHK or the two local universities before they can apply to the MCHK for full registration.
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