醫護短缺須多管齊下 增聘海外醫生勿再拖

<轉載自2019年1月29日 明報 社評>

流感疫潮肆虐，公立醫院迫爆，病房猶如戰場，醫護不勝負荷，接連集會控訴，再度突顯公院醫護嚴重短缺的絕望真相。當局呼籲「包容」，問題是醫護和市民已經「包容」太久，決策者必須拿出果斷行動，回應公院醫護吶喊，不能僅以一句「人手不足沒有即時徹底解決方法」了事。減少醫護行政工作，雖然有助減輕人手壓力，然而若要紓緩短中期缺人危機，加強招聘海外合資格醫生，尤其是負笈海外讀醫的港人子弟，實為必要選擇，醫生專業團體應該放下保護主義心態，政府官員亦應迎難而上，不能畏事避難。

土地問題公院爆煲 危機本質如出一轍

本港公營醫療系統「爆煲」，需要對症下藥，有意見將問題歸咎於新移民，有關說法建基於印象觀感，多於科學證據，相比之下，人口老化影響卻是清晰可見，醫管局主席梁智仁提到，長者病情較為複雜，住院時間一般較長，加劇了公院牀位緊張。展望未來人口老化，市民對公營醫療系統依賴只會有增無減。本港土地房屋問題水深火熱，公營醫療問題其實亦不相上下，若論背景成因，兩者共通之處也甚多﹕政府短視、官員避難、政策失敗、缺乏規劃、管理失當，無不導致供求嚴重失衡；部分持份者私心太重，小我凌駕大我，導致社會不斷空轉，無法走出困局。

政府未有積極擴大公營醫療容量，20多年來未見龍頭級醫院落成，又沒有大力增加資源培訓醫護，以往有些高官甚至認為，公營醫療系統「不要辦得太好」，否則只會吸引更多市民使用廉價公共醫療服務，加劇政府財政負擔。政府高談公私營合作分流病人多年，政策成效有限。公院醫生不勝負荷，即使成為顧問醫生，月薪不過20多萬元，反觀投身私營市場卻有機會當上「月球醫生」甚至「星球醫生」（即月薪或周薪超過百萬元）。公私營醫生環境待遇差天共地，政府就算動用銀彈挽留人才，也難以扭轉公院醫生流失趨勢。

土地問題也好，公營醫療問題也好，政府都是等到「水浸眼眉」，才去追落後。近年政府開始催谷醫科生學額、增加醫學院教育資源，然而就像造地一樣，培訓醫護新血，沒有十年八載成不了事。無論是土地問題還是公營醫療爆煲，當局都必須本着多管齊下原則，盡用各項短中長期措施。公院醫護人員表明，他們需要的不是當局賣口乖「噓寒問暖」，也不是聊勝於無的津貼加碼，而是當局切實拿出短中期可行方案，盡快救他們出生天。

公院不少醫護投訴行政工作太多，醫管局有責任理順情况，減少醫生行政工作，然而要在短中期顯著紓緩公營醫療系統壓力，最實際還是盡快增加醫護人手，加快引入合資格海外醫生，是一個最合情理的短中期選項。以往本地醫生團體一談到這個問題，總是抱着懷疑抗拒態度，然而眼見公院人手短缺水深火熱，近日有業界人士亦主張，向合資格海外醫生打開大門，諸如重新考慮認可英聯邦醫生資格。政府是時候提出具體方案，讓社會和業界取捨，不應怕事避難放棄作為。

業界須棄保護主義 政府不能怕事避難

不少國家如新加坡、英國和澳洲等為了應付醫生不足，都向海外醫生招手，然而本港卻面對保護主義阻力。回歸前，香港容許在英聯邦地區受訓的醫生免試來港執業，輿論從沒懷疑他們的質素，然而回歸後本地醫生團體以「專業自主」之名，奉行保護主義路線。業界不再承認英聯邦醫生在港執業資格，連負笈海外讀醫的港人子弟也未能倖免。

業界人士常稱，增聘外來醫生，可能良莠不齊，影響醫療質素，有人甚至利用部分市民抗拒內地心態，進行政治操作，將增聘海外醫生，等同向內地醫生「大開中門」。然而增聘海外醫生不代表一定拉低醫療水平，容許負笈海外的港人醫科畢業生回港執業，更是合情合理。倘若有人認為，現在回復港英時代英聯邦醫生免試做法「政治不正確」，大可仿效新加坡，選定全球約150家頂尖醫學院，容許這些學府的醫科畢業生可以先在本地有條件註冊，在指定醫院服務受訓，若表現理想，即可申請正式註冊執業。

近年特區政府提倡以「有限度註冊」方式，增聘海外醫生來港工作，當局還修例將「有限度註冊」年期由最長1年延至3年，希望在外國執業的港人醫生回流，然而礙於醫生業界阻力，進展有限，醫管局近6000名醫生，有限度註冊醫生僅得20多名。有業界代表聲稱，有限度註冊醫生的申請人毋須應考本地執業資格試，又未必懂得中文等，「有損公眾利益」，云云，卻未提「有限度註冊醫生」全部要經醫委會審批。專業團體自律自管，前提是要符合公共利益，為了大我利益，醫生業界應放下保護主義心態，支持增加合資格海外醫生來港執業，當局和醫委會亦應增加誘因，吸引海外醫生特別是港人子弟回流，諸如豁免實習要求，以及為他們創造一條階梯，得以在港成為正式註冊醫生。

Recruitment of overseas doctors necessary to address manpower shortage

THE influenza epidemic sweeping across the city has left public hospitals bursting at the seams and rendered hospital wards little more than warzones. Healthcare workers overwhelmed by workload have held protests one after another. This has once again put on full display the grim reality of a serious lack of healthcare professionals in public hospitals.

That Hong Kong's public healthcare system has reached a breaking point is a problem requiring a solution of pinpoint accuracy. Some blame the problem on new immigrants, a theory based more on impressions and instincts than on scientific evidence. The impact of population ageing, in contrast, is clear and visible. As mentioned by Leong Chi-yan, Chairman of the Hospital Authority, elderly people have more complicated conditions and usually spend more time in hospital, exacerbating the shortage of beds in public hospitals. As population ageing is expected to continue in the future, the public's reliance on the public healthcare system will only increase. While Hong Kong's land and housing problems are dire, the situation of public healthcare is not much better. A look at the backgrounds and causes reveals quite many parallels: myopia on the part of the government, officials' failure to rise to the challenge, failed policies, lack of planning and mismanagement all contribute to the serious imbalance between demand and supply in both areas. Furthermore, some stakeholders are too self-centred to consider the common good, leaving society purposelessly spinning its wheels without making any progress and unable to find a way out.

The government has not actively expanded the capacity of the public healthcare system. Not a first-rate hospital has been built over the past 20-odd years, nor has the government allocated any additional resources to the training of healthcare workers. Some high-ranking officials in the past even believed that the public healthcare system should not provide excellent services, otherwise more and more people would be drawn to inexpensive public healthcare services and the government's fiscal burden would be increased. The government has been talking about cooperation between public and private healthcare providers to distribute patients for years, but the result has been limited. Public hospital doctors are overwhelmed. Even if they become consultant doctors, they earn a salary of just over $200,000. If they join the private market, they might become what are publicly known as "moon doctors" or even "star doctors" (doctors earning more than $1 million monthly or weekly). A world of difference between the remunerations of public and private doctors means that even if the government tries to lure doctors to stay with money, it will still be difficult to reverse the brain drain.

In recent years, the SAR government has been advocating for recruiting more overseas doctors for Hong Kong through a "limited registration" scheme. The government has even amended the respective law to lengthen such doctors' "limited registration" from one year to three years in the hope that Hong Kong doctors practising overseas might return. However, owing to resistance from the medical industry, progress has been limited. The Hospital Authority employs nearly 6,000 doctors, while doctors with limited registration number just over 20. Some representatives of the medical industry claim that applicants for limited registration do not have to sit a local licensing examination or speak Chinese, so their employment might "hurt the public interest". What they have failed to mention is that all of the doctors with limited registration are approved by the Medical Council. The prerequisite to the self-regulation of a professional body is that it must be in the public interest. For the sake of the common good, the medical industry should do away with protectionism and support the recruitment of qualified doctors from overseas. The government and the Medical Council should also provide more incentives to attract overseas doctors — especially those of Hong Kong descent — to practise in the city, an example being exemption from the licensing examination. A career ladder should be provided to enable them to become registered doctors in Hong Kong.

醫護短缺須多管齊下 增聘海外醫生勿再拖

流感疫潮肆虐，公立醫院迫爆，病房猶如戰場，醫護不勝負荷，接連集會控訴，再度突顯公院醫護嚴重短缺的絕望真相。

本港公營醫療系統「爆煲」，需要對症下藥，有意見將問題歸咎於新移民，有關說法建基於印象觀感，多於科學證據，相比之下，人口老化影響卻是清晰可見，醫管局主席梁智仁提到，長者病情較為複雜，住院時間一般較長，加劇了公院牀位緊張。展望未來人口老化，市民對公營醫療系統依賴只會有增無減。本港土地房屋問題水深火熱，公營醫療問題其實亦不相上下，若論背景成因，兩者共通之處也甚多：政府短視、官員避難、政策失敗、缺乏規劃、管理失當，無不導致供求嚴重失衡；部分持份者私心太重，小我凌駕大我，導致社會不斷空轉，無法走出困局。

政府未有積極擴大公營醫療容量，20多年來未見龍頭級醫院落成，又沒有大力增加資源培訓醫護，以往有些高官甚至認為，公營醫療系統「不要辦得太好」，否則只會吸引更多市民使用廉價公共醫療服務，加劇政府財政負擔。政府高談公私營合作分流病人多年，政策成效有限。公院醫生不勝負荷，即使成為顧問醫生，月薪不過20多萬元，反觀投身私營市場卻有機會當上「月球醫生」甚至「星球醫生」（即月薪或周薪超過百萬元）。公私營醫生環境待遇差天共地，政府就算動用銀彈挽留人才，也難以扭轉公院醫生流失趨勢。

近年特區政府提倡以「有限度註冊」方式，增聘海外醫生來港工作，當局還修例將「有限度註冊」年期由最長1年延至3年，希望在外國執業的港人醫生回流，然而礙於醫生業界阻力，進展有限，醫管局近6000名醫生，有限度註冊醫生僅得20多名。有業界代表聲稱，有限度註冊醫生的申請人毋須應考本地執業資格試，又未必懂得中文等，「有損公眾利益」，云云，卻未提「有限度註冊醫生」全部要經醫委會審批。專業團體自律自管，前提是要符合公共利益，為了大我利益，醫生業界應放下保護主義心態，支持增加合資格海外醫生來港執業，當局和醫委會亦應增加誘因，吸引海外醫生特別是港人子弟回流，諸如豁免實習要求，以及為他們創造一條階梯，得以在港成為正式註冊醫生。