吸引醫生外援踏首步 業界保護主義待糾正

<轉載自2019年5月9日 明報 社評>

放寬海外專科醫生實習爭議，醫委會以主席關鍵一票通過政府屬意方案。有關方案以原先的「政府方案」為藍本，對於豁免實習期要求，是3個付諸表決方案之中較為寬鬆的一個，投票結果算是給社會一個合理交代，惟不代表業界保護主義有所消退，整個制度還有很多無理關卡和刁難，令海外專科醫生感到屈辱，連港人子弟也對回流卻步，若不進一步拆牆鬆綁，就算放寬實習要求也不會有太大作用。政府必須繼續推動醫委會改革，確保專業自主不會凌駕公眾利益。

輿論制衡起作用 保護主義未消退

本港醫生短缺，短期內需要吸引更多合資格海外醫生，以濟燃眉之急。豁免海外專科醫生實習期，是提供更多誘因的第一步，未料上月初，醫委會全數否決4個豁免海外專科醫生實習方案，要求相對寬鬆的「政府方案」得票最多，仍以一票之差飲恨。

上次醫委會否決四大方案後，醫生業界拋出「業界共識方案」，變相對在大學醫學院和衛生署工作的海外專科醫生，設下更多門檻障礙。昨天的醫委會會議，實際就是「業界共識方案」與「政府方案」較量。雖然醫委會表決結果，最終選擇了較為寬鬆的「政府方案」，然而必須留意，這次投票爭持極為激烈，兩大方案各有16票支持，「政府方案」全憑主席投下關鍵一票，始能險勝，反映很多業界代表仍然是「捨鬆取緊」。投票結果僅反映輿論對業界起到一些制衡作用，不代表業界保護主義消退。

本港私家醫生收入，比起英美等地同行都要高，部分醫生更是「月球人」、「星球人」（即月薪甚至周薪超過百萬元）。政府投入大量資源培訓他們，目標是服務社會、照顧病人，可是醫生團體的保護主義傾向，確實令市民懷疑業界是否以社會福祉為先。部分業界代表稱，公院人手不足原因是醫管局管理不善，以及投訴文化「過於惡劣」，導致公立醫院工作環境太差，留不住本地醫生，也吸引不到海外醫生，云云。本港公營醫療問題叢生，醫管局難辭其咎，惟業界保護主義顯然亦是導致合資格海外醫生卻步的因素。

海外專科醫生經歷多年訓練，有一定工作經驗，要求他們再實習，去做收症、抽血等最基本的工作，實際是將他們視作「初哥」、製造屈辱感，即使業界稱呼這是「評核期」，堅持只是為了「海外醫生熟悉本港醫療制度」，都不會改變事情本質。「政府方案」通過後，海外專科醫生在醫管局、大學醫學院或衛生署工作，做滿3年並考獲執業試，便可豁免半年實習，成為註冊醫生，然而整個制度還有很多關卡，有意無意地刁難海外醫生，令他們感到屈辱。這些關卡看似瑣碎，疊加起來卻足以拒人於千里。

以海外醫生執業試為例，很多安排實際都是強人所難，製造不必要障礙，多於為醫生質素把關。海外醫生執業試一般在年底舉行，然而醫委會往往在考試前6周才公布確實日期，對在職海外醫生應試構成頗大障礙，皆因海外醫生工作也相當繁重，往往需要提早多時向醫院請假，很難臨急請假來港應試。另外，執業試及格率僅得兩成左右，亦備受詬病。

無理關卡製造屈辱 折牆鬆綁減少刁難

海外醫生執業試分為筆試及臨牀試，臨牀試包括內科、外科、兒科及婦產科。業界常辯稱，降低考試門檻會拖低醫療質素，惟一些「過來人」指出，考核內容超出實際臨牀需要，以兒科臨牀考試為例，部分考核內容極為專門，甚至出現萬中無一罕見病例，若非兒科專科醫生，考核這些病例對評估能力並無多少幫助。有海外資深外科醫生對於臨牀考核竟包括最基本的洗手步驟，也感到相當侮辱。將針對醫科畢業生要求套在他們身上，不是為港人把關，而是戲弄別人。

行業保護主義離不開門戶之見，又或「多個香爐多隻鬼」一類私心。現在一些業界保護主義者最想「證明」的，是放寬實習後，港人子弟醫生也不會回流，這樣就可反證問題「完全」出在醫管局身上，無關保護主義。這套論述有誤導成分。公院工作環境持續惡劣，愈是可能嚇走有意來港的海外醫生，公院無法紓緩人手，倒過來又令公院工作環境惡化，要在短期紓緩這一惡性循環，必須為吸引專科外援進一步拆牆鬆綁，減少刁難，問題癥結不在於放寬實習「無用」，而是不能止於這一步。

醫者父母心，本港很多醫生每天都不辭勞苦服務病人，然而業界內的保護主義問題，確是改善本港醫療服務的絆腳石，政府的責任是確保專業自主不會變成私利先行，凌駕公眾利益。政府必須加緊推動醫委會改革，遏阻保護主義傾向，若然醫生業界抗拒採取更多措施，方便專科外援來港，政府應考慮收回專業自主權力。

Protectionism in the medical profession has to be curbed

AMID dispute over the relaxation of the internship requirement for overseas specialist doctors, the chairman of the Medical Council has cast a tie-breaking vote to support a government-backed proposal, which was subsequently adopted. The proposal, modelled on a "government proposal", was the least restrictive among the three submitted for voting in terms of the exemption of the internship requirement. It can be said that by delivering such an outcome, the Medical Council has reasonably lived up to society's expectations. But it does not mean that protectionism in the medical profession has weakened. The system still has many unreasonable barriers and things that create difficulties for overseas doctors. They make overseas doctors feel humiliated, so much so that even offspring of Hong Kong people baulk at returning to Hong Kong and practise here. Relaxing the internship requirement may not help much if the other restrictions are not lifted. The government must continue to initiate reform in the Medical Council to ensure that the guarantee of professional autonomy does not override the public interest.

After the passage of the "government proposal", overseas specialists can become registered medical practitioners after working for three years in the Hospital Authority, medical schools or the Department of Health and passing the licensing examination. They will be exempted from the six-month internship requirement. However, there are still many barriers in the whole system. While these barriers may seem trivial, together they are enough to stop overseas doctors from coming to work in Hong Kong.

Take the licensing examination for overseas doctors. The Medical Council usually announces the exact date for the examination only six weeks in advance. This poses a rather big obstacle to overseas doctors who are already practising. The passing rate of the Licensing Examination, which is only about 20%, has also come under a lot of criticisms.

The licensing examination for overseas doctors is comprised of a written examination and a clinical examination. Some overseas doctors who have taken the examination point out that the scope of the assessment far exceeds actual clinical needs. Take the clinical examination of paediatrics. Some parts of the examination are very specialised. Unless the examination is for paediatricians, what is tested does not have much use in assessing the ability of a doctor. Some overseas veteran surgeons also felt humiliated when they learnt that even the most basic handwashing procedures were included in the clinical examination.

What some protectionists in the medical profession want to prove most is that doctors who are offspring of Hong Kong people will not return even if the internship requirement is relaxed. This, they argue, inversely shows that the problem lies totally with the Hospital Authority and has nothing to do with protectionism. This argument is somewhat misleading. If the working conditions of public hospitals continue to deteriorate, it will further discourage overseas doctors from coming to Hong Kong. When public hospitals fail to alleviate the problem of manpower, it will in turn lead to a deterioration of the working conditions in public hospitals. The only way to check this vicious cycle soon is to take steps to remove restrictions and reduce the barriers that discourage overseas specialists from coming to work in Hong Kong. The crux of the issue is not that it is "useless" to relax the internship requirement, but that this should not be the final step.

Doctors are like parents to their patients. Many doctors in Hong Kong work very hard every day to help their patients. Nevertheless, the problem of protectionism in the medical profession is a barrier to improving Hong Kong's health service. The duty of the government is to ensure that guaranteeing professional autonomy does not mean allowing private interest to come first and override the public interest. The government must speed up the introduction of reform in the Medical Council and discourage protectionism. If doctors and the medical profession oppose the government's further introduction of measures to recruit overseas specialists, the government should consider revoking their right to professional autonomy.

吸引醫生外援踏首步 業界保護主義待糾正

放寬海外專科醫生實習爭議，醫委會以主席關鍵一票通過政府屬意方案。有關方案以原先的「政府方案」為藍本，對於豁免實習期要求，是3個付諸表決方案之中較為寬鬆的一個，投票結果算是給社會一個合理交代，惟不代表業界保護主義有所消退，整個制度還有很多無理關卡和刁難，令海外專科醫生感到屈辱，連港人子弟也對回流卻步，若不進一步拆牆鬆綁，就算放寬實習要求也不會有太大作用。政府必須繼續推動醫委會改革，確保專業自主不會凌駕公眾利益。

「政府方案」通過後，海外專科醫生在醫管局、大學醫學院或衛生署工作，做滿3年並考獲執業試，便可豁免半年實習，成為註冊醫生，然而整個制度還有很多關卡。這些關卡看似瑣碎，疊加起來卻足以拒人於千里。

以海外醫生執業試為例，醫委會往往在考試前6周才公布確實日期，對在職海外醫生應試構成頗大障礙。另外，執業試及格率僅得兩成左右，亦備受詬病。

海外醫生執業試分為筆試及臨牀試。一些「過來人」指出，考核內容超出實際臨牀需要，以兒科臨牀考試為例，部分考核內容極為專門，若非兒科專科醫生，對評估能力並無多少幫助。有海外資深外科醫生對於臨牀考核竟包括最基本的洗手步驟，也感到相當侮辱。

現在一些業界保護主義者最想「證明」的，是放寬實習後，港人子弟醫生也不會回流，這樣就可反證問題「完全」出在醫管局身上，無關保護主義。這套論述有誤導成分。公院工作環境持續惡劣，愈是可能嚇走有意來港的海外醫生，公院無法紓緩人手，倒過來又令公院工作環境惡化，要在短期紓緩這一惡性循環，必須為吸引專科外援進一步拆牆鬆綁，減少刁難，問題癥結不在於放寬實習「無用」，而是不能止於這一步。

醫者父母心，本港很多醫生每天都不辭勞苦服務病人，然而業界內的保護主義問題，確是改善本港醫療服務的絆腳石，政府的責任是確保專業自主不會變成私利先行，凌駕公眾利益。政府必須加緊推動醫委會改革，遏阻保護主義傾向，若然醫生業界抗拒採取更多措施，方便專科外援來港，政府應考慮收回專業自主權力。