The Hong Kong government’s first projection study on health care manpower includes claims that most medical professions, including doctors, nurses and dentists, will face shortages in the next 10 years, of which doctors will be most severely affected.

Joseph Kok-Long Lee and Dr Pierre Chan, both members of the Legislative Council of Hong Kong representing the healthcare sector, have ascribed the claimed shortage to the government’s short-sighted policies over the years.

Regardless of the reasons for this, consensus needs to be reached sooner rather than later to alleviate the burden on public hospitals and safeguard the quality of healthcare. In the first of two parts in this series, we will examine the viewpoints from the government and healthcare sector with regard to manpower shortage in the healthcare sector.

What the government says

From the government’s point of view, the shortage is a result of many factors. One of the major factors is a rapidly ageing population. It is projected that the Hong Kong population aged 65 or above will more than double from 1.07 million in 2014 to 2.58 million by 2064, which creates a huge demand for chronic illness treatment and end-of-life (EOL) care.

The government also says that the stringent requirements for overseas-trained doctors to practice in the city is another major reason resulting in the shortage. Compared with the passing rates of over 70% in the United States and England, it appears seemingly impossible for overseas-trained doctors to practice in Hong Kong – a passing rate of approximately 3.6%, resulting in annually only 10 doctors on average satisfying the requirements after 1997.

Other reasons suggested by the government include an immature Public-Private Partnership (PPP), and an emphasis on secondary care such as hospital services over primary care such as health promotion and prevention.

The healthcare sector’s point of view

Refuting the government’s claims, both councilors representing the healthcare sector have referred the root cause of the shortage to the government’s lack of long-term planning.

Chan, also the President of the Public Doctors' Association, specially pointed out the situation where the government increased the number of medical school openings, but provided inadequate positions for the graduates to work in public hospitals in 2013, resulting in a manpower surplus and unemployed doctors.
Because of this surplus, the government at that time decided to cut the number of medical school openings from more than 300 in 2003 to about 250 in 2009 – which has led to the shortfall now instead.

Additionally, continuous reduction in the government’s funding to the healthcare sector over the years has induced a negative impact in attracting healthcare professionals to work in the public sector. According to records, the public sector serves about 90 per cent of the city’s patients but only employs 40 per cent of the doctors. With the private hospitals offering lucrative packages, the remaining 60 per cent of the doctors need only to focus on 10 per cent of the patients.

“The Hospital Authority has once consolidated a set of guidelines to align with international standards, recommending that each nurse take care of a maximum of six patients at a time. However, it then abolished such guidelines after reducing its expenditure due to economic downturn in recent years,” Lee explained.

According to data published by the Association of Hong Kong Nursing Staff in 2013, the ratio of nurses to patients in public hospitals was 1:11 during the day, and could go up to 1:24 during the night shift.

“The government is adding incessant beds and patients to the hospitals, but not hiring extra manpower to deal with the growing demand. Although it’s near impossible for Hong Kong to catch up with the international standard in the near future, the government should at least specify a reasonable ratio for nurses to follow,” he added.

Hong Kong healthcare professionals under unprecedented stress

According to the University of Hong Kong’s projection, the number of inpatient days will total 14.77 million in 2041. It is expected healthcare professionals will face an unprecedented level of stress by then. Currently, with bed occupancy rates in medical wards already reaching up to 130 percent, nurses are left with no choices but to navigate themselves amongst extra beds to take care of as many patients as possible.

Apart from suffering physical exhaustion due to poor working environments and long working hours, studies also showed that nurses are three times more likely to suffer from stress, anxiety or depression as compared to the general population.

Nurses also had the highest suicide rate (9.46 per 100,000 people) among professions, including policemen and teachers, based on a report published by the Centre for Suicide Research and Prevention at the University of Hong Kong in 2012.

Doctors are no better than nurses with regard to both the physical and psychological stress they suffer. They occasionally need to work up to 80 hours per week rather than the usual 44 hours, with very little time between shifts.

“Doctors have been used to being busy even during non-peak seasons as the manpower of public hospitals has always been very stretched,” said Chan.

The manpower issue has not only affected healthcare professionals, but also the healthcare quality patients receive. Due to the chronic undersupply of doctors and nurses, it is not uncommon for patients in non-emergent cases wait up to seven hours for medical treatment, and up to 20 hours to be moved to a general ward. MIMS

Read more:
Healthcare professional shortages in Hong Kong - The many reasons and controversies - Part 2
CUHK Nursing's Director shares her take on manpower and maximising the role of nurses in Hong Kong
More than just manpower shortage: Why does Hospital Authority fail to address overburden over the years?

Sources:醫護人手緊絀 1護士對15病人