On 14 June 2017, the Strategic Review on Healthcare Manpower Planning and Professional Development report was released to the public. Ten key recommendations were made to address the growing issue of shortage of medical professionals, especially those within the public sectors. However, questions remain unanswered as to whether the recommended measures are sufficient to address manpower shortages at public hospitals and alleviate the pressure on frontline healthcare workers.

Recommendations made in the report included increasing the number of training places, assistance in self-financing programmes, recruiting non-local staff, and conducting manpower planning and projections every 3 years.

However, the Steering Committee on Strategic Review on Healthcare Manpower Planning and Professional Development did not elaborate much on the part of retaining doctors within the public healthcare system. With regards to doctors, the proposed short- to medium-term solution was to increase the retirement age within the public sector and to recruit non-locally trained doctors through limited registration. By previously increasing the retirement age to 65, the Hospital Authority hopes to be able to retain a larger workforce to help support the system.

Insufficient healthcare expenditure and manpower


It is commonly understood that public hospitals in Hong Kong are understaffed, especially at the frontline. Approximately 60 percent of doctors in Hong Kong work in the public sector and take care of 90 percent of the inpatient population and 30 percent of primary care services in Hong Kong. In contrast, the remaining 40 percent of doctors work in the private sector and look after only 10 percent of the patients.

Yet, the government has not formulated any long-term plan to hire more doctors for public hospitals to cope with the growing ageing population of Hong Kong. The total expenditure on healthcare as a percentage of the GDP in Hong Kong is only 5.7 percent – a figure that is markedly lower than many similar countries such as the UK (9.1 percent), Canada (10.4 percent), Australia (9.4 percent) and Japan (10.2 percent), in which universal healthcare is provided. That figure is notably low even when compared with the US – which does not provide universal healthcare – with a healthcare spending of 17.1 percent of its GDP.

Annual recurrent funding to Hospital Authority provided by the government for the period from 2003 to 2017 (Source: Hospital Authority)
Annual recurrent funding to Hospital Authority provided by the government for the period from 2003 to 2017 (Source: Hospital Authority)

To make matters more complicated, the Hong Kong government does not plan to increase annual recurrent funding to the Hospital Authority for the year 2016–2017, with estimates showing recurrent funding to have decreased by HKD 10 million.

In fact, in the past 4 years, recurrent funding for healthcare has only gone up by 10 percent. In the year 2015–2016, the total number of doctors recruited was just 419. With a growing ageing population, a dwindling workforce and a stagnant healthcare budget, Hong Kong faces several real issues moving forward.

Long Working Hours


Because of a small workforce, doctors in Hong Kong are having to work more than 65 hours a week, which resulted in serious issues such as sleep deprivation and increased medical errors. As a result of sleep deprivation and long working hours, 14 percent of doctors have fallen asleep during surgery, and medical errors have increased from 21.8 percent to 36.2 percent.

Over the years, the Hospital Authority has been aware of the issue and has been actively trying to regulate the number of working hours to improve doctors’ welfare. For example, the proportion of specialists working more than 65 hours per week had decreased from 18 percent in 2006 to 4.6 percent in 2016.

Nevertheless, the situation remains far from satisfactory as members of the inadequately staffed medical workforce still have to work harder and longer. As a result, a large proportion of doctors in the public healthcare sector have suffered from severe burnout.

In a survey among doctors in the Hong Kong public sector, approximately one-third reported severe burnout, and those with severe burnout were often younger and had to work longer shifts. Moreover, more than half of the doctors suffering from burnout were very dissatisfied with their jobs and felt low levels of personal achievement.

In the survey, long working hours was also found to be the main contributing factor towards stress-related work issues, and relevant preventive strategies were strongly recommended. Aside from that, the survey also highlighted other key factors, such as recognition of contribution and job security, as issues to be addressed to improve the quality of life of those within the workforce.

Growing ageing population, declining healthcare budget


(Proportion of population under 15 and 65 and above from 2012 to 2016, # provisional figures. Source: Census and Statistics Department)
(Proportion of population under 15 and 65 and above from 2012 to 2016, # provisional figures. Source: Census and Statistics Department)

At the end of the day, the undeniable fact remains that Hong Kong is faced with a growing ageing population. This creates growing demands for healthcare that are not addressed by relevant increases in the medical professional workforce in public hospitals or increases in healthcare budget. Steps have already been put in place towards alleviating the issue. Nonetheless, these stop-gap measures may not be enough to hold back the looming issue that lies ahead.  MIMS

(Editor’s note: This article has been updated on 22 June, 2017)

Read more:
Healthcare professional shortages in Hong Kong - The many reasons and controversies - Part 1
Staff shortage in obstetrics and gynaecology (O&G) in Hong Kong: A parents’ worst nightmare
Overcrowding in 14 out of 15 Hong Kong's public hospitals: Can Rapid Assessment & Treatment (RAT) help?
Poor salaries and overwork led to shortage of doctors in China

Sources:
https://www.news.gov.hk/en/categories/health/html/2017/06/20170614_143407.shtml
http://www.hpdo.gov.hk/doc/e_sr_final_report.pdf
http://www.info.gov.hk/gia/general/201612/07/P2016120700680.htm?fontSize=1
http://www.fhb.gov.hk/statistics/en/statistics/health_expenditure.htm
http://www.scmp.com/news/hong-kong/health-environment/article/1873500/urgent-case-lawmaker-calls-hong-kong-hospital
http://www.hkmj.org/system/files/hkm1206p186.pdf