“In the beginning of last year, I spoke with the Hospital Authority [HA], hoping that they could come up with measures to cope with the winter surge in 2017, but the medical wards were already severely overburdened this summer.”
While many, including the government, have pointed out shortage of doctors as one of the main causes of the overburden, Chan remains doubtful.
“I graduated in 2000. At that time, there were about 4,000 doctors, and the HA claimed there was a surplus. That’s why they introduced a Voluntary Early Retirement Scheme in 2002, inviting senior doctors to retire,” Chan recalls.
“Today, 17 years later, the number of doctors has increased by more than 40% to over 6,000. Meanwhile, the number of hospital beds stayed pretty much the same. However, the HA is now claiming there is a shortage of doctors. Why?” he questions.
“I’m not trying to protect doctors’ interest by limiting the number of doctors. The problem is, even if we do increase the supply of doctors, we cannot guarantee they will join the toughest departments in deep water,” he explains.
In this exclusive interview, MIMS sits down with Chan to uncover the root causes of the recurring issue of overburden in public hospitals. “This issue cannot be resolved unless we identify the root cause. Otherwise, it will just recur—like what’s happening to us now,” reiterates Chan.
A management problem – more than a manpower issue“30 years ago when I visited a doctor, I waited for three hours for a three-minute consultation. Today, after I’ve become a doctor—my patient waited three hours for a three-minute consultation with me. The situation has not improved,” observes Chan.
“We are not working in a private practice. We don’t earn more when we see more patients,” continues Chan. “It’s not just the patients who prefer spending more time with doctors, so they can ask questions on their conditions. We, doctors, also want to provide quality time and care to our patients. We don’t want to see our patients as if we are chasing ‘targets’,” laments Chan.
According to the Population and Vital Statistics for 2016, there were 14,013 doctors in the city. In the same year, HA’s annual report stated that 6,040 medical professionals were hired full-time at various public hospitals. The remaining doctors were thus either working in private practice, universities or the Department of Health (DH).
In addition, Chan also notes that a significant proportion of the doctors are responsible for administrative duties —leaving only approximately 5,000 doctors working in the frontline.
Pointing out that the current scenario of overburdened hospitals is not entirely due to the shortage of doctors—Chan comments that this is more likely resulted from a management issue; or more specifically—an uneven distribution of manpower and resources.
“There was a news report about the Accident and Emergency (A&E) Department at one particular hospital, which was on the verge of collapse as two of the doctors were on sick leave. Considering HA has more than 6,000 doctors in total, would you observe this as something more related to an overall shortage of doctors; or a management issue?” challenges Chan.
Yet, Chan emphasises that such issue cannot be resolved simply by increasing the supply of doctors. “If you see a job advertisement which says poor working environment, long working hours, slow career progression and heavy workload: Would you still be interested in applying for the job?” asks Chan. “How do you ensure these extra doctors go to the departments that are in need of manpower? Even if they join, how do you ensure that they stay?” asks Chan.
HA’s recurrent funding not dependent on population growth and ageingSome have advocated doubling the supply of A&E doctors to address the manpower shortage at A&E. Chan, however, comments that such recommendation “is not practical”.
“Who pays for the additional salaries? Apart from salaries, expenses on other resources such as consultation rooms and IT equipment, will also double,” he notes. “It is impossible for the government to double its expenditure on healthcare.”
As Chan explained, the government’s expenditure on healthcare abides by Basic Law Article 107. The budget has to be commensurate with growth in gross domestic product.
Although the demand for public healthcare services has been increasing over the years—due to the growth and ageing of Hong Kong's population—Chan points out the government does not take these factors into account when they determine the level of recurrent funding to the HA.
Instead, Dr Wing-man Ko, former Secretary for Food and Health, revealed in his reply to Chan’s question in the Legislative Council, that the government considers the actual operational needs and financial situation of the HA, as well as the government's overall fiscal position to determine the amount of funding.
“Still, we have to understand the government’s concerns. After all, HKD61.9 billion is a huge sum of money,” says Chan. “While I will continue to lobby for more funding on healthcare, we have to consider the more pressing question: How can we make sure the expenditure is well spent on what is necessary?”
Rotating Cluster Chief Executive, enhancing HA’s transparencyThe challenge in managing manpower and resources across clusters and within hospitals is also reflected in the A&E waiting time.
In 2015, a story covered by Oriental Daily News described two hospitals, Prince of Wales Hospital (PWH) and Queen Elizabeth Hospital (QEH), as war hospitals with patient beds stuck at A&E and patients were unable to be admitted to medical wards.
This summer, Chan observed the severe overloading issue did not happen to all public hospitals. Instead, the problem repeated in the two hospitals—even though the Steering Committee on Review of Hospital Authority has recognised the issue, and published corresponding recommendations in their report two years ago.
“Tuen Mun Hospital (TMH) had the highest number of A&E first attendances. But their waiting time was only approximately an hour. Princess Margaret Hospital probably handled the most complex patient conditions as they had 102 inpatient admissions to Med via A&E out of 363 A&E first attendances; but their waiting time still ranged from only one to two hours,” explains Chan, as he illustrates the statistics. “What are the underlying issues leading to the seemingly unresolvable situation at PWH and QEH?” he asks.
Nevertheless, Chan emphasises that he is neither putting the blame on these two hospitals, nor is he claiming other hospitals do not encounter an issue of uneven distribution of manpower and resources. “Criticism without constructive feedback is meaningless in resolving the issue. What I’m trying to do is to identify the root cause and try to come up with practical suggestions,” elaborates Chan.
One of his suggestions is to take reference from the department of Obstetrics and Gynaecological (O&G). “Labour wards rarely reach 100% occupancy rate, since certain degree of manpower and resources are reserved to handle any emergency situations, like emergency caesarean section,” explains Chan.
“Basically, we can foresee the winter season will overload various hospitals. Every year, the occupancy rates goes up to around 120 – 130%. In this case, why aren’t we increasing 30% of our hospital beds to prepare for the surge in demand?”
Internal allocation of resources between clusters is another possible reason contributing to the calamity. For this, Chan proposes to rotate the Cluster Chief Executive for every three to six years. “Imagine the Cluster Chief Executive needs to manage another cluster after three years, do you think he/she would still request excessive resources for his/her cluster before then?” he questions.
Additionally, Chan suggests for HA to further enhance the transparency of its management—including its internal information and numbers. “We are not experts in management. We don’t have the expertise and ability to teach them how to manage. However, as long as they can enhance transparency, there are media and concerned parties who would monitor if the resources are allocated in a rational manner,” he affirms.
Some still insist to stay and help“I have never thought about being a Legislative Councilor. To be frank, I prefer to be a doctor,” shares Chan. “I saw around 30 patients yesterday, and conducted colonoscopy screening for six of them. One of them was diagnosed of an early stage of cancer, meaning we may be able to save his life. This job is more fulfilling to me,” says Chan.
Meanwhile, Chan does not feel the same as being a LegCo member, because the job tends to be more abstract. “I’m not sure how long it takes to prevent the overloading issue from recurring. Yet, I do observe improvements. There are some hospitals which were less overloaded during the influenza season. To some extent, they can absorb the surge in demand,” Chan says.
When asked if he has anything to share with doctors in Hong Kong, Chan emphasises that doctors across all sectors are equally important.
“One of the competitive edges of Hong Kong’s healthcare system is that patients can choose between the public and private sectors. We cannot say that doctors working at public hospitals are necessarily better simply because we are here and work harder to treat patients. Doctors in private practice are also contributing to our healthcare system,” justifies Chan.
“However, I sincerely thank those who still insist to stay on and help at public hospitals—despite the harsh working environment and immense pressure during this extremely difficult time.” MIMS
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