As a private medcial specialist, the public service is not my major concern. In fact one may eye public sector as direct competitor for patients.
However, as part of the medical community, the state of running of public sector has a lot to be in consideration.
Over 60% doctors registered in Hong Kong are in private practice. Less than 40% work in the public sector. Over 90% of patient are attending public hospital or clinic services. The demand is already under control by crowding or long waiting list or concern for delay aspect. Also the public sector has to shelter the purpose of training, internship supervision and front line reseach and other continued medical training problem. Last but not least, there is a lot of public services such as the arena of East Asian games, preparation of disaster, SARS drill training and mangerial work.
So we need more working hands in public sector, as versus we want more doctors in community. As in many large corporation, retention of human resources or experienced worker is key to success of an institution. So we should look into individual institution and develop ways to retain experienced person. Every year, there is new graduate who would largely join the public services. Out of all these trainess,only one third of them are fully trained and worked satisfactorily in their position. Although, for healthy institution, some movement of manpower is inevitable. However, for particular field such as medical field in Tuen Mun Hospital, A/E department in various hospitals or anaesthesia field. Shortage is constant.
So why did doctors move to private practice despite advantages of stable salary in public sector.
In fact, it is a competition to be retained inside the research based institution in oversea medical field.
Constraint of medical practice and overwork is keypoint for dissatisfaction.
Human resources control is another factor.
The burden of public doctors in senior role is always higher than their private counterpart.
Hierachy in pulbic service is also the reason for stress,
For example, every newly qualified specialist has to shoulder the clinical burden fo patient complaint or untoward event or even to unjustified complaint. However, the doctor has the right to choose his patient, call pattern or working subspecialty.
The clinical hierachy has been two tiered, resident and specialist.
However, the managerial hiearchy is long. HCE - COS - Team Head - Senor specialist - specialist - resident. So there is high likelihood that the senior guys choose the gem of the department and leave the tough and donkey work to the lower tier. Even worse, the reporting mechanism in HA is causing constraint of whistle blower, the poor performance of the senior is never reported and will be penalised. The senior control the promotion and yearly assessment of lower class workers.
Further more, the competence of junior doctors is largely reliance on altruistic sacrifice of the senior person. If the senior person would not teach his helpers for skill and training, the junior will foreever will be untrained unskilled doctor that see no satifaction of job. With such situation there is no way to ensure the senior doctor to do their job. They claim to provide consultant level to all patients by depriving the less experienced training opportunity.
For health care administrator, the over dominence of COS or department team head make job satisfaction ot lower class doctor impossible to be achieved.
Therefore the proposal of two tier system and the non-involved third party for specialist consultation or assessment must be implemented to eliminate such problem.
So as clinical duty is two tier, the managerial or reporting duty should also be two tier. An non involved committee is created to assess the capability and performance the two tiers. For junior specialist,they should care for less number of patient and be remnumerated less. As their performance justify more patient, more patient load is directed to him and more salary is given to the two tier team.
This is a preliminary thinking of how we should improve our public care system. Will discuss more in future.
Thank for reading. I am Dr SS Chung
Chung Shiu Shek Specialist in Cardiothroacic Surgery