2013年3月21日 星期四

Lack of manpower in Cardiothoracic Surgery Divison in Prince of Wales Hospital

Doctors manpower supply is always a sensitive question to politician and general public.There is no point of satisfaction. More doctors mean more comprehensive service and shift the balance of power to patient's side. For all types of treatment approach, patient will have no choice or no say if there is an insurmountable statement of lack of man power.

In Cardiothoracic Surgery, this is creme de la creme of all surgical specialties. Competition for training post is difficult and learning of skill is tedious and demanding.The talent of the trainee will in some form or the other affect the maturity of the surgeon. The character of the surgeon in this field must be perfectionist in surgical skill, diplomat in dealing with relatives and colleagues and decision maker for difficult situation.  Training usually span for more than 6 - 8 years.

Also, the higher the professional ladder , the higher demand of time ane energy in this field.

Not long ago, this specialty has suffered a manpower loss with shift of senior surgeons to private market.

However, there is no lack of new comers and young budding surgeon to take up the challange.

There is no complaint of lack of surgeon then.

In fact, there is complaint of lack of cases and referral from their medical colleagues.

So, why is there a sudden outcry of lack of resources? Lack of doctors? Lack of trainees and expert surgeon?

This boils down to the surgeons desire of easy life and competition for resources.

For all 3 centres in Hong Kong, to speak the truth, I would say it is never the Prince of Wales Hospital that is lacking resources.

Indeed, the climbing of number of heart cases is evident to that.

The reason of demanding more manpower is just a gesture to demand for reward for the volume of cases.

In Cardiothroacic field, usually one doctor is shouldering responsibility that the mean number of works hours is among the highest in all field.
We cannot judge the number of expert surgeon needed in a large centre. Only that there is pros and cons of more expert surgeon. First the experience is diluted. Second the competition and challange of the team to meet different surgeons demand is high. The surgeons may be in standby time more than actual service. The number of operations delegated to experienced trainees are much less.

Overall, more supporting doctors are needed instead of mature surgeon in a busy unit.
Maybe it is Prince of Wales Hospital CT Surgery Division wish to recruit more basic or higher surgical trainee instead of saying there is failure of retention of experienced staff.

Who would like to see their surgery postponed or waiting list lengthened from patients perspective.
But it is still an unknown black hole of crying for more resources.

(Back in the old days, when I was the only cardiothroacic first call surgeon, I and one experienced cardiothoracic surgeon manage the whole services with annual number of open heart surgery 60 - 80 per year and 300 throacic operations and average 2 - 3 major trauma consultations in the same setting of the teaching hosptial. I have not expressed of lacking manpower in year before the turn of millenium)


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