President’s Jottings

After a much protracted “labour”, for reasons undisclosed, the Consultation Document on Health Care Reform was finally “delivered”.  However, the Document leaves many queries unanswered and other areas untouched.  For the purpose of the medical profession, the long-awaited document certainly does not fulfill our expectations and anticipation.  Many lament that it is a “skeleton with no muscle”, while others consider it as the Government’s measure to quiet the public.  Irrespective of the Government’s goal, it is a consultative health care policy paper since the last one published 26 years ago.

Despite its shortcomings this is a comprehensive document that covers many areas of health care that need reform of our system, control of standards and financing.  Thus, it is imperative that the medical profession responds actively to this document in a positive manner – giving constructive criticisms and suggestions.

As a College, to drive our expectations home, there are at least two areas we must respond to - the training of specialists and the assurance of standard of the medical profession.

The training of Primary Health Care Physicians has been heavily addressed in this “Green Paper”.  Few would dispute that there is a great shortage of Family Physicians and that they are important as gatekeepers for hospital care.  Unfortunately, areas on training of other specialties – including the manpower required and the funding provision – have not been substantively examined in the document.

With the Hospital Authority freezing trainer posts and reducing trainee numbers to accommodate productivity gains, specialist training is set to suffer.  It is imperative that the College and the Academy work together to produce a realistic manpower survey and thus, to demand from the Government the necessary financial requirement.  Moreover, it is important that the College and the Academy should be assured of a role in the Hospital Authority posting of trainees.  It is ironic that whilst the Academy and its Colleges define the training programme for each trainee, they are not given the opportunity to perform the matching role in the Hospital Authority posting exercise.

The Academy has also called for a review of training policy – do all specialties need a six-year training programme?  What proportion of “general” specialists versus “supra” specialists do we need in each specialty?  These are the areas that your College will respond with vigilance and I will be bringing to the Council and the membership for final consultation.

“Life long learning” is to many professions and trades a norm rather than an exception.  It is for this reason, and to assure the public that all Academy Fellows are always up to date in our pursuit of medical advances, that adequate continuing medical and dental education (CME) is a prerequisite of specialist registration and re-registration.  It only stands to reason too that a structured CME, in the course of time, be mandatory for registration to practice medicine and dentistry if our professions are to remain in the trust of the public at large.

As a corollary of CME is, of course, quality assurance – a task that your College and the Academy must take an active step to promulgate and take responsibility.

Finally, there are other areas that the Council of the Academy has deliberated and proposed for initial response.  I would urge all Fellows to study them with care and instigate constructive criticisms.  Your College awaits eagerly your opinion and wisdom!

27 January 2001