Medical bills: A look into the Hospital Authority-funded pay rise for HK doctors

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The biggest protest in the public medical sector for eight years saw 1,300 doctors joining a silent sit-in back in October. They asked for a pay rise, and now they’re getting it. Rhoda Kwan finds out whether those in the industry think the finances are sustainable 

As more than 1,300 doctors sat in the lobby of the Queen Elizabeth Hospital on October 21, holding up placards reading ‘anger’ in Chinese, it was clear something had to give. This was the first time in eight years public sector doctors had held such a protest, and tensions between doctors and the Hospital Authority (HA) over pay were running high. It’s long been established that public sector doctors work long hours in an unforgiving environment. Indeed, there have been renewed calls for the HA to cap doctors’ hours at 65 per week – an industry survey undertaken in 2013 by Chinese University revealed that around 40 percent worked more than that amount each week. Worryingly, at least a third of that group also reported that they’d made a medical error in the last year, compared to only one in five of those who worked under 50 hours per week. More disturbingly, 14 percent of the longest-working group admitted to falling asleep during consultations or surgery.  

The arrangements surrounding the protest boil down to the fact that doctors were offered a pay increase of five percent, but civil servants received an offer of eight percent.  It’s long been customary for doctors’ pay trends to follow that of civil servants, but this year civil servants were assessed using a ‘Pay Level Survey’, which isn’t conducted in the health industry. Doctors were adamant that, regardless, they should be treated the same. 

Following the sit-in, the HA changed its mind and confirmed that 3,200 senior doctors would, after all, get the extra three percent. This will come out of the coffers of the HA, at a cost of $216 million per year.  But will this be enough to placate the doctor’s unrest? Many still worry if the decision is financially sustainable and whether it could compromise the quality of public medical service. 

“The Hospital Authority has a duty to exercise due diligence in managing its resources and has adopted a prudent attitude in its financial planning,” an HA representative tells Time Out. “In planning for additional financial commitments arising from this special pay rise, we have taken into account the current and future trend of efficiency gains and savings [as well as] scope for redeployment of resources, while ensuring that patient service will not be adversely affected.”

However, the authority’s promise to ensure financial sustainability seems implausible in the absence of a secure system for doctor’s pay arrangements for the future – so claims the organiser of October’s protest, Dr Pierre Chan, President of the Hong Kong Public Doctors’ Association. “We want to secure our salary adjustment system,” he declares. “Previously, there hasn’t been much attention paid to the system because it was linked to the civil servants’ one. The problem now is that someone wants to delink the system; this is the cause of the doctors’ unhappiness. The system has worked smoothly for the last 20 years.”

Chan expresses his fear that the unpredictability of senior doctors’ pay arrangements will cause them to leave the public medical service. “When we have experienced doctors leaving, they can only be replaced with new graduates who require training. It’s important for us to secure this salary system so that our experienced doctors will have the confidence and heart to stay in the public sector.”

This instability in the doctors’ payment system exacerbates a slump in public sector doctors’ morale in regards to their career outlook in the HA and the strenuous nature of their work. “They may be working a lot of overtime without overtime pay or no pay at all,” says Dr Chow Pak-chin, vice-president of the Hong Kong Medical Association, which has over 10,000 members – half working in the public sector. “The administration doesn’t give enough appreciation to the staff who are working overtime because they care for their patients! They are not given the due recognition they deserve. These factors cause the doctors’ morale to be very low and some of them are very angry.”

Discontent among public sector doctors poses grave problems for the already troubled public healthcare service, which has been under increasing pressure due to higher expectations from the public. “Hong Kong’s ageing population, the rising incidence of chronic illnesses and the ongoing threat of emerging infections are placing greater demand on our services in an environment of escalating costs and manpower shortages,” the chief executive of the HA, Dr Leung Pak-yin, expressed in his keynote speech at the opening ceremony of the Hospital Authority Convention 2015. “In response, we must focus on our human resource needs, increase the use of technology and upgrade our equipment, infrastructure and facilities.”

But how far can the Hospital Authority still guarantee this focus on improving its services if it has to bear the costs of the doctors’ future salary rises? “The government is trying to limit their budget in terms of particular spending on the public service,” says Alex Lam, president of the patient advocacy group Hong Kong Patients’ Voices. “The problem is now ‘solved’ because the HA is using money from its own pockets to pay the extra salary. This is not healthy. The government should undertake this burden. The salary for doctors is something the government should take an initiative on because the HA’s problem is the government’s problem.”

Some believe that doctors’ pay arrangements should be ‘unlinked’ from that of civil servants. Dr Chow believes the solution to securing the system is to form a separate and predictable pay system for public sector doctors. “We are supportive of our colleagues in the HA. They are under a misunderstanding caused by the previous administration,” he explains. “They were told that their salaries were ‘closely linked’ to that of civil servants. But the system for the doctors should be separate and independent. This is how and why the HA was set up.”

Whatever way the HA and the government decides to address the issue from here, it highlights the fact that the system should be secured as soon as possible. Doctors simply don’t have time to safeguard the quality of public healthcare if they are also lobbying. “Doctors want to focus and spend time with the patients instead of with the media or administrators. We prefer giving our time back to our patients,” Chan stresses.

“Being a doctor is a profession that we all respect. They are there to save lives and they deserve a decent remuneration,” Lam observes. They pay a high price in delivering this public medical service in Hong Kong. For this reason, we should make sure they work happily in their environment, and pay is one of the key factors.” 

Find out more about the Hong Kong Medical Association by visiting hkma.org.

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