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Ella Lee

The grievances of the city's public doctors over long hours and heavy workloads are not new. 
Ten years after launching legal action to fight for overtime compensation, young doctors are still struggling to get the basics: enough sleep and recognition.
The latest exodus of doctors, especially from the internal medicine department, is the result of a number of factors that together have exacerbated the situation for public doctors. Factors such as poor manpower planning, the booming private sector, the lack of promotion in the public sector and growing demand on services. Is that all? 
Some critics say the root of the problem is what they call the overmanagement culture of the 50,000-strong Hospital Authority. It has been striving for efficiency and higher output, which has come at the expense of staff welfare and morale. 
The battle for better work conditions has been a long and tough road for the city's 5,000 public doctors, which began with a lawsuit filed in 2002 at the Labour Tribunal that resulted in two landmark High Court rulings that doctors should be compensated for some of their work. 
Although the authority introduced reforms to gradually cut doctors' workloads to 65 hours a week, many still do shifts lasting 24 hours, with only one four-hour break. 
And these sleep-deprived doctors often care for 200 patients at night. So instead of improvements since the landmark rulings, their work conditions have been eroding, with turnover  of 5 per cent this year.
Doctors at Tuen Mun Hospital's internal medicine department are particularly frustrated with the rising workloads - 25 per cent of junior staff have quit since January last year. 
Some physicians at the hospital wrote on a Facebook group. 'The system is on the verge of breakdown and patients will be affected,' one posting said. Another said: 'Physicians are not rubbish, we need dignity and respect.' And another posting said: 'Doctors who stay at public hospitals are dedicated to serve the poor, but we need some recognition.' A person familiar with the system said: 'The authority has been so keen to strike for efficiency, to use the least resources for maximum output in  the number of admissions, outpatients  and shorter lengths of stay for patients. 
'However, it forgets its core business, which is good clinical care, quality time doctors can spend on each patient. The latest issue of the high turnover of doctors comes as a wake-up call for the authority, the pendulum should swing back from one extreme of good figures to basic clinical care.' 
Dr Ernie Lo Chi-fung, Medical Council member and a former president of the Frontline Doctors' Union, said the authority's corporate culture was aimed at high-profile projects such as setting up new centres or innovative services. 'Medical staff have been asked to work as much as possible for new projects. Their core business, spending more time with patients, is no longer a priority for the authority. Now doctors can only afford a few minutes on each patient at clinics,' Lo said.
'Here is a strange phenomenon: on one hand, a medical team may be proud of having a new centre for innovative services, but on the other hand, its patients have to wait three years for a first consultation and no one cares about this, ' Lo said.
The lack of long-term manpower planning for medical staff and the doctor-to-patient ratio for hospitals has not helped. For example, the government has been unable to say how many doctors are needed per 10,000 population, and what should be the minimum number of doctors and nurses for patients in each ward.
The lack of trust between frontline staff and the authority was rooted in the 1990s when junior doctors were employed on short-term contracts.
These doctors said there was no sense of belonging at the authority, and they left public hospitals after gaining a specialist's qualification.
Medical lawmaker Dr Leung Ka-lau, who was the lead plaintiff in the 2002 lawsuit against the authority for overtime compensation, said doctors had been an easy target for exploitation. 
The Court of First Instance in March 2006 ruled that public doctors can claim compensation for working on rest days, and public and statutory holidays. In October 2009, the Court of Final Appeal ruled that doctors could get a day off or the equivalent in pay for being on call, even though they may not be needed. But the top court ruled that public doctors are not entitled to any compensation, either in pay or time off in lieu, for their overtime.
 'Now the authority keeps asking doctors to work more and more, because it costs the authority nothing for this extra manpower,' Leung said.
He will move a motion debate in the Legislative Council  asking the authority to set standard work hours for doctors, among other reforms recommended.
'Doctors are the only staff at public hospitals not protected by standard work hours. Other grades such as nurses, paramedics and supportive staff such as cleaners, work 44 hours a week and they will be compensated for working overtime.'  
Immediate past president of the Public Doctors' Association Dr Ho Pak-leung said that in European Union countries  medics work only 44 hours a week, some countries were leaning towards a policy of a 38-hour week, but many Hong Kong public doctors still work more than 70 hours a week. 'Airlines have to ground their fleets when pilots and crew members do not have adequate rest, why are doctors asked to work serious overtime while they have to make important clinical decisions?'
 The authority has pledged to consider paying extra for doctors who need to do more duties. 'We need to see clearly a road map on how doctors' work hours can be cut in the next five or 10 years, or any measures such as allowances or senior posts will be in vain in stopping the brain drain,' Leung said.
Overworked staff
This is the number of frontline doctors working in the public sector: 5,000



10 years since lawsuit, little has improved for public doctors