Replies to LegCo questions
LCQ5: Contract Medical Officers Scheme
Following is a question by the Dr Hon Kwok Ka-ki and a reply by the Secretary
for Health, Welfare and Food, Dr York Chow, in the Legislative Council today
(June 1):
Question :
The Hospital Authority (HA) has implemented the Contract Medical Officers Scheme
(CMOS) since 1997-98. All new recruits have since been appointed under three
employment contracts that last for seven to eight years in total, and they must
complete the relevant medical specialist training programmes and become a
specialist within such contract period. Since the implementation of CMOS, all
sorts of related problems have surfaced and are getting more serious. In this
connection, will the Government inform this council:
(a) whether it knows, in each year since the introduction of CMOS, the
respective numbers of doctors who were employed on contract terms, who were
unable to complete their specialist training programmes due to their contracts
not being renewed, and who were unable to transfer to other specialist
departments for relevant training;
(b) whether it knows the details of the employment conditions, such as
remuneration level and fringe benefits, for doctors who joined HA in different
years, and whether there are any differences in these employment conditions; if
so, whether the authorities have any plans to resolve the problem of disparity
in pay among doctors performing the same duties; and
(c) how the Administration resolves the problems caused by CMOS, including
reviewing the duration required for specialist training programmes in various
specialist departments and assisting doctors who wish to transfer to other
specialist departments for training, thereby facilitating the training and
development of medical specialists?
Reply:
Madam President,
The Hospital Authority (HA) has been shouldering the bulk of the responsibility
for providing specialist training to new medical graduates in Hong Kong for many
years. The HA takes in and remunerates around 300 such new medical graduates
year after year. Due to the low turnover of doctors in the public sector in
recent years, the HA was left with a net yearly increase in the number doctors
on its payroll. To manage the fiscal burden brought on by the ever-enlarging
pool of medical trainees, the HA discontinued the use of permanent employment
terms for new trainees and introduced contract employment terms in 1997. The
introduction of contract employment terms for doctors can also be attributed to
the general and prevailing use of contract employment in both the private and
public sectors and HA's need to make appropriate changes to its human resources
practices in the light of changing trends and circumstances.
(a) Since 1997-98, the HA has recruited a total of 2,249 Resident doctors by
contract terms. A breakdown of the yearly intake is set out in
Table 1.
A total of 58 of these doctors did not have their contracts renewed by the HA
(18 in 2003-04 and 40 in 2004-05) due to unsatisfactory training progress and
unsuitability for training. In respect of the number of doctors who requested
for a transfer from one specialty training programme to another, the HA received
a total of 199 applications between 1997-98 and 2004-05. Of these applications,
17 of them were denied, as shown in
Table 2. The majority of the unsuccessful cases were due to their
unsuitability for training in the new specialty as assessed by the receiving
specialties.
(b) The contract employment terms for doctors have undergone a number of changes
since its introduction in 1997-98. These include -
* Replacement of the cash allowance (which is calculated as a percentage of
basic salary) by a monthly allowance (which is calculated on the basis of the
prevailing civil service staff oncost rates and set as a fixed sum of money not
linked to the staff's basic salary) in April 1998. This is to fulfil the
recommendation of the recommendation of the Public Accounts Committee in 1996 of
introducing a mechanism for regular review and adjustments of the HA package so
as to ensure that the principle of cost comparability is adhered to at all
times.
* Lowering of starting salary and introduction of a delinked pay scale in April
2000, following changes adopted for the civil service by the Government.
* Introduction of a new pay scale for Resident doctors with a lowered maximum
salary point in June 2000, as part of HA's reform measures for its Medical
Grade.
* Introduction of fixed pay contracts in June 2002.
* Pay cuts in October 2002, January 2004 and January 2005, following similar
cuts by the civil service.
This has led to the situation where doctors in the same rank may have different
employment terms and remuneration packages. However, it should be appreciated
that offering different remuneration packages to the same rank/group of staff
joining an organisation in different years is an inevitable consequence if the
organisation is to honour existing contracts with old staff, while continuing to
recruit staff at the market rate in a declining economic climate with salaries
falling. Such disparity also exists in the civil service, and is more commonly
found in the private sector.
The HA appreciates the concern of staff over the problem of pay disparity and
its effect on morale. While the budgetary situation remains very stringent and
HA must continue to operate within the confines of its contractual obligations,
HA has recently introduced a mechanism to award pay increment to well-performing
staff recruited in 2002 with fixed pay contracts. The Government and HA are also
exploring ways of re-distributing some of the specialist training
responsibilities to the private sector.
(c) The HA also appreciates that apart from pay disparity, contract Resident
doctors are also concerned about their prospects of continuous employment and
training opportunities. On the one hand, it is widely recognised that contract
employment terms encourage performance by linking it with employment
opportunity. On the other hand, the HA recognises that contract employment does
not provide long-term job security which could be important for many staff. In
order to strike an appropriate balance on the extent of use of contract
employment so as to ensure that cohesive, loyal teams of staff are available for
delivery of quality service to the public, the HA is considering the
establishment of a mechanism for converting some well-performing contract staff
to permanent terms of employment.
In respect of training, the Hong Kong Academy of Medicine stipulates that the
mandatory training period leading to specialist qualification is 6 years. To
give Resident doctors sufficient opportunity to attain their training
requirements and sit for the relevant examinations, the HA has been exercising
flexibility in extending the contracts of Resident doctors beyond 7 years,
taking into account such factors as the variations in the timing and passing
rates of various stages of examinations in different programmes, the performance
of the doctors concerned and their potential for further training. In the past
few years, the HA has provided all Resident doctors who have been passed the
intermediate examination and accepted to higher training with the necessary
contract period to complete their specialist training. Apart from those trained
to become community specialists, the majority of trainees who have acquired
specialist qualification will be retained within the HA to meet service needs
and facilitate development of expertise.
As for the current system for transfers from one specialty training programme to
another, the HA would normally only consider requests made within the first year
of the training programme. This serves to strike a balance between giving
specialist trainees a reasonable time period to ascertain their career
aspiration, while ensuring the efficient and rational use of valuable training
resources. Since the current system appears to be working well, there is no plan
to make further changes at this stage.
In closing, I would like to point out that it is the HA's objective to provide
rewarding, fair and challenging employment to all of its staff, in an
environment conducive to attracting, motivating and retaining well qualified
staff. Item 10 in Schedule 3 of the Hospital Authority Ordinance (Cap 113)
provides that the Authority shall determine "the remuneration, and the terms and
conditions of employment, of its employee." Since taking up the Office of the
Secretary for Health, Welfare and Food last October, I have raised the issue of
staff morale with the HA on a number occasions. While I understand that there
will be no easy solution and fully recognise the initiatives that the HA has
already taken in this regard, I am still looking forward to receiving further
proposals from the HA for improving its human resources management.
Ends/Wednesday, June 1, 2005
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