Speech to Hong Kong College of Anaethesiologists 6.11.99
On the occasion of the 10th anniversary celebrations of the Hong Kong College of Anaesthesiologists, I wish to convey most hearty congratulations from the Academy of Medicine. Throughout the formative years of the College, from the Board of Studies for Anaesthesia and Intensive Care in 1984, to the incorporation of the College in 1989, to the admission of the College as an Academy College in 1992, the inaugural intermediate examination in 1994, the final examination in 1995, and admission of the subspecialty of intensive care in 1997, I have watched your leaders with great pride and admiration. You have chosen dedicated, resourceful, and wise Councillors whose insight, appeal, and diligence have established a perpetual system ensuring high professional competence, and goodwill both here and abroad that guarantees successful growth well into the next millennium. Most of all, they have all been great friends of the Academy, lending mutual support when we both were growing up.
Today, out of 3284 Academy Fellows, 182 are in anaesthesiology and 12 are in intensive care. This is out of 8695 medical practitioners on the resident list, and 1108 on the overseas list, while 123 are under limited registration. The ratios are one anaesthetist out of every 46 doctors, or one to 33505 population. While there is a general impression of an oversupply of doctors, at least at the post-registration year, the manpower situation looks far from saturated in your particular specialty. While I was working in a general hospital, it took the greatest of efforts to set up a trauma list, and old ladies with fractured hips routinely waited for up to 2 weeks for surgery. That situation has greatly improved in the past 5 to 10 years, so that I seldom see acute hip fractures having to be transferred to private hospitals where anaesthetists seem to be always ready to start a case for their surgical colleagues. Yet, barring the recent withering of surgical cases in this adverse economic environment, I have observed that even in the private sector there may be room for further growth, for some anaesthetists there do not appear to have sufficient time to pay a preoperative visit to their patient.
Nevertheless, their tremendous experience and efficiency continues to amaze me. But I may be entirely incorrect in these impressions, for what can I possibly rely on for evidence to support the assumption that we must train more anaesthetists for the foreseeable future?
And that brings me to remind you of the importance of careful manpower planning. The Government's Health and Medical Development Advisory Committee relies on the Academy for advice on specialist manpower. Even though manpower planning is far from an exact science, the Academy does try to produce a pragmatically based assessment of current and future needs. To such end the medical manpower planning committee chaired by Dr CH Leong has conducted a pilot study of actual detailed workload and predicted manpower needs for expected services across the sectors for one selected specialty, orthopaedics and traumatology. The study suggests that a similar approach can be used for more evidence-based predictions in other specialties. I hope that your College can take useful reference from the methodology in arriving at the manpower needs for anaesthesiology for say the next 15 to 20 years. It will be the Academy's responsibility to negotiate with the Government for any consequential funding. Although the current economic climate remains overcast, when major reforms are put into place-and they will-the sun that is hiding behind the dark clouds will once again shine on us. That is provided we conscientiously ensure that standards of competence are meticulously nurtured through not the least letup in training and continuous professional development.
In closing, I wish to pay special tribute to a few of your leaders without whose selfless devotion you will not have todays celebrations. They are Andrew Thornton, Ivan Houghton, Mike Moles, Teik Oh, John Lo, Ronald Low, CT Hung, and of course currently T W Lee. Every Fellow of the Academy joins me in extending our very best wishes for the HKCA. I am sure that you will have the greatest success in your endeavours, beginning with the annual scientific meeting, AGM, Congregation and celebrations today. Thank you.
Dr David Fang
Speech to Hong Kong College of Otorhinolaryngologists 23.10.99
President Prof W Wei, Fellows of the HKCORL, distinguished guests,
It is a great pleasure and honour for me to attend this honorary Fellowship conferment ceremony, particularly when you are honouring the President of the Royal College of Surgeons of Edinburgh Professor Arnold Maran, who is such a great friend and supporter of the Academy, and who is so close to many of us that he is affectionately known as Arnie. As I am sure you will be duly informed of his achievements and attributes, I would like to speak to you on the subject of the Academy's public standing.
The Harvard report pilloried the medical profession for variable standards, but acknowledged the role of the Academy, which required all its Fellows to undertake continuing education, while no such requirement existed for general practitioners. To be sure, the Academy must relentlessly pursue her goal of ensuring the highest possible standards of specialist training and continuous professional development. We are coming to the end of the first 3-year cycle for most Colleges and the results at the end of 2 years show a compliance rate of 82.4% for otorhinolaryngologists, compared with 86.2% for surgeons, 94.7% for physicians, and 100% for ophthalmologists, pathologists, and paediatricians.
Dental surgeons, however, are at 52.8% and anaesthesiologists, 70.4%. But I am reliably informed that their figures have not been completed and are still coming in. Overall therefore we should be reasonably satisfied that our Fellows have seen it necessary and useful to adhere to what the law requires of specialists.
On the other hand, there is little room for complacency because we know only too well that CME in its present state can give no assurance of professional competence. Starting from the next CME cycle, the Academy hopes all Colleges will introduce elements of Quality Assurance (QA) into specialist practice. The components of QA, or more correctly continuous quality improvement, will not be stereotyped but will rather follow the needs of the specialty. They may for instance include outcomes audit and peer review processes, or improvements in clinical and information management. All of these processes, including CME, are appropriately described as continuous professional development, CPD.
To encourage participation, Council has very wisely decided that QA measures will be voluntary but will be accreditable for CME points next year. At some time in future, probably the third CME cycle, the law will be amended so that specialists will have to fulfil the requirements for CPD as determined by the Academy. In parallel with the Academy's initiatives, the Medical Council has also established a committee on quality assurance. It looks certain that CME will be compulsory for all medical practitioners, and CPD will follow at a later date.
If we look to our overseas counterparts, many of us may wonder why none of this is required in for example the UK. The reality is that the days of relying on GPs and specialists to remain competent on their own initiative may be over. The indications are that compulsory recertification processes will be in place within 2 years. Still, one might argue that in Asia we are the first to set such high and rigid standards. The answer must be that we should pride ourselves in being the leaders to set standards which eventually all developed Asian nations will surely follow.
One of the most important tools for CPD that have emerged in the past decade is the Internet. Indeed, it has been said that information networking as achievable through the Internet will change the way we practise medicine forever. The SAR Government sees the development of information technology as essential for our economy, and the Academy also recognises that we must harness all that MIT has to offer if we are to remain at the forefront of medical training and professional development.
The Harris Poll reports that over the past year, 60 million people surfed the web for disease-specific information, and over 90% said they found what they wanted. Most visited sites...
- medical societies
- patient advocacy and support groups
- pharmaceutical companies
Most frequently researched diseases...
- allergies or sinus problems
- bipolar disorder
- arthritis or rheumatism
- heart disease
- sleep disorders
US Physicians' Median Gross/Net Incomes, 1998
- Neurosurgeons ... $492K/$290K
- Orthopaedic surgeons ... $489K/$273K
- Cardiothoracic surgeons ... $413K/$267K
- Plastic surgeons ... $484K/$247K
- Urologists ... $382K/$227K
- Gastroenterologists ... $ 363K/$227K
- Radiologists ... $250K/$213K
- Otolaryngologists ... $380K/$209K
- Anaesthesiologists ... $233K/$202K
- Pulmonologists ... $312K/$199K
- Ob/Gyns ... $319K/$195K
- Ophthalmologists ... $374K/$194K
- General surgeons ... $305K/$190K
- Dermatologists ... $377K/$187K
- Neurologists ... $255K/$159K
- Internists ... $216K/$141K
- FPs ... $218K/$138K
- Paediatricians ... $206K/$129K
- Psychiatrists ... $171K/$118K
- GPs ... $156K/$92K
Note: Gross = individual share of receipts before professional expenses and taxes.
Source: Medical Economics, September 20, 1999, pg. 178.
Physicians who are new to the Web report these anticipated uses of the technology...
In anticipation of increased usage of the Internet among all doctors, the Academy has entered an agreement with CWHKT to develop an International Intercollegiate Network for specialist training and CPD. The system will be up on the Internet by mid-December of this year, in time to celebrate the new millennium.
- literature searches
- online journals/books
- medical education
- clinical guidelines
- drug information
- association/specialty information
- patient treatment information
Source: Chi-Lu BI and Durkin RM. JAMA. 1999;282:633-4.
Dr David Fang
Speech to Hong Kong College of Pathologists, 20.11.99
President, Fellows and guests,
It gives me great pleasure to address the Eighth AGM of the Hong Kong College of Pathologists, whose fellowship falls within the centre of the Academy numerically. It is the eighth largest College, with 157 Academy fellows among a total of over 200 college fellows. Since its inauguration in October 1989, the number of trained pathologists has more than doubled. Six specialties have been recognised under the College, providing clear guidance on subspecialisation for the profession and the public. Training programmes, and intermediate and exit examinations have all been successfully implemented. Moreover, the latest figures indicate that CME compliance for the first 2 years is 100%. These are achievements, which the Academy take great pride in acknowledging. Further challenges lie ahead and I hope the College will continue to work closely with the Academy so that we may achieve a high standard of continuous professional development.
The Chinese Medicine Council of Hong Kong is a statutory organisation set up under the Chinese Medicine Ordinance to regulate the practice, use, manufacture and trading of Chinese medicine. The Ordinance was passed by the Legislative Council in July this year. Members of the Council are drawn from different Chinese medicine sectors and also include representative from other sectors of the community and the Administration to ensure that public interest will be fully reflected.
Mr Leung also announced today the appointment of the Chairman and Members of the Chinese Medicine Practitioners Board and the Chinese Medicines Board, which underpin the work of the Council. The Practitioners Board is responsible for regulating the practice of Chinese medicine, while the Medicines Board is responsible for controlling the use, manufacture, and trading of Chinese medicines. Mr Cheung Tai-chiu, a reputable Chinese medicine practitioner, has been appointed as Chairman of the Chinese Medicine Practitioners Board. The Director of Health is the Chairman of the Chinese Medicines Board as provided for under the Chinese Medicine Ordinance. Members of the Council and the two Boards will serve for a term of 3 years.
The HKAM, in response to the consultation on the Chinese Medicine Bill, did raise concern over the lack of definition of the scope of practice of Traditional Chinese Medicine (TCM) practitioners. We received no official reply, although I have been reassured by the Department of Health that overlap and duplication would be insignificant. Albeit the scope of work now falls under the jurisdiction of the Chinese Medicine practitioners board which will produce a code of practice. From personal contacts with influential TCM practitioners, it seems highly unlikely that they will try to limit the practice to TCM only. The reason given is that Chinese medicine also needs modern scientific methods for research, education, and development. Back in 1986 when the HKMA submitted a paper supporting the regulation of TCM, there was genuine belief that TCM and Occidental medicine were clearly demarcated. In the eyes of the public at least, it remains relatively well demarcated. Our profession cannot be so narrow-minded as to exclude scientific methodology from other health care professions, yet there clearly needs to be a dialogue with the Chinese Medicine Council in order to reach an understanding on our obviously separate and different roles.
The question of inclusion of the TCM professional within the Medical Functional constituency is an even more contentious one. Modern TCM training involves 5 years of university education, including 2 years of basic sciences. On that basis, the two professions can easily communicate and even integrate to provide the widest choice of treatment to the patient. After all, we must admit that there are strengths in TCM, which can mitigate the shortcomings of western medicine.
However, the ordinance also recognises TCM practitioners who may have no qualification apart from 15 years of full-time practice. We cannot presume that they will have common interests, nor can we assume that the interests of the whole TCM profession can be catered for in a functional constituency that looks certain to be dominated by the medical profession. Until such time that their profession have proven that they are responsible, disciplined, hold the interest of the public above their own, and can work harmoniously with us, it is premature to share a common constituency. The government is therefore wise to hold the proposal in abeyance until these uncertainties are resolved.
On a more fundamental question of the integration of western medicine and TCM, I have always held the view that medicine knows no boundaries. As men and women of science, we cannot afford to close our minds to any methodology. So long as the method conforms to ethical principles and can scientifically be proven to be efficacious, we are duty-bound to explore, research and utilise. The corollary must be that scientific medicine will prevail and ultimately absorb so-called alternative medicine. It behoves all of our profession to adopt a visionary attitude, or the consequence could be steady erosion in our own capabilities as well as the trust of our patients.
Dr David Fang