Gilberto Leung, president of the Hong Kong Academy of Medicine, is on the show this week. He talks about the government’s plan to build a third medical school, and whether and how that can help address the shortage of doctors in Hong Kong.

Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Professor Leung:

Chan: Good evening and welcome to Straight Talk. I am Eugene Chan, and our guest this evening is President of the Hong Kong Academy of Medicine, Professor Gilberto Leung. Prof Leung is a neurosurgeon and a clinical professor at the University of Hong Kong, where he also holds the Tsang Wing-Hing Professorship in Clinical Neuroscience. Currently Professor Leung is also co-chair of the academy’s Professionalism and Ethics Committee and holds several key positions in research and teaching, not just in neurosurgery, but also in medical education, law and ethics. Welcome, Gilberto!

Leung: Thank you for having me, Eugene!

Chan: Gilberto, I am sure the viewers will say to you, and you will agree with me, that it is an undisputed fact that there is a shortage of healthcare manpower in Hong Kong. And I read in government papers, as of March 31, 2024, several months ago, there are 16,459 doctors in Hong Kong. That is about 2.16 doctors per 1,000 persons, a ratio a bit lower than many of the Western countries. And maybe you can give us a background, how does … what does this number mean? And whether this 2.16 says that we are in big trouble? Or what does that imply? I mean how does the public and private interface go, and also between general practitioners and the specialists?

Leung: Yeah, thank you. Well, this 2.16 per thousand is quite low when you compare it with, say, Japan or Singapore. But the key issue is the distribution between the 16,000 doctors, between the private and the public sector, because currently when you look at the inpatient statistics, we have lower than 50 percent of doctors working in the public sector, but they look after over 90 percent of the patients who are receiving public hospital care in Hong Kong. So, their workload is very, very severe, and the attrition rate is also worrying in recent years, up to about 8 percent, even 10 percent in some cases. So, there is an urgent need, I think, to boost the manpower situation, at least within the public sector. And that is compounded in the coming years, by the enlarging elderly population. Currently we have about, I think, about 20 percent or so of people in Hong Kong older than 65 years old. But in about less than 10 years’ time, we will have much more than that, 30 percent at least. So, these are patients with multiple medical problems, they have chronic diseases. If all of them would have to require in-hospital care, we don't have the adequate manpower. And therefore, I think the government is absolutely commendable for promoting the primary care blueprint so that patients can be kept out of hospital, and we also can adopt a more preventive community based approach to healthcare in general.

Chan: Right. Professor, thank you for giving us a very broad view of the situation. I am sure the viewers will start to see the issues we are facing. So, when you were talking about the healthcare manpower shortages, I am sure we are not referring only to doctors, also the nurses, supporting staff. But maybe we concentrate on the doctors today.

Leung: Yes, please.

Chan: Has the situation worsened in recently, especially after COVID?

Leung: When you say worsened, it depends on whether you mean pure figures because …

Chan: You just mentioned an attrition rate of like 8 percent.

Leung: Yes, but at the same time the Hospital Authority is also having more doctors coming back from overseas or coming to Hong Kong from overseas, and we are expecting maybe 100 or more in the coming months or years. So, we are doing a lot to compensate for the loss that we saw in recent years. But figures are only figures, the important thing is about the quality of care that we actually provide. A problem that we like to think is that when you are short of people, there would be a high risk of having medical mishaps, errors, etc. That is not necessarily a direct correlation. We have to be careful by that narrative. But so far, I think the doctors in Hong Kong are still of a very, very high standard. I think while we have a lot of room for improvement, in terms of patient safety, efficiency, the adoption of advanced technology, we have to, have to be very mindful of the achievements that we have done. And I am not saying that because I am blowing my own trumpet. I am talking about people whom I work with in the Hospital Authority, at the university, at the academy. These are people who go well above and beyond their duty to deliver the care that they do.

Chan: Right. I also would like to know are there any specific areas or specialties that have the most significant shortages? Because I mean although you said that our medical standard is high, but when you only have so few pair of hands, something has got to give. So, any sort of specialty that you can sort of let us know that is maybe on a bit of the shortage side?

Leung: Well, I think primary care is a critical field, although we like to think that the hospitals are understaffed and overcrowded. In fact, if you look at the bigger picture, what we want is to keep people out of hospital to have, as I mentioned, a more preventive and community based approach to healthcare. For example, people with chronic diseases, many of them could be looked after in a community by general practitioners, family medicine physician. But currently as far as the academic is concerned, many, many graduates would like to go into a specialty other than family medicine. I think because just the career trajectory would be very different. So, I think we need to boost the power in the primary care sector, so that we can have a more sustainable system. If we continue to have this very hospital-based approach, no matter how many specialists, hospital specialists you produce, it is not sustainable, so …

Chan: I think I can’t agree with you more than the word ‘prevention’. I mean being a member of the dental profession myself, we know that if the patients, they do come regularly to see their own dental practitioners for check-up and preventions, a lot of the problems won't happen.

Leung: Yes.

Chan: So, this primary healthcare blueprint is something that I am sure everybody must embrace.

Leung: Yes, we are very much supportive of it. We have a college of family physicians, and we also like to work very closely with the primary care commission to explore ways to improve training, enhance awareness, and to make sure that we have enough family doctors to realize all the goals of the primary healthcare blueprint.

Chan: Right. So, Professor, I must ask you another direct question. Since you mentioned because of various factors, like attrition rate, maybe overworked, or even doctors migrating, or increasing needs by the increasing ageing or increasing population, do Hong Kong public have to worry when they go to the public system that they won't get the best care that they deserve?

Leung: Well, in the coming years, I don't think that would happen. We still have very dedicated doctors of very high caliber. I think the best way to find out the answer of that question is to ask people who have been abroad in recent years, and they can tell you whether Hong Kong is still delivering better care than many other countries do. I am sure many of them would think that they are very lucky, or they should feel very lucky and proud of being residents of Hong Kong because of the relatively inexpensive and very effective, and very high caliber care that we provide.

Chan: Are you referring to stories that we have Hong Kong residents returning from, say Canada or even England?

Leung: Oh, there are many stories. I am sure you know more than I do about who have experienced what in these countries.

Chan: Right, thank you, Professor, for being so diplomatic, but definitely reassuring all of us that Hong Kong actually has a very good system.

Leung: I think so, I think so.

Chan: But one thing that I am going to also ask you is with the more of the integration between Hong Kong and the mainland, especially the dental profession, we already see a lot of advertisement that Hong Kong, we just don’t allow that. Actually there are people moving across the border to seek for medical care. How is it going to affect us? Is it going to lessen the load of the public hospital system?

Leung: It is a matter of degree, I think. And also it would affect certain subsectors or subgroups of patients, depending on what kind of services are opened up and available to Hong Kong residents. I think a certain degree of integration would be inevitable and probably beneficial. But in the long run, I think there are issues, such as professional standards, recognition, accreditation etc. There are different specialties and doctors from different medical schools in the Chinese mainland, whether there should be a free flow of manpower across the border is an issue that we have to look at very carefully. And also when you talk about Hong Kong doctors going up north to practice, we also have to consider things like professional indemnity and other things that can ensure that, you know, they can have a good practice, a fulfilling practice.

Chan: Right. Gilberto, before we go to the break, I want to just ask you a very direct question as well. The title of the show tonight is “How will Hong Kong people benefit from the third medical school as just been proposed by our Chief Executive in his Policy Address?” In short, do you think we will benefit?

Leung: Now, given the manpower shortage we have, I think the medical school would play a key role in producing more doctors. It would also help to boost research, which would be commensurate with the government's direction to develop Hong Kong into a research and technological hub. It can also have an impact on the university itself, in terms of status ranking, donation, grants. But I’d like to think that that is not the primary reason why people want to have a medical school, that would be wrong because the primary role of a medical school is to train doctors and to do good research, and to translate that into real benefit to society, entrepreneurship, industry development, collaboration, for example. For the first two, I think a third medical school will do something positive. However, the key thing is we have to look at other considerations, such as the impact on the ecosystem of academia, cost effectiveness, feasibility, and how soon and what way that the perceived benefits will be realized.

Chan: Right. Let’s take a short break now. But viewers, stay tuned, we will be right back.

Chan: Thank you for staying with us. Professor Gilberto Leung is our guest this evening, and we have been talking about the government’s plan to build a third medical school to help address the shortage of doctors in Hong Kong. So, Professor, we touched on the area, and then you mentioned that you believe that the third medical school will help the shortage of doctors, at least, in Hong Kong. But I know that you are also on the working group that the government has set up to develop the direction and guidelines of the new medical school, I know you had your first meeting. But without going into real details, I am sure a lot of things will be sort of changed along the way – what will be the direction? Does it mean that more of our graduates from DSE will have more chance of becoming a doctor now because of increased medical sets?

Leung: First of all, allow me to clarify that for me personally and for the working group, we are examining ways to identify the right proposal to build a third medical school. A third medical school can potentially be a good solution, but it is by no means the only solution, but may not even be the best solution. It all depends on the proposed medical school, the curriculum, the software, the hardware, and then the community would decide whether or not to adopt it. So, we are still at that stage, but we are expecting to receive the first proposal in, say, first quarter of next year.

Chan: Right.

Leung: So, the devil will be in the details, I think. As I mentioned, we will have to look at things like whether there will be overlap with the current two medical programs; we don't want that. We want the third medical school to add value, to have something innovative, in terms of what kind of students we are taking in. I think the overall approach is that we are expecting that third medical school to take in degree holders, i.e. not students coming fresh out of secondary school or DSE. That is a general direction, and the good thing is that then we can give opportunities to students have who done another degree, but then who have the ambition, aspiration, and willingness, to actually read medicine.

Chan: Professor, if that is the case, it may be one of a very important element of making Hong Kong an even stronger medical hub because dealing with patients, I mean I had that experience, I mean the more mature you are, with life experiences, you’d be able to communicate a lot better, see the problem, and be able to treat the patient.

Leung: Yes, I would think so. I mean, medicine is something you have to learn by immersion, as well as just studying books.

Chan: Yes.

Leung: And being more mature, having seen the world, and understand more about people in general, would make you a better doctor. And currently, the two medical schools are already taking in degree holders.

Chan: Right, that is the right direction.

Leung: In the right direction. And the two med schools are proposing to have their own graduate entry program, so maybe we will take in 20-30 each every year who are people who read other degrees.

Chan: Right.

Leung: So, that is the general direction because we have a diminishing population of high school students, as you know very well, so we would like to expand that catchment population.

Chan: The Secretary of Health, Professor Chung-mau Lo, we had him on the show before, and he hopes that the new school will provide sort of an innovative strategic position, complimentary to the two existing ones. What does he mean by that?

Leung: Best person to answer that would be him, I think. But I guess what he was talking about is number one, as I mentioned, a new way of identifying good students, taking them in, and also whether the curriculum could be geared towards other areas that the traditional curriculum program have not addressed. For example, new technologies, research, entrepreneurship. There are many, many possibilities.

Chan: With this third medical school, I mean everybody will have high hopes because Hong Kong is well known for our HKU and the CUHK, having provided us with very good high standard of medical practitioners. When do you anticipate this new batch of graduates will be serving our population?

Leung: Well, if you take into example, the history of the Chinese University of Hong Kong medical program, it took them roughly about 10-12 years …

Chan: Wow, that is a long time!

Leung: To produce their first batch of graduates. I think they were established in … I think the Legislative Council that time approved it in 1974, and then they had the first team, and then it took a while for the first cohort to be admitted, and then 1986 was when they delivered.

Chan: Right.

Leung: So, assuming we are going along that direction, at that rate, we are talking about probably 10 years from now. I mean having a medical school is a very complicated enterprise.

Chan: Right. I am going to also ask you because with my experience, finding enough teachers, educators, will be also a big challenge. And also there is also a risk of diluting whatever we have with the other two medical faculties.

Leung: Yes, yes, very much so because in medicine, you ought to have teachers, you have to have a certain number of teachers, who are clinically qualified, who are also willing to do teaching and research. These people, whom we call clinical academics or clinical professors, because they have to teach and deal with patients, they have to be registerable or registered in Hong Kong as practitioners, at the same time have the capacity to do research and teaching. Now and we are not talking about 10 or 12 or 20. We have different specialties at med school, medicine, surgery, orthopedics, pediatric, psychiatry ... each of that would require a number of academics, clinical academics. So easily you are talking about over 100, if not 150-200, clinical academics to run a medical program effectively, efficiently. I believe at the HKU, we have about 180-200 clinical academics, probably the same in the CUHK. So, to have a third medical school, we will need to find that 150-200 clinical academics. Remember, these are people with medical degree, reputable in Hong Kong, probably high degree in MD or PhD. Now would be good if we find them, which is the matter of how.

Chan: Maybe that is part of Hong Kong’s government policy of attracting talents to come to Hong Kong.

Leung: Yes, yes. The last thing we want is to cannibalize that the third medical school and the two existing ones would try to find their best people, that would be …

Chan: Right. I think we have talked about this medical school. Hopefully, we will deliver our doctors in 12 years and maybe earlier. Let's talk about the standard medical care since you are here. You are the president of the Academy of Medicine that is responsible for the training of medical and dental specialists. How good are our specialists? I know you are going to say you don’t want to blow your own trumpet, but let’s tell the viewers how good we are. And do we have to go abroad to get even second opinion, should that situation arises, the need arises?

Leung: Putting aside second opinion, if we look at our specialists, not only dental, but medical ones, the best way to judge it is not by saying how tough our exams are, how rigorous our programs are, you look at the health care statistics. We have currently number one or number two longest life expectancy, as we all know. Our infant mortality rate, our maternal mortality rate are among the lowest in the world, I think it’s number two or number three for that. And we are very efficient in terms of the amount of GDP spent on healthcare we are currently running about 9-10, compared to 16-18 in many other western countries. So, in terms of value for money and the actual outcome of the people’s healthcare, we are doing extremely well. As far as the Academy is concerned, we are almost 31 years old. We have been training specialists over the last 3 decades, and we are a very unique organization, our specialists are very well respected around the world. So, I think there is reason why we think we should seek help from outside in general, although there are individuals who might want to go on aboard to have very, very advanced special treatments. But in general, I think we should be very grateful for what we have.

Chan: Right. Professor, I am going to ask you a direct question, but I would like a very brief answer. What is your anticipation of Hong Kong's medical landscape intended for the next 10-20 years, especially with a sort of increasing demand from the community, even from the ethical side of things? How will you answer my question?

Leung: I think it is a very broad question because how a healthcare system is designed and how would things be implemented reflect necessarily the value tolerance and the priorities of society. Some countries expect a certain number of, say, avoidable deaths, certain rates of infant mortality, at a certain cost, taxation, GDP, how much we are going to allocate our resources. So, it's not a simple question of what healthcare likes to achieve, but how society wants to allocate the resources and how to prioritize it, and what they do think is important.

Chan: Right. Thank you, President Leung, for sharing with us your insights into how Hong Kong would benefit from a third medical school.

As the German physician Rudolf Virchow said, “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community”. Thank you for joining us and have a good evening!