Loletta So, president of the Hong Kong Public Doctors' Association, says doctors suffer long working hours and endure a heavy workload.
"Many find it frustrating to not achieve their mission of providing good quality care to patients," says the leader of the main doctors' group in the public sector.
Poor and unclear career progression in public hospitals - especially for specialities such as internal medicine, paediatrics, orthopaedics and clinical oncology - also explains why many doctors have made the switch. "Some doctors need to wait more than 15 years after graduation to get the chance of promotion," So says.
The rigid salary system is also driving doctors into private practice, which is thriving thanks to the growth in numbers of mainland patients, among other factors.
"There's a constant loss of [public] doctors in some specialities that are better rewarded financially in the private sector," says Peter Yuen, principal investigator of Polytechnic University's Public Policy Research Institute and professor of management and marketing at the university.
Choi Kin, president of the Hong Kong Medical Association, attributes the changes to the "mismanagement and poor distribution of financial and human resources", resulting in the allocation of too many resources to hospital services at the expense of the development of primary care and family medicine.
Hong Kong has about 11,000 doctors, almost half of them employed by the Hospital Authority. Choi says while private doctors attend to about 20 patients a day, the daily caseload of a public doctor can be as many as 100.
Academics and representatives of medical professionals say the solution lies in improving health care management and promoting primary health care - especially family medicine - to ease pressure on the secondary and tertiary health care systems.
The former refers to treatment by specialists and the latter describes treatment in a health care centre that includes highly trained specialists and advanced technology.
"There is a severe shortage of management talent because [the health care sector] is a very big industry," says Yuen, who is also an adviser to the Hong Kong College of Health Service Executives.
"The budget of every hospital is immense, and it is no easy task to manage these institutions," he says.
"Their management is dominated by doctors, yet not all of them have received training in health management."
Meanwhile, family doctors can provide continual, comprehensive and holistic health care and serve as the patient's advocate in dealing with other medical professionals.
"If you have a doctor who can offer holistic care, you don't need to shop around to look for a specialist or to queue for services at hospitals. This could help to cut down expenditure," Choi says.
He adds that more resources should be devoted to training in family medicine and primary care. "There's training in family medicine in public hospitals, yet its content is very much hospital-oriented," he says.
Easing the burden
- Polytechnic University runs a master of science in management programme with a focus on health services, for
- individuals working or intending to work in health care.
- The programme offers a variety of subjects, from health care economics and health informatics, to health services evaluation and planning. For details, visit http://www.gsb.polyu.edu.hk/index.asp?nodeID=164lang=en-us.
- The Hong Kong College of Health Service Executives organises workshops and seminars on management, covering topics such as management planning and health economics. Go to http://www.hkchse.org for more information.