Doctors lambast local healthcare system, ask for more training

During his visit to the Conde de São Januário Central Hospital (CHCSJ) yesterday, the Secretary for Social Affairs and Culture, Alexis Tam listened to the opinions and complaints of medical staff who are dissatisfied with training and promotion procedures at the hospital. They also discussed some of the problems plaguing Macau’s healthcare system, such as the long waiting list for government specialist clinics and the lack of education for some public clinic doctors and patients.
Accompanied by the directors of the Health Bureau (SSM) and CHCSJ, Alexis Tam inspected the 24-hour clinic of the hospital, the emergency department, the pharmacy and the cancer patient resource centre, before attending a two-hour meeting with medical staff of CHCSJ. More than 10 doctors and nurses spoke during the session.
Dr Pui Hing Wah, a consultant in the CHCSJ radiology department, spoke during the meeting and listed six issues she thinks the hospital should resolve in order to match international standards. Pui said she did not understand why CHCSJ does not require its doctors to participate in an annual license review, a lapse she believes is problematic.
Another problem she raised with the secretary was the lack of continuing professional development (CPD). She said that her department started providing a mandatory CPD program to its staff two years ago. However, the attendance record showed that, while non-local doctors with a CPD requirement achieved an attendance of 50 percent to 100 percent, local doctors’ attendance was only 9 percent to 50 percent. “If we do not have a CPD program [for the whole hospital], a doctor could still be practicing medicine with the methods they learnt decades ago from the mainland. How can there be improvement then?” she said.
Moreover, Dr Pui was concerned with the specialist training program in CHCSJ. She questioned whether the standards of doctors trained locally can match that of specialists who receive training overseas, since Macau does not require specialist trainees to attend a specialist examination.
Another doctor, Dr Lei from the obstetrics and gynecology department, said that many of the complaints residents filed against medical staff were caused by misconceptions and a lack of understanding about the limits of public health service. She gave the example of a recent media report accusing her department of not providing some specific services for patients. Lei claimed that the services named by the report were actually provided by private clinics and not necessarily by public hospitals. “It’s like what I always explain to the patient: even if the government is providing a 15-year free education, it does not mean the government has to provide students with piano classes or mathematical Olympiad classes… I think the government is responsible for educating the students of [the limits of public services],” she said.
Meanwhile, Dr Choi Nim, an attending doctor in CHCSJ and president of the Macau Health Bureau Physicians Association, said that the most important issues for doctors are their regime, duties, promotion, compensation and retirement. He said that CHCSJ can only attract talent and retain its staff with a good regime.
Dr Choi feels exploited by the current regime, explaining that while doctors work a nominal 36 hours every week, they end up working an extra nine hours per week paid in compensation. He claimed that these hours are not counted when calculating doctors’ retirement pensions. “We feel like we are exploited…Those nine hours are not included into the calculation of experience and retirement pension. How can you attract others to join us? Even we the current employees think that this is unfair,” he said.
Furthermore, several doctors have mentioned the difficulties for specialists in handling the ever-growing number of patients referred to them by doctors in public health centers. They asked the bureau to educate general practitioners to only refer patients to specialists after a period of follow up and observation. They also asked to allow specialists to refer patients, who did not need to see specialists anymore, back to the general practitioners in public clinics in order to reduce their workload.

Alexis Tam blames problems on ‘bad management’

In response to the complaints and opinions of medical staff, Alexis Tam admitted that the healthcare system in Macau is falling behind the international standard. He has already requested the Health Bureau (SSM) to develop a mature healthcare system and resolve problems related to the training and promotion of medical personnel.
Tam told the media that “80 to 90 percent of the problems and opinions heard from doctors and nurses can be attributed to poor hospital management,” something the secretary said “can be corrected”.
Tam stressed that SSM and the healthcare system of MSAR has to gear to international standards. “The largest constraint for MSAR currently is the human resources shortage, especially for medical personnel. Fortunately, the government’s revenue and Macau’s economy can support the healthcare reform of MSAR”, he said. “Therefore, I will tell everybody here that we have requested the CHCSJ and SSM management to…create a mature healthcare system within a year.” This improved healthcare system, he said, has to be geared to international standards and resolve various issues that are currently plaguing CHCSJ, such as the promotion and training issue. Tam reiterated that the call for reform cannot merely be a slogan, which is why he has given a clear time limit for the bureau and the hospital.
Moreover, the secretary vowed to make improvements in the information system of the health authority. He said that SSM will, in collaboration with non-government organizations and clinics, roll out a mobile application that allows residents to receive information on the number of patients waiting to see a doctor in the hospitals and some public and private clinics in Macau.
Furthermore, Mr Tam revealed that SSM intends to hire 529 medical personnel in the upcoming year. Around 73 percent will be doctors, nurses and pharmacists.
Although he did not say what the consequences would be if SSM and CHCSJ failed to improve the health system within a year, Alexis Tam maintained that he is confident his departments will achieve the goal and claimed that as a government official, he is obliged to keep this promise.