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LCQ13: Private practice by teaching staff of medical faculties

    Following is a question by Dr the Hon Kwok Ka-ki and a written reply by the Secretary for Education and Manpower, Professor Arthur K C Li, in the Legislative Council today (March 8):

Question :

     Regarding private practice by full-time and part-time teaching staff (except those in honorary teaching positions) of the faculties of medicine at the two universities in Hong Kong and its impact, will the Government inform this Council whether it knows:

(a) in each of the past five years, the number of full-time teaching staff of the faculties of medicine providing private service consultation or surgical treatments and, among them, the number of those providing such services in private hospitals; the number of full-time teaching staff who changed to part-time appointment in order to engage in private practice, and whether any vacancies arose from such change of appointment in these faculties, broken down by specialty and post; if so, whether such vacancies were filled by open recruitment in order to attract capable young doctors for the appointment;

(b) the amount of Government subvention received by the faculties of medicine, and the amount handed over to the faculties by the teaching staff from their income in private practice in each of the past five years;

(c) the formulae for calculating the proportion of the working hours spent by such teaching staff on their private practice, and the income shared between them and their faculties; whether there is any mechanism for declaration of interest or any express provisions for limiting the duration of their private practice;

(d) the existing mechanism and guidelines for monitoring full-time teaching staff of the faculties engaging in private practice and for approving the applications in this respect, so as to avoid situations such as unfair handling of these applications and conflict of interests; and

(e) whether assessment and review will be conducted on the impact of private practice by such teaching staff on the medical service provided by the relevant organizations, the operation of specialty departments, the continuation of the education and training efforts, the development of scientific research and the promotion opportunities of the teaching staff?

Reply :

Madam President,

     All institutions funded by the University Grants Committee (UGC) are autonomous statutory bodies governed by their respective ordinances and councils.  They enjoy autonomy in the management of their internal affairs and finance. In the circumstances, neither the UGC nor the Administration possesses information regarding private practice by teaching staff of the Faculties of Medicine at the two UGC-funded institutions.  Nevertheless, based on information provided by the Chinese University of Hong Kong (CUHK) and the University of Hong Kong (HKU), full-time teaching staff of their Faculties of Medicine are generally not allowed to take up private practice and work as private medical practitioners.   While staff may engage in "clinical outside practices", e.g. providing consultation at the request of other doctors/in teaching hospitals or performing surgical treatment in Hospital Authority and private hospitals etc, these outside practices are normally organized on a departmental/faculty basis.  Cases are normally referred to and assigned by the Faculty of Medicine/its departments of the respective university.  Such practices are allowed and undertaken for reasons of contributing to teaching and research effectiveness, as well as for staff professional development.  Both CUHK and HKU have established their own regulations governing this area of practice which, inter alia, explicitly require that outside practice should not interfere with a staff's normal university duties.  On the specific questions asked, relevant information provided by CUHK and HKU is set out below íV

(a) As set out above, full-time teaching staff of the Faculty of Medicine of CUHK and HKU are not allowed to work as private medical practitioners.  As regards "clinical outside practice", 98 full-time clinical academic staff of CUHK have been approved in the current academic year to provide such service, whereas 97 full-time teaching staff of HKU were engaged in clinical outside practice in the 2004/05 academic year.

     Both CUHK and HKU have a small number of non full-time clinical staff, and staff taking up such appointments are based on various personal considerations reflecting their choices and aspirations.  Nonetheless, clinical staff vacancies at both universities have been filled by open recruitment.

(b) Government recurrent subvention is provided to the UGC-funded institutions mainly in the form of block grant, which is primarily calculated on the basis of the approved number of students at various levels and the mix of academic programmes offered by an institution.  The institutions have autonomy in distributing the block grant received among their own departments subject to the use of funds being within the ambit of UGC-funded activities. As reported by CUHK and HKU, the expenditure in medicine academic programmes by the two institutions in the 2004/05 academic year was $748 million and $667 million respectively.

     As regards income generated by "clinical outside practice", both universities have established their own sets of procedures and guidelines in handling such "income".   In the case of CUHK, such income will first be accrued to the University with appropriate charging of outgoings, expenses and overheads.  The remaining balance will then be shared among the University, the department and the staff concerned according to CUHK's established regulations.  For HKU, income generated from clinical outside practice will be credited to the University and departments concerned, and clinical teaching staff are generally not permitted to receive such income.   The sums received by the Faculties of Medicine of the two universities as a result of staff's engagement in clinical outside practice over the past five years are detailed at Annex.  

(c) As stated above, full-time teaching staff in both universities are not allowed to take up private practice.  In respect of "clinical outside practice", both universities prescribe that the time devoted by full-time clinical appointees should not normally exceed an average of two half-day sessions per week.  They are also required to comply with the respective university's policy on conflict of interests and established regulations governing outside practice.   As for medical practitioners who work part-time for both universities, while they may engage in other employment on their own time outside of their university appointments, they cannot participate in any outside activities (paid or unpaid) during their agreed working time at the universities.  

(d) Both CUHK and HKU have clearly-defined and well-established mechanisms and guidelines regulating clinical teaching staff's "clinical outside practice", income sharing and declaration of interests, etc, and criteria have been drawn up for approving staff to take up such outside practice.  Internal committees have also been set up by the two Faculties to process such applications and case referrals, review procedures, and handle matters involving possible conflict of interests.

(e) As stated above, private clinical practices are not allowed by full-time clinical staff. As regards the conduct of "outside clinical practice", it aims to enhance the teaching and research effectiveness and promote professional development of the departments and staff involved through their exposure to various medical cases.  Such practice is subject to regular assessment and review by both Faculties of Medicine and the universities.  

Ends/Wednesday, March 8, 2006
Issued at HKT 14:30