The Hong Kong Special Administrative Region government has proposed that fresh graduates from the University of Hong Kong dentistry programs need an additional one-year internship requirement before they can register as dentists. In addition, they face the prospect of working for two more years under the Department of Health or in Hospital Authority facilities before they can choose to work where they want. This has met with objections from among the students currently enrolled as well as concerns raised by practicing dentists.
In view of the sorely inadequate public dental care services in Hong Kong today, the proposed requirement would seem reasonable. After all, dental training requires a lot of input from the community in terms of tax money. Unfortunately, there is no indication that the “public service requirement” will address public needs. This may sound strange, but the fact is that today, Hong Kong’s publicly provided dental services almost exclusively cater to the needs of civil servants and those of retired civil servants. According to data assembled by Ming Pao from the Department of Health, Legislative Council documents and the government consultation documents, in 2021 only 27,560 dental clinic attendances were from members of the public, while 138,173 were from civil servants or retired civil servants. Since the population of the public is vastly bigger than the population of civil servants and retired civil servants, it is obvious that the dental services provided by the Department of Health have very little to do with the public, and are even nonexistent in the eyes of the public. It should be pointed out that the Dental Clinics with General Public Sessions, according to the Department of Health website, explicitly are limited to serving emergency cases involving pain relief and extraction.
Currently, there are 40 government dental clinics in Hong Kong. Eleven of them are open to the public for limited hours. Nine of these are open one morning or one afternoon one to two days a week. The remaining two are open one morning or one afternoon once a month. One student currently enrolled in the dentistry school at the University of Hong Kong complained, “If I am going to be bound by the new arrangements to serve in the Department of Health only to serve the needs of civil servants, I would be most dumbfounded and upset.”
The virtual absence of dental service in our publicly provided healthcare system will not change with the proposed measures. The public interest case for the proposed change is extremely weak. Indeed, if the new “bondage” proposal is not explicitly to serve patients among the public, it goes counter to the public interest. If the dentists are not allowed to serve in the community, the supply of dental services open to the public will diminish. That would push up the charges in the private sector, and those who cannot afford the higher charges will suffer.
The proposed measures are likely prompted by the high vacancy rate for dentists at Hong Kong’s public clinics or Hospital Authority, which stood at 22.3 percent in October last year. To address this problem, the government should first ask why the dentists are leaving. Pay could be a factor but need not be. If the dentists had wanted to serve the public out of a sense of vocation, realizing that instead of serving the public they are being prevented from serving the public, they would want to leave. The proposed changes will aggravate the sense of alienation. The president of the Hong Kong Dental Association, Nelson Wong Chi-wai, suggested that the authorities should consider why there is a brain drain in the public sector.
Dental care is very important to residents’ well-being. Someone without the teeth to eat well or suffering from a toothache will find life miserable and hard to bear. Although dental care is costly, it certainly should have priority over the recent extension of the transport cost subsidy from serving only those at 65 years old or over to serving all who are 60 or over. Saving a few dollars on each trip is nice, but being saved from minute-to-minute pain and given the chance to enjoy food again is like being delivered from hell to heaven. Medical and Health Services Constituency lawmaker David Lam Tzit-yuen has proposed that the government distribute dental care vouchers to the elderly for annual checkups. I would propose that the government line up some private dentists and design a private-public collaboration plan modeled on the highly successful Cataract Surgeries Programme.
According to the Dental Council of Hong Kong, there are around 2,700 dentists in Hong Kong, meaning there are only 3.7 dentists per 10,000 people. This is very low compared with that of Singapore, which had 5 dentists per 10,000 in 2021. We should expand the dentistry enrollment at the University of Hong Kong, and perhaps establish a new dentistry department at the Chinese University of Hong Kong medical school. In the near term, we should import more dentists to make up for the shortfall. Keeping locally trained dentists in our public sector is the last thing we need at this time, unless the retained dentists are going to exclusively serve the public or the elderly.
The author is the director of the Pan Sutong Shanghai-Hong Kong Economic Policy Research Institute, Lingnan University.
The views do not necessarily reflect those of China Daily.
HONG KONG NEWS