Dr Samuel Kwok, president of the Association of the Private Medical Specialists of Hong Kong, attends the Straight Talk show on TVB, May 2, 2023. (PROVIDED TO CHINA DAILY)

Dr Samuel Kwok, president of the Association of the Private Medical Specialists of Hong Kong, is on the show this week.

Dr Kwok says Hong Kong medical professionals can help bring our experience from an established medical system to the Chinese mainland. Hong Kong doctors cannot only practice in the Guangdong-Hong Kong-Macao Greater Bay Area but also learn from it. And he believes more Hong Kong doctors will follow the city’s patients into the bay area as well.

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

Chan: Good evening! Thank you for joining us on Straight Talk. Our guest this evening is Dr Samuel Kwok, president of the Association of Private Medical Specialists of Hong Kong. He is a medical specialist in general surgery, and Chief Medical executive of the Virtus Medical Group. He has appointments at several hospitals and universities, both here in Hong Kong and on the mainland. In addition, he is a member of the election committee, and the executive director of the medical and health committee of Council for the Promotion of Guangdong-Hong Kong-Macao Cooperation. This evening, we will be discussing the potential for Hong Kong doctors to practice in the Greater Bay Area. The question is: 'Is it time for them to take the plunge?' Welcome, Samuel!

Kwok: Thank you. Good evening!

Chan: Thank you. Thank you for coming today. There has been a lot of talk about the Greater Bay Area in Hong Kong, in particular in the government and other business circles. It is within an hour living circle within Hong Kong. And basically, it is a no-brainer in terms of expanding our business network, because there are 86 million people right across the border. So, it's also accessible for Hong Kong people. Because we know it takes about 15 minutes to get there by the high-speed rail. So, is it a no brainer to ask? I mean, why do people still have to be encouraged to go to Greater Bay Area, since you're the executive director?

Kwok: Yes, you outlined it very, very well. Now, the Greater Bay Area is just one area we ... people living there can travel within an hour to everywhere. So, previously, it would be limited by the territory of Hong Kong, I have to explain to you about the system – the healthcare system in Hong Kong as well as in the Greater Bay Area. And this is indeed two different systems. And with that, I think I can explain more about whether we can go into Greater Bay Area and expand our services. 

Chan: You know one area that we always talk about is the doctor to patient ratio. In Hong Kong, it is about every one thousand people, we have two medical doctors. What is the situation in the Greater Bay Area?

Kwok: In fact, you've talked about number of doctors, we in Hong Kong have the lowest – two for one thousand population. But in the Chinese mainland, we have more than two, maybe two point six or two point seven. So, looking at the sheer number is not enough to understand about the healthcare sector, their services, because most people have to have the basic general medical care. But on top of that, we need specialist care. In Hong Kong, the system is that you can visualize the Hong Kong system as a three-dimensional structure. For example, you have to cover a big area of different needs. And then you have the private sector and the public sector. And on top of that, now, we have also the primary care services, which may be on the first floor and then you go up second tier and third tier into the secondary and tertiary care provided by medical specialists. So, we have that kind of system. In Hong Kong, the division between public and private, if you talk about primary care, private sector constitute about 70 percent of the care. So, more private. But if you talk about the specialist care, hospital care, you're talking about 85 to 90 percent of the care are in the public sector – the Hospital Authority. So, now, people talk about lack of doctor in Hong Kong mainly is the lack of doctor in the public sector in Hong Kong, with the Hospital Authority.

Chan: Dr Kwok, so far, you have outlined the picture in Hong Kong. How about the mainland? I often hear about the hospitals. And everybody, when they're not well, they will go to the hospitals and the private sector is basically on the minimal side. So, how many hospitals would there be in the Greater Bay Area? Do they have adequate number of hospitals, or they have too many?

Kwok: The system in the mainland is totally different. It's a socialist care system. So, the hospitals are categorized into a provincial, city and then you know villages. So, we're talking about big hospital, the 3A hospitals, and those are the big hospitals that people go to for all kinds of care – primary, secondary or tertiary – whatever they go into hospitals. So, the system is different. And they didn't even have the system for medical specialist. And they, of course, they are experienced people in doing different specialties, but they go according to the rank. If they promote into, you know, chiefs and then higher, then they become specialists. But we have different systems, we have certification for medical specialists in Hong Kong, which you don't have in the mainland. So, talking about these two different systems, of course, in the longer term, we have to build and then construct a prosperous Greater Bay Area. We need to go hand in hand go together.

Chan: Right. One question is, when you are saying that we have different systems, which is fine. How accessible it is for the people in GBA to go to seek medical care?

Kwok: The people all over the mainland, they are basically covered by the National Insurance System. So, they go into hospital, the National Insurance System cover them. So, the price is kind of regulated, and most people would have that. But in the bigger hospitals, they have special wings, maybe divisions that do kind of international business. So, they can charge more, maybe four to five times more. And those are for the people who are you know, more affluent, they can pay, or they have better insurance like medical, the private medical insurance or for expatriates. So, we have about kind of 10 percent people can go for this kind of semi-private market in the mainland.

So, you just mentioned that most of the population will have the general insurance by the state. And expatriates, they had to go into private services. 

Chan: Yeah, I mean, are they readily available? Is the standard good over in GBA in that aspect? 

Kwok: Now, this kind of public  ... and kind of public-private system all run by the state, basically, its government. But of course, now we see private hospitals, really, but they are just a few in the Greater Bay Area, mainly invested by Hong Kong people, or some overseas money. So, they can have a totally private setup. But those are small. So, it's not a big way that people can go into but knowing that the Chinese maiinland is, you know, becomes more and more prosperous, people are wealthier, this market is big. So, we expect to see more patients may be seeking private sector health care system in the mainland. 

Chan: I mean, we had Dr Dennis Lam here last week, and he commented there are world class medical institutions in the mainland, however, because the country is so big, then there's a quite a wide range of standards. So, how does... will Hong Kong doctors have a role to play in that area, where there are quite a wide range of standards?

Kwok: That's quite true, the system or the standards of different hospitals, different settings, even different professional personnel are quite different, you know, the differently accredited as compared to Hong Kong. So, the system is just various, in different places, not that they're not good. All right. In Hong Kong, we are more, you know, systematic, we have systems better and maybe if you've talked about doctor, in qualifications of doctors are divided into two groups. One the general practice and the other is the medical specialists, which is accredited by the Academy of Medicine in Hong Kong, which is a well-known standard of qualification. But in the mainland, they don't have this. So, it's even difficult to say who is the medical specialist in the mainland, I think in this respect, Hong Kong can help out in importing standard more international kinds of standard. 

Chan: So, basically, more like a benchmark. 

Kwok: For different things, like institutions, like the professional people, qualifications, doctors, nurses and other allied health. So, those will be important. If these two systems can co-evolve like an ecosystem and then we go hand in hand, I think together we complement each other – Hong Kong and the Greater Bay Area – can make the Greater Bay Area healthcare sector into a higher level, another level for higher quality services or high-end services provision for the whole region for Asia even.

Chan: You know in Hong Kong, one area they often talk about on Straight Talk is we have a what we call an aging population. What will be the demographics over the GBA, they got 86 million people. From your point of view, do they have a similar sort of demographics like Hong Kong, or they are more of a younger generation?

Kwok: Now how Hong Kong is aging, everybody knows. We have about 19 to 20 percent of people over the age of 65, as of today, and over the mainland, of course, are also aging, every country is aging, but they apparently are less aging than Hong Kong at the moment. Especially if we talk about Shenzhen, which is the city just across the border, is a young city. So, they have about what four or five percent of old people. So, the demographic is very different in Hong Kong, because of the population, as well as an aging population, the disease load is high. So, we have more and more patients to see both in public and private.  

Chan: Many people said that in mainland they have such a vast population. Therefore, you see a vast number of diseases and more variants of presentations. Do you agree that would be a good thing for Hong Kong doctors who actually to really practice what you have been trained?

Kwok: That's both for practice and also for learning. You know, when people go into training, they need to see more patients, or a bigger variety of people or different presentation of disease that will be good for them. So, I think that is one aspect to look at it. If we want doctors in Hong Kong to really go into the Greater Bay. First of all, they have to know the other system. So, you know, see more patients there. So, start with, you know, students, medical students, and then medical trainees, specialist trainees, and then as a practitioner to work there. So, it's just kind of a gradation that people can go through and enter into the market in the Greater Bay Area.

Chan: Right. So, Samuel, let's take a break now and viewers stay tuned, we will be right back.

Straight Talk presenter Eugene Chan (left) interviews Dr Samuel Kwok, president of the Association of the Private Medical Specialists of Hong Kong, May 2, 2023. (PROVIDED TO CHINA DAILY)

Chan: Thank you for staying with us. We have been talking with Dr Samuel Kwok about the healthcare system in the GBA, mainland cities, and how Hong Kong fits into the overall GBA picture in the healthcare arena. So, president, in the first half, you have categorically said that Hong Kong and the GBA can complement each other.

Kwok: That’s right.

Chan: Hopefully we can rise to a new level, so both sides of the medical profession will benefit. So, let's talk about how we can actually go in to practice in the GBA. I remember we had the mainland and Hong Kong Closer Economic Partnership Arrangement, the CEPA, that was in the … nearly 20 years ago now, that allow Hong Kong registered medical practitioners to go to GBA to work. But it doesn't allow the mainland counterparts to come to Hong Kong. But recently, we saw that there are three doctors and 17 nurses from Guangdong coming over through the GBA healthcare talent exchange program. Do you see that because of us getting closer and closer, do you see that it kind of limits or allows the registration to be more and more relaxed in time that maybe both sides’ doctors can easily reciprocate?

Kwok: This is a very interesting development for mainland doctors coming over to Hong Kong. That is not in the CEPA, as you said, CEPA is Hong Kong’s doctors going into the mainland.

Chan: Exactly.

Kwok: But that is because the lack of doctor problem in the Hospital Authority that led to this development, all right? I must say this is a problem in health sector in Hong Kong, and doctors are just one piece in the whole jigsaw puzzle of this healthcare problem. Now even you have doctors, now we don’t have enough nurses and other personnel, and infrastructure, and facilities. So, now we know that a lot of wards, a lot of operating theatres are not open because we don't have enough nurses. So, that can help with it, I think, that is one movement from the mainland to Hong Kong. But I think the other movement is for Hong Kong doctors to go into the Greater Bay Area, into the mainland. And that has been open for some years, as you said in the CEPA. Nowadays I think doctors who graduated in the year 2002 or before, they can just apply for a license to work in the mainland, provided that they have the qualification of medical specialist in Hong Kong. So, you think about that that is 20 years’ experience. Very experienced doctor that they are expecting. So, I think this, although it kind of allow, but it is not allowed in a big way.

Chan: Right. But will the general practitioners of Hong Kong be able to go to the mainland as well?

Kwok: If according to this regulation, they are not.

Chan: Unless you belong to the family medicine specialty?

Kwok: Yeah, yeah. You have to be a medical specialist. So, they are not allowed. Of course, there are bits and pieces, little institutions they can apply specifically for specific doctors, but not in a general way. Those are barriers that we need to really work out to allow bigger influx of doctors.

Chan: So, president, one area that you have said very clearly in the first part of the show is that while Hong Kong are having so-called a shortage of medical doctors, let’s not talk about all the other personnel, is mainly in the public sector.

Kwok: That's true.

Chan: Whereby in the private sector, not everyone is going to be very busy because it is a private choices by the patients. So, does that mean that being able to, a specialist, being able to work over the border and be able to develop a new line of business, so-called, in the Greater Bay Area, would be a good opening for our specialists in Hong Kong?

Kwok: That is true. As I have said, the…if you talk about the medical specialist sector, 85-90 percent of patients in the Hospital Authority, and just 10-15 percent of patients in the private sector, but if you talk about the number of doctors, they are half and half. A lot of doctors in the private sector serving much less number of people, all right? So, there are lot of surplus in …

Chan: Capacity.

Kwok: In capacity. 

Chan: Right. 

Kwok: So, where do they go? I think what happens will be doctors go where patients go. I think, of course, there are some patients coming over from the mainland to Hong Kong, that is quite true, in the private sector mainly. And recently I have seen people from Hong Kong going back to the mainland. We have an aging population, and more old people are trying to live in the mainland, in the Greater Bay Area. So, people are moving up into north. And also the Greater Bay Area as I have said, is also aging. So, there are a lot of people, a lot of disease, a lot of patients that doctors can take care of. So, as I have said, doctors will go where patients go. 

Chan: Right. Samuel, as we both are in the healthcare profession, I remember helping to draft the CEPA like 20 years ago. At that time, I mean the idea was there, but the professions, all right, time to go, but not many people will go. After 20 odd years now, the title of today’s show is ‘Is it time for Hong Kong doctors to take the plunge into the Greater Bay Area?’ They used to be called the Pearl River Delta Area or go by Southern China. What will be your simple answer to that?

Kwok: The answer is yes. I think I am seeing the beginning of this time. Although you said that doctors going there for quite a number of years before, but I think I would expect a surge in the next maybe 5-10 years, for private doctors in Hong Kong looking for opportunities in the mainland. 

Chan: Right.

Kwok: So, provided there are opportunities. So, there are a number of things that the government has to do now.

Chan: So, it’s still not too late to go now? 

Kwok: Well, it is not late, it is just the beginning, I would say. The system now changes and it is a national strategy to build Greater Bay Area, even in the healthcare sector. So, with this strategy or with this initiative for the whole country, I think we have to really cooperate to see how we can collaborate with the other side and build a better Greater Bay Area. And doctors and the healthcare sector is definitely one of them.

Chan: You know our University of Hong Kong has a teaching Hospital in Shenzhen, has that helped to set a standard so-called or how much has it affected the medical landscape in the Greater Bay Area in your view?

Kwok: Of course, our universities in Hong Kong going north to the Greater Bay Area, and Shenzhen Hospital is one step early and is already many years.

Chan: I think 20 years.

Kwok: And there are Hong Kong doctors in there working as well, so to set some kind of standard. So, that would be an example. But if you have to influence the whole area, you need a lot more doctors. You have to, you know, go to their hospitals and also some new hospitals, maybe invested by the Hong Kong investors. And I know that there are policies now favoring this because the listed Hong Kong drugs and the medical devices can go into the mainland in specific places, selected sites.

Chan: That is something that doctors … yeah.

Kwok: Incentives to help Hong Kong to build up more, so that we have more investment there, and so, that opens up more job opportunities for doctors, for other professionals. And then doctors can go. I think if we talk about doctor going into the mainland, it is not solo doctors, never happen because it is so risky, so high risk for doctors, just move, really emigrate into the mainland and do business. It is a risky business. So, we need better setup, better investment, to have jobs for doctors to apply. And doctors can work both sides.

Chan: You know just now you mentioned about the medical devices and medicine, that is something Dr Dennis Lam mentioned last week. And also I know that the Hong Kong government is trying to help Hong Kong residents to be able to use the healthcare voucher, even in the Shenzhen hospital. So, you see this is definitely happening, but you think solo doctors a bit, I won’t use the word risky, maybe there will be more obstacles to overcome, rather than a big group to move into Shenzhen.

Kwok: Yes, I mean solo doctors is difficult. You know you have legal and regulatory restrictions, and also if you talk about practice, for Hong Kong, we have the Professional Indemnity Coverage for doctors, we have this system. But in the mainland we don’t. So, if you got a problem in the mainland, a doctor gets sued or whatever, they don't have coverage, they don't even have this system. So, we have to, you know, really look into all these difficulties or barriers that doctors can go into the mainland. Then if we solve these problems, if there is job opportunities there in a big way, and people just go in there.

Chan: Right. Samuel, you are the Executive Director of the Medical and Health Committee of the council for the promotion of Guangdong-Hong Kong-Macao Cooperation. Can you tell the viewers what your committee has been doing to facilitate this happen? I mean so far the show has been, the message is very clear, it is time to go. What has your committee done so far to make this happen?

Kwok: So, I would say at least three different levels. First, we have to look at the rules and regulations, we talked to governments, both the Hong Kong side, as well as the Chinese side, to really to, you know, for things that can merge or they have mutual recognition of qualifications, for example, and the medical protection thing that I have just talked about. So, to facilitate people doing things, all right? And the other is that to really try to talk to companies or healthcare groups where they can invest more in the Greater Bay Area, because for this overseas investment into Greater Bay Area, they can have more business in a kind of, you know, some more incentives like the vouchers.

Chan: Yes.

Kwok: The listed …

Chan: Right. Samuel, one last question I ask you is – AI is something we've been talking about all the time, and telemedicine has been starting to practice, especially in time of COVID-19. Do you see this is part of Hong Kong doctors’ tool of entering into the market in a bigger way by telemedicine?

Kwok: Telemedicine actually helps medicine altogether. So, it also helps medicine if you happens in a big way, in a bigger area. So, it is just really to connect people, connect doctors and patients, and connect doctors with doctors. So, this would help; the AI, the telemedicine. Even now, if you see patients, do an operation, the patient can go into Greater Bay Area or other parts of the mainland the next day. So, we have to communicate with patients. This helps, this helps the business, helps you grow.

Chan: Okay. Right, thank you, Samuel, for highlighting the opportunities and challenges for doctors wanting to expand into the rest of the GBA. It is certainly something for all professionals, not just medical doctors to consider, as Hong Kong continues to play its unique role in the Greater Bay Area. Thank you for watching and have a good evening!