i. Development of traditional Chinese medicine in post-colonial Hong Kong
Whilst traditional Chinese Medicine (TCM) has been part of the culture for centuries its official position in both mainland China and Hong Kong has varied. In the mainland it has been officially part of the healthcare system since 1950 when it was promoted by Mao Tse Tung, and remains an integral part of care provision [1
]. However, in Hong Kong TCM was not recognized as part of the healthcare system until 1997, when the 100 year lease to the UK came to the end and Hong Kong was returned to China[3
]. The then newly formed Hong Kong Special Administrative Region (SAR) Government was obliged to enact the requirement laid down in the constitutional law, in which the development of TCM was explicitly stated [4
]. A decade has passed since the first Chief Executive of Hong Kong announced the government's commitment to develop TCM in Hong Kong [5
] and in his official addresses has reiterated commitment as in the Chief Executive Policy Addresses of 2005 [6
], and in the recent 2007 Election Manifesto of the current Chief Executive of the SAR [7
]. In the past 10 years, the three major developments in TCM include:
1. Formal regulation and registration of TCM practitioners by the Chinese Medicine Council of Hong Kong (CMCHK), a statutory TCM regulation body established under the Chinese Medicine Ordinance [8
2. Introduction of TCM services into the public healthcare system, including integrated TCM-western medicine services at both outpatient [9
] and inpatient levels[10
3. Establishment of full time undergraduate training of TCM practitioners in three local universities [11
], and the implementation of compulsory Continuing Medical Education (CME) program for all registered TCM practitioners, under the auspice of the CMCHK [14
ii. Professional TCM education in Hong Kong
New entrants to the TCM profession must obtain formal registration with the CMCHK and this requires the passing of a two part licensing examination with written and clinical components. Currently, only holders of recognized TCM degree(s) are eligible for sitting the examination. Since 1998, undergraduate degree programs have been established in three Schools of Chinese Medicine in public universities. Despite slight differences in structure and emphasis, all three curricula have heavily borrow from TCM universities in mainland China, and include basic western medicine taught along with professional TCM subjects. However, unlike the mainland practice, where graduates are expected to practice both kinds of medicine, Hong Kong TCM graduates, or TCM practitioners from mainland and elsewhere, are not allowed to practice western medicine under the current legislation. For example, TCM practitioners are not permitted to order any diagnostics tests and a western doctor must be involved in any integrated in-patient treatment.
In 2005, a system of continuing education in Chinese medicine (CME) was launched by the CMCHK as an "integral component of the registration system". In each of the three year CME cycles, all registered TCM practitioners must earn 60 CME credits to fulfill their license revalidation requirement. Educational activities are organized by 30 CME program providers accredited by the CMCHK. To be accredited, affiliation with TCM academic departments is not mandatory and many of these providers are private companies [14
]. Major components of CME learning include: (a) attending or giving of lectures; (b) submitting reports on independent studies; and (c) publication in TCM journals with or without peer review requirement [15
In this study, the term post graduate training (PGT) refers to both (a) CME and (b) practice based training provided by either public or private sector that are taken by registered Chinese medicine practitioners graduated from the three local Schools of Chinese Medicine.
iii. Employment and further training for local TCM graduates
In 2003, the first cohort of local university trained TCM practitioners entered the work force but there was a lack of employment opportunities for these graduates. This raised public concern and in the following year, the Legislative councilors twice suggested a stronger role for government in the professional development for TCM graduates [16
]. Despite prior rhetoric in TCM development, the government's response was that the public sector had no intention of becoming "the sole or major player" in the training of young practitioners, and had assumed the private sector would take a major lead as most of the graduates were expected to "practice in the private sector environment on completion of training" [18
]. However, lack of employment opportunities and career pathways continue to be a major issue for TCM graduates [19
]. A survey published in 2005 showed that 72.3% of the graduates failed to obtain a full time clinical job after 1 year of graduation [20
At the time of writing , there are nine TCM clinics within the public sector which are jointly administered by the Hospital Authority (HA), universities, and non-governmental organizations [9
]. Despite their institutional identity, these clinics are self-financed and are in line with the government's private sector reliance policy for TCM graduate PGT — only 45 junior posts are made available each year for about 90 new graduates, under a fixed term of 12 months [18
]. Those who are employed as Junior Chinese Medicine Practitioners receive practice based training in these clinics but there is no published or accredited curriculum to follow. The lack of PGT guidance also applies in private sector training and the quality of training is largely unknown.
iv. Objective of the study
Despite the government's widely publicized plans for TCM development, its subsequent reluctance to nurture the next generation of TCM practitioners has cast doubts on the quality of PGT, and more importantly, about whether the current system is producing a sustainable TCM workforce that provide quality and safe healthcare for the population. The main objective of this study is to evaluate the perspective of TCM graduates on the effects of current policy by using qualitative methodology. Specifically, we sought graduates' views on their future career prospects and the need for PGT and their opinions on how to improve the current system.