Paul and Kathy never imagined they would one day be studying late into the night, hours after their work shifts ended, to prepare to obtain medical qualifications overseas so they can leave Hong Kong for good.

Even though he has long been qualified to practise as an emergency room doctor in Hong Kong, Paul has recently been spending another three to four hours revising medical textbooks, after his work shift at a public hospital ended.

coronavirus virus mask airport
File photo: GovHK.

He hopes to obtain the equivalent qualification in emergency medicine in the UK, so he can obtain full registration there as a doctor and thus have the option to immigrate.

For fear of retribution, Paul and Kathy, who do not know each other, spoke with HKFP under assumed names about their plans to move overseas.

In the past year of sometimes violent street protests, Paul said there had been times when he could not carry out his responsibilities as a doctor properly, which made him deeply uncomfortable. “For police custody cases, for example, if you stand your ground for the patient, they [the police] could call it obstruction,” he said.

Officers escorting a patient would often refuse to step out of the examination room or allow curtains to be drawn when a doctor conducts their examination, especially if the patient had been arrested and injured during a protest, said Paul.

bean bag round protester eye shield
A suspected bean bag round stuck in a protester’s eye shield. File Photo: SocRec.

“If you ask the patients questions in front of other people, it will affect their answers and the diagnosis. It’s a medical, not a police interview,” Paul said. Injured protesters feared giving out incriminating information, especially their causes of injury, if police were present during the examination.

At the height of the protests in late summer last year, arrests were made inside hospitals, as police sought out those wounded by tear gas canisters or batons. The fear of arrest drove some injured protesters away from public hospitals to seek underground medical treatment.

“The Hospital Authority (HA) has issued policies saying that you could discuss [situations] with supervisors,” Paul said. “But the reality is your supervisor won’t support you as you try to stand up to three police officers having custody over a patient.”

“You try to defend your patient’s rights – you know what’s right for the patient, you know this is wrong, but there is nothing you could do about it,” he said.

There were occasions when Paul felt it was necessary to defer treatment for an arrested patient and admit them to a ward instead. He would wait until late at night to speak with the patient once police guarding them had gone for a break.

doctor emergency medicine revision material
Paul’s study materials. Photo: Selina Cheng/HKFP.

Failure to offer a patient strict confidentiality during a medical interview and examination could amount to negligence. “The stress is big,” Paul said. “For us at the hospital’s front door service, this is on an every-other-day basis. It’s a very visible experience to me.” 

Kathy, a nurse at the government’s Queen Elizabeth Hospital, had similar views. “As a nurse, I could see how many of the protesters were injured from being beaten,” she said. “It’s much more of a reality to see that in person than online.”

NCLEX RN US Nursing council qualification exam
Photo: Supplied by Kathy.

“To think that the police have no accountability, I think it’s [Hong Kong] not a great place for my own future and if I have children.”

When Paul studied to become an emergency room doctor, he was prepared to stay within Hong Kong’s public health care system, as private hospitals typically do not offer full emergency services. He was ready to work longer hours for lower pay, but mounting political pressure – and an increasing sense of hopelessness about the city’s future – might just be the last straw.

Paul said he knew of around ten other doctors of varying seniority who are currently taking steps to obtain registration overseas.

NCLEX RN US Nursing council qualification exam
Photo: Supplied by Kathy.

Doctors who graduated in Hong Kong before the handover in 1997 would already be registered with the UK General Medical Council and could reinstate their status upon application. Some mid-career specialists-in-training, such as those in internal medicine, radiology and paediatrics, would also be able to practise in the UK without additional exams, Paul said.

However, Paul would have to retake his emergency medicine qualification exams before he could practice in the UK. He will have to pass three papers (to be taken online, due to the Covid-19 pandemic) and one clinical exam, in two to three years’ time. Once qualified, he would be granted full registration and would be able to seek employment and a sponsored work visa with the National Health Service, even though it could mean up to a 50 per cent pay cut.

Half a million spent, no turning back

“There is a 100 percent chance that I’ll leave,” said Kathy, who has just passed an exam that grants her registration with the New York State Nursing Council.

She is eyeing a US immigration programme that offers green cards to registered nurses, eliminating years of waiting faced by other green card applicants.

Registered nurses in Hong Kong are eligible to take US nursing council exams, which are offered at a test centre in Wan Chai. After this, Kathy must pass an English test, find an employer to sponsor her in the US and pass an immigration interview at the US consulate.

Medics strike Feb 4 2020 doctors nurses hospital authority
Thousands of medics joined strikes February 2020, calling for a border shutdown. Photo: Kevin Cheng/USP United Social Press.

In the early days of Covid-19, in February, Kathy was among 7,000 public hospital medics who joined a week-long strike to demand that the government shut its borders with the mainland.

Over the following months, medics were asked by the Hospital Authority (HA) to explain their absence on strike days, with letters threatening further action. Secretary for Food and Health Sophia Chan said in November the medics who joined the strike would be handled with the “established mechanism.”

“I thought about how I might lose my job or never get a promotion because I joined the strike,” Kathy said, discussing her decision to move overseas.

In response to HKFP‘s enquiry, the Hospital Authority said it “has introduced a series of measures to attract and retain the healthcare workforce,” with more promotion opportunities, additional posts for nurses, training opportunities and special allowances for professional development.

“We will also continue to hire full-time and part-time healthcare staff, offering flexible work arrangements to alleviate work pressure of current staff, and closely monitor the situation and implement various measures to attract and retain staff.”

Kathy took out half a million Hong Kong dollars (US$64,100) from her savings to pay a Hong Kong immigration agency, Goldmax Associates, to help her prepare for the nursing council exam, arrange paperwork and match her with an American employer.

In subsequent months, she studied up to ten hours a day on each of her days off, and two to three hours on workdays. She used a mobile app to revise even on public transport. “I did about 7,000 mock test questions.”

willis fu immigration consultant Goldmax Associates.
Willis Fu. Photo: Supplied by Goldmax Associates.

Willis Fu, the marketing director and senior immigration consultant at Goldmax, told HKFP he received nearly 200 enquiries from nurses from various hospitals since the National Security Law in Hong Kong was enacted on June 30. A dozen have signed on as his clients. He only received a handful of enquiries the year before.

“Frankly speaking, many medics in Hong Kong are rather ‘yellow’,” Fu said, referring to their pro-democracy sentiments. “Those with children would worry about Hong Kong’s education getting red-washed… While others worrying about the city’s future, might not want to have children.”

“So if money could get them a better life, and the salary isn’t much lower in other countries, they would rather emigrate,” he said of his clients. At a starting position, a registered nurse in New York would receive a minimum of about US$30 an hour in pre-tax wages, Fu said, which translates to about HK$37,440 a month.

“If HK$500,000 could get you four green cards for the whole family, that’s a pretty good deal.”

A new life ahead

“I don’t think I could go back after taking this path,” said Kathy, who now looks forward to starting a new life in the US. “Nursing jobs are more diverse in the US. You could be a travelling nurse or set up your own practice.”

To Paul, the future in Hong Kong looks grim. “As you go on, the world is much worse than you think,” Paul said. “Things won’t really get better but will get worse from what you want it to be,” Once he passes his UK qualification exams, at least he has another hand to play.

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Selina Cheng

Selina Cheng

Selina Cheng is a Hong Kong journalist who previously worked with HK01, Quartz and AFP Beijing. She also covered the Umbrella Movement for AP and reported for a newspaper in France. Selina has studied investigative reporting at the Columbia Journalism School.