What surprises me most about the $629 million offer by the Hospital Authority to settle a dispute over on-call work during holidays is that even senior doctors - the best-paid public-system doctors in the world - are also entitled to the compensation.
The doctors claimed that the lawsuit was not about money, but the protracted problem of excessively long hours. In my opinion, the real reason behind it is unequal pay: inequality is always a more powerful catalyst for discontent than other hardships. But the fact that the highest-paid among them will only get richer will do nothing to improve morale among the lower ranks.
In the good old days of the Department of Health and Medical Services, every doctor who reached the same seniority received the same pay. Those who passed specialist examinations were promoted and those who didn't moved on to something else, such as private practice. Life was fair.
Then came the Hospital Authority, first presided over by Sir S.Y. Chung, whose biggest fear was that when it was established, no one would show up. To entice government doctors to join, the board had to offer sweeteners. In lieu of the standard civil service benefits, it was decided that there would be a cash allowance of up to 66 per cent of senior doctors' basic salary.
These calculations were flawed. Most civil service benefits are meant to last only a finite period of time, such as 10 years for the home-purchase scheme. The overseas education allowance ends when children have completed their education.
Before joining the Hospital Authority, many senior doctors had already milked the old system dry by claiming the maximum allowances. Yet they then went on to receive the authority's cash allowances until their retirement. Nor is there any safeguard against double benefits if both husband and wife work for the authority. The salaries of senior doctors working for the authority are now almost double those of government-employed doctors outside the authority.
The authority's budget deficit began in 2001, but administrators saw it coming. In 1998 and 1999, newly recruited medical graduates were offered contracts with much-reduced pay, which was further reduced in 2000 and later. While senior consultants make over $250,000 a month and doctors who joined the authority before 1998 get at least $113,000, those who joined in 2000 can expect only $57,000. Those who joined later make even less, and will never reach the same levels as their predecessors. Thus, there is bound to be discontentment.
Since their contracts stipulate a fixed income, the only legal challenge they could mount is on working hours, which are nominally set out in their contract.
However, life after graduation from medical school has always meant long hours at work. When I did my surgery internship in the 1970s, the roster would begin with 32 hours of non-stop work, followed by 16 hours on call, then another eight hours of active duty. When I finally got some time off, being of an age when sleep was thought a waste of time, I would play mahjong late into the night.
This was the norm: a baptism of fire. No one ever complained. This is why I think the lawsuit was more about pay inequality than long hours.
The authority has a new chief executive, from Australia. He faces two major problems: poor morale among junior doctors and a budget deficit. He could probably tackle both simultaneously by cutting senior doctors' salaries - instead of giving them overtime pay.
Dr Feng Chi-shun is a consultant pathologist at St Paul's Hospital