OVERSEAS MEDICAL DEGREES

[Mr Speaker in the Chair]

Dr Lily Neo asked the Minister for Health if he will review (i) the policy of restricting the number of overseas universities for approved medical studies; (ii) the criteria for the recognition of overseas medical degrees; and (iii) the list of universities with degrees approved for registration in Singapore.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, the intake into the NUS medical school is currently 200 a year. Each year, we expect about 80 overseas graduates to be registered for practice in Singapore, including both foreign doctors and overseas trained Singaporeans. The 20 universities whose medical degrees are registrable with the Singapore Medical Council are in various developed countries, such as the UK, USA and Australia, so we have sufficient choice of graduates. This number also excludes the 160-odd doctors who are under temporary registration in Singapore at any one time.

The overseas medical schools are top ranking institutions in their respective countries and have been assessed to be of a standard comparable to the NUS medical school, or better. The list is reviewed from time to time and updated. The present list remains relevant and serves our needs.

Dr Lily Neo (Kreta Ayer-Tanglin): May I ask the Minister if we are in fact short of doctors here again and, if it is so, why are we adhering with the policy of restricting the number of recognised universities for medical students?

Mr Lim Hng Kiang: When we debated the health policy in the White Paper in 1993, we made it quite clear that we want to prevent over supply of doctors and specialists in Singapore. Because if there are too many doctors and specialists, the demand for medical services will be inflated and healthcare costs will go up. So that has been the fundamental pillar of our policy. In the White Paper, we would control the output from NUS at 150 per year and also from foreign trained doctors at 50 per year. Because of the change in population policy, we have increased the intake in NUS to 200 and also the intake from foreign trained doctors from 50 to 80. So we have made the necessary adjustments to meet the higher population that we have. The situation is quite comfortable today.

Dr Lily Neo: May I ask the Minister whether it is likely that we will be requiring many more doctors for multi-factorial reasons, one of which will be the ageing population that will need more medical care. And will a shortage of doctors in fact be perpetual in the coming years, especially if we have to depend mainly on our own university for the supply of our medical personnel?

Mr Lim Hng Kiang: We are constantly reviewing our requirement for doctors. The need for doctors for an ageing population is in fact factored in the White Paper when we studied the issues in the White Paper in 1992/1993. The population profile and the ageing phenomenon in Singapore are quite well understood. This is something that you can project 30-40 years ahead of time. What is new now is our thrust into life sciences. That is a new factor which we are taking into consideration. As you may know, Dr Tony Tan has set up a task force to look at how Singapore should respond to life sciences. It is entirely possible. Because of this new requirement, we may have to increase the intake of doctors, both in servicing for clinical trials as well as for research. So I do not rule out the need for more doctors from both our local intakes, local training as well as from overseas sources. But for the time being, the 20 universities that we have, as registrable under the SMC, serve our need because we can recruit what we want from these 20 universities. And those who do not come from these universities, we can put them either on temporary or conditional registration.

Dr Lily Neo: Will the Minister be able to get better postulation on our medical staff requirement, considering that medical training takes many years to complete and that many years of advance planning is necessary?

Mr Lim Hng Kiang: That is indeed one of the considerations, that it takes many years to train a doctor, and also the people, particularly Singaporean parents and students, make their decisions based on what we put up. When we say that there are 20 registrable universities, they would put their children in these universities and those who have done so since 1993 will have reason to be upset if we chop and change every other year. So when we do projections for medical personnel, particularly doctors, we have to do so in a very deliberate manner. And we did so in 1992-1993. The situation has changed somewhat. We have adjusted it in 1998, not so long ago, by increasing the intake in our university and allowing more registrations from overseas. Now, there is another new consideration, how to position ourselves for life sciences. As I said, this is something that we are studying and it is conceivable that, because of this very major change, we may have to make further modifications to our plans. But I would be reluctant to chop and change because people are making very important decisions based on what we publish as registrable universities.

Assoc. Prof. Chin Tet Yung (Sembawang): May I just ask the Minister whether he has the figures for the number of doctors per year that come from the overseas institutions?

Mr Lim Hng Kiang: I do not have the detailed breakdown with me. But I presume the 80 doctors that we recruit every year will come from these 20 universities. Because the people who can come in and are registrable without having to go for extra examinations are the ones listed in these 20 universities. So I assume the 80 doctors come from the 20 universities.

Dr S. Vasoo (Tanjong Pagar): Would the Minister be prepared to review the earlier list of universities that he had delisted and consider reinstating them? He has the original list of the universities when he first started and he had delisted some of them. Will he be able to reinstate some of these comparable universities?

Mr Lim Hng Kiang: I thought that has been the purpose of my whole answer. In 1993, we changed from 170-odd universities and we trimmed it down to 20. People made their decisions based on this list of 20 universities. They have committed their children to study in these 20 universities. If now we change without good reasons, I think if I were a Singaporean parent, I will be quite upset. But if there is a significant change in the direction that is needed, say, for example, life sciences, and we cannot generate the graduates to meet this requirement from within - that is the subject of a task force set up by Dr Tony Tan - then, of course, we may have to broaden or widen the list to take in the necessary numbers from overseas. But, today, we have expanded from 50-odd to 80 doctors and the 20 universities can provide the 80 doctors that we are recruiting every year. Those who do not come from these universities, we will put them under temporary or conditional registration, that means they work under certain hospitals or VWOs for very specific purpose. The situation today is that our needs are met through temporary and conditional registration of these foreign doctors. My primary concern is if you tell Singaporeans that you will recognise these 20 universities and they have gone overseas for studies, I will be very reluctant to chop and change so frequently.

Dr Vasoo: May I ask the Minister how accurate is this manpower projection because it is always changing from time to time? Since it is changing all the time, how accurate is your projection for such manpower needs?

Mr Lim Hng Kiang: We do not have a fixed ratio that we target for. It is not to say that if you have one doctor to 700 population, you are going to get so much better medical care than 1:750. These are not critical numbers or planning norms. Basically, the indigenous population of Singapore can be quite easily projected. What happens is in 1996, we made a major strategic decision to increase the intake of PRs and that changed the scenario quite drastically. Now, we are considering the second strategic decision that we have to take probably this year and, that is, we have to look at doctors not just as servicing the healthcare industry, but also as participants in this new life sciences industry.

So I see these as two major changes in the strategic scenario. Other than that, you cannot project accurately how many will stay after they have passed out from their university. Give and take 10 or 20 every year, it does not change your situation that drastically. What we are looking for are significant changes in direction, ie, the 1996 population intake of PRs, and now what we are going to do strategically for life sciences. These are major decisions which of course will have an impact on the production of doctors. Beyond that, we are quite comfortable. Our primary care sector is well taken care of. We are building new hospitals, and all these projections are taken care of.

Dr Vasoo: In view of the move by Singapore to make our place a medical hub and to develop a medical centre of excellence, are these factors taken into consideration in the projection for manpower?

Mr Lim Hng Kiang: This is nothing new. This was already anticipated in the 1993 White Paper.