FOREIGN JUNIOR DOCTORS (Number employed in public hospitals)

Dr Lily Neo asked the Minister for Health if he will give the number of foreign junior doctors recruited over the past 3 years from neighbouring countries for our public hospitals with breakdown figures by nationality and university attended.

Dr Balaji Sadasivan (for the Minister for Health): Mr Speaker, Sir, our public hospitals have recruited an average of 33 Malaysian and two Indonesian junior doctors annually over the past three years. Among these doctors, 62% of the doctors graduated from universities in Australia and 21% from universities in UK.

Dr Lily Neo: Sir, I have asked for the breakdown on the nationality and the university attended. Could the Minister of State be more specific, please?

Dr Balaji Sadasivan: As for the breakdown of universities, there are about 20 universities, and if Mr Speaker will give me the time, I will run through them as quickly as I can.

Mr Speaker: Go ahead.

Dr Balaji Sadasivan: From Australia, Adelaide University, 2 Malaysians; Flinders University, 1 Malaysian; University of Melbourne, 37 Malaysians; University of Monash, 5 Malaysians; University of New South Wales, 5 Malaysians; University of Queensland, 1 Malaysian; University of Sydney, 11 Malaysians; University of Tasmania, 1 Malaysian; University of Western Australia, 3 Malaysians.

From Indonesia, Gadjah Mada University Indonesia, 2 Indonesians; Maranatha Christian University, Indonesia, 1 Indonesian; University of Indonesia, 1 Indonesian.

From Ireland, Dublin University, 4 Malaysians; National University of Ireland, Dublin, 1 Malaysian; University College Dublin, 3 Malaysians.

From Malaysia, University of Malaya, 3 Malaysians.

From New Zealand, University of Otago, 3 Malaysians.

From the UK, Charings Cross, 1 Malaysian; Edinburgh,

1 Indonesian; Imperial College School of Medicine, 2 Malaysians; London University, 4 Malaysians; University of Newcastle, 2 Malaysians; Nottingham University, 2 Malaysians; Queens University of Belfast, 2 Malaysians; University of Aberdeen, 1 Malaysian; University of Dundee, UK, 1 Indonesian; University of Leicester, 2 Malaysians, and University of Manchester, 1 Indonesian and 3 Malaysians.

Dr Lily Neo: The Minister of State has just mentioned a few universities from the neighbouring countries which were never recognised before. Will this not diminish the standard of our medical healthcare here? Will it not affect the excellent reputation which we have built up over the years? Is it right to take short cuts like this in easing the shortage of doctors in the public hospitals? May I ask the Minister of State whether now is the time to revisit and review the policy implemented in 1993 of not recognising 150 previously recognised foreign universities? Surely, it is better to recruit from such reputable previously recognised universities.

Dr Balaji Sadasivan: Sir, Dr Lily Neo refers to the MRA Schedule that came into force in 1993. The Ministry has received many requests for the MRA Schedule to be revised, in particular, to restore medical schools that were recognised prior to 1993 to the Schedule. Our position at this time is that there is no need to amend the schedule for the following reasons.

The current shortage of doctors in the public sector is due to two main factors. Firstly, there was a marked reduction in the NUS medical school intake from 1991 to 1996. NUS has already increased its intake progressively from 1997 onwards. But the increase of junior doctors will only begin to enter the medical workforce from 2007 onwards. Secondly, there is a significant maldistribution of doctors between the public and private sectors. For example, while there is a shortage of junior doctors in the public sector institutions, there is a surplus of GPs. In addition, there are shortages in some specialties, due either to the rapid growth in demand or unpopularity of that specialty amongst trainees. The situation is compounded by the very long time - generally, six years - required to train a specialist.

Our assessment is that an annual intake of 230-250 students into the Faculty of Medicine at NUS, supplemented by an annual intake of 50-80 foreign-trained doctors - many of whom would be returning Singaporeans - would be sufficient to meet our overall clinical service needs. Expanding the Schedule to address the present shortage will create more problems in the longer term by allowing a greater influx of foreign doctors that would continue after the manpower situation has eased.

The current registration system already allows foreign-trained specialists from medical schools, both on and off the Schedule, to work in Singapore, under conditional registration, to support the delivery and development of our clinical services. The Schedule does not prevent or hinder the entry of foreign medical talent, especially in disciplines where local specialists are in short supply. In this regard, the Schedule does not impede or conflict with the plans to develop Singapore into a biomedical research hub, as well as a regional medical service hub. Both of these developments would require the inputs of fully-qualified specialists, rather than doctors with only basic medical degrees.

Expanding the Schedule will increase the number of options that Singaporeans will have to study medicine abroad, if they are unable to enter the Faculty of Medicine at NUS. Given the popularity of medicine as a career and the calibre of students seeking admission, such an increase would have significant implications on our national talent spread.

Dr Lily Neo: Mr Speaker, Sir, the Minister of State did not answer my question on whether it will diminish our reputation and our standards by employing doctors from the neighbouring unrecognised universities.

Dr Balaji Sadasivan: Mr Speaker, Sir, from the list of universities, there are seven doctors from the University of Malaya and the University of Indonesia. When our hospitals went to recruit these doctors, they recruited the best from Malaysia and in Indonesia. The number is small, and they are working under supervision. I do not think our reputation will be in any way diminished.

Dr Lily Neo: Sir, we are talking about the principle of the issue here, and it does not matter whether it is one, seven or 15. May I ask the Minister of State whether it is right to take risks on the care of our patients in the public hospitals?

Dr Balaji Sadasivan: Mr Speaker, Sir, I would like to assure Dr Lily Neo that these doctors are excellent doctors, and there are excellent doctors in our neighbouring countries. If some of them are recruited, these are worthwhile foreign talent to have in our country.

Mr Speaker: Dr Neo, I think the assurance has been given, unless you want to pursue another question.

Dr Lily Neo: Sir, I would like to pursue on what the Minister of State said earlier. He said that these doctors are allowed to practise here under strict supervision. Can I seek a clarification on what he has said earlier?

Mr Speaker: Yes.

Dr Lily Neo: May I ask the Minister of State whether the senior doctors have enough time to supervise these junior doctors all the time? Are we not addressing the shortage of doctors? By having the senior doctors looking after the junior doctors, is it not defeating the purpose? Are we not talking about people's lives here? Why are we taking risks with the patients in our public hospitals?

Dr Balaji Sadasivan: Sir, junior doctors must always be supervised by senior doctors, whether they are local, UK, Australian or Malaysian graduates. We expect our senior doctors to supervise junior doctors. In time, our junior doctors will become senior doctors and supervise those who are junior to them. This is the normal practice in medicine.

Dr Lily Neo: Sir, I disagree with the Minister of State on that, because there are many types of registration. Is he saying that the local graduates are exactly the same? Surely, they are under different medical registrations.

Dr Balaji Sadasivan: Mr Speaker, Sir, a good doctor remains a good doctor, regardless of the registration category, the country they graduate from or their country of origin.

Mr Steve Chia Kiah Hong (Non-Constituency Member): Mr Speaker, Sir, the Minister of State has said that there is a shortage of junior doctors. The question is: are the junior doctors being forced to work extended shift hours of up to 120 hours per work week, and will such punishing work schedules possibly endanger patient care?

Dr Balaji Sadasivan: We have taken steps in our hospitals to reduce and monitor the working hours of doctors. The recruitment of some of the foreign doctors will help to ease the workload of junior doctors in the hospitals. But by the year 2007, we expect the higher intake of medical students into the university to increase the supply in the hospitals, and a more permanent solution would be found at that time.

Dr Lily Neo: Sir, the Minister of State said earlier that the junior doctors are also recruited from universities not scheduled in the 1993 policy. Why can the Ministry not just acknowledge this in the open and be transparent, and say that this policy is void since it is not implemented?

Dr Balaji Sadasivan: Mr Speaker, Sir, our Ministry is transparent and the policy is in effect.

Mr Steve Chia Kiah Hong: Mr Speaker, Sir, there is a shortfall of junior doctors until 2007. What is the Ministry going to do during this interim period to cover this shortfall of doctors?

Dr Balaji Sadasivan: Mr Speaker, Sir, to cover this shortfall, we have recruited doctors from the UK, Australia, New Zealand and the neighbouring countries. I had earlier given the House a list of doctors from Malaysia and Singapore.

Dr Lily Neo: Why did the Minister of State contradict himself? Earlier, he said that the policy was implemented and yet, in the next breath, he said that they had been recruiting doctors from Malaysia, Indonesia, Australia. These are not the universities in the Schedule at all.

Dr Balaji Sadasivan: Mr Speaker, Sir, there is no contradiction. We recruit foreign doctors during this period because there is a shortage. But corrective measures have been taken. The intake in the university has been increased, and it takes a long time to train a doctor. So these medical students will become doctors, and they will enter and work in the hospitals in 2007.

The purpose of the Schedule is to ensure that there is an even distribution of talent amongst young Singaporeans in the various careers. If the Schedule is removed, then a greater number of Singaporeans would go abroad and study medicine if they cannot get into the medical school in Singapore. However, even if a doctor is from a university that is not in the Schedule, he can come back to Singapore and, under certain conditions, get himself registered. Basically, it would be under a conditional registration and he would have to sit for an examination. So, this has served to discourage too many Singaporeans from going into medicine.

Dr Lily Neo: The Minister of State just mentioned about conditional registration. Could he explain to the House the meaning of "conditional registration"?

Dr Balaji Sadasivan: It means he is registered under certain conditions. I have the list of conditions.

Mr Speaker: Dr Neo, I think we have spent enough time on this. I shall only allow you one last question.

Dr Lily Neo: Sir, the Minister of State has said that the shortage of doctors here is temporary. Can he assure the House that this assessment is correct this time, or is it going to be skewed again? How would he respond to the visiting Harvard don who said that Singapore needs another medical school to train more doctors, in view of the long-term needs of the life sciences?

Dr Balaji Sadasivan: Sir, I can assure the House that in 2007, we will have far more doctors entering the hospitals than we have today. As for the Harvard don's recommendation that we should have a second medical school, the Ministry of Education is studying this.

Mr Speaker: I hope that assurance will bring the Question to a close.