MEDICAL REGISTRATION (AMENDMENT) BILL

Debate resumed.

Mr Lim Hng Kiang: Mr Speaker, Sir, as I was saying, we will allow the SMC to refer any information regarding the criminal conviction of a registered medical practitioner to the SMC's Complaints Panel, without first having to receive a formal complaint regarding the practitioner. This will ensure that doctors who have been convicted of offences in the criminal court are also reviewed by the SMC to determine if there had also been breaches in professional conduct.

The title of a specialist is currently not protected by law. A new amendment will allow the SMC to institute disciplinary proceedings against doctors who falsely hold themselves out to be specialists.

Mr Speaker, Sir, let me now highlight the amendments in this Bill that seek to streamline the registration processes of the SMC.

First, currently, any Singapore medical degree holder is entitled to full registration. A proposed amendment will ensure that only those who have completed their housemanship satisfactorily can progress to full registration. If the SMC is of the view that a particular doctor has not fulfilled the requirements for full registration but is safe to practise under supervision, the SMC will be given the discretion to award conditional registration for such cases. Singapore degree holders who complete their housemanship overseas would also be granted conditional registration in the first instance.

Second, foreign degree holders seeking registration will be required to either complete their housemanship locally or produce a certificate of experience that is recognised by the SMC as evidence that they have satisfactorily completed their housemanship overseas. The SMC will also be allowed to impose conditions on the restoration of a doctor who has been struck off the register, such as placing him under conditional registration rather than restoring him to full registration right away.

Another amendment is to allow the SMC to release information to prescribed persons or Government organisations for policy planning and other purposes. Such information includes names and biodata, information on professional qualifications, as well as employment data. This is consistent with the provisions made in the Private Hospitals and Medical Clinics Act.

Before closing, Mr Speaker, Sir, I would like to take this opportunity to touch on two related matters:

Firstly, the Schedule of the Medical Registration Act, which lists the basic medical degrees recognised for registration in Singapore, and secondly, the one-third quota placed on the female medical student intake into the National University of Singapore.

Several Members have asked for these two policies to be reviewed. I am happy to announce that the Ministry of Health has decided to expand the Schedule, which lists the foreign universities and medical schools whose medical degrees are recognised for registration in Singapore. Also, the one-third quota on the intake of female medical students into NUS will also be lifted with effect from academic year 2003.

I would like to thank Members who have raised this, including Mrs Lim Hwee Hua and Dr Lily Neo, and to thank them also for their patience when raising these two issues for review. Good things come to those who wait.

In conclusion, Mr Speaker, Sir, the proposed amendments to the Medical Registration Act would allow the Singapore Medical Council to maintain the high professional standards of the doctors practising in Singapore. This will help ensure that Singaporeans will continue to enjoy a good quality of medical care and to continue to have full confidence and trust in the doctors whom they consult.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Jalan Besar): Mr Speaker, Sir, I would like to declare that I am a General Practitioner and I stand to speak in support of the Medical Registration (Amendment) Bill.

First of all, I must say that I welcome the good news that the quota on the admission of female medical students to our university is to be removed at long last. The public and many Members of Parliament in this House, myself included, had spoken for the regulation to be rescinded. Sir, I am indeed heartened that our Government has responded to the people's wish and that the Backbenchers in this House had not spoken in vain. Today's announcement removes the quota of 33% on the admission of female students into the Faculty of Medicine which NUS introduced in 1979. The reason for introducing the quota for female medical students was that the attrition rate for female doctors then was 16-19%. Of course, this reasoning is not valid anymore as, currently, the attrition rate for male doctors is 2.8% and for female doctors is 4.2%. This announcement thus removes this rejection of entry to qualify people on the basis of gender, and will go a long way towards our vision of making NUS a "first world" university. Sir, Singapore prides itself on being a meritocratic society and the long overdue removal of this quota is definitely a right step forward for Singapore.

The 1993 policy of not recognising the degrees from over 176 previously recognised foreign universities will be reversed. However, I believe that not all the previously recognised universities will be reinstated for recognition. Why is the Ministry of Health half-hearted in reversing this policy? As Singapore is emphasising the importance of life-sciences, and as we will need many doctor-researchers, would it not facilitate our future needs better by recognising all of the previously recognised medical schools?

Sir, the Ministry of Health's projections for ideal numbers of doctors have been less than satisfactory so far. How sure are we that the Ministry of Health has better projections now to take into consideration our changing needs and trends?

It is a known fact that there has been a shortage of doctors in the public sector for many years and this policy change will certainly help solve this urgent problem. Not only can we have the chance to get those Singaporean doctors who have graduated from these foreign universities to come home, we can also very likely attract other non-Singaporean doctors from these reputable overseas universities. This is especially significant when the cost to train a doctor in Singapore is so much higher in comparison to medical schools overseas. Yes, it apparently costs at least $400,000 here as compared to about $170,000 to $250,000 at the universities of Sydney, Oxford and Cambridge.

Would the Ministry of Health be circumspect in assessing the shortage of doctors and solving the problem at the root cause of the shortage? Finding and attending to the reasons for shortages would be more effective than merely increasing the numbers of doctors. There is now an uneven distribution of doctors, with an abundance of doctors in the private sector and a shortage, especially of junior doctors, in the public sector. Junior public doctors have been facing problems like unsatisfactory work-terms, long and tedious working hours and poor career path developments. Sir, their morale is low and they often leave for private practice as a last resort. And, even if we increase their numbers, more junior doctors in the public sector will still leave in spite of poorer prospects outside if these causes are not addressed.

I would like to suggest that, with the new policy in place, our public hospitals should stop employing doctors from non-traditional sources like Burma, Indonesia, China and so on, whose medical degrees were never recognised in the past. Singapore is known for its medical excellence and this had been built upon through years of excellent training of our doctors from the best centres. This prestige status must be preserved at all costs. To me, public hospital's reflex response to recruit doctors in the last few years from these non-traditional sources and to save costs is not acceptable. Sir, may I ask the Minister for Health whether the hundreds of doctors from the non-traditional sources presently in our public hospitals are being tracked and monitored continuously in terms of their performance?

On the new regulation concerning Compulsory Continuing Medical Education, most physicians in Singapore are in general concurrence that the desired goal of CME is essential to improve medical practice. But many grouse that this has to come in the form of compulsion. The proportion of doctors who are already keeping themselves updated is definitely higher than the quoted figure of 49.5% for the year 2001 of doctors obtaining the minimum CME points. This figure refers to those who have officially documented their CME activities with the Singapore Medical Council. The CME programme has up till now been entirely voluntary and, hence, many doctors do not formally record or report their efforts in CME to the Singapore Medical Council. The fact is that continued medical education is part and parcel of a doctor's life, and when one takes up medicine, continuous learning becomes an inherent life-long practice. I dare say that all doctors do practise CME in some form or other and in varying degrees as a matter of necessity in the course of their clinical practice.

Yes, we want medical excellence amongst our medical profession but we must still retain some degree of respect and compassion for human expectations and limitations. For doctors in the public institutions, the CME requirement is fairly easy to achieve. However, for some private practitioners, especially the solo HDB doctors who work long hours on days and nights, the timing and format of CME become an issue. We have to spare a thought and cater for their difficult situations. I hope the Ministry of Health can be the body that facilitates and formulates CME for them and ensures that professional bodies cater to their needs.

May I also beseech the Ministry of Health to ensure that the implementation of this programme on CME is flexible, realistic and achievable. Formal CME lectures may not be as effective as it was believed to be. Interactive CME sessions that enhance participant activity and provide the opportunity to practise skills may be more useful to effect change in professional practices. High quality professional learning opportunities online should be readily available for self-directed learning. CME programmes to meet the needs of the nation should be incorporated. For example, in view of our ageing population, there should be programmes to better equip the medical profession here for the care of the elderly in the community and, in their own homes, so that the elderly can avoid tertiary institution as much as possible.

May I ask whether the Ministry of Health will set a certain budget for this Continuing Medical Education yearly? At the end of the day, the quality of CME will depend on the resources put in. Although the pharmaceutical industry may be very willing to generate goodwill by helping the providers of CME with the costs of educational programmes, the curriculum content and the educational event are often-times influenced by the financial support and the quality and value of such CME activities may thus be closely linked with the marketing of a particular pharmaceutical product.

May I ask the Minister if there is a provision for doctors who, due to unforeseen circumstances, cannot fulfil the required points of CME in the prescribed time? Will the Minister elaborate on the circumstances allowed in such cases?

Mr Speaker, Sir, the Interim Orders Committee (IOC) amendment seeks to put in place an IOC to suspend or order a restricted registration for a doctor under investigation. This amendment applies to a situation when the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee refers the matter to the IOC. However, it does not address the issue as to under what circumstances the matter can be referred to IOC. Furthermore, there can be a possibility that the doctor in question had been suspended but the eventual finding of the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee is in the negative. On the other hand, as suspension or orders had been granted by the IOC, the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee may be under pressure to make a positive finding. As such orders to be dished out by the IOC have grave implications on the doctor in question - being seen guilty even before the finding has been concluded, standing to lose patients and practice and living with the stigma attached to the order - such a provision ought not to be introduced in the first place. The truth is that the circumstances on the charge may be difficult to ascertain and controversial. For example, a doctor that is accused of repeated poor performance may not be entirely at fault. It may be because the doctor was frequently getting bad cases that were not curable.

In the event that such a drastic suspension measure has to be taken by the complainant, the matter can be referred to the High Court for an injunction against the doctor in question. An injunction will attract an undertaking from the complainant to pay damages to the doctor in question, if the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee, after its investigation, arrives at the finding that there is no misconduct or incompetence on the part of the doctor in question. This will ensure that there is no frivolous application for injunction, or suspension.

As per the amendment, the IOC majority vote will be sufficient to make an order. This may not be equitable given the grave implications. If the IOC is to vote for an order, it should be by way of an unanimous decision. The amendment also gives the IOC the power to vary the order if the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee recommends the same. This again seems to be inequitable. If a variation is required, the matter ought to be moved to the High Court for a decision and not remain within the IOC Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee level.

Amendment to section 20 (clause 7) proposes to amend that only those who have completed their housemanship satisfactorily can be granted full registration. Sir, under what circumstances would housemanship be deemed unsatisfactory? This could be very subjective and there are assessors with different expectations and standards to demand of their housemen. In any case, I would have expected that doctors coming out of NUS, deemed a world class medical school, would have produced high quality doctors. There is also no stipulated maximum period for this conditional registration. So housemen can be forever in the same position for as long as his seniors think they are not satisfactory in their performances. By the way, will hospitals that are short of doctors now use this regulation to tie these doctors to ease their shortage? How will the Ministry of Health ensure the avoidance of such high-handed unfair practice? What kind of recourse can these housemen seek? Furthermore, the amendments do not address how the Medical Council is going to decide on the procedure of granting conditional registration. Will there be a committee? Who will be on the committee? Is it the whole Medical Council? Will a meeting be convened? There are lots of uncertainties as to the procedure.

Sir, now that Singapore Medical Council is to be given sweeping powers, we must ensure that there is a fair representation of doctors from both the public and private sectors and from as many disciplines and groups. We must also ensure that the members of the Council are of a high calibre. Could the Minister elaborate on how this is being ensured?

Sir, these are some of my concerns and I hope that the Minister for Health would address them in this House.

Dr Tan Cheng Bock (Ayer Rajah): Mr Speaker, I did not give notice to speak. But having heard the Minister and also Dr Lily Neo, I thought I want to say something.

In particular, I am very concerned about CME. I remember 20-odd years ago, when I was in the College of General Practitioners, we mooted this idea of CME. I am indeed glad that it has been adopted now. 20 years is a long time. But, at that time, we set out the format for doctors to undergo this CME training. It is true that doctors should stay abreast of science and also the practice of medicine.

However, I can see some problems now because many practising doctors, especially general practitioners, are trying to find time to attend all these lectures and talks. At the moment, I notice that there are also drug companies trying to participate in these CME exercises, and I remember this has stretched as far as 20 years ago when we started this, where they invited a lot of practitioners to attend the talks that were given by drug companies and the lectures were given by doctors and specialists. I thought that was very good.

In the year 2000, as stated by the Minister, 39% managed to fulfil the 25-point requirement, and in the year 2001, 49.5% fulfilled. I hope that the Ministry, or the people who are in charge of this CME, would find some easier format for the hardworking doctors, both practitioners outside and also in the institution, to be given the time to participate in this CME exercise. In other words, like Dr Neo said, it must be flexible and achievable. I am sure the Minister would take note of that and make those recommendations to the people who are formulating all these CME exercises.

When I first read the Bill, there is one particular clause that caught my attention and, that is, the new sections 49A and 49B which actually call for the interim suspension order. And like Dr Neo, I was a little bit worried because we might be actually prejudging a doctor and subjecting him to some sentence before he is actually found guilty. But having heard the Minister, I am quite comforted now. He said that this particular interim order will only be used when there is compelling evidence. And he also cited compelling evidence like doctors who may be of unsound mind. After some time, we doctors, through years of practice and ageing, may also have undergone mental changes. Some of them may also be a bit of schizophrenic. When you get all those cases, I would agree with the Minister that you had better suspend these doctors first before you put them back into practice, or even wait for the lengthy procedure that usually takes place when we investigate a doctor who is subjected to disciplinary procedures. He also mentioned about the safeguards for the rights of doctors, and I do not want to elaborate on them.

The other point was this full registration of doctors or housemen who are Singapore degree holders. I honestly do not see much change. In the past, it was also the same. The doctor who has completed six years of medical school, goes through one year of housemanship and then he gets registered. Of course, he must subject himself to a review by his peers to make sure that he is fully qualified because passing an examination is one thing, but doing the practical aspects of medical practice is another thing. Therefore, I agree with the Minister too.

The other point is that he also mentioned that there will be more women being allowed to enrol into medical school. I know that the original reason why they did not allow was that many women, who took up medical studies, finally did not end up practising, and that is a sure waste of manpower. I remember also in the old House, we had a lot of discussions on why women, who want to take up medicine, should have a little less priority. But through the hard work of Dr Lily Neo and many Members in the House, the Minister has changed this.

The other point is enlarging the list of overseas medical colleges and universities. Yes, we had actually many cases of very bright students who could not get places in the universities here and they had gone into some of the overseas universities which were very good. But, unfortunately, they did not get recognition. Dublin, Adelaide, for example, are very good universities. But they did not fall into that list and the students who graduated from those good universities failed to get registration. And that is a pity. So I hope that list would include such good universities too.

With that note, I support the Bill.

Mr Lim Hng Kiang: Mr Speaker, Sir, I thank the Members for their comments. Let me respond to them. First, on the schedule for recognising the universities and the medical colleges. Dr Lily Neo asked why not just recognise all 176 universities in the pre-1993 list. It is already 10 years since 1993, and we have asked SMC to take a look at all the universities from a fresh approach and recommend to the Ministry which universities and medical colleges should be put into the schedule for recognition.

There are two aspects to it. One is the quality of the medical schools and the universities. And secondly is the compatibility of their training and curriculum to our practice here. So not being on the list does not mean that the universities are not good. They could be good, but we also want the way they teach their students and the way they organise their curriculum to be reasonably compatible to ours. There is really no need to have such a long list, because our projection is that we would need to supplement our local output of doctors by between 50-80 doctors who are foreign-trained, whether Singaporeans or foreigners. We really do not need such a long list of universities. If we look at the pre-1993 list, the bulk in the list are American universities. We do not really get many graduates from the American universities. SMC should look at the list and identify those universities and medical colleges that we are likely to have Singaporeans or where we are likely to be able to recruit foreign talent. So, it is with a clearer objective in mind.

On the shortage of junior doctors, I agree with Dr Lily Neo that we should look at the root causes of the shortage of junior doctors. I think the way to approach it is really to restructure the whole process in the hospitals and in our clinics. In the past, our hospitals and clinics had got used to using junior medical doctors, because they were bonded to us for a number of years and, when the numbers fluctuate, then the establishment is not filled. We have asked the hospitals to actually look at the processes and to look at employing experienced medical officers and not just use these people who are with us for the period of the bond, but use experienced doctors who may not want to go on to a specialty but who are quite happy to have a career working in the hospitals as very experienced medical officers. So, they have done so and they have a resident physician scheme and it is becoming quite attractive.

In the meantime, the hospitals have recruited doctors from some non-traditional sources. They have been very careful to make sure that these doctors are of very high quality, and all these doctors are practising in an institutional set-up. They are closely supervised and monitored, and they add value to our healthcare system. So, it is not just a matter of cost and lowering cost. I know Dr Lily Neo says we must preserve quality at all costs. But I am sure the next time I come here and ask for a fee increase, she would be the first to jump up and argue against a fee increase. So, we have to be quite clear. It is not just a matter of lowering cost; it is complementing the range of expertise and experience that we have in the hospitals.

On CME, I take both Dr Lily Neo and Dr Tan Cheng Bock's comments. We have tried this on a voluntary basis. Other countries and jurisdictions have gone on to make it compulsory. I think we should follow suit. Our requirements are not that stringent. 50 points over two years is not an overly difficult hurdle to cross. I recognise that those working in the restructured hospitals or institutions will find it easier, whereas those who are operating solo practices out in the heartlands will find it more difficult. And that is the reason why we have worked very closely with the College of Family Physicians and the Singapore Medical Association to work out mechanisms, whether it is online or self-directed, to make sure that the private sector general practitioner can have access to CME.

Both the clusters have extended schemes to the private sector general practitioner under the partnership scheme, where GPs actually work with the clusters as partners, referring to the specialist clinics and vice versa. Therefore, this link-up will allow the private-sector GPs to attend the CME classes run by the clusters. But I must say that in the end the private-sector GP must make an effort. We do run these classes in the evenings and on weekends, but they must make the effort. My view is that 50 CME points over two years is not that big an effort to make. But I take the comments of Dr Lily Neo and Dr Tan Cheng Bock that we should make sure that this is flexible, realistic and achievable, and that we will work together with the various professional organisations to make sure that this is so.

In the end, the professional organisations must run CME on their own budget. The Ministry of Health has given them a transitional budget to help set up the online processes, working out the curriculum. But it is not our intention that this fiscal support should be in the long term. So, beyond the transitional grant that the Ministry of Health has given them, our intention is that the medical profession must stand on its own feet.

On the points made on the Interim Orders Committee, as I explained in my speech, we know this is a very delicate balance. We need to protect public safety. At the same time, we need to recognise the rights of the doctors. Therefore, if we ever have this order to suspend a doctor's practice, I can assure the House that this would be done very, very selectively and, when there are compelling reasons in order to protect public safety. We have modelled this after the UK. Let us try this out. We have put in all the safeguards that we have researched on. But I think we need to strike a balance. We cannot just give the doctors a blank cheque to say they must practise, whatever the circumstances. At the same time, there are issues of public safety involved, especially if the doctor is a very severe alcoholic or has a drug addiction problem or a very severe mental illness problem.

So, I assure the House we will do this very selectively, and only when there are compelling reasons.

On the registration of housemen, today graduates from our local universities go for housemanship and, at the end of housemanship, they are given full registration. But in one, two or three cases every year, the panel of assessors and the Dean would have been happier if the doctor underwent a longer period of supervision. The system here is that we allow the doctor, after the one-year housemanship, to go and practise solo. This is a very high burden. If I may use the analogy of a private pilot's licence. You may know the theory of how to fly a plane. You may be able to fly a plane with the instructor next to you, to land and to take off. But to fly solo, you need a certain exposure to the different circumstances that may arise. You need experience and judgement. In a few of these cases, the panel of assessors and the Dean would rather that the doctors not go solo in the HDB heartlands, but that they spend another three months, six months or another year under supervision. Then, I think, we will be more confident that the doctor can fly solo in the HDB heartland clinics.

This provision is to allow the panel of assessors and the Dean to have this flexibility of awarding conditional registration, so that the doctor still continues to practise, but practise under supervision. Then, after a period of review, when the panel is confident, then the doctor is given full registration. Again, I will assure the House that when we implement this, there will be proper checks and balances, as we do whenever we assess the capabilities of the doctors.

On the representation of the SMC, the Act allows for the SMC to be constituted, some appointed by the Minister, for which we have certain criteria to make sure we have a cross-section from the private and public sectors, people from different specialties. But the bulk is elected by the doctors themselves. This is the essence of self-regulation by the SMC. Here, I think, we would expect the doctors to exercise good judgement in electing a professional body to look after their professional interests and who will be in charge of regulating them. So far it has worked well. We will continue to monitor the SMC. Over the years, it has built up a strong reputation. It has the support of all the doctors and I am confident it will continue to do so.

Dr Lily Neo: Mr Speaker, Sir, I would like to seek a point of clarification. The Minister did not answer my points on whether there is a provision for doctors who, due to unforeseen circumstances, cannot fulfil the required CME points within the prescribed time. Will he elaborate on the circumstances allowed in such cases? Also, is there any recourse for a houseman to take? The Minister said earlier that the non-traditional sources of doctors are of high quality. Is he implying that there is no need to recruit doctors from reputable universities now, and that there is no necessity to send our doctors to the reputable universities and the best centres to train? Where is our medical health heading then? Is he not risking throwing away the prestige of medical excellence that we have painfully built up over the years? What kind of confidence can we get from our own Singaporean patients and foreign patients, especially from the region?

Mr Lim Hng Kiang: Mr Speaker, Sir, as I mentioned just now, 50 points over two years should not be such a difficult hurdle to cross. Many of these points are accumulated just by self-reading, answering questions. We are talking about 50 CME points over two years. I do not see that being difficult to achieve.

Dr Lily Neo: No, should the doctor be hospitalised, for example, due to unforeseen circumstances.

Mr Lim Hng Kiang: If the doctor is immobilised for two years, then I am sure the SMC would take that into account.

On recourse by junior doctors for the housemanship, this is the usual process: we have interviews with the housemen, they go through three supervisors and are supervised by the Dean. So, there are a lot of feedback channels for the housemen, if they think that they have not been properly assessed. The Director of Medical Services takes a very personal interest in all the housemen. This year, for example, one houseman came to my office and asked to see me, and I saw her. We keep a fairly open-office policy in the Ministry of Health. So, I think there is enough recourse. Of course, if they find all these unsatisfactory, they will make a beeline to see her!

On the quality of doctors, I think we are still maintaining the very high quality of our doctors. The main strategy is really our Health Manpower Development Programme (HMDP). This has been on for many years. Our doctors go to the best and most reputable centres around the world, funded by the Government. This is how we keep up with the latest. The HMDP programme is our key in keeping this quality.

At the same time, we do face a shortage of doctors. With the expansion of the schedule, we will be able to recruit both Singaporean as well as foreign doctors from the foreign universities. After 1993, when the list was restricted to 28 and then, now 24, our avenues of recruitment were limited. So, with the expansion of the schedule, obviously we have more choices. But I would not rule out completely and insist that our clusters are not allowed to recruit from universities not on the list. Why do we want to constrain them? As long as they make the assessment that these doctors meet the quality standards and these doctors practise under close supervision, they add to our capability. And many of these doctors may later on continue to take up specialist courses and join our system. Why do we want to restrict ourselves and restrict recruitment from some of these good universities, even though they may not appear on the schedule? They come, work for us for two years, we assess them and, if they are good, we encourage them to go for specialist training. They add to our talent pool. I do not see why we should cut them off.

Dr Lily Neo: Now that the Minister condones such a practice, I am sure our public community hospitals and even the private hospitals will take in more doctors from the cheaper non-traditional sources for the benefit of saving costs, but not necessarily to the benefit of the patients and the nation.

Mr Speaker, Sir, I just want to register one more point to my disappointment over this response from the Minister, because I feel that this is definitely a soft option and not preserving the prestige of medical excellence in Singapore, and changing the position of our healthcare service.

Dr Tan Cheng Bock: Mr Speaker, Sir, can I just seek a point of clarification from the Minister?

This is a matter concerning CME and registration. Must a person be a practising doctor before he can do his CME? For instance, there are quite a number of doctors here in this House, eg, Dr Balaji Sadasivan, Dr Vivian Balakrishnan, who are no longer practising. They also need registration but they are non-practising doctors. Can they get registration also, without having to go through, say, the CME, because they are in this particular position, and let them take the CME later, say, when they have finished their political career and they want to go ---

Mr Speaker: You have made your point, Dr Tan. Mr Lim.

Mr Lim Hng Kiang: You mean, to get registered?

Dr Tan Cheng Bock: Right. I hope you get what I am trying to say.

Mr Lim Hng Kiang: When the doctor comes up for the renewal of his practising certificate, he must demonstrate that he has at least 50 points over the last preceding two years. If they do not want to practise and they are not seeking a renewal of their practising certificates, they are temporarily exempted from doing the CME. But if they want to practise at some point in time, if they want to renew, then they must take the CME.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Lim Hng Kiang].

Bill considered in Committee; reported without amendment; read a Third time and passed.