Tuesday 24 November 2015

Number of foreign doctors rising in Singapore public hospitals and polyclinics

Over 2,100 in public hospitals, polyclinics at end of last year; most are primary care docs
By Salma Khalik, Senior Health Correspondent, The Straits Times, 23 Nov 2015

More than a quarter of the doctors in the public healthcare sector are foreigners.

At the end of last year, public hospitals and polyclinics had more than 2,100 foreign doctors in their employ, and the number continues to grow as Singapore faces a shortage of trained medical staff.

Most are primary care doctors with only 477 foreign specialists, a spokesman for the Singapore Medical Council (SMC) told The Straits Times.

In contrast, the private sector had only 156 doctors who were neither Singapore citizens nor permanent residents, according to the SMC's 2014 annual report.

To meet the demand for doctors, the Ministry of Health (MOH) has worked with the Education Ministry to raise the number of students accepted into medical schools here from 350 in 2012 to 460 this year.

MOH also tries to attract Singaporeans who are midway through their medical studies abroad to return to work here, by offering to pay up to $50,000 a year for their final three years of study.

In return, they need to work at a public hospital for three to four years, including their training year as housemen.

But a spokesman for MOH added: "Even as we grow the local supply of medical professionals, we will need to augment our local medical workforce with qualified medical professionals from abroad."

To ease them into the local environment, hospitals organise programmes to familiarise them with the local culture and behaviour as well as clinical practice. They also offer classes in local languages.

The MOH spokesman added that public institutions ensure a good mix of local and foreign staff in each shift and, in some cases, also provide interpreters to reduce any risk of miscommunication.

Among the public sector doctors who are Singaporeans or permanent residents, more than 1,800 were trained overseas.

Among them are the 615 who have taken up MOH's offer to sponsor part of the cost in their final years at a foreign university.

Said the spokesman: "The demand for healthcare services is expected to rise substantially with an ageing population, coupled with changing disease patterns arising from lifestyles and diets."

Dr Lee Chien Earn, chief executive officer of Changi General Hospital (CGH), said: "Even as we grow and train our local medical professionals, there may be areas to selectively fill unmet or critical shortages with suitably qualified doctors from abroad.

"Besides mandatory supervision by senior doctors, the hospital has put in place training programmes to fit them into our local clinical practice and our cultural context to enable them to practise competently."

Last year, CGH hired 35 new specialists, of whom eight were foreigners.

Many foreign doctors, after working here for several years, have come to like Singapore so much that they have become permanent residents or citizens.

Associate Professor Thoedoros Kofidis, a senior cardiothoracic surgeon at the National University Hospital, is originally from Greece. In Singapore since 2006 and a citizen since 2013, he said he identifies strongly with Singaporean values, especially meritocracy.

Before planting his roots here, he worked in Germany, Switzerland and the United States.

Dr Kofidis and his wife and daughter find it comfortable living here and have no problems making friends.

He also has a good rapport with patients, even those whom he needs a translator's help to communicate with.

He said: "When I can't communicate verbally, I do it with gestures. I try not to be 'sterile'."

His colleague Anita Lim, a senior rheumatologist who was born in Brunei and trained in Britain, said: "I've been here for a decade. It's become home.

"Becoming a citizen was a natural progression."

Foreign doctors help fill a need
By Salma Khalik, Senior Health Correspondent, The Straits Times, 25 Nov 2015

As Singapore's population ages, the need for doctors will increase.

Chronic diseases such as diabetes, high cholesterol and high blood pressure start rising in people who are 40 years and older. Left untreated, they can lead to severe health problems such as blindness, kidney failure, heart attacks and stroke.

Although this year's intake of 460 medical students is about double the figure a decade ago, it will be many years before they join the workforce.

Meanwhile, Singapore needs enough doctors to help this growing group of older people to keep their chronic ailments under control, so that they can continue to lead normal lives.

Public sector hospitals and polyclinics have turned to recruiting qualified foreign doctors to fill this need - so much so that today, one in four is a foreigner.

These foreign doctors do not take jobs away from locals but, instead, help to lighten their workload and provide much needed care to patients.

These doctors are in no way inferior to local ones.

Possibly the only gripes are their lack of facility in local languages or dialects when treating older patients who do not speak English, and not understanding local cultures in a way that might impact their patients' treatment.

Public institutions have tried to overcome these by pairing such doctors with local nurses, or having translators ensure accurate communication.

Many foreign doctors have also put in extra effort to learn the local lingo, and some have become so well assimilated that it would be difficult to tell they are foreigners.

Even those of non-Asian origins can have good rapport with their patients. It is in their blood. Anyone who spends years studying how to take care of sick people must have their welfare at heart.

For a patient, it really doesn't matter where a doctor was born or what languages he speaks. What's important is that he is knowledgeable, experienced and cares.

SMA offers programmes to help foreign doctors assimilate here

We refer to the article, "Number of foreign doctors rising in public sector" (Monday).

The growth in the number of people residing in Singapore and its ageing population has had a far-reaching impact on the medical institutions and its fraternity, including the pressing need for more doctors.

We agree with the Ministry of Health that there is a need to assimilate the medical professionals from abroad into the local environment.

Foreign-trained doctors include both foreign doctors and Singapore doctors trained overseas.

The percentage of foreign-trained doctors in Singapore has grown slightly, from 36.45 per cent in 2011 to 41.42 per cent last year.

The Singapore Medical Association (SMA) started organising seminars for foreign-trained doctors in 2011, as Singapore is unique in its customs and practices.

These seminars were organised to provide insights into the Singapore healthcare system, including the intricacies of Singaporean culture and customs, and help foreign doctors better understand and assimilate into our society.

We hope that foreign-trained doctors who currently do not voluntarily join medically related professional bodies, which can help them understand local contextual issues and interact with the local medical fraternity better, will find the SMA and our educational outreach and development programmes helpful in understanding the local culture and clinical practice environment.

Wong Tien Hua (Dr)
Singapore Medical Association
ST Forum, 28 Nov 2015

* MOH committed to growing local core of doctors, nurses

We refer to recent letters in The Straits Times on developing our healthcare professionals.

The Ministry of Health (MOH) is committed to growing a strong local core of healthcare professionals to meet the increasing needs of our ageing population ("How are foreign doctors selected?" by Mr Francis Cheng, "Work to retain public sector docs" by Mr Ho Kar Kaye and "Not easy to attract medical teaching staff" by Ms Ada Chan Siew Foen; all published on Nov 27, and "Shortage of doctors? Train more Singaporeans locally" by Ms Maria Loh Mun Foong; Nov 25).

Through joint efforts by MOH and the Ministry of Education, the local medical intake has increased by about 29 per cent, from 350 to 460 between 2012 and this year, and is expected to grow to 500 eventually.

Over the same period, the local nursing intake increased by 17 per cent, from 1,550 to 1,820.

We need to expand our local healthcare manpower pipelines in a calibrated and gradual fashion.

This enables us to maintain the quality of training for students in healthcare programmes and avoid straining the training resources of our public healthcare institutions.

MOH and our public healthcare institutions also protect time for experienced healthcare professionals to train the next generation, with outstanding educators recognised, for example, through the National Medical Excellence Awards.

The Pre-Employment Grant (PEG) was introduced in 2010 to attract Singaporeans studying medicine overseas to return to practise locally.

As of March this year, 615 PEGs have been awarded.

All overseas-trained doctors, including foreign doctors, need to meet the Singapore Medical Council's stringent registration requirements before they can practise here.

MOH takes a holistic approach in our efforts to enhance retention of our healthcare professionals.

We worked with public healthcare institutions to implement a new pay framework for public sector doctors in 2012.

The revised framework better recognised the complex roles they play in public healthcare.

Many of these roles are unique to the public sector, offering our doctors a fulfilling career that allows them to manage more challenging clinical cases, nurture future generations of doctors, undertake research to improve patient care and take up leadership positions in their organisations.

For nurses, the Care Package launched last year introduced, among other initiatives, two rounds of pay increases and a new Assistant Nurse Clinician role to enhance clinical competency and recognition for experienced nurses. Almost 400 nurses have been promoted into the role as of July this year.

Public healthcare institutions have also put in place measures to improve the work environment for our healthcare professionals, such as adopting IT to minimise administrative workload.

MOH is also working with these institutions to redesign care delivery processes in tandem with the evolving needs of our ageing population.

Lim Bee Khim (Ms)
Corporate Communications
Ministry of Health
ST Forum, 7 Dec 2015

Stop inflow of foreign docs? It's the patients who will suffer

By Salma Khalik, Senior Health Correspondent, The Straits Times, 11 Dec 2015

The growing number of foreign doctors in the public sector appears to have touched a chord with readers, resulting in several letters in The Straits Times' Forum pages.

This followed news reports that more than one in four doctors working in the public sector are foreigners.

Readers' concerns fall into two broad categories: those who are upset that young Singaporeans who want to become doctors have been denied that opportunity when they were turned down by medical schools here, even though there is a heavy demand for the profession; and people worried that patients might not get the best care with the foreign influx.

The first concern is valid but overstated, while the second is misplaced.

First, those who argue that Singapore should have given more local students the chance to study medicine here, instead of driving them away to universities overseas with the risk of losing them to those countries once they qualify, have a valid point. A shortage of university places to study medicine did result in hundreds going overseas in the past. Many stayed on overseas to work, and Singapore lost their talent.

But we can't turn back the clock.

Meanwhile, the policy has changed. Singapore now has three medical schools with a combined intake of 460 students this year - double the number 10 years ago.

Should even more students be given places to study medicine at local universities?

It might not be prudent to do so. Unlike other professions, the training of good doctors requires a significant amount of high-quality supervision. Book learning, no matter how well assimilated, is just not good enough when lives are at stake.

The second concern: Does a high proportion of foreign doctors compromise patient care?

The Ministry of Health requires foreign-trained doctors to be supervised when they start working here. It isn't easy to find enough senior doctors to do this.

A few years ago, the Singapore Medical Council (SMC), which is in charge of registering doctors, eased some of the supervisory requirements. Changes include putting some better foreign-trained doctors on a fast track so they can start working independently earlier, allowing registrars - or trainee specialists - to help in supervising new doctors and increasing the number of newbies a senior doctor can oversee.

There were some concerns raised then that this might lower the quality of healthcare, but the authorities gave the assurance that standards would remain high.

This begs the question of just how well-trained foreign doctors are.

A senior public-sector doctor said the experience and abilities of foreign doctors vary greatly. Some are highly competent. Others might require close supervision.

Singapore now accepts medical graduates from close to 160 universities. While all the universities on the list were chosen for their high standard of teaching, according to some supervising doctors here not all their graduates live up to the expected standards.

However, this is not an insurmountable problem. Those who are found to be lacking can be axed, the promising ones can be given support to improve and the good ones will be retained and, hopefully, will eventually call Singapore home.

One issue is that a good number of the recognised universities teach in a non-English language, so not all their graduates are fluent in English. The SMC requires proficiency in English as a prerequisite for admitting foreign doctors.

Will poor English fluency hinder not just communication, but also result in inferior care?

Will it cause problems in doctor-patient relations?

In Singapore's context, however, even if doctors speak English fluently, not all local patients do. Many doctors, especially in the public-sector hospitals and clinics, need to use Malay or a Chinese dialect to converse with older patients.

However, this problem is not unique to foreign doctors. Some younger Singaporean doctors too lack such language skills.

To overcome this, hospitals provide translators where needed, and offer doctors basic training in local languages.

The dilemma the Health Ministry faces is that there simply are not enough local doctors to cater to a growing, and rapidly ageing, population. Foreign doctors help make up the numbers.

Ten years ago, in 2005, there was one doctor for every 640 people. Last year, there was one doctor for every 466 people. The improved ratio is due in large part to the influx of foreign doctors over the past decade. As a result, patients get appointments faster at public hospitals, have shorter waiting times to see polyclinic doctors and get more time with doctors when it is their turn.

The Government is trying all ways to make up the doctor numbers. In addition to raising the medical school intake and welcoming foreign doctors, it is also trying to get Singaporean students overseas to come back to Singapore to practise.

It offers to pay up to 60 per cent of tuition fees, capped at $50,000 a year, for the last three years of medical study overseas. The idea is to bring back as many trained Singaporean doctors as possible. Last year, 160 foreign-trained locals returned to work here, up from 121 in 2013.

The bottom line is, Singapore needs more doctors, especially with Sengkang and Woodlands general hospitals and Yishun, Sengkang, Outram and Woodlands community hospitals opening over the next seven years.

Cutting off the supply of foreign doctors would be a case of cutting off the nose to spite the face. It is patients here who would suffer.

It is far better for patients if foreign doctors receive the support and training needed to integrate into the healthcare system here, than if foreign doctors are stopped from coming altogether.

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