MAIN AND DEVELOPMENT ESTIMATES OF SINGAPORE FOR THE - FINANCIAL YEAR 1ST APRIL, 1974 TO 31ST MARCH, 1975
Mr Speaker, Sir, listening to the Member for Anson makes one think that only he is concerned about the shortage of doctors, not the Minister or the Ministry. I think he has made a very far-fetched statement. May I just deal with the Member for Kim Seng now? He spoke about the shortage of doctors last year and also about why they should have their salaries revised and so on, and that nothing has been done to date. That is not strictly true because, as far as our specialist doctors are concerned, their pay has been increased by the recent increase in specialist allowances. Further, they can now be promoted on merit and their promotion will not be dependent upon vacancy in the posts available. In fact, there is no limit to the superscale level to which they can be promoted. For example, a head of a unit has been promoted to Superscale Grade D, whereas in the past heads of units were limited to Superscale Grade E. That is just for a start. There have been promotion exercises, and it is not true to say nothing has happened. But as far as medical officers are concerned, hon. Members may be aware that the National Wages Council has been given the responsibility of reviewing salaries not only of doctors but also others in the context of the nation as a whole. In fact, to be fair, doctors are not the only professionals working in the Government. There are architects, engineers, and so on. So any increase or revision in salaries must also include the doctors. Of course, as the Health Minister, I would very much urge that their terms and conditions of service are improved. But, before the National Wages Council deliberates over these matters, the medical officer, in the meantime, has benefited from the 13th month payment - there were two 13th month payments in one particular year - and also the 9 per cent wage supplement as recommended by the National Wages Council. So it is not true to say that nothing has been done with regard to their salaries. Something has been done although perhaps not as much as we wish it to be. But it is rather odd - and I am not saying anything in objection - that salaries of doctors have been raised again and again in this august Assembly, but so far I have not heard in this Chamber of any raise in salaries of accountants, engineers and architects employed by the Government. 5.30 p.m. The other point is the resignation of doctors. Let me hasten to assure the public that they should not be alarmed. Although the rate of resignation has increased, I do not think the way in which the Member for Kim Seng has presented the case is correct, that is, just because there has been a large number of resignations in the first few months of this year, resignations will come up to a very high figure by the end of the year. I do not think that will happen. I would like to assure members of the public that although we are understaffed at the moment we are not badly off. In fact, some years ago doctors had to work longer hours. At the moment, although not in all hospitals but in quite a number of hospitals, doctors have been given a day off following night duty. With regard to the figures about the resignation of doctors in 1970, which the Member for Kim Seng quoted, they are more or less correct. They tally with my figures although there may be a difference of one or two. Then he did ask me how many of these doctors had emigrated to Canada, Australia and so on. I do not have the actual figures, but the figures which I have on migration are obtained from various sources, that is, the Singapore Medical Association, medical colleagues, the Medical Register and so on. I can say that in 1973, out of the 67 resignations, four went to Australia, one to Brunei, one to Canada, one to India, one to New Zealand, one to Sibu, two to the U.K, and 10 joined the University of Singapore. And 41 of them actually resigned for personal reasons, which means that they are probably in private practice earning, as the Member for Kim Seng has said, three or four times more. If they want to earn much more money in private practice, we cannot help it. But we try our best to retain them. In fact, as far as the movement of doctors from Government service to private practice is concerned, as Members would know, we have introduced two schemes to get them back to work for at least a few sessions in our hospitals. First, there is the part-time consultant scheme whereby those in private practice who volunteer to work in the hospital will be paid a certain sum per session. This scheme is particularly helpful to those departments which need the specialists concerned. The other scheme, of course, is the appointment of honorary consultants so that their expertise will not be lost in the private sector. In fact, they will see more searching cases in the hospitals and their talents will be more usefully employed there than in the private sector. Now, on the point about foreign doctors having been recruited into the Singapore health service, may I say this? As far as Government policy is concerned, we do not go out of our way, for example, to advertise in the press to recruit doctors from other countries. Any applicant who writes in and is found suitable for recruitment is offered employment. Recruitment of foreign doctors into the service is in the main confined to those with higher qualifications. With regard to the breakdown of figures of foreign doctors which we have employed, may I say that the largest group consists of Malaysians. We have in service today 43 Malaysian doctors, 16 of whom are with higher qualifications and 27 without higher qualifications. The second group consists of 13 Ceylonese, 11 of whom have got higher qualifications, in other words, they are specialists. Only two of them are without higher qualifications. We have also six Indian doctors, two with higher qualifications and four without higher qualifications. And there are 14 others, five with higher qualifications and nine without higher qualifications. Altogether the number of foreign doctors is 76. As far as our policy is concerned, as I have said, we do not go out of our way to recruit foreign doctors. If they apply and if they are found suitable, we employ them if there are vacancies. We cannot be too choosey in our recruitment. If we have vacancies we fill them up. Of course, we are very concerned about their competence and standards. In fact, as I have said, most of them have higher qualifications. For the information of Members, the vast majority of the Indian and Ceylonese doctors we have recruited have recognised higher medical qualifications from the U.K. Their qualifications include the M.R.C.P. London, or Edinburgh, or F.R.C.S,. London, or Edinburgh. Most of them had hitherto held specialist positions in the U.K, hospitals. On recruitment into our service they were appointed directly to consultant positions, as for example, Senior Registrars. Thus with regard to the policy of appointing doctors from overseas which I have enumerated, the possibility of recruiting incompetent doctors is very much reduced. The majority of them have performed satisfactorily. However, in any group there would be a few who might not perform as satisfactorily as we would have wished. In this respect there has been only one case in which it has been necessary to terminate the contract of a foreign doctor. This was not for lack of competence but because he did not fit well into the service. However, if any one of them is found to be incompetent. We can easily terminate his contract. With regard to the intake of medical and dental students into our medical schools, I agree entirely that we should do our very best to get our citizens to take up medicine and dentistry. But, unfortunately, it appears that with rapid industrialisation going on in Singapore and the shortage of engineers, architects and accountants, many of our young men now tend to opt for such courses and overlook medicine and dentistry. This is the situation we are now facing. But, in any case, we will give them every encouragement to take up medicine, not only for an under-graduate course but also a post-graduate course for those who have already qualified. In fact, we have devised a very attractive training scheme for young doctors to take up a higher qualification. I do not think there is much complaint as far as that scheme is concerned. Many doctors have taken advantage of that scheme and, as a result, we produce quite a large number of Masters of Medicine in the various specialities each year. With regard to projections for staff requirements, may I say that there are not only new projections but also new services as well. This is based on the criteria determined by actual observation in the ward. For example, in the medical unit, for every 70 beds there should be a staff complement comprising one consultant, two senior registrars, three medical officers and three to four housemen. The figures are higher, for instance, in the surgical, obstetrics and gynaecology wards. Of course, this is the ideal number. We try to project the Ideal, but if we do not have the ideal number we try to make do with what we have. With regard to incentives to retain doctors in the service, particularly young doctors, apart from the scheme for Government officers to be eligible for housing, we are also considering building some blocks of flats for medical officers as part of the development of the new hospital that is coming up in Outram Road. I am personally very sympathetic to the need of doctors for houses, especially the young doctors, who have not established their own homes. My Ministry has recently appointed a committee to study this question and to make recommendations. I believe that if our young doctors are given houses they will not only be tied down to their service but they will also have something to lose if they think of emigrating. Before I go on to the Member for Anson, I might as well enlighten the Member for Kim Seng about employing lady doctors part-time. I would like to say straightaway that we have a scheme at the moment to employ lady doctors part-time. It is not that we have no such scheme. In fact, there are two schemes whereby doctors in private practice can be appointed to the medical service. The first Scheme A is based on sessional appointment where we pay $30 for a two-hour session up to a maximum of $400 a month. The second Scheme B is a part-time appointment paid in proportion to the hours of work given each week to a 42 hourly times the last drawn salary. Such appointments would be for those who were previously in Government service. At the moment, in respect of Scheme A we have four appointments. For the information of the Member for Kim Seng, three of them are married women and I think one is a male doctor. With regard to Scheme B, two lady doctors have also been appointed. In other words, they are being utilised for the benefit of the medical service. It is not true to say that their applications are not considered at all. We will be happy to take in a larger number under this scheme. Perhaps the Member for Kim Seng can encourage some of his colleagues to apply for these appointments. 5.45 p.m. Unless I have left out anything else that the Member for Kim Seng has raised, may I just go on to the Member for Anson. The Member for Anson has again brought up the question of the recent amendment to the Medical Registration Act whereby we have in our local List excluded medical schools in India. This does not mean that those who graduated from medical schools in India are not able to practise in Singapore. Under a certain provision of the Act, they can apply to practise. The Singapore Medical Council will judge their competence by invariably setting an examination, and on passing the examination, they will be registered. I have already answered this question when the Member for Anson raised it at the last Budget debate. Of course, the Member may have his own views. But that is the position. It is very important that we guard our standards of medical practice very jealously. Other countries may have other standards, but that is their privilege. As far as Singapore is concerned, human life and health is important and we want to ensure that only competent doctors are allowed to practise independently.