More foreign doctors to increase capacity and lower costs
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THE door has been opened wider to foreign doctors, as Singapore moves towards a new goal of having one doctor per patient in public hospitals.
The public sector currently employs 3,156 doctors - which translates to one doctor for every two patients at any given time.
The Health Ministry is relaxing registration rules for foreign doctors by reducing their probation periods, and recognising qualifications from more foreign medical schools to boost the number of doctors here.
Singapore currently has 7,611 registered doctors, including 2,286 who were trained in foreign institutions. Of these foreign-trained practitioners, 976 are Singaporeans and the rest are foreigners. The relaxed rules will also benefit Singaporeans who qualify at newly recognised schools.
Previously, all foreign specialists had to work under supervision in an approved institution - usually a public hospital - for three years, while non-specialists had to be supervised for six years, before receiving full registration.
From this year, the probation period for foreign doctors has been shortened to two years for specialists, and four years for non-specialists.
Those who have had at least five years' relevant experience after becoming a qualified specialist or family physician are now allowed to practise immediately in the private sector.
More institutions, including three top Indian medical schools, will be added to the list of recognised institutions here next month. Since 2003, the number of schools on the list has soared from 20 to 120.
The aim is to emulate renowned teaching and research institutions overseas, such as Sweden's Karolinska Institutet, where the doctor to patient ratio stands at one to one.
With more doctors, each can have more time to spend with each patient as well as on teaching juniors and conducting more research. This would improve patient satisfaction, and also job satisfaction for doctors, said MOH's director of medical services, Professor K. Satku.
The need for doctors will become more pressing as the number of patients is expected to rise, with a growing and ageing population, and more foreign patients.
Speaking to students at the Singapore Management University on the globalisation of healthcare on Friday night, Health Minister Khaw Boon Wan said: 'When more (foreign patients) come, and we do not plan our capacity, whether it's more hospital beds or doctors, prices are bound to go up... our job is to anticipate this and move the supply curve so that prices will come down to a more competitive level.'
His strategy is to increase the number of doctors trained here as well as overseas.
The National University of Singapore (NUS) has increased its intake of medical students, and classes at the new Duke-NUS Graduate Medical School will start this August. So from 2012, Singapore will produce about 300 doctors every year.
Mr Khaw also hopes to further increase Duke-NUS' intake by another 50 students in future.
But this will not be enough as doctors retire or quit. Last year, 212 doctors left the profession.
Foreigners are needed to fill the gap but they are in short supply worldwide.
One big recruitment pool may be the Asian doctors in Europe who might consider a return to Asia now that European Union rules are kicking in to favour EU citizens over foreign residents.
'This is an opportunity for Singapore to draw them in and expand our health-care,' Mr Khaw said.
(Straits Times 26 Jan) -
Lots of doctors from India and China will start to flood in.
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As expected, the government has responded to the public's complaints about long waiting times and higher medical costs by bringing in more foreign doctors. They are cheaper to hire and can be required to work in the public sector, as local doctors move into the private sector.
There is a large supply of Indian doctors in the UK who now have to leave the country due to new EU rules on employment. Most of these are non-specialists but they have experience working in British hospitals. They will have no choice but accept the lower pay in Singapore or return to even low pay and worse working conditions in India.
Our junior doctors must expect to work even harder or they will be forced out even if they want to remain in the public hospitals. Indian doctors are willing to work for half the usual pay.
After doctors, we will need to hire more foreign nurses and health attendants. Now that filipino nurses can easily find jobs in UK, we will have to look for nurses from China. -
Foreign doctors can be labelled as cheap labour too.
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yeah that's cool...
but lets wait till one of these foreign docs mistakes some poor soul's heart for a kidney....or removed a section of colon instead of apendix...
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If we want to get foreign talents, we must get the best.
Only the cream of the crop will attract similar talent to gather around, as the old saying goes, "Birds of same feather flock together", something that NOT any Tom or Dick (Where's Harry? He is now known as Minister Mentor) can achieve. -
you know, I thought I'd never say this, but at least I KNOW that the docs who've graduated from Singapore's systems are pretty much up to standards ... an undergraduate med student friend of mine told me medicine is 90% memory work, so I suppose our education system prepares our docs very well from young ...
I dunno about others, but I hold a very "elitist" view when it comes to docs, i'm placing my life in their hands after all, I like to know that the docs treating me for anything are the straight A survivors of our darwinian education system .... not some third raters who've graduated from say some medical university from st kitts, poland, or some other sungei road places, which is pretty common in north america (especially popular among certain sectors of the south and east asian population, those who can't make it to med school anywhere else that is) ...
I don't think opening the flood gates will depress costs at all, after all, these people are attracted to Singapore precisely because of the chance of earning higher wages, no ? ... but it just may lower the standards of general health care here ....
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All you need is a Dr Death like Dr Jayant Patel who killed a few patients to know the impact .
Oxford is not worried because he is ALREADY in UK. HAHHA -
Haha...what makes you think I am staying put for good? The pay here is slightly higher than that back home but with the taxes and national insurance, I am better off returning home.Originally posted by fymk:All you need is a Dr Death like Dr Jayant Patel who killed a few patients to know the impact .
Oxford is not worried because he is ALREADY in UK. HAHHA
Local doctors should not be worried if they keep up with the latest and upgrade their skills. Pay for public hospital doctors will be depressed, but that's because Singaporeans demand lower medical fees and shorter waiting times. So they get cheaper foreign doctors in the public hospitals whilst local doctors move out into the private sector.
Don't blame the government if you don't like the foreign doctors. Singaporeans have demanded it. You want shorter waiting time and cheaper rates...well, the only way is to get Indian doctors. Those who want to be treated by local doctors with internationally recognized qualifications will have to go to the private sector. However, with the influx of cheap foreign doctors and more local doctors leaving, medical costs in the private sector will also drop due to increased competition. In time, we will see more Singaporeans going to the private medical sector and only the poorest who cannot afford will see the foreign doctors in public hospitals. -
the citizens didn't demand for foreign doctors, it's the govt that's failed to supply enough doctors...like lawyers, the myopic policies of yesteryears in curbing the numbers in these professions are now beginning to bite....there'll be no shortage of talented persons from within the country willing to be trained, only the indecisive and poorly thought out actions of those at the helm that's always causing reversal in policies....
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So beautifully put!Originally posted by countdracula:the citizens didn't demand for foreign doctors, it's the govt that's failed to supply enough doctors...like lawyers, the myopic policies of yesteryears in curbing the numbers in these professions are now beginning to bite....there'll be no shortage of talented persons from within the country willing to be trained, only the indecisive and poorly thought out actions of those at the helm that's always causing reversal in policies....
Well said!
This is exactly what's happening across the board, and not just in healthcare.
>>> http://www.sgforums.com/?action=thread_display&thread_id=234098 -
Not true.Originally posted by countdracula:the citizens didn't demand for foreign doctors, it's the govt that's failed to supply enough doctors...like lawyers, the myopic policies of yesteryears in curbing the numbers in these professions are now beginning to bite....there'll be no shortage of talented persons from within the country willing to be trained, only the indecisive and poorly thought out actions of those at the helm that's always causing reversal in policies....
We have enough doctors in Singapore. The problem is that we have too few in the public sector. The pay difference between the public and private sectors is too marked. That is one big reason for the exodus to the private sector. The government is unable to raise salaries of doctors in the public sector since Singaporeans want lower healthcare costs but have to increase the number of doctors in the public sector to cut waiting times.
It is therefore Singaporeans who have demanded more foreign doctors. -
The problem is not inadequate supply. It is the distribution of the labour. We can double the number of local doctors, but the problem will persist as long as the pay in the private sectpr is that much higher.Originally posted by ShutterBug:So beautifully put!
Well said!
This is exactly what's happening across the board, and not just in healthcare.
>>> http://www.sgforums.com/?action=thread_display&thread_id=234098
We will now see a two-tier healthcare system. The public sector with lots of cheap foreign doctors offering cheaper healthcare catering to the poor and the private sector with local doctors offering more expensive and cutting-edge healthcare for the well-off and foreigners. There will be a greater exodus of doctors from the public to the private sector but as long as we have a ready supply of cheap Indian doctors, we can offer cheap healthcare with shorter waiting times. -
You have to be joking if you say it is slightly higher- it is not slightly - it is HIGHER - the Aussies are running to UK to work because they are offered MORE. Then why are you there in the first place if the pay is not worth the trouble?Originally posted by oxford mushroom:Haha...what makes you think I am staying put for good? The pay here is slightly higher than that back home but with the taxes and national insurance, I am better off returning home.
Local doctors should not be worried if they keep up with the latest and upgrade their skills. Pay for public hospital doctors will be depressed, but that's because Singaporeans demand lower medical fees and shorter waiting times. So they get cheaper foreign doctors in the public hospitals whilst local doctors move out into the private sector.
Don't blame the government if you don't like the foreign doctors. Singaporeans have demanded it. You want shorter waiting time and cheaper rates...well, the only way is to get Indian doctors. Those who want to be treated by local doctors with internationally recognized qualifications will have to go to the private sector. However, with the influx of cheap foreign doctors and more local doctors leaving, medical costs in the private sector will also drop due to increased competition. In time, we will see more Singaporeans going to the private medical sector and only the poorest who cannot afford will see the foreign doctors in public hospitals.
I don't blame the government for anything because I have a choice not to return in the long run.
I don't believe that Singapore's healthcare cost will be blown apart that easily if you continue to hire locals. First of all , it is pay per use - even for the poorest of the poor unless they have absolutely no asset or children. Where has all the money gone to?
Probably too many administrators. I remember watching Yes Minister - the old british comedy about a bumbling minister and his workers - they overemployed too many administrators and had to pay them instead of the doctors. So one hospital only had administrators - no patients , no nurses. It was a good comedy skit - abit of a deja vu but not that extreme.
If ministers can increase the pay of the president and keep their 1 million dollar a year salary , I see no reason why local doctors and nurses should be forced to accept lower wages. It is a short term fix to decrease overhead costs and increase profits to enrich the upper achelons of management .
In the long term , Singapore will find that all the brightest and smartest have gone to greener pastures . Does nothing but damage in the long term.
Anyways all I can say - the way I see it - Singapore is only having short term fixes in policies to cover up the cracks . One day ,those cracks are going to be massive and will be exposed no matter how much covering is placed on it - by that time , it will be too late for Singapore. They hub so much but they never bother to build on it - only moving to the newest fad ....last time was information hub then medical hub now biomedical hub ...Hub this Hub that ...Hubba bubba...
Singaporeans are just paying for million dollar ministers to follow the new fads ...oh wow ...might as well pay a teenager less to get ideas out. -
Well, it is in this regard seemingly fair, being that waiting time gets reduced and that it is that much more affordable to those who don't have the means. I suppose there will be a trade off.Originally posted by oxford mushroom:The problem is not inadequate supply. It is the distribution of the labour. We can double the number of local doctors, but the problem will persist as long as the pay in the private sectpr is that much higher.
We will now see a two-tier healthcare system. The public sector with lots of cheap foreign doctors offering cheaper healthcare catering to the poor and the private sector with local doctors offering more expensive and cutting-edge healthcare for the well-off and foreigners. There will be a greater exodus of doctors from the public to the private sector but as long as we have a ready supply of cheap Indian doctors, we can offer cheap healthcare with shorter waiting times.
At leats there is a choice, rather than none. -
Rubbish. If you employ foreign doctors and nurses at lower costs - it won't be kept affordable instead it should be free for all who earn below a threshold amount - consultation, hospital care etc.Originally posted by ShutterBug:Well, it is in this regard seemingly fair, being that waiting time gets reduced and that it is that much more affordable to those who don't have the means. I suppose there will be a trade off.
At leats there is a choice, rather than none.
If it cannot be free, it ain't a choice but an excuse. -
FREE??Originally posted by fymk:Rubbish. If you employ foreign doctors at lower costs - it won't be kept affordable instead it should be free for all. If it cannot be free, it ain't a choice but an excuse.
FREE is a dirty word to our gov.
Remember "No Free Lunches"?
Unless they eventually increase our income tax exorbitantly then perhaps, healthcare may become "FREE"... -
Then it is an excuse.Originally posted by ShutterBug:FREE??
FREE is a dirty word to our gov.
Remember "No Free Lunches"?
Unless they eventually increase our income tax exorbitantly then perhaps, healthcare may become "FREE"...
I am sorry but Singapore proposing to take in lower paid foreign doctors and nurses as well as forcing down the salary is a short term fix. Singapore is not a welfare state like Australia or UK but Australia can still afford to pay its local doctors and nurses higher rates as well as keep workload down. How come Singapore can't?
Like I say , do that and you see the smartest , brightest out of the country pronto . The government has spent so much money to subsidise their education as well as foreigners . Foreigners don't have a loyalty to Singapore but Singaporeans do . Treat the foreigner and the Singaporean the same and you find that the best will run out leaving you with a few good ones. It will become a cycle and damaging to Singapore's future. -
I do agree with your opnion and stand on this matter, but unfortunately this country of ours has been suffering from Talent and Brain drain for a long time now. And the day our gov coughs up money from their reserves to meet with the public's incessant request for affordable healthcare, will be the day we see pigs flying around.Originally posted by fymk:Then it is an excuse.
I am sorry but Singapore proposing to take in lower paid foreign doctors and nurses as well as forcing down the salary is a short term fix. Singapore is not a welfare state like Australia or UK but Australia can still afford to pay its local doctors and nurses higher rates as well as keep workload down. How come Singapore can't?
Like I say , do that and you see the smartest , brightest out of the country pronto . The government has spent so much money to subsidise their education as well as foreigners . Foreigners don't have a loyalty to Singapore but Singaporeans do . Treat the foreigner and the Singaporean the same and you find that the best will run out leaving you with a few good ones. It will become a cycle and damaging to Singapore's future.
All the half-assed moves so far are things like allowing the use of Medisave for common ailments of up to $300 per year, minute adjustments to Medisave so that we pay lesser upfront, likewise with Eldershield and Medishield.
These are all the baby-steps they are taking, fearful of becoming a Welfare State.
But frankly, as much as our gov would like to steer clear of Welfarism, as a country and its society ages, providing certain degree of welfare becomes inevitable.
And as you said, other countries are willing to pay their doctors more, but do we have the Tax to match the act? Which do we prefer, low Income Tax and high healthcare costs, or high Income Tax for FREE healthcare costs?
I told OM that I'd rather our gov Tax us more and give us SUBSTANTIAL healthcare in return than the current stupid Medisave scheme.
And talking about Singapore's future? I dare not go into that topic... it gives me palpitations... -
unless you import cuban or former soviet bloc doctors, you are not going to get any doctors on much cheaper pay scale. you neglect to consider any foreign doctor who comes here will soon realise what he should be able to charge....the gp i visited sometime ago was complaining how difficult it was getting a locum (part-time doctor) to man his clinic because the last few he had returned to polyclinics which is paying about $8k monthly....so it is a supply issue....cheaper health care? don't bet on it.....Originally posted by oxford mushroom:The problem is not inadequate supply. It is the distribution of the labour. We can double the number of local doctors, but the problem will persist as long as the pay in the private sectpr is that much higher.
We will now see a two-tier healthcare system. The public sector with lots of cheap foreign doctors offering cheaper healthcare catering to the poor and the private sector with local doctors offering more expensive and cutting-edge healthcare for the well-off and foreigners. There will be a greater exodus of doctors from the public to the private sector but as long as we have a ready supply of cheap Indian doctors, we can offer cheap healthcare with shorter waiting times. -
It is significantly higher only for junior doctors. Once you come to the consultant level, the pay is not much higher than that in Singapore. For certain specialties like surgery, the pay is higher in Singapore compared to the UK. The British surgeon is paid the same amount as his psychiatrist colleague, whereas the pay difference can be twice as high in Singapore. And you must factor in the taxes and national insurance which will wipe out about 45% of your income if you are earning a consultant's salary. There are a few reasons why I am here for this period of time, but pay is definitely not one of them.Originally posted by fymk:You have to be joking if you say it is slightly higher- it is not slightly - it is HIGHER - the Aussies are running to UK to work because they are offered MORE. Then why are you there in the first place if the pay is not worth the trouble?I don't believe that Singapore's healthcare cost will be blown apart that easily if you continue to hire locals. First of all , it is pay per use - even for the poorest of the poor unless they have absolutely no asset or children. Where has all the money gone to?
Tell that to the Singaporeans and forumners who complain that health care costs are too high....They want more doctors to cut waiting times but do not want to pay more. If you raise the salary of doctors in the public sector to retain them, will the population understand? If the patients don't pay more then the government will have to pay. If you want the government to increase health care expenditure, then we have to pay more taxes to balance the budget. Will Singaporeans agree?Probably too many administrators. I remember watching Yes Minister - the old British comedy about a bumbling minister and his workers - they over employed too many administrators and had to pay them instead of the doctors. So one hospital only had administrators - no patients , no nurses. It was a good comedy skit - abit of a deja vu but not that extreme.
That was true in the past. This Minister has changed it...he ordered some of the non-core administrative offices closed and outsourced many of the administrative and IT functions to private firms with a great deal of savings.In the long term , Singapore will find that all the brightest and smartest have gone to greener pastures . Does nothing but damage in the long term.
There are plenty of bright and able youngsters from China, India and Vietnam only waiting to replace those that leave. It is not the brightest who leave we have to worry about. It is those who cannot go because their skills are not as marketable in the global market...that is the problem.
Anyways all I can say - the way I see it - Singapore is only having short term fixes in policies to cover up the cracks . One day ,those cracks are going to be massive and will be exposed no matter how much covering is placed on it - by that time , it will be too late for Singapore. They hub so much but they never bother to build on it - only moving to the newest fad ....last time was information hub then medical hub now biomedical hub ...Hub this Hub that ...Hubba bubba...
Singaporeans are just paying for million dollar ministers to follow the new fads ...oh wow ...might as well pay a teenager less to get ideas out.
Looking for new avenues of growth is essential. As China and Vietnam develops, our low-value industries will gradually lose out in the competition. That is inevitable. We have to look for new opportunities, new growth industries to ensure our continued prosperity. There is no other choice. -
You might be surprised but I agree with most of this post.Originally posted by ShutterBug:But frankly, as much as our gov would like to steer clear of Welfarism, as a country and its society ages, providing certain degree of welfare becomes inevitable.
And as you said, other countries are willing to pay their doctors more, but do we have the Tax to match the act? Which do we prefer, low Income Tax and high healthcare costs, or high Income Tax for FREE healthcare costs?
I told OM that I'd rather our gov Tax us more and give us SUBSTANTIAL healthcare in return than the current stupid Medisave scheme.
Singapore wants to steer clear of welfarism because a welfare state is a very expensive affair. Even in Australia, a certain amount of co-payment is required in addition to the high taxes and premiums on health insurance. As society ages, health care costs will rise. Modern health care is a commercial 'commodity'...but whilst you would forgo a nice car or the chance to study in Harvard if you don't have the money or a scholarship, patients will demand the best medical treatment even if they cannot afford them. In a welfare state, you are obliged to give them that treatment.
The UK NHS is running out of money as it is, having to close emergency departments and hospitals (http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/04/18/nhs18.xml). Yet because of a woman's demand to have the expensive b_reast cancer drug Herceptin (http://news.bbc.co.uk/1/hi/health/5063352.stm), the NHS will have to find another 100million pounds a year to pay for this drug. That figure will only rise as more women are diagnosed with the cancer as a result of early b_reast cancer screening. If Singapore were a welfare state and has to provide Herceptin for our patients, we are talking about 21,800 GBP (S$65,659) per patient per year (http://www.timesonline.co.uk/article/0,,8122-2027540,00.html).
Free healthcare at point of contact is far too expensive as the NHS experience has shown us. You may not realize how high the taxes will have to be to pay for the 'free' healthcare. With an aging population, it will be the young who will have to bear the bulk of the burden as the elderly retires from the work force. We will see the young leaving Singapore to avoid having to pay high taxes for a service that they do not consume as much. Even Australia has chosen a co-payment scheme rather than to follow the UK route.
You are prepared to pay higher taxes in exchange for cheap, high quality healthcare in the public sector. But have you considered that fact that the majority of Singaporeans do not have to pay income tax because they are not working or earning too little. That means you will have to pay for them as well. And as the population ages, you will have to pay for more of them. When you become old, there is no guarantee that our children will want to stay and pay such high taxes, rather than emigrate to somewhere else. What will happen to you then? -
Free? Foreign doctors and nurses are cheaper, not free. At the very least, they are expected to have medical and nursing qualifications in their home country and in any case, some local doctors are still required to supervise them.Originally posted by fymk:Rubbish. If you employ foreign doctors and nurses at lower costs - it won't be kept affordable instead it should be free for all who earn below a threshold amount - consultation, hospital care etc.
If it cannot be free, it ain't a choice but an excuse.
If patients won't pay more fees and Singaporeans won't pay more taxes but everyone demand to have more doctors in public hospitals and shorter waiting times, foreign doctors can be part of the solution. If more local doctors and nurses leave for the private sector, their places can be taken by double the number of foreign professionals who are willing to accept half the pay, let's say, it is possible to cut waiting times.
Our waiting time problem arose because of a distribution problem with many local doctors leaving for the private sector. Since nobody wants to pay to retain these local doctors, the solution is to exaggerate the exodus and replace them with cheaper foreign doctors. -
Indian doctors are cheaper. We can hire them as clinical fellows rather than medical officers and give them lower pay but make them do the same work.Originally posted by countdracula:unless you import cuban or former soviet bloc doctors, you are not going to get any doctors on much cheaper pay scale. you neglect to consider any foreign doctor who comes here will soon realise what he should be able to charge....the gp i visited sometime ago was complaining how difficult it was getting a locum (part-time doctor) to man his clinic because the last few he had returned to polyclinics which is paying about $8k monthly....so it is a supply issue....cheaper health care? don't bet on it.....
Foreign doctors can be given a limited or conditional license which will limit them to practice in public hospitals only. Since the UK does not want them, many non-specialist Indian doctors have to leave UK soon. They have no choice...either work for us for 3-4k or work in India for 1-2k. -
The 45% taxes goes into paying unemployment benefits, pensions, free healthcare, free education, etc. That's why taxes need to be high to cover the cost.
Entitlement to help with health costs (NHS prescription and dental charges, optical and hospital travel costs) is based on the principle that those who can afford to contribute should do so, while those who are likely to have difficulty in paying should be protected.
The only problem I see is that you might not reap some of the benefits of paying the higher taxes.
http://www.direct.gov.uk/en/Bfsl1/BenefitsAndFinancialSupport/DG_10018978
http://www.direct.gov.uk/en/Over50s/index.htm
http://www.dwp.gov.uk/international/sa29/benefits_01.asp
Another error in your so called analysis, as China and Vietnam develops, their wages will increase as their standard and cost of living increases, so wage levels will increase to our levels, making competition more or less equal.Originally posted by oxford mushroom:Looking for new avenues of growth is essential. As China and Vietnam develops, our low-value industries will gradually lose out in the competition. That is inevitable. We have to look for new opportunities, new growth industries to ensure our continued prosperity. There is no other choice.
You said nobody wants to pay higher taxes, the progeny of the parents will leave UK emigrate to somewhere else. But statistics from the UK government has shown an increase in the population, I guess all of these people that the UK government grant residency and citizenship to are all idiots (like you), they like to pay higher taxes.Originally posted by oxford mushroom:You are prepared to pay higher taxes in exchange for cheap, high quality healthcare in the public sector. But have you considered that fact that the majority of Singaporeans do not have to pay income tax because they are not working or earning too little. That means you will have to pay for them as well. And as the population ages, you will have to pay for more of them. When you become old, there is no guarantee that our children will want to stay and pay such high taxes, rather than emigrate to somewhere else. What will happen to you then?