Changes to the Medical Registration Act Schedule

05 Dec 2002

A. EXECUTIVE SUMMARY

The Ministry of Health has decided to expand the list of recognised foreign universities and medical schools in the Schedule of the Medical Registration Act. The one-third quota on the intake of female medical students into the National University of Singapore will also be lifted with effect from the next academic year (2003).

B. MEDICAL REGISTRATION ACT SCHEDULE

The Medical Registration Act (MRA) Schedule lists the foreign universities and medical schools whose medical degrees are recognised for registration in Singapore. In 1993, because of concerns about an oversupply of doctors that would lead to increased health costs, and the increasing number of Singaporeans going overseas to study medicine, the number of universities and medical schools in the MRA Schedule was reduced from 176 to 28.

Over the last decade, the medical manpower situation and needs have changed significantly. In the mid-1990s, higher immigration flows and an increase in the total population led to increased demand for healthcare services. Attrition of doctors to the private sector also exacerbated the manpower situation in the public sector. Looking ahead, we will also need more doctors to support our efforts to develop our biomedical research and development sector, and strengthen our position as a medical services centre for the region.

A judicious expansion of the MRA Schedule would allow our hospitals and medical institutions to recruit sufficient numbers of good foreign-trained doctors to meet their needs. Rules that are already in place to regulate the entry and practice of foreign-trained doctors in Singapore will help ensure that there will not be an oversupply of doctors.

MOH has tasked the Singapore Medical Council to look into the expansion of the MRA Schedule and recommend to MOH which foreign medical schools should be included in the revised Schedule. The SMC's report is expected in about 3 months' time.

It should be noted that even a limited expansion of the Schedule would mean an increase in the number of Singaporean medical graduates who are eligible to take up junior doctor positions in public sector hospitals. While there should be enough capacity in the public sector to accomodate the local graduates and some overseas-trained graduates, there can however be no assurances that there will be public sector jobs and training posts for every medical graduate who is a Singaporean.

C. LIFTING THE QUOTA ON FEMALE MEDICAL STUDENTS

A one-third cap on the female medical student intake into the National University of Singapore (NUS) was introduced in 1979 because the proportion of female doctors who did not work, or worked only part-time, was consistently higher than the comparable figure for male doctors. For female doctors, attrition from the workforce ranged from 16% to 19%, compared to only 5% to 8% for male doctors at that time. In addition, there was difficulty in deploying female doctors in hospitals especially for the night shifts. Few female doctors opted to practise in specialties that had irregular working hours.

It costs about $400,000 over 5 years to train a medical student, 80% of which is subsidised by the government. The total subsidy for medical students is about 5 times that for students in other disciplines. The quota on female medical students had helped to ensure that our limited resources are maximised and that there will be sufficient number of doctors to serve the community, beyond the five-year bond period.

In recent years, the situation has improved. Based on follow-up data from cohorts of doctors who graduated between 1983 and 1994, there is now only a difference of 5% between the attrition rates of male (9%) and female (14%) doctors. Following the increase in the total NUS medical student intake from 150 to 230, the proportion of female medical students had to be increased in order to fill available places without lowering intake quality. The one-third quota was waived, and female students constituted 40.5% and 41.3% of the total medical intake for the academic years 2000/2001 and 2001/2002 respectively.

Several groups have come forward to support the lifting of the quota. These include the the Remaking Singapore Committee and its Group on Women's Issues, led by Mrs Lim Hwee Hua, the Association for Women Doctors and several MPs, including Dr Lily Neo and Mr Charles Chong.

MOH has assessed that lifting the quota would not cause any significant increase to the current attrition rates of doctors. Feedback from the public sector healthcare clusters confirms that there is no significant problem in deploying female doctors nowadays. Female doctors also no longer avoid working in specialties with irregular hours.

The NUS female medical student quota would therefore be abolished and will take effect from the academic year 2003.