Public Consultation on the Proposed Amendments to the Medical Registration Act

14 Jan 2009

Public Consultation on Proposed Amendments to the Medical Registration Act

                  The Medical Registration Act (MRA), which governs the registration of medical practitioners and regulates the conduct and ethics of doctors, was last amended in December 2002. Since then, new issues in professional conduct and standards of healthcare have arisen. The Ministry of Health (MOH) and the Singapore Medical Council (SMC) propose to amend the MRA to ensure that the MRA is relevant to new developments in the practice of medicine.

2               The amendment to the MRA provides for the establishment of the Register of  Family Physicians and allows the Specialists Accreditation Board to define sub-specialties.  These would serve to raise the standard of both primary and specialist care.

3               Secondly, the demand for medical manpower has grown, partly due to the ageing population. Given the establishment of Duke-NUS Graduate Medical School and the increase in number of overseas trained doctors seeking registration in Singapore, the proposed amendments to the medical registration process will allow SMC to register doctors from diverse sources with different skills and training, and at the same time, ensure that professional and ethical standards are not compromised.

4              Thirdly, we propose to streamline  disciplinary processes to facilitate  the more effective and timely  disposal of complaints and ensure that doctors maintain professional standards and practise ethically and competently. These include finer gradations to the disciplinary orders available to the SMC's tribunals.

Proposed Key Revisions to Medical Registration Act

 Establishing Register of Family Physicians

5             To raise the overall standard of family medicine practice in Singapore, a Register of Family Physicians will be established and a Family Physicians Accreditation Board set up.  Since  2005, more doctors have been trained in  Family Medicine and it is timely to set up a register to recognize these doctors for their  additional skills and knowledge as FPs.  By establishing the register, MOH hopes that more doctors will be encouraged to voluntarily upgrade themselves and hence raise the overall standard in the primary healthcare.

6             A public consultation was conducted in 2005 on the establishment of a Family Physicians Register. There was general support for this proposal, with both the public and healthcare professionals agreeing that this would better equip family physicians with the necessary skills to treat patients with chronic diseases.

Developing Sub-specialties

7            We propose to raise the standard of specialty care by amending the MRA to allow the Specialists Accreditation Board to define appropriate sub-specialties in medicine. This will enable us to be more responsive to new growth areas that can meet patient's needs. With sub-specialties, it will also allow for many specialists from  different base specialties to provide the same type of subspecialty care, and hence reduce  fragmentation of care.

Improving Medical Registration

8            To enhance the medical registration process and safeguard ethical and professional standards, we are proposing various amendments to the MRA and this includes the following:

a. To allow SMC the flexibility, with the Minister’s approval, to determine the criteria for full registration of graduates from local medical school, taking into consideration the content and structure of the course.

b. To allow the SMC to refuse an application for medical registration if the applicant is unfit to practice medicine because his ability to practice has been medically impaired.

c. To empower the SMC to specify requirements and impose restrictions on conditionally registered doctors, where this is necessary to safeguard the public. For example, if the training or practice of a doctor seeking registration is limited to a certain scope of practice, the SMC may have to impose restrictions before allowing that doctor to be registered.

d. To allow the SMC to cancel the registration of provisionally-registered housemen if their performance is found to be very unsatisfactory and they are unable to improve.

Amendments to Disciplinary Proceedings and Health Committee Inquiries

9             Various amendments to the MRA are proposed to strengthen professional self-regulation, streamline disciplinary proceedings and provide additional avenues for the appropriate resolution of complaints. These proposed amendments include the following:

a. To allow doctors who have insight of their own professional competency, or who acknowledge that they have medical problems that make them unfit to practice medicine, to constructively discuss these issues (whether on their own initiative or after receiving notification from the SMC) with the regulator and find appropriate ways of restricting their practice.

b. To allow the SMC’s Complaints Committees to appoint officers who will be empowered to investigate complaints. This will ensure that complaints against doctors are more thoroughly and expeditiously resolved,  In this way, unmeritorious complaints can be more quickly disposed off, while the facts and circumstances of more serious cases can be established in greater detail.

c. To enhance the powers of the Complaints Committee to facilitate just and effective disposal of complaints. These include the power to refer complaints for external conciliation or mediation, require the doctor concerned to undergo further training or receive counseling, and require the doctor to receive appropriate treatment. In addition, if the doctor acknowledges the complaint, the Complaints Committee may, with his consent, curtail his practice or remove or suspend him from the register, instead of requiring him to go through a formal disciplinary hearing.

d. To rename the Disciplinary Committee as the Disciplinary Tribunal, and retain the doctor as its chairman but provide for the option of appointing a judge, legal officer or senior lawyer as chairperson. This is because formal disciplinary proceedings tend to involve legal issues, both procedural and substantive.

e. To allow the Disciplinary Tribunal to impose a penalty of up to $100,000.

f.  To remove the cap of up to 3 years restriction on the practice of a doctor convicted of professional misconduct by the Disciplinary Committee. With this proposed changes, the Disciplinary Tribunal will be given greater scope to impose effective and proportionate sentences.

g. To allow the Health Committee to be able to impose longer-term restrictions on doctors whose fitness to practice is medically impaired, if this is imperative for patient protection.

h. To allow aggrieved complainants to appeal to the High Court against the Disciplinary Tribunal’s decisions.

10         A table on the current Act and proposed key revisions is attached at Appendix.

Public Consultation

11        MOH will conduct a 6-week public consultation (14 January  to 25 February 2009) to obtain feedback on the proposed MRA amendments. The Public Consultation paper and the draft Bill are attached for reference below. These documents are also available on the REACH website. All feedback should reach the Ministry by 25 February 2009.

Reference

Draft Medical Registration Act Bill.pdf

Public Consultation on the Proposed Medical Registration Act