On March 6, 2024, Singapore's Minister of Health, Ong Ye Kung answered a question from MPs about the training of doctors and the proportion of doctors in the population in Parliament.
The following is a translation of the Singapore Eye based on Parliamentary sources:
(Continued from the previous article Singapore's Health Minister Ong Ye Kung Parliament's reply to MPs: By 2030, the number of public hospital beds will reach 15,000) Another key to expanding medical capacity is to strengthen human resources. Mr. Ang and Dr. Chan Yau Ming asked if we needed to train more doctors to meet the demand. Yes, we have done this in the past and will continue to do so. In fact, over the past 10 years, our local medical school enrollment has increased by about 30% and now has about 500 students. If you consider each session, it is now slightly more than 30,000 people. About half, about 15,000 to 17,000 people, are in college, and of this group, 500 are in medical training. [See Clarification of the Minister of Health, Official Report, 6 March 2024, Vol. 95, No. 131, Written Statement Correction.] 】
At the same time, more people are being trained by integrated health care staff and nurses. As a result, we are attracting a lot of talent. We also offer scholarships and grants to attract Singaporeans who have graduated from overseas medical schools to join the local public healthcare system.
What is the situation in Singapore in terms of doctor-to-population ratio, and in terms of practicing doctors, our ratio is about 2.6 (2.6 doctors per 1,000 people). Let's put this number in some context.
Compared to developing countries, we are in the lead, and our proportion is higher. Our situation is similar compared to the advanced economies of Asia. South Korea, Hong Kong, and Taiwan all have ratios of around 2.6. Japan is also 2.6, although they are actually aging earlier than us, with about 30% of the population aged 65 and over.
Compared to the developed Anglo-Saxon countries (Great Britain, the United States and Canada), we are only slightly behind.
Compared to European countries (continental Europe, Australia), we are indeed a cut behind. Why? I think there are various reasons. This could be a legacy of the welfare state, or it could be a tradition that European countries don't really have human resource planning.
We can further explore whether we need to increase further, but we must recognize that talent is in short supply across all industries. In healthcare, we should be attracting our share of talent, not too much of it. Exceeding this fair share, countries may reap the consequences.
First of all, it's not a simple numbers game. The right mix of doctors is just as important as the number of doctors. It doesn't help if the doctor registers but doesn't practice. If the doctor is practicing medicine but is engaged in areas such as cosmetology, it doesn't help much.
In Singapore, medical school graduates have found that the competition for residency through specialist training is more intense, as there is no shortage of doctors in many specialties. On the other hand, we are facing a shortage of doctors in areas such as family medicine, internal medicine, geriatrics, and rehabilitation medicine.
This is because, as Singapore becomes a super-ageing society, there are more patients with complex and multi-faceted conditions, and these doctors with a wider range of skills are needed. As a result, the Ministry of Health has been increasing the number of training positions in these specialized areas.
We have also seen how the supply of doctors in many countries has generated its own demand. As more doctors compete for business, doctors tend to prescribe more tests, scans, drugs and surgeries. Patients are less likely to say no because it's a matter of your health, especially if healthcare is free or insurance covers all costs.
Thus, although Mr. Ang provided data showing that Singapore's doctor-to-population ratio is lower than in some OECD countries, this has not led to worse outcomes, less accessibility or less affordability in Singapore. For example, we know that the U.S. healthcare system isn't the most convenient unless you have the right insurance.
The UK has a higher doctor-to-population ratio than we do, but they have 8 million patients on the waiting list and are chronically plagued by a lack of medical capacity. Germany's doctor-to-population ratio is also much higher than ours, but it faces enormous challenges in meeting the medical needs of the elderly in the states. Singapore, on the other hand, has seen very good health care results.
A broadly defined indicator that is generally accepted is the healthy life expectancy of the Chinese population. In Singapore, people are expected to live to a healthy age of 74, one of the longest in the world, compared with 66 years in the United States, 70 years in the United Kingdom, and 71 to 72 years in Germany, France, Denmark, the Netherlands and Australia.
Singapore spends about 5% of its gross domestic product (GDP) on healthcare, compared to 10% to 13% in most developed countries and 17% in the United States. In short, we're getting better results with less spending, fewer hospital beds, and doctor-to-population ratios than many OECD countries, and it's not just a numbers game.
Factors such as the quality and mix of doctors, the geographical distribution of countries, how the system as a whole works, and the behavior of patients all vary greatly. We still have a lot of room for improvement, but there's no reason to feel sorry for ourselves or envy others. In fact, we are in a good situation because we are constantly learning from others and trying to improve.
The following is the content of the question in English:
Another key aspect to expanding capacity is to enhance manpower. Mr Ang Wei Neng and Dr Tan Wu Meng asked if we need to produce more doctors to meet demand. Yes, we have been and will continue to do so. In fact, intakes into our local medical schools have increased by about 30% over the past 10 years, to about 500 now. If you consider each cohort, it is now slightly over 30,000. About half of them, 15,000 or so, 15,000 to 17,000 go to university; and out of that group, 500 are training to be doctors. [Please refer to “Clarification by Minister for Health“, Official Report, 6 March 2024, Vol 95, Issue 131, Correction By Written Statement section.]
Still, more are training to be Allied Health Professionals and nurses. So, we are taking quite a lot of talent. We are also offering awards and grants to actively attract Singaporeans who graduated from overseas medical schools back into the local public healthcare system.
Where does Singapore stand, in terms of our doctor to population ratio? Ours, in terms of practising doctors, is about 2.6. Let us put that number into some perspective.
Compared to developing countries, we are ahead, we are higher. Compared to developed economies in Asia, we are similar. Korea, Hong Kong and Taiwan are all around 2.6. Japan is also 2.6 and despite having actually aged much earlier than us, with about 30% of their population 65 and older.
Then, if you compare to developed Anglo-Saxon countries – the United Kingdom (UK), United States (US), Canada – we are just slightly behind.
It is really when we compare to European countries – continental European countries, Australia – that we are a notch behind. Why is that so? I think there are various reasons. It could be a legacy of the welfare state. It could be the fact that European countries do not really have a tradition of planning for manpower.
We can explore if further increases are needed, but we have to recognise that talent is in short supply across all sectors. And healthcare, we should attract our fair share, but not disproportionate share of talent. Beyond this fair share, countries can also end up chasing its own tail.
Why is that so? For one, it is not a simple numbers game. The right mix of doctors is just as important as the sheer number of doctors. If, somehow, doctors get registered but do not practise, it does not help. If doctors are practising, but they go into areas like aesthetics, it also does not help very much.
In Singapore, graduates from medical schools are already finding it more competitive to get residency positions to be trained as specialists, because there is not much of a shortage in many of these specialist areas. On the other hand, we are facing shortages in areas like family medicine, internal medicine, geriatric medicine and rehabilitation medicine.
This is because as Singapore becomes a super-aged society, we have more patients with complex and multiple medical conditions, needing doctors with these more broad-based skillsets. Hence, MOH has been increasing the number of training positions in these specialist areas.
We have also seen in many countries, how supply of doctors creates its own demand. As more doctors compete for business, there will be a tendency to prescribe more tests, scans, medications and procedures. Patients are not likely to say no because your health is at stake, and especially if healthcare is free or insurance covers all the costs.
Hence, while Mr Ang Wei Neng provided numbers to show that Singapore’s doctor-to-population ratio is lower than some Organisation for Economic Co-operation and Development (OECD) countries, this did not translate to poorer health outcomes, less accessibility or affordability in Singapore. For example, we know that the US healthcare system is not the most accessible unless you have the right insurance.
The UK’s higher doctor-to-population ratio than us, has eight million patients on their waiting lists and is suffering from a chronic capacity crunch. Germany, also much higher than us in terms of the ratio, is facing a major challenge meeting the healthcare needs of their seniors across their länders or their states. Conversely, Singapore, we are delivering quite good healthcare outcomes.
A commonly accepted broad measure is the expected health span and lifespan of our people. In Singapore, a person is expected to live up to 74 years old in good health, one of the highest in the world; compared to 66 in the US; 70 in the UK; 71 to 72 in Germany, France, Denmark, Netherlands, Australia and so forth.
Singapore achieved this by spending about 5% of our gross domestic product (GDP) on healthcare, compared to 10% to 13% in most developed countries; 17% in the US. In short, we have better outcomes with less spending and lower hospital beds and doctors-to-population ratios than many OECD countries, because it is not just a numbers game.
The quality and the mix of doctors, the geographical spread of the country, how the whole system is run, the behaviour of patients – all makes a big difference. We have a lot of room for improvement, but there is no reason to feel bad about ourselves or to envy others. We are, in fact, in a good place as we continue to learn from others and strive for improvements.
CF丨Editor
Edited by CF丨
Singapore Parliament丨Source
Singapore Parliament丨Source
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