Speech at Singapore Medical Council Physician’s Pledge Affirmation Ceremony

Professor Nambiar, President Singapore Medical Council

 

Professor Satku, Director of Medical Services

 

Distinguished Guests

 

Colleagues

 

Ladies and gentlemen, good evening.

 

 

I am happy to join you this evening as you affirm the Physician's Pledge. This must be a special occasion for all of you, charged with emotions of pride, satisfaction and high expectations for your future. This occasion marks a significant milestone in your life, as having completed your housemanship, you now formally join the medical fraternity as registered practitioners.

 

2.   This is also a solemn occasion. The pledge that you make today must be honoured. But these vows and values will also serve as guide-posts - and in difficult moments, light-posts - in this long and winding journey as a doctor.

 

 

3.   You have graduated into promising and interesting times. The years ahead will bring exciting opportunities, but also new challenges.  While Singapore already has an established and highly regarded healthcare system, this will grow further – in both volume and expanded domains of expertise.  Needless to say, more healthcare services will be needed as our population ages. A recent UN study projected that, in about 50 years' hence, still within your career and physical life-times, Singapore could become the fourth oldest country globally in terms of the median age of the population¹. The number of residents aged 65 years or older will multiply threefold to about 900,000 in 2030, or about one in five residents. Demand for low-cost, long-term step-down care and rehabilitation services for the elderly will increase.

 

4.   We are also promoting Singapore as a regional medical hub through the Singapore Medicine initiative, and this will attract more medical travellers. This effort has already had early successes. The annual growth in the number of medical travellers has averaged 20% over the past few years², and we are attracting medical travellers from traditional regional countries like Indonesia and Malaysia as well as further beyond, from new sources such as Russia, Middle East, US and UK. Hospitals have geared up to this change by providing translation services, dedicated international patient service centres locally and international one-stop shop patient referral centres in more than 20 countries. The different flavours of international medicine in Singapore will be felt, and medical professionals will have to update and expand their horizons and knowledge to accommodate these changes. I am not speaking narrowly of medical expertise per se. The more industrious and enlightened among you will gain an advantage if you could speak another foreign language or know the customs and preferences of different nationalities who come here to seek medical help. 

 

5.   Our efforts and increased spending in biomedical sciences will boost clinical care, translational research and medical scientific R&D. The Government has committed to funding of S$1.55 billion³ for phase 2 of the Biomedical Sciences (BMS) initiative over the next few years. This will have a focus on translation and clinical research. A new ecosystem will be built from these focussed efforts. It will not only require medical and scientific researchers, but just as important, the entire supply chain to bring ideas from mind to bench to bedside. A plethora of sub-specialities will be expanded including those in marketing, venture capitalist, pharmaceutical and managerial executives, patent lawyers, ethicists and research coordinators.

 

6.   All these developments will not only require more healthcare and allied professionals but will also require them to have expanded domains of knowledge and expertise. There will be more pathways for those like you with that basic medical degree to forge ahead.  In this eclectic environment, those who can adapt will more likely thrive. In countries where these systems are more developed, it is not unusual for many to proceed from medicine to other fields in research, law, marketing and management.

 

7.   The Government is working with stakeholders to meet the healthcare sector's manpower needs at all levels.  For example, the NUS-Duke Graduate Medical School (GMS) is an exciting new development that will admit its first batch of 25 students this year. They have chosen an even more blue skies outcome - to produce the leaders for tomorrow – not only medical leaders. The GMS provides an alternative medical education programme that will produce doctors who can be further trained as clinical-scientists to help support the life sciences development in Singapore. I am certain too that the more established medical faculty at Kent Ridge, from which you graduate, will also continue to monitor and respond to world-wide trends and practices.

 

8.   In addition, we have started an undergraduate and a Master's course for nursing at NUS.  The Singapore Workforce Development Agency (WDA) is also working with healthcare institutions to convert and train existing workers in other industries to enter the healthcare sector.

 

 

9.   Both the scope and rate of expansion of these trends and developments can be daunting to you as fresh graduates, at the start of your careers. No sooner than having scaled one peak, new ranges of mountains rise before you. How does a new medical graduate navigate this future?

 

10.   Take comfort that you need not face these challenges alone. The Government has committed to this course towards a cosmopolitan city – plugged into the global grid. This is the way forward for us to make the next quantum leap, to secure a relevant role in a changing future. But to do this well, we must encourage a healthy circulation of ideas and talents. This is not a new strategy. Indeed, the medical fraternity were among the first to employ it many years ago. Under the HMDP (Health Manpower Development Programme) started in 1980⁴, Singaporean doctors and other health care personnel were sent abroad to learn cutting edge practices in top medical institutions. They returned to share that expertise and raise clinical standards. At the same time, the HMDP facilitated a steady stream of foreign specialists into Singapore to share their knowledge. This created a virtuous cycle and was critical in elevating our standards of medical care. This willingness to open ourselves to new ideas and standards was an important element in putting Singapore medicine on the world map. 

 

11.   We must continue these virtuous traits of being open to the world. But, the competition is heating up, even in the medical industry, as other countries have also begun to adopt these practices. Qatar has established a medical school essentially administered by staff from Cornell University. Teaching is done by Cornell faculty seconded there, and standards are identical to those of the main campus. Degrees awarded there will also be recognised in the US⁵. The Royal College of Surgeons of Ireland together with University College Dublin runs a medical school in Penang – its degrees allow graduates to work in Malaysia and are recognised all over the world for the purposes of post-graduate training and practice⁶. The Netherlands and United Arab Emirates have streamlined their work pass application procedures and offer dependants' privileges for medical professionals as an added incentive. Other neighbouring countries, like Thailand have allowed foreign medical specialists into private practice in order to boost their share of international patients.

 

12.   Even in the rarefied atmosphere which the medical industry occupies, competition is intensifying. Singapore must continue to train and retain its local graduates, as its major effort. At the same time, we must complement and fill gaps with global talent to stay ahead. To help attract global talent here, MOH and MOM's Contact Singapore are working with the hospitals to identify key groups of overseas medical talent to systematically reach out and attract them to Singapore.  This includes reaching out to our own Overseas Singaporeans studying or working overseas. We are also going beyond the traditional sources of talent, such as the UK and Australia, to identify new sources such as India, China and Hong Kong. MOH recently expanded the number of recognised foreign medical institutions to practice here from 120 to 140.

 

13.   There will be enough opportunities for all. The whole will be greater than the sum of diverse parts. Global talent will provide a diversity of skills, experiences and knowledge that add vibrancy to our healthcare system and our overall economy as a whole. We have therefore continually refined our policies to better attract talent. MOM introduced the Personalized Employment Pass in January this year to better attract and retain talented foreign professionals working in Singapore. With effect from 1 June 2007, the quota for the S pass, which caters to mid-skilled manpower, will increase to 15%. These measures will help meet our immediate needs. However, in the global race for talent, we also need to positively shape international opinion of Singapore and raise our profile. We need to recognise that others have upped the ante and we need to attract and secure a mindshare of Singapore as an attractive destination and a global city.

 

 

14.   To augment this effort, my Ministry will introduce a Work Holiday Programme from 1 December 2007. This programme will target to bring bright young people to Singapore – we are targeting them early because there is a growing phenomenon of well-qualified young students and graduates who travel abroad to gain exposure. Our own young people do the same. These students and graduates are a rich source of talent whom we should try to tap on when they eventually join the workforce.  The Work Holiday Programme, or WHP, will first start with 2,000 places for students and graduates from universities in Australia, France, Germany, Hong Kong, Japan, New Zealand, the United Kingdom and the United States. Participants of the WHP will be allowed to work in Singapore for a period of up to 6 months. A positive experience of living and working in Singapore under the programme would encourage some of them to work here when they graduate, or at a later stage in their careers.  Many countries already have this Work Holiday Programme. So this is not a new idea, but we are starting this now. This programme will therefore help enhance Singapore's reputation as a talent destination, valued for its working and living experiences. MOM will work with relevant agencies to operationalise and promote this scheme worldwide.

 

 

15.   The opportunities ahead are exciting but to navigate this changing future, some constants will be needed. Ethics and professionalism must continue to be your signposts. There can be mis-steps and wrong paths as you advance in your careers. As a physician, you will often be put into situations where complete trust is placed in you. You will have an immense and special ability to do an enormous good, but also much harm – to patients, their families, your medical community, our society - if you lose your moral bearings.

 

16.   Ethics and professionalism are like two joined wheels. One cannot progress without the other. Each by itself, is unbridled and likely to lose its way. From our humble beginnings, medical fraternities worldwide have understood that doctors are expected to hold to the highest standards of both. For example, in 1996, the Royal College of Physicians and Surgeons of Canada adopted a framework for medical education called the Canadian Medical Education Directions for Specialists or CanMEDS, a framework of essential physician competencies.  Fundamentally, CanMEDS is an initiative to improve patient care.  But under this framework, more than clinical or scientific competency alone is prescribed. A medical professional is one who delivers the highest quality care with integrity, honesty and compassion.  The medical professional exhibits appropriate personal and interpersonal professional behaviour.  He practices medicine ethically, consistent with the obligations of a physician.

 

17.   What about Singapore?  We have a fairly long history of medicine in Singapore.  Our medical school is slightly more than 100 years old, and is now one of the top medical schools in the world.  But it is distressing to see in media reports that some highly-trained medical professionals have engaged in professional misconduct, unethical behaviour and other offences.  They have failed in their duties to the patient and to themselves.

 

18.   That is why today's ceremony is important. It is not just a public ceremony, but an occasion to emphasise the importance of ethics and professionalism as each new cohort of young doctors enters the profession.  Apart from today's ceremony, there are other initiatives spearheaded by the medical profession to boost the awareness of ethical and professional duties.  

 

19.   The Singapore Medical Council's Ethical Code represents the fundamental tenets of conduct and behaviour expected of doctors practicing in Singapore.  It is important for every doctor to know the ethical code and of the minimum standards required of practitioners in discharge of their professional duties and responsibilities.  The Singapore Medical Association has also set up a Centre for Medical Ethics and Professionalism, which aims to develop and promote medical ethics and medical practice for the betterment of patient care and public health.  These concepts of medical ethics need to be translated into daily clinical practice.

 

20.   The Specialists Accreditation Board (SAB) and the Joint Committee for Family Medicine Training in Singapore have also introduced a compulsory course in medical ethics for all trainees.  This mandatory core course will equip advanced specialist and family medicine trainees with a basic working knowledge of clinical ethics, local health law and medical professionalism.

 

 

21.   In closing, let me offer my heartiest congratulations to the new cohort of doctors entering the profession.  As you recite the pledge, I am confident that you will internalise the principles within and translate it into your daily practice.  I urge you to go beyond the call of public duty and contribute to the continued excellence of our healthcare system. In this life, which you have chosen, much will be given to you. But much is also expected – live up to those expectations.

 

Thank you.

 

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