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Chee Hong Tat’s aimless political jab at Dr Tambyah

It seems to be a trend in Singapore nowadays for political figures to make baseless claims or allegation against individuals without any justification apart from motherhood statements, and after the "attack" is done and reported by the mainstream media, one pretends nothing has happened and move on with life.

Earlier on 10 May, Dr Paul Ananth Tambyah, a medical professional and activist, issued a statement to criticise The Independent SG for misrepresenting his remarks made at a May Day commemoration event organized by Transitioning.Org on 1 May 2017,  commenting that an anonymous writer from TISG had put a spin on what he had said during the event.

Dr Tambyah noted that people in institutions who are connected to him, have expressed their concerns over what has been written in the "irresponsible" article and he, himself is appalled at the misrepresentation by TISG.

Dr Tambyah had said in the opening speech for the May Day event,

"Singapore is the only country without a minimum wage and yet when you think about it, a minimum wage which will help Singaporeans far more than people coming from overseas because I can tell you this. Even in my own field, the junior doctors tell me this and I don't know how true it is. Every time, they complain about conditions in a public hospital, they are told, "Oh complain lar, we can hire somebody from south or south-east asia who is willing to work for three thousand dollars a month". And you know if even doctors are feeling this kind of thing, you can imagine what other professions are facing.

He wrote, "Anyone who was at the event will know that I was not referring to NUH hospital administrators at all or the entire healthcare system, but calling out bad behavior by those who try to divide us".

Subsequently on 12 May, People's Action Party's Senior Minister of State for Ministry of Health, Mr Chee Hong Tat published a Facebook post to call out Dr Tambyah's statement, alleging that TISG wrote is exactly what Dr Tambyah had said during the event.

He wrote,

"For the record, the foreign doctors whom Prof Tambyah mentioned are under Temporary Registration, they currently make up less than 4% of our doctor population in the public hospitals. Temporary Registration is granted by the Singapore Medical Council for training and for visiting experts, there are similar arrangements in the United States, United Kingdom and Australia. While these doctors may supplement the hospital’s workforce during their temporary stint in Singapore, they are not here to replace or compete with our local doctors.

It begs the question why Prof Tambyah repeated serious allegations regarding his healthcare sector colleagues when he did not know if these were true. The junior doctors were speaking to Prof Tambyah in his capacity as a senior doctor. Instead of clarifying the facts with the junior doctors or surfacing his concerns to the management, he chose to repeat unsubstantiated allegations at a public conference.

I find it disturbing that as a senior doctor, Prof Tambyah does not see anything wrong with this behaviour. He even tried to justify his actions by paraphrasing James Baldwin and claiming that he is “doing the right thing”. If Prof Tambyah was not sure if the allegations were true, as he stated in the video, then isn’t the right thing to first clarify the facts before pointing fingers at his colleagues in the public healthcare system who were not there to defend themselves?

If Prof Tambyah has specific details such as the names of the administrators and what exactly they said to the junior doctors, I welcome him to provide the information to Ministry of Health, Singapore. We will certainly look into the matter."

Following his post, both mainstream media and alternative media platforms reported on the claims made by Mr Chee on Dr Tambyah.

People's Action Party also stuck a foot into the matter and shared the Minister's Facebook post.

As a Senior Minister of State for the Ministry of Health, Mr Chee seems to be uninformed of the problems faced by medical professionals in Singapore.

According to the annual report published by the Singapore Medical Council in 2015, there are 2054 doctors who are non-residents but foreign trained and 1005 Singapore Permanent Residents who are foreign trained.

Strictly speaking if we were to take this figure as a gauge, 35% of Singapore doctors are foreigners. But of course, such a number cannot be used as the doctors are equally paid as their local counterparts and can easily be employed elsewhere in the world if they are not treated with respect and fairness.

It is those doctors whom Minister had chosen his words carefully to address, those who are under the Temporary Registration (Service) arrangement. Doctors who work under such an arrangement typically command a much lesser pay than the local doctors because their certifications are not accredited by Singapore Ministry of Health.

However, due to the severe lack of doctors in Singapore, MOH has no choice but to allow such doctors to be part of the health care system, deployed mainly at the polyclinics.

So while the Minister may be right that the figures are small, but regardless how small the number of such doctors are (In this case, 327 of them), the hospital will always have a leverage over the local doctors with their presence. 
Based on a 2016 survey conducted on the starting pay of Singapore doctors, the median income for a Bachelor of Medicine and Bachelor of Surgery is $5,000 while back in 2013, it was $4,500.

Although the local doctors is paid higher compared to the doctors under Temporary Registration, they assume a heavier responsibility by taking care of patients with complex medical conditions or complications while most of the doctors under the Temporary Registration are often assigned to polyclinics as medical officers, taking up straight forward jobs to follow up on stable patients for their medication and paid around $3,000.

Such an arrangement might seem the best of two worlds for the local hospitals where they can pay as little as possible to address the lack of staffing while having expensive trained doctors to address the serious medical cases but what this creates is an obvious disparity between the doctors, with local doctors being overworked with cases pushed to them, with little time to spare for their patients who need more care than just medical advice.

The lack of increase of pay and burden upon the local doctors create a vicious cycle where doctors are spurred to leave the public section into the private sector, opening their own general clinics for better wages and work-life balance. As for the foreign doctors, though as little as they may be in number, ought to be reimbursed the same amount as they do cover the same amount of work despite not as qualified as their local counterparts.

Which is why as what Dr Tambyah has said in his speech on May Day, a minimum wage ought to be enforced for professions such as the doctors to ensure equality among colleagues regardless of nationality and compel the companies to make full use of their employees, enhance their skill sets, improve productivity through the use of technology instead of just making use of cheaper labor to solve the issues.

Physicians disagree with Mr Chee's statement about the state of medical profession in Singapore

A few individuals who claim to be from the medical profession also responded to Mr Chee's post and noted that what Dr Tambyah has stated in his speech is the truth on the ground.

Lakshmi Ganapathi, a Singaporean physician who now lives and practices in United States, commented:

"You speak of foreign doctors being granted temporary registration for training and that they do not compete with local doctors. Sure. That is a fact as it is incredibly difficult for such foreign doctors to enter residency training programs. One only needs to do a survey of our residency training programs to know the proportion of foreign versus Singaporean doctors in such programs. I do think that your ministry should release salary figures for foreign versus Singaporean doctors because that is the bigger question here. As a medical officer in our public hospitals, I earned more than foreign "clinical associates". However, make no mistake -- these foreign clinical associates did the same clinical duties as I did including the same number of overnight calls, clinics etc. Foreign doctors fill our service gaps and are paid less for doing equivalent tasks. The training they receive is not part of official training programs necessarily. Correct me if I am wrong with figures. This is data that can be easily gathered."

"You mention that the United States has a similar set up. Which programs/arrangements are you referring to? I moved to the U.S for training and even though I was "foreign", I was paid just as much as American trainee doctors. Are you referring to the J1 exchange visitor program? Again that has no bearing on salary because if you are foreign but are accepted into a formal training program then you have to be paid like American trainees. To not be paid so is labor discrimination and one could argue perhaps even unconstitutional. If you are foreign and not part of any formal training program but would like to gain skills anyway, then you need to come with your own funding. Take for example, Singaporean doctors wishing to train in the U.S; the HMDP scheme offers that funding. However, U.S hospitals do not provide a salary or funding for such arrangements. HMDP visitors do not necessarily do the same tasks as trainees. For example, HMDP visitors from Singapore who join our division as "honorary fellows" do not do calls like other fellows in a formal training program. Visitors who are here for training do not fill service needs and are not expected to. I am well aware of this as I work for one of the top children's hospitals in the United States and we regularly receive HMDP visitors from Singapore. Clarity in your post regarding "similar arrangements" in other countries would be helpful."

She further adds, "On a personal note, Prof Tambyah has dedicated an entire career working in our public hospitals. Physicians on the ground in any healthcare system (be it in Singapore or the U.S) are acutely aware of the issues facing colleagues and patients -- because these are the people we interface with day in and day out.

Administrators will do well to heed the issues raised by physicians in whatever capacity they are raised because it can only lead to strengthening of existing systems."

She noted to the Minister that she would be more than happy to continue discussing some of the issues she have raised with you and that he is welcome to send her a personal message or discuss more publicly on his Facebook thread.

Another commenter, Han Lim, a physician who is practicing at Tumby Bay Hospital in Australia,  wrote, "Mr Chee, it's interesting to note that the Prof's point was implied at a MOH recruitment talk I attended 7 years ago. Today, I still practice in Australia. Hopefully it has changed. Please pm me if interested to know more."

A month has about passed since the Facebook post was published, neither Mr Chee nor his admin for the Facebook has responded to the few doctors who wrote on his post.

Dr Prof Tambyah is quoted by the media, to have said that his comments "are not untrue" and can be substantiated in several doctor chat groups. He added he had, in fact, raised the issue with the administrator in question "dozens of times" but to no effect. Which makes it all the more puzzling that Mr Chee choose to make such allegations upon Dr Tambyah, who has been practicing as a doctor for thirty years without first checking with him of any concerns he may have, in private. In comparison, Mr Chee had only been appointed as Minister of State for the Ministry of Health in October 2015.

So with such extensive coverage and milking of exposure by Mr Chee, should he not try to address this matter by conducting an actual survey with the doctors in Singapore, rather than making a potshot at a political opponent (who so happens to be a doctor under the purview of his ministry) and then running off into the far distance without a fair chance for Dr Tambyah to prove his point.

If what Dr Tambyah is indeed speaking the truth on behalf of the medical profession in Singapore, then Mr Chee as one heading the health ministry, might be jabbing himself in the back.