Will Singapore's bid for doctors from India, UK, Australia lead to a 'race to the bottom'?

A recruitment exercise for foreign doctors has drawn anger from some Singapore residents, highlighting local-foreigner tensions and concerns about fake certification, although medics say that recruitment from overseas is a bitter pill Singaporeans have to swallow.

The tender, put up by the holding company of Singapore's public healthcare cluster last month, sought to appoint a recruitment agency to recruit doctors in India.

The Ministry of Health Holdings (MOHH) has since stated that it plans to hire 180 junior doctors from India over the next three years, and that 90 per cent of junior doctors recruited annually were local.

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The firm is also recruiting from other countries including Australia and Britain, the aim being to alleviate the heavy workload of existing doctors and bring in more of them to meet the city state's needs.

MOHH also said it would take in candidates who have graduated from schools on a list of approved overseas medical schools with registrable basic medical qualifications under the Medical Registration Act.

Selected doctors would be granted conditional registration for clinical practice and must undergo strict supervision, it said.

"Priority is given to locals who graduate from medical schools recognised by the Singapore Medical Council," the firm said.

The furore takes place as Singapore ramps up efforts to attract nurses and other medical professionals, holding exploratory talks with the Philippines on the recruitment of Filipino healthcare workers under a government-to-government arrangement.

Singapore's hunt comes after many working in the health sector became exhausted by the long working hours and manpower shortage during the pandemic, causing them to leave the profession entirely.

While such recruitment exercises are not new, they have sparked concerns that foreign doctors hired are not properly certified and that aspiring medical professionals in Singapore, who have to compete for limited spots in medical programmes at local universities, will be squeezed out of the equation.

In a Facebook post on the tender by The Online Citizen website, some netizens suggested that Indian doctors might have "fictitious" degrees and criticised the government for taking the "easy way out".

Many also asked why the intake of medical students in Singapore was not increased to meet demand for doctors, instead of looking abroad for manpower.

But the solution is not so simple, doctors say, and they point out that recruiting doctors from abroad is necessary to plug the current gap.

Describing junior doctor positions as a "period of training", associate professor Jeremy Lim from the Saw Swee Hock School of Public Health, said it is difficult to convince local doctors to remain within the public healthcare system due to the challenging career path.

A sizeable number of doctors leave the public healthcare system after a period of time to become general practitioners in private practice.

"It's a period of training, in the same way that no one wants to be a junior accountant or a legal pupil, because there's a lot of hard work and people recognise that some of this is for training, some of it is simply service, a service that needs to be fulfilled," he said.

Dr Raymond, who declined to reveal his full name, said the positions taken up by foreigners tended to be tougher, with responsibilities like covering night calls.

"It's busy, it's tiring and for Singaporeans, typically, you do that during your first five years when you have to serve a bond deal if you pursue medicine," Raymond said, referring to the five- or six-year bond that locally-trained doctors must serve depending on their medical programme.

After that "you're free", he said, adding that the hiring of foreign medics was "something we've lived with, and it doesn't cause unhappiness among the doctors".

Besides taking on harder jobs, employing foreign doctors keeps medical costs low, Raymond said.

He explained that having a stronger supply of foreign doctors in Singapore would mean more doctors competing for the same pool of patients, and would force local doctors to keep their charges and requested salaries low.

"It doesn't really benefit us as doctors," he said. "We can't earn that much because if your numbers can easily be beefed up then you've got to fight for the same share of the pie."

Nevertheless, immigration issues can stir up strong emotions and the government will have the difficult task of allaying concerns of job insecurity, especially amid a gloomy economic climate.

Dr Mathew Mathews, head of Singapore's Institute of Policy Studies' Social Lab, which carries out research into perceptions, attitudes and behaviours, said: "The government does provide facts and figures from time to time, but some find disjuncture with their day-to-day life. If you or your family members lose jobs, or housing prices go up and the cost of living is high, it is hard to believe that your welfare is being safeguarded, and you are more likely to cast your unhappiness on immigrants and immigration policy here."

Such concerns are "understandable" too, said Dr Paul Tambyah, a doctor and professor of infectious diseases. He added that junior doctors were in jobs increasingly seen as "precarious".

"The concern is that if the floodgates are opened and professionals with qualifications which are not officially recognised are brought in to work at presumably lower wages, this will be a 'race to the bottom', similar to what has happened in other fields in Singapore such as banking or IT."

Moving forward, the government must ensure that it can come up with a system "discerning enough" to recruit the right foreign workers who can also enhance job creation and promote the well-being of citizens, said Mathews.

"Some feel that there is a lack of proper vetting to distinguish those who truly can contribute to Singapore and who thus should be given these passes," he said.

"Ultimately, businesses here who hire global talent will have to be responsible, to make judgments as to the potential hires' ability to collaborate with local colleagues and create a dynamic place for all."

This article originally appeared on the South China Morning Post (SCMP).

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