SMA’s Journey with Medicine and Doctors

As we celebrate the nation's 60th anniversary, SMA takes this opportunity to look back at its own journey in shaping and impacting Singapore's medical landscape. We recap below SMA's key contributions in accordance with three of its objectives: (1) to support a higher standard of medical ethics and conduct; (2) to voice its opinion and to acquaint the Government and other relevant bodies with the policies and attitudes of the profession; and (3) to foster and preserve the unity and aim of purpose of the medical profession as a whole.

Legend

Blue: Works towards enabling higher standard of ethics
Green: Advocacy work for the profession
Yellow: Supporting doctors in their practice

1960s

• Released the first edition of the SMA Code of Ethical Conduct.
• Formed the SMA Ethics Committee.

• Formed a committee to study and make recommendations on the feasibility of establishing a medical health insurance scheme in Singapore.

• Medical Defence: Advised Members to insure themselves against possible litigations.

1970s

• Conducted internal discussion on whether SMA should get Singapore Medical Council (SMC) to accept the SMA Ethical Code as the national medical ethical code.
• Revised and distributed the SMA Ethical Code to all Members. A copy was forwarded to SMC seeking their agreement to have the Code used not only by SMA Members but by doctors in Singapore in general.

• Wrote to the Government highlighting concerns with the terms of the bond it was imposing on medical students in their second to fifth year of studies.
• Participated in the formulation of regulations tabled with the Private Hospitals and Medical Clinics Act (1980).

• Maintained a National Medical Directory to ensure updated information of qualified doctors.

• Proposal to set up SMA Foundation Fund to support doctors, nurses, medical students or paramedical personnel and their families who, either through death or disease, may suffer severe financial hardship; to provide bursaries and scholarships; and to stimulate research by offering research grants and prizes.

1980s

• SMA's suggestions on issues such as confidentiality between doctors and patients, the need to give reasons for evocation or suspension of practitioners' licences, and the right of appeal to SMC were included in the Private Hospitals and Medical Clinics Bill passed.
• Appointed a committee to look into factors contributing to costs of medical practice to serve as a foundation in drawing up a Guideline on Fees (GOF).
• Published the first edition of the GOF in a bid to manage rising doctors' fees in 1987.

• Set up computer club to promote computer literacy among doctors.
• Launched the SMA Bulletin Board System with a bulletin, message, conference and file system to encourage computer use among doctors; to allowfor information sharing; and to link up and get the profession closer together.

• Organised the first National Workshop on AIDS on 4 October 1987.

1990s

• Solicited and collated feedback from Members regarding the newly released SMC Ethical Code.

• Formed the Medical Officers' Committee (precursor to the SMA Doctors-in-Training Committee) to better understand and represent junior doctors.
• Conducted the survey and published the report on the concerns of young doctors in Singapore, primarily regarding salary, working hours and career opportunities.
• The advocacy by the Medical Officers' Committee culminated in the Ministry of Health's (MOH) adjustment of salary, including night call allowance.

• Published the first edition of SMA Fitness to Drive guidelines, to help doctors in assessing a driver's fitness to drive a vehicle.
• Published the first edition of the SMA House Officer (HO) Handbook.

• Medical Defence Union moved out of Singapore and their portfolio was absorbed by Medical Protection Society (MPS). SMA stepped up and brought in United Medical Protection (UMP) to ensure the availability of more than one medical defence organisation.

2000s

• Formed the SMA Centre for Medical Ethics and Professionalism to uphold medical professionalism and ethics amid rising costs of healthcare, patient expectations and medico-legal risks.

• Spoke up for the removal of the one-third quota imposed at that time on the intake of female medical students.
• Explored and negotiated means to exclude the GOF from Section 34 of the Competition Act. This was unfortunately unsuccessful and the GOF was ultimately withdrawn in April 2007.

• UMP failed, leaving one-third of Singapore doctors without cover. SMA negotiated with both MPS and NTUC Income, resulting in nose coverage by MPS at no additional cost and lower-priced claims-made policies by NTUC Income for affected doctors.
• At the onset of the SARS outbreak, there was no national stockpile of personal protective equipment or N95 masks, and none were available for sale. SMA successfully sourced critically needed N95 masks for private sector doctors.
• Purchased/obtained 3M masks for sale to Members to tide them over the interim period before new supplies arrive amid the SARS outbreak.
• Organised medical supplies fairs and mask fit testing sessions for doctors and dentists.

• Set up the Medical Students'Assistance Fund (MSAF), following a survey of medical students' financial backgrounds.

2010s

• Submitted a position paper to provide feedback on the SMC Ethical Code and Ethical Guidelines for its update.

• Set up the SMA Charity Fund to better raise funds and support needy medical students. It absorbed and took over the functions of MSAF.

• Issued a joint advisory with Academy of Medicine, Singapore (AMS) and College of Family Physicians Singapore (CFPS) on fees paid to managed care and third-party administrators about a percentage charge for administrative fees which could constitute fee-splitting.

• Advocated for fee transparency, contributing to MOH fee benchmarks.

2020s

• Launched the mandatory medical ethics continuing medical education (CME) programme, offering 17 programmes in the first year for doctors to accumulate the necessary CME points.

• Conducted a survey on Integrated Shield Plans (IPs), with the results published in April 2021 issue of SMA News.
• Conducted a nationwide survey on overnight duty systems (results published in October 2020 issue of Singapore Medical Journal).
• Provided input on the forming of the Multilateral Healthcare Insurance Committee (MHIC), whose work has resulted in more equitable treatment of doctors and patients. Before the formation of the MHIC, individual doctors were powerless when they felt unfairly treated by insurance companies.
• Conducted a survey ranking of IP insurers as per one of the initiatives proposed in SMA's position statement on troubled IPs (results published in June 2023 issue of SMA News).
• Jointly wrote a letter with AMS to Monetary Authority of Singapore on the regulation of IPs.

• SMA arranged for release of MOH stockpile of N95 masks and organised sale of N95 masks to doctors.
• Published special SMA e-News to provide the latest COVID-19 updates and information.
• Jointly organised with CFPS and Singapore Dental Association (SDA) a complimentary "Bring Your Own Bottle" hand sanitiser distribution exercise for registered medical/ dental clinics and CFPS/SDA/SMA members.
• Initiated the #SGartforHCW campaign to rally the art community to generate artworks to show appreciation and support for healthcare workers during the fight against COVID-19.
• Launched the DIT 101 Digital Pocketbook (replacing HO Handbook) to support HOs.