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HONG KONG: OVERSUPPLY OF DOCTORS? 
SINGAPORE: UNDERSUPPLY OF DOCTORS?  

As Hong Kong prepared feverishly for its handover to Chinese rule on 1 July 97, an interesting article appeared in the leading Hong Kong English daily there on 26 Jun 97, the South China Morning Post. It was titled “Warning on oversupply of doctors” by Rhonda Lam Wan. The article said “The number of doctors registered to practise in the territory is growing so fast there might soon be an oversupply, the Academy of Medicine warned yesterday”. The article reported that the President of the Academy, Dr David Fang said that there was one doctor for every 780 patients but this ratio would fall to 1:580 by 2010. Universities should cut their annual intake of 270 to prevent oversupply. The doctor patient ratio was 1:625 in Japan and 1:714 in UK and 1:435 in the USA (as reported in the article). The problem will be aggravated by the registration of 6000 traditional Chinese medicine practitioners later this year.

This article is interesting and can be compared and contrasted with the local situation in Singapore. It was mentioned in the last SMC annual report that there are 4661 fully or conditionally registered doctors in Singapore, giving us a doctor-patient ratio of 1:770, a shade better than Hong Kong’s. We intend to increase the annual medical students intake in NUS to 200, versus Hong Kong’s 270. However, Hong Kong’s population is roughly double that of ours. On top of that, they have a more aged population and a lower fertility rate than Singapore. In other words, they are more aged and probably a more “aging” population as well. Both are urban communities with little or no geographical maldistribution of doctors. Both have a reasonably well developed health services infrastructure. From the Report by the Committee on Traditional Chinese Medicine, we know that Singapore too has the intention of eventually registering traditional Chinese medicine practitioners. And yet Hong Kong’s Academy of Medicine is concerned with overproduction of doctors while we have come to the conclusion that we need to produce more. Who is right and who is wrong? Only time will tell. Hopefully, both will turn out to be right with respect to their own local circumstances.

BUDGET FOR HEALTH 
In the recently released Budget for fiscal year 97, it was noted the following: 2 ministries/sectors will receive less in FY 97 than what they did in FY 96. They are public housing and Ministry of of Law. Another 2 received no change in the amounts allocated: Medical Endowment Fund (100 million) and Edusave Endowment Fund (S$500 million). The other 18 out of 22 ministries/sectors were all allocated more in FY 97 than 96. Of the 18 receiving more in FY 97, Health experienced the least growth (+ 3.19%). (Source: The Business Times, Weekend Edition, July 12-13, 1997).

The bottom line for doctors in the public sector is that if the above figures are anything to go by or be inferred upon, please do not expect a very big pay review in FY 97. Unless revenue collection (eg. patient charges) are revised upwards substantially, or there is a decrease in development expenditure, A+3.19% growth probably just about covers inflation with some spare change left over. 

To borrow a phrase from an old man of our profession (Dr Chee Phui Hung): Quo Vadis Medicine?