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"Foreign Talent in Our Healthcare"

The arrival of Johns Hopkins University onto our health-care scene has been greeted with mixed feelings. The Straits Times on 5 August published an article that 50 doctors and members of the public have expressed concern and apprehension at the arrival of Johns Hopkins. A letter written by prominent local doctors to the Singapore Medical Council expressing concern against the "advertisement" and "unfair playing field" of Johns Hopkins is an example of uncertainty felt by some.

To address the "advertisement" issue by Johns Hopkins, the SMA President and his Council recently wrote to Johns Hopkins to point out to them where they have gone out of bounds with regards to the Ethical Code issued by the Singapore Medical Council. To their credit, Johns Hopkins has immediately replied to clarify their stand and agreed that as an organisation "we should have educated ourselves more completely with regard to the policies and actions of the medical community in Singapore." Effective immediately, JHSCS has suspended the use of their brochures. Both letters are printed in this month’s issue of the News.

There are more fundamental issues than just "advertisement" involved, like the rationale of introducing foreign institutions into Singapore to provide health-care at a level that existing local institutions supposedly cannot. In other words, how is "foreign talent" applicable in our health care structure?

What is the purpose of Johns Hopkins’ entry to the Singapore scene? Does it have an important role to play? What are the issues involved? In this respect, we must first clearly distinguish the 2 separate arms of Johns Hopkins. There is Johns Hopkins Singapore Pte Ltd (JHS) whose primary mission is to pursue collaborative research and medical education with Singapore institutions. Then there is the Johns Hopkins Singapore Clinical Services Pte Ltd (JHSCS), whose aim is to provide health care services for "complex" medical problems. The introduction of JHSCS is slightly more controversial, so I will concentrate on this body in the following discussion.

Let me start by sharing some thoughts.

Firstly, we need to understand the role of JHSCS in our health care services. It is clear that their role has not been well-defined or understood by local doctors and the public alike. We have a highly competent health care service system, comprising both the public and private sector services. We are already a regional medical hub in many respects, with a fair share of patients referred for tertiary care from surrounding countries. We have National Specialist Centres in several fields of medicine (eg. in dermatology, cardiology, ophthalmology, oncology, etc). Where then can JHSCS come in? Is there medical care beyond what these Centres can provide, which only JHSCS can? If this were true, is this "lower standard" of our National Specialist Centres due to inadequate facilities, to medicines not yet available, or to inferior skills of specialists from inadequate training? And does bringing in JHSCS as a "foreign talent" help in addressing these deficiencies?

On the broader front, can the same argument for bringing in foreign talent (whether it is JHSCS or other "world class" institutions) to Singapore be applied to other aspects of our health care service? This is a complex problem and we have to ask," Is the health care service just another industry?" It obviously is not, because the provision of health care has strong social and political undertones. Will bringing in JHSCS "improve" the health care service industry? Will it generate revenue and employment for the country? Or will it mainly increase health care cost?

Secondly, we want a level playing field between local doctors and JHSCS. For example, we know that JHSCS is presently located at NUH. Is there substantial subsidy involved in the setting up of a private foreign company in a government-restructured institution? To what extent will they take over the resources and facilities for research that Singapore doctors now are given?

Another related issue is the medical registration of doctors not educated in Singapore. We have strict policies regarding the registration of our locals who studied medicine at foreign universities and in only selected circumstances do we allow someone with degrees not from the "recognised" lists to practice in Singapore. Do we apply the same standard with regards to "foreign talent"? There is a need to ensure that specialists invited under the foreign talent scheme must have good proven track records that are open for scrutiny.

Thirdly, we need to actively explore with Johns Hopkins how they can play an effective role in our health care structure. Potentially, we have much to gain if we are able to interact in a mutually satisfying way with the Number One hospital in the US for the past 8 years (and arguably the Number One in the world) setting up its regional office in Singapore. Patients would benefit from the additional option in getting world class medical care without having to travel thousands of miles provided the cost of services can be kept affordable.

At the same time, Singapore doctors would profit from greater interaction with top-notch clinicians. Medical scientists and researchers would undoubtedly welcome joint research projects and exchange programs. Potentially, Johns Hopkins could help to propel the Singapore medical services from just a regional medical hub into a world-class status.

Clearly, the entry of Johns Hopkins University to Singapore can have profound effects on the future of our health care scene. There will be a period of adjustment for local physicians and Johns Hopkins. What will be the long-term implications for Singapore and the local physicians? With a mutually supportive attitude, mutual respect and understanding, having Johns Hopkins in Singapore could turn out to be a "win-win" situation for everyone.