5th Singapore Obstetric & Gynaecological Congress

07 Sep 2005

By Prof K Satku, Director of Medical Services

Venue: The Sheraton Towers

Dr Tay Eng Hseon, President, O & G Society of Singapore and Chairman, Organising Committee

Dr Beh Suan Tiong, Vice-President, O & G Society of Singapore and Co-Chairman, Organising Committee

Distinguished Guests, Colleagues, Ladies and Gentlemen

It gives me great pleasure to be here this evening at the opening of the 5th Singapore Obstetric & Gynaecological Congress. I am pleased to note that the Society has contributed greatly to the field of O&G through its regular organisation of congresses, workshops, seminars, courses.

The Society has not only served as the focal point for clinical and academic networking among obstetricians and gynaecologists in Singapore, but has also established strong affiliations with international professional organisations such as the International Federation of Gynaecology and Obstetrics (FIGO), the Asia-Oceania Federation of Obstetrics and Gynaecology, and the International Federation of Fertility Society.

I commend the O&G Society for its many contributions in enhancing the practice of obstetrics and gynaecology in Singapore. 

I am also happy to note that the Society has taken an innovative approach for this meeting. It has adopted the theme - a congress of forums and workshops - and will focus on events such as "Meet the Expert" workshops instead of having the conventional series of plenary lectures and symposia. This promotes interaction, discussion and "hands-on" demonstration between presenters and participants and will greatly enhance the exchange of information and expertise.

In addition, the Society has recognised the multidisciplinary model of patient care and has included topics such as anaesthesia, nursing and allied health sciences in the Congress.

With the increasing emphasis on collaboration between health care professionals of different disciplines to provide holistic care, this is clearly a step in the right direction. 

This evening, I would like to touch on 2 key issues which today are on the minds of many doctors. First, what it will take for Singapore to become a regional medical hub; and second, some of the challenges faced by obstetricians and gynaecologists.

Singapore Medicine was launched almost 2 years ago. It aims to make Singapore a regional medical hub. This is an initiative by the Ministry of Trade and Industry to market Singapore's medical expertise as an economic force to bring in revenue for Singapore and create jobs for Singaporeans. The medical fraternity is poised to go beyond its traditional role.

In this endeavour, Singapore will face many challenges. It will take us much more than active marketing and competing on cost to become a regional medical hub. Our strong regulatory framework helps but we need to ensure that Singapore has outstanding medical expertise and excellent teams of healthcare professionals. It will be through our medical capabilities, scientific breakthroughs and good outcomes that we would be able to succeed in attracting patients to Singapore. 

We have achieved success on many fronts in O&G that will attract patients to Singapore. I am glad to learn that great strides have been made in minimal access surgery. Singapore boasts of top gynae-oncology expertise and our fertility programmes report success rates equivalent to that of world renowned centres.

Singapore has also highly acclaimed uro-gynaecological and menopause centres that offer patients improved quality of life. We must continue to strive to sustain and where possible heighten our excellent reputation in these areas.  

We know that competition among medical institutions or services in Singapore is good because it increases efficiency and reduces cost. However, for competition to be effective there must be good information available to patients about the relative merits of the institution or service.

So as one of our many initiatives to promote excellence and contain cost the Ministry has begun to provide more information to the public. Last year, we released a paper on in-vitro fertilisation charges and success rates in institutions in Singapore, and a paper on deliveries in Singapore in terms of volume and resources used.

This information is not only helpful to patients to decide where to obtain affordable quality care, but could also help the O&G specialist to assess areas of demand and his competitiveness relative to other providers. It also allows us to identify areas which we can improve upon. For instance, the information paper on in vitro fertilisation in public and private hospitals highlighted a single hospital where the success rate was considerably lower compared to other hospitals. The hospital has since reviewed its processes. 

Of course we need to be cautious about interpreting these papers as there might be many clinical factors affecting outcomes. Nonetheless, it is through publishing and examining such information that we can improve our services and better position ourselves as a regional medical hub.

CHALLENGES IN O&G

I would next like to touch on some of the challenges facing the O&G profession.

First, I would like to address the changing profile of patients. Singapore's birth rate has declined by almost 40% in 10 years, from 16.8 per 1,000 population in 1993 to 10.4 per 1,000 population in 2003. This indicates a significant decrease in workload for the obstetrician. On the other hand, we have a rapidly ageing population. The proportion of the population aged 65 years and above is projected to almost triple from 7% in 2000 to 18% in 2030. 

The implications are that the type of care provided by O&G specialists would shift from obstetric based services to more gynaecology based services such as uro-gynaecology, gynae-oncology and menopause services. We therefore need to look towards building the necessary capacity and capabilities to meet the needs of an ageing population. 

A related issue is the high proportion of O&G specialists who are in the private sector. About 70% of O&G specialists are in the private sector. This proportion is much higher than other specialties, where on average only 40% of all specialists are in the private sector.

Also continued attrition from the restructured institutions is significant. About 5 years after being exit certified only about 60% of specialists remain in restructured hospitals (RHs) service. The sustainability for research and development of new techniques and training can be challenging under these circumstances. 

In this regard, public-private sector collaboration becomes imperative and I am happy to note that RHs continue to engage colleagues from the private sector in these endeavours and the private O&G specialists reciprocate positively.

Finally, I would like to highlight the issue of medical indemnity. The subscription rates for medical indemnity have been rising through the years and going by the trend in other countries are likely to increase further. For obstetrics, which is presently the highest category in the Medical Protection Society's (MPS) subscription rates, the premium has more than doubled from just less than $10,000/=  to more than $20,000 in just three years.

Various countries have reviewed their legislation to reduce the burden of huge claims on the medical liability system and rising liability premiums. The Australian state of New South Wales enacted the Civil Liability Act in June 2002, while the United States House of Representatives passed the Health Act of 2005 in July this year.

The Professional Standards and Development Division of the Ministry of Health is studying these initiatives and other related law reforms to assess the approach that we should take. If necessary, we will review our laws. For the present however specialist forums and conferences such as this provide a very important platform for doctors to be updated on the latest developments and standards of care so that claims arising from mis-management are minimised.

As the rising medical indemnity premiums is also likely to be a function of rising public expectations and declining public trust, there will also be a need to equip physicians with the awareness of the principles and values of medical professionalism in order to prepare them to manage these challenges in a systematic and rigorous manner.

In this regard, the Specialist Accreditation Board has introduced a core course on medical ethics, health law and professionalism for specialist trainees. The course's objective is to develop awareness of medical ethics and professional behaviours in specialist trainees and equip them with a working knowledge of clinical ethics, local health statutes, and commonly encountered ethical and legal issues in Singapore to enhance their professionalism.

We might not be able to stop the increase in the premiums for medical indemnity, but I have no doubt that the Ministry and the profession can work hand in hand to keep the rate of increase in check.

CONCLUSION

Summing up, I would like to recognise the great strides that have been made in the field of O&G in Singapore since the opening of the first maternity hospital in Singapore more than 100 years ago. You have done Singapore proud.

On this note, I wish you all an enjoyable learning and sharing experience.