Sep 12, 2009

Medical School and the Uselessness of Being A Citizen

Not too long ago, I gave an example of how Singapore discriminates against its own citizens, in favour of foreigners, when providing opportunities for higher education. The New Paper picked up the story, and followed up by interviewing the Vice-Dean of the NUS Law Faculty.

J, a reader of my blog, just emailed me to share his own story. J's account relates to his own application to Duke-NUS Graduate Medical School (which is located at the Singapore General Hospital but is part of NUS).

Based on what J says, this does not really strike me as an example of Singapore discriminating against Singaporean students, in favour of foreign students. This is more an example of the authorities treating foreigners and Singapore citizens exactly on par (in other words, citizenship has no advantages). It is also an example of the Singaporean tax-payer's money being used to pay for the education of foreigners.

It's important to understand that unlike, say, Harvard in the United States, NUS is not a private university, operating on its own private funds. If NUS were a private university, then it should be fully entitled to make its own decisions as to whose education it wants to subsidise. However, NUS is funded by taxpayers' money (YOUR money, and mine).

Therefore I feel that it's important that this issue receives some scrutiny. Well, at least my blog will help to raise some public awareness.

Anyway, J's email is reproduced in full below. I've made a few editorial changes, mainly for clarity (and also to make J's identity less traceable).
Hi Mr Wang,

I read your post on education in singapore some time back. Recently, I have been busy with my application to Duke-Nus Graduate Medical School. It is the second medical school in singapore and is funded by the Ministry of Health. They conducted a series of admission seminars recently ... I [also] had a long chat with the admissions officer ....

From both the seminar and the admission officer i came to know that:

(1) there are thousands of applicants each year with a very significant proportion of students from overseas

(2) there are NO QUOTAS reserved for singaporeans

(3) foreigners ARE eligible for our tuition fee loan of up to 90% of course fees.

(4) Foreigners CAN serve their bond in their countries if their families are not in singapore (although this is subject to approval, it makes you wonder why bond them at all?)

.... I really begin to wonder if my very own country whom I had sworn to protect when I was 18 is really worthy of my protection.

Regards,
J

86 comments:

Ted said...

Well, the only lament worthy part is why did RJ have to wait till he is affected by the system to realise, Singaporeans, have mostly been receiving the short end of the stick?

So, what is this meritocracy?

And conversely, I wonder too, that would this same RJ, be singing the praise of the 'meritocratic' system should he be accepted? Hmmmm

Charles said...

Shouldn't there be equal treatment regardless of nationality?
Shouldn't citizenship be only about belonging?

kayangmo said...

Singaporeans are left with no choice, even if they do not get that medical degree to stay in Singapore.
If and when Singaporeans receive that degree, they instead become mobile and even move out of Singapore.

Foreigners will at least have the choice to stay on, if they do acheive that degree. They will compare their "poorer" country to Singapore and usually opt for the better life here.

So in the end, to increase population count, who do you think will get that place in U or Poly?

Answer is sadly: foreigner.

Anonymous said...

To play the devil's advocate here, can somebody breakdown Singapore personal income tax revenues into 3 buckets based on source
1. Singapore citizens
2. Singapore PR
3. Foreigners on EP

My guess is that the 2+3 % will surprise you.

In the US, 70% of personal income tax revenues come from the top 5% earners. This figures was used by some lobbyists to justify the bailouts of the banks which ultimately benefitted the rich.

Food for thought...

Anonymous said...

Charles:

Will the citizens of France pay for my healthcare in Singapore?

Will the people of New Zealand subsidise my education in Singapore?

Will the population of Brazil contribute towards my HDB payments?

Will the taxpayers in Timbuctoo subsidise my water bill?

Will the foreign students in Duke-NUS join my NS platoon for training?

If so, then I am all for "equal treament".

Anonymous said...

I agree, Singaporean is not the only one who contributes to income tax.

angry doc said...

Do you want to be treated by a foreigner who graduated from a local medical school, or do you want to be treated by angry doc, who was less well-qualified than the foreigner, but got his place because he was Singaporean?

As kayangmo stated, the key is not whom we take into our medical school, but how we retain people in our healthcare system.

Mr Wang Says So said...

LOL .... I can't be treated by a foreigner, if he simply studies here on taxpayers' money, and then leaves Singapore to go off and practise elsewhere.

angry doc said...

Nor will you be treated by a Singaporean who buys his bond off and goes work in Australia.

More taxpayer money is spent per year on paying working doctors, Singaporean or foreign, than on funding medical students. If we want to recruit and retain ood doctors, the process does not necessarily have to begin at medical school or end there.

(But I realise this is not the topic of your post, so let me just end my part here.)

Mr Wang Says So said...

LOL, if he buys his bond off, then he hasn't been subsidised by taxpayers' money.

Mr Wang Says So said...

"Shouldn't citizenship be only about belonging?"

-- What? You don't think it should involve NS?

Anonymous said...

Dear Mr. Wang,

I agree with angry doc's sentiments.

I would rather be treated by a well-qualified doctor, local or foreign, than by a poorly-qualified doctor, local or foreign.

Could you not make the argument that our tax dollars was spent trying to lure the best medical talents in the world to treat us? As angry doc suggests, what's to prevent a Singaporean doctor from breaking his or her bond? Money lost from the non-performance of bonds is well, money lost, regardless on whom, Singaporean or not, it was spent.

Lastly, you are an intelligent man, Mr. Wang. But please stop patronising readers by prefacing your replies with "LOL's." W-E C-A-N U-N-D-E-R-S-T-A-N-D what you attempting to convey.

Thank you.

Mr Wang Says So said...

"Could you not make the argument that our tax dollars was spent trying to lure the best medical talents in the world to treat us?"

Errr, no. I find it quite hard to make that argument. After all, the government has stated its plan for Singapore to become a regional medical hub.

In other words, the push for more doctors, to a signicant degree, is not for the sake of healthcare for Singaporeans, but for the sake of making money out of the rich sick people in the region, who will travel here for medical services.

Anonymous said...

What's surprising is that you actually sound surprise.

You mean ..... you didn't know?

Anonymous said...

mr wang, please do check your mrwangsayso email. thanks.

angry doc said...

"if he buys his bond off, then he hasn't been subsidised by taxpayers' money."

You are right and I was wrong.

Let me start being mean to foreign medical students starting Monday morning...

Anonymous said...

Angry Doc :
"Do you want to be treated by a foreigner who graduated from a local medical school, or do you want to be treated by angry doc, who was less well-qualified than the foreigner, but got his place because he was Singaporean?"

Why do you need to frame your argument this way? How would you know that the next foreigner is more "well-qualified" than you ? Are you not in any way more capable than any of them supposedly been through our world-class education system (i.e. bi-lingual etc). Following your logic, if its true how then would a trained local doc being a sub-par would be mobile enough to break the bond to seek new breakthrough in other countries?

JamesNeo said...

to angry doc: not sure if you are sarcastic when you say :Let me start being mean to foreign medical students starting Monday morning...

Mr Wang is not asking us to be mean to foreigners but want to highlight that if the foreigners take public funds for their studies they should at least contribute to the medical healthcare of singaporeans for a few years. We should inculcate the values of contribution to those who have helped us and not follow the decadent greedy behaviors that have emerged among the financial systems whereby people want to have freebie without real work.

Anonymous said...

In other words, the push for more doctors, ... for the sake of making money out of the rich sick people in the region, who will travel here for medical services.

Singapore's primary preoccupation is one of survival aka staying relevant.

Globalisation has made the game plan of the 80s, 90s obsolete. A small sterile, safe island paradise for those who can afford it does sound like a pretty good game plan for the future don't you think?

Anonymous said...

Foreigners pay tax in Singapore too! So it's not just Singaporean tax dollars that go towards paying for these medical students. As a working, tax paying, foreigner in Singapore, I would rather have the best foreign doctor, who may or may not be trained in Singapore, treating me, as opposed to an inferior quality local born local trained doctor. And by the way, since I have been here, I have seen 1 GP and 2 specialists, all of whom were Singaporean and all of whom were trained in the UK. Do you think the taxpayers in the UK are griping about where their doctors have come from or returned to? It's time Singaporeans realized that things don't just get handed to them on a plate, they need to earn them. RJ, if Duke-NUS rejects your application, it's probably because you're not the cream of the crop!

Anonymous said...

I am a Singaporean who has served my NS and suffered some degree of permanent physical disability as a result.

I do agree that I wish to get treated by competent doctors regardless of nationality.

But why are our moneies being spent on people who never sacrificed (for NS), are not effectivey bonded and were never inclined to stay or practise in Singapore?

angry doc said...

Nor will you be treated by a Singaporean who buys his bond off and goes work in Australia.

So what's stopping these foreign nationals from using their medical training obtained using SG taxpayers' monies to apply for PR or citizenship in other countries, e.g. Australia?

Anonymous said...

Duke NUS admissions webpage clearly says that foreign students are to serve 5 years in Singapore. Citizens and PRs serve 4 years.

Can J really verify his last assertion that the bond for foreign students can be negotiated away? Or should this be considered hearsay?

Anonymous said...

angry doc at September 12, 2009 8:07 PM wrote:
Do you want to be treated by a foreigner who graduated from a local medical school, or do you want to be treated by angry doc, who was less well-qualified than the foreigner, but got his place because he was Singaporean?

Well, as a nurse observing other nurses, here's my 2 cents on attracting regional talents into healthcare locally. We have plenty of foreign students recruited from overseas to be trained locally. They are supposedly interviewed and filtered strictly such that we only get the top brains. They are sponsored then by taxpayers' money and bonded to serve in Singapore hospitals. Why shouldn't the foreign doctors sponsored by our taxpayer's money be similarly bonded to serve in Singapore hospitals?

Anyway, why should we associate Singaporean (i.e. citizen) with poorer qualification/care compared to foreigners who graduated locally? I have personally witnessed a foreigner (student recruited from overseas) trained-locally as a nurse, who bo-chap in her nursing care whenever no one "senior or with-authority" is observing what she does. Some things she did simply breaks the nurses' code of ethics. She only dared to do them openly in front of student nurses who cannot complain about her because the ward manager is hoodwinked by her senior staff nurse from the same country (the country featured for its dictators' mass murder of monks).

At the end of the day, no point attracting top brains from the region into healthcare professions if they are in for the wrong reasons. I have personally not seen such persistent callous attitude from the Singaporean nurses (i.e. citizens). I sometimes think that as Singaporean nurses (i.e. citizens), we empathise better with our local patients.

yh said...

it should be interesting to find out how much of our investment in research is used on PRC lecturers supervising PRC students collaborating with some prof in PRC. Other than padding their CVs with publications, I really wonder what is in it for Singapore.

Anonymous said...

"Errr, no. I find it quite hard to make that argument ... In other words, the push for more doctors ... is not for the sake of healthcare for Singaporeans, but for the sake of making money out of the rich sick people in the region, who will travel here for medical services."

Hi Mr. Wang,

I agree with your point, up to a point, since the sick rich will flock not to Tan Tock Seng (where I'll be) but to Raffles Hospital (make that Raffles Spa-cum-Hospital).

Your argument is valid to the extent that ALL medical students to which you refer in your original post end up in private hospitals.

Regards.

angry doc said...

I agree with those who disagree with me on this thread.

Point 4) is RJ's email makes the whole scheme unfair to the taxpayers of Singapore.

What I raised about Singaporean doctors breaking bond is irrelevant to RJ's complaint.

Anonymous said...

To Anon September 12, 2009 11:35 PM

Your inference could be flawed on the point where your encounter with 3 locals that were trained overseas in UK, and that UK tax payers funding foreign students receiving medical education in UK.

All (~99% majority) foreign students (Non-EC, Non-UK) studying in UK are on full-fee paying scheme, especially more so for an expensive one such as medicine. Very often one full-fee paying student from Asia could typically fund/subsidize up to 8 local UK students. UK education sector welcomes us anytime.

Why then are so many Singaporean locals doctors received their medical education overseas one may asked. It boils down an old and outdated government policy in restricting the number of doctors to be trained in our university every year resulting in supply crunch now.

cy said...

Hmm sorry but I don't see any concrete proof of how NUS discriminates against local students. It would be great if you could find any breakdown of financial aid being given to local and foreing students.

Nonetheless I fully agree that this is a cause for concern for two reasons.

1) There are Singaporeans who need the money more than the foreigners, and who deserve the money more than they do since they are, well Singaporeans. There's a Chinese saying that goes along the lines of - ownself person or he's on our side.

2) Many Singaporean managements adopt the mindset that foreigners are automatically better for some magical reason. Perhaps it is the enterprising spirit that brings them to Singapore in the first place - however this makes it seem as if Singaporeans are not enterprising if they stay in Singapore (some just can't afford it). This is discrimination.

angry doc said...

"the sick rich will flock not to Tan Tock Seng (where I'll be) but to Raffles Hospital (make that Raffles Spa-cum-Hospital)."

That is not true. Restructured hospitals do have pay-class beds and these are open to and 'patronised' by rich foreigners.

tiredman said...

In my view, foreigners need to pay tax to Singapore because Singapore provides them with the job opportunities.

These job opportunities can be translated to a job loss to a local. So what the concern about paying tax when foreigners themselves do not need to serve National Service and now fighting to get equal rights?

While foreigners take up study loan, it will translate to a loss of place for a local student.
While foreigners can get free education, these male students get no place and will have to pay for their education in the private education institute. But then, why should there be national service when local males can be denied from government heavily subsidised higher education?

While foreigners are enjoying their life with their families after work what is the male Singaporean doing at that time?

Sitting in the camp training just to pass IPPT or running up and down the hills in the jungle while serving their re-service.

Come on foreigners, use your brain. Perhaps, your brain is just too good to use to think how much more you can take advantage of the locals just for your high income salary.

Situation has gone very very wrong.

Anonymous said...

To Anon on Sep 12@ 11.35pm, Do you think the taxpayers in UK are paying for SG medical student's course fees?

Do SG students not pay hundreds of thousands per year for medical training when they are overseas?

Anonymous said...

If Singaporean's do not want foreigners coming in and using the money they've paid in taxes to fund their training then it should work both ways. There should also be a ban on Singaporeans travelling abroad for their education and spending other people's tax money, then returning to Singapore! As a researcher, I know many Singaporeans who have obtained their PhDs in Australia, USA, UK etc, where their stipend and tuition is paid for them, and then come back to Singapore to work once they have completed (in these countries there is no bond either). So what's good for the goose should be good for the gander. In fact, you should all go one step further and ban forigners from coming to live/work/train in your country, full stop. How many of you would actually sign up for NS, if you had any choice in the matter, so please stop using this as an excuse to seem superior to those who don't have to do it!

Anonymous said...

Mr Wang,

I really cannot understand why the "doctor" got so "angry" when a citizen of Singaopore complains that he is not treated better than other nationalities.

Does he not even allow his own children to complain when he gives more pocket money to a strange boy/gal

It makes me really wonder,what has gone wrong with Singapore elites.

Elites,they are all infested with holy values,that is:all human being are equal,although some are slightly more equal,and we so decide who they are!

Anonymous said...

Mr Wang,

Some of yr clever readers have pointed out it is possible that foreigners in Singapore contribute more in income tax than Spore citizens,as a result,they should be entitled to equal treatment fr Singapore government.

I have no doubt about their tax contribution as almost 60-70% of our GDP is contributed by MNCs.

But I would also like to point out that Japanese and the Chinese now hold most of the treasury paper issued by Uncle Sam,w/o their contribution,US$ would definitly instantly banana currency,and USA collapse to be 3rd or 4th world country.

Am I justified to declare that Uncle Sam should give Chinese and Japanese citizens equal treatment as US citizens,the no.1 sought after citizenship in the whole world?

I guess they would agree,going by their logic.

Anonymous said...

for those who think that foreign trained docs are as good as local ones, consider this for a moment.

- they might be better in some aspects but have you ever seen a foreign doctor try to communicate with our elderly?
- much of our elderly (>70 yo) speak no English.
- even those who are between 50 - 70 speak some but not much English
- have you ever seen the the frustrations of our elderly at trying to make sense of what the heck the doctor is trying to say?
- the same goes for the nurses.

Secondly, most countries in the world reserve some proportion of the vacancies in medical school for their citizens.

and lastly, medical education is heavily subsidised even at the rate of school fees being paid. so unless you say that the school is a fully private one, we have nothing to say.

SMS said...

"....the government has stated its plan for Singapore to become a regional medical hub.. "

There is a lot of money to be earned as a medical hub. BUT not so for the private practitioner (GP). I know of a few Singaporean friends ... they spend >16 hrs each day just to stay competitive with two other doctors just a few shops away.

Could this be the real reason why we need foreign workers (doctors too) who are willing to sweat out the hours? .. to make the relocation justifiable. Our home grown talent just cannot take the heat. Would this heat be there if the foreign doctors did not enter the "arena"?

SMS said...

"Singaporeans are left with no choice, even if they do not get that medical degree ..."

I know of one friend whose son was not admitted to NUS due to their "strict selection" criteria. So he paid tons of money for his son's medical training abroad.....

And you know what happen next.. his son was headhunted back to Singapore when he was thirty something.

Guess it MUST be a wise choice to leave and achieve elsewhere and the garmen will headhunt you back. But if cannot achieve, you are not welcome back to the Garden of Eden ... as our dear PM had sadly said during his speech.

SMS said...

Ask any lecturer friend in the Univ..... you can collect the statistics yourselves.... how many

1)Singapore citizen
2)Singapore PR
3)Foreigner

Same conclusion as the ratio of income tax return. It is all about business. Whatever brings in the $$$

Perhaps we should consider employing mercenaries as soldiers.

SMS said...

" .............Singapore discriminates against its own citizens ..... when providing opportunities for higher education"

We sponsor school children from China providing them with lodging and allowances with no strings attached... No choice, the big picture --> the chinese Singaporean adults are not procreating. The number must be fulfilled.

SMS said...

We do not have any choice to have more foreigners in singapore.. There is a medical condition here in Singapore that has not gone unnoticed.- AUTISM is on its way up.

Anonymous said...

Hi Angry Doc


Do you want to be treated by a foreigner who graduated from a local medical school, or do you want to be treated by angry doc, who was less well-qualified than the foreigner, but got his place because he was Singaporean?


The biggest regret in my life is that I hesitated in transferring my late mother from a supposedly qualified foreign doc in a public hospital (class A btw) to a local doc in Mt E.

My Ans: angry doc. any day of the week.

Ah Wang

angry doc said...

Let me clarify again:

My initial point was that the most eligible or qualified candidate should be the one accepted into our medical schools - since what we want at the end of a day is a competent or good doctor working in our healthcare system - regardless of his nationality.

RJ's point, however, is that a foreigner-medical student is not required to serve his bond in Singapore, which makes my argument invalid.

I then make another irrelevant point, this time about Singaporean doctors leaving the system.

Mr Wang correctly points out that a Singaporean doctor leaving the system effectively 'refunds' the subsidy for his education, unlike a foreigner-graduate, who is not required to do so.

There is no assumption on my part that all or most foreigners are better-qualified for medical schools compared to Singaporeans.

I agree with Mr Wang that as long as local medical schools are funded by Sinagapore's taxpayers (Singaporeans and foreigners), the graduants, regardless of his nationality, should repay the subsidy by either service in Singapore's healthcare system, or in cash. To exempt foreigners from this repayment to Singapore is therefore unfair to Singaporean graduants.

Anonymous said...

Higher education (in public universities) in Singapore is highly subsidized for students, both local and international.

For non-medical Singaporean students, they are not required to fulfill any "bond", whereas PRs and international students are typically required to work in Singapore-registered companies for 3 years.

This allows PRs and international students to "give back" to Singapore, in the form of them working in companies that have to contribute and pay taxes.

For medical students, ALL students have to work for at least 4 years (5 for International students).

About the tuition fee loan- it's a loan from the banks. So it's not subsidized by taxpayers. The bank earns the interest from the students who take the loan- Singaporean or not.

Pete of Perth said...

To SMS

Medical hub? What ever happened to the arts/cultural hub? Another catchphrase along the way to a Swiss standard of living

Anonymous said...

"Restructured hospitals do have pay-class beds and these are open to and 'patronised' by rich foreigners."

Hi Angry Doc,

I take your point, but it does also mean that Singaporeans can get access to these medical "talents," doesn't it?

Anyway, could you tell us what you think, from your position within the Singaporean healthcare system, how it stacks up against others in the world?

Regards.

Anonymous said...

singapore is not leaving any legacy for singaporeans anymore.

at the end of the day, singapore will and still be managed by "migrants" from all parts of the world.

anyway, once singapore loses it's "tax haven" status. there isnt any incentives for rich sick ppl to seek medical advice in the island.

they will most likely seek alternative in countries like m'sia, china etc.

she will no longer be an attractive place.

Anonymous said...

We need not spend money to educate overseas foreigner up their pre-entry level for university. Therefore overall cost in getting a medical graduate out of our system is less when foreigners are selected.

Singaporean should see the all world as possible studying and working environment and not restrict to thinking and leaving in Singapore. Hope you still take care of your old folks wherever you are.

Anonymous said...

Anon of September 12, 2009 11:35 PM
Foreigners pay tax in UK too! But the UK govt does *not* subsidise foreign medical students a single cent. All the 3 Singapore doctors who treated you and who were trained in the UK, had to pay full fees, while their fellow UK classmates need not. Moreover, more than 90% of their classmates were UK citizens, because there is a quota on foreign student intake. The taxpayers in the UK will of course gripe, if their government subsidise foreign medical students or admit foreign medical students with no quota. I do not know where you get your strange idea that they will not gripe!

You said you pay tax in Singapore. Are you doing that as a student, or as a working person? Do foreign medical students pay tax in Singapore, while studying medicine and not earning an income? I thought you are paying tax here for the benefit of Singaporeans, as an exchange to being granted a visa to work here! Oops, perhaps you have thought that because you pay tax, you own Singapore as much as a citizen does and that your tax should be used, not on Singaporeans, but on sponsoring your fellow countrymen from India/China/USA to study medicine here? You are mistaken!

Anonymous said...

Angry doc,
Do you want our Singapore grannies to be treated by a qualified (passed MBBS at first try) local doctor who was admitted to Duke medical school with "only" a 2nd class Upper Honours degree in Chemistry from NUS (where most students are not even admitted to the honours year, to begin with) and who understand what she meant when she complains that her muscles feel very 'sour' on rainiy days" and that she has "salted eggs with porridge for breakfast everyday"...

...or would you rather she be treated by a qualified (passed MBBS at 1st try with no better marks, due to reason explained below) foreign doctor who was admitted to Duke medical school with a 1st class Honours degree in Chemistry from Burma/India/China/USA (where all students get a chance to do the honours year, and 11% of the cohort gets 1st class upper - stats for UK uni) and who wonders why his 80-year old dialect-speaking patient thinks that muscles can have a taste and can feel "sour", and who is unaware that local cantonese grannies are very prone to nasal cancer due to their salty-egg diet and who doesnt even know what "porridge" means and who need a translator?


On another note,
Do you want to spend your hard-earned money from your medical practice to sponsor your less-qualified son for his costly medical school education given that he got "only" ABB in his A-levels,

.. or do you prefer to deny your son of his ambition because you prefer to spend your hard-earned money to sponsor a more qualified young man unrelated to you, with AAA in his A-level, in the hope that one day, after he becomes a doctor, you can adopt him as your step-son and he will some day call you step-dad?

Do you think you are fit to be called a father if you choose to do the latter? Do you think your son is justified to become an "angry non-doc" and leave you for what you have done? Do you naively think your adopted step-son (that is, if he does acknowledge you to be his step-dad! A big if!) is going to take care of you in your old age, more than your own son, just because of his AAA at A-level versus your son's ABB?


Finally, may I know what the word "family" means to you? Does it mean spending your hard-earned money to further the happiness, education and career prospect of your own family members i.e. sons and daughters so long as they are educationally capable of going through the course, or does it mean furthering said happiness etc of outsiders at the expense of your own family members, if the outsider is more qualified than your own offspring? If it's the latter, I feel sad for your family!

Anonymous said...

Anon September 13, 2009 1:17 PM,
SIngaporeans did not, and could not have, traveled aborad for edu and spend other people's tax money. That's because no country is as nonsensical as ours. Thus, Singaporeans studying medicine in UK/Australia pay full fee and are not subsidised by "other people's tax money". Singaporeans who obtain their PhD in Australia, USA, UK etc works as Teaching Assistant or Research Assistant and in return for their 20 hours of work on top of their studies, they are paid a fair compensation: a stipend and a tuition waiver. No Singaporeans are eligible for USA's National Science Fellowship (i.e a sholarship which need not involve work, so that the recipient can do research full time) because that prestitious fellowship is exclusively reserved for United States citizens. Likewise, no Singaporeans are eligible for UK's govt research scholarship which are reserved for UK and EU citizens.

As a researcher, you are very familiar with all these fact, but you chose to deliberately distort the full picture. I wonder why. Finally, may I know where country you are from? Have you, even once, told your government to quit favouring your fellow citizens in matter of university tuition subsidy and quota? Remember: what's good for the goose should be good for the gander. Have you commented in blogs written by your fellow citizens that your government should make no distinction between citizens and foreigners since the latter pay tax too?

Yes, we have no choice in the matter of NS - we have to serve the country, like it or not. And so likewise, the govt should have no choice but to serve its citizens first over foreigners, whether it like it or not.

Citizens are always superior to non-citizens. If you don't like it, you should really return back to your country. I am sure in your country, your government treat foreigners and citizens equally, just as you wished. Funny though, you are in Singapore, not in your country! Why?

Anonymous said...

Even Duke medical school itself, in its USA main campus, has a quota on the number of foreign students it take in. The number is less than 10 student in total out of a class of more than 100.

So, let's not talk about public universeities, because even private universities the world over would rather take in "less qualified" citizens than more qualified foreigners. If they do otherwise, their alumni and those rich corporations and foundations would not donate money!

This is especially so in medicine, where you want to train your own doctors to treat your own people. I have yet to come across any medical school, private or otherwise, in any western country which places no quota on the number of foreign students admitted!

Anonymous said...

The Singapore government has not trained enough doctors. The Singapore government has an obligation to train enough doctors. The Singapore government cannot expand NUS medical faculty any further due to physical constraint. So, the responsible temporary solution is to subsidize citizens who are admitted to foreign medical school, to the same extent as students who are admitted to NUS med sch,in return for the same bond that local students are subjected to. The responsible long term solution is to start a new medical school to train doctors who will be practicing as doctors as soon as possible.

The irresponsible temporary solution is to take in cheap trained foreign doctors and to keep reducing the criteria for granting them the license to practice independently. The irresponsible permanent "solution" is to come up with a new medical school whose aim is to train clinician scientist that will be invovled in research much more than practicing as doctors!

It was George Yeo, in his 1990 health ministry review who said that Sg had too many doctors and that we needed to reduce NUS's intake from the then 200 to 150. Was he taken to task now? Did the people of Aljunied vote him out?

Singaporeans get what they deserve and what they ask for!

Anonymous said...

Sg Govt: If you are already our citizen and you can't leave, why do we need to spend money on you? Makes no "cents" at all! But if you are not our citizen, that's when we need to spend money on you, to entice you to become one! And of course, if you have already left, that's also when we need to spend money to fly hawkers to cook for you, to entice you back. And so that's the principle we work on when reserving university places, when subsidizing education, when sponsoring sports events...

Sg citizen: Yes, Sir. Yes, Sir. We are citizens who will never leave and who will always vote for you, and so we have no bargaining power. We have no problem with that.

Anonymous said...

To me,a Spore citizen,Singapore as a nation is not attractive at all.

But if you trurn it around,how about Singapore Hotel,1 6 star international play ground for the rich and famous,it may be different.

How many Singapore citizens take the trouble to understand that it is the hidden agenda-because 154th does not spell it out-of our chosen leaders.

Can you fault them for not having the missionary zeal to achieve their ambition?

I dont think so,so long as they are chosen,by hook or by crook.

Anonymous said...

I just hope that some of our morally upright opposition parties is a consistent reader of your blog. You and your readers do present some hard facts which will never be picked up by our controlled media.
I am a lower-middle income S'porean who has seen better days(finacially). But because of the house that I had bought 20 years ago, I'm now penalised by being unable to receive all the subsidies that the Govt gives(workfare,CPF life plan, Communit hospital susbsidy).
It's a good thing that my children do not aspire to be doctors, or else, I will really have to beg, borrow or steal to send them overseas, if they do not meet the cut-off grades as compared to S'porean students and Global students who applied.
Our Govt , the way I see it, serves only the poor and the rich. The rest have to fend for yourselves.
Sorry, I digress, but I feel this is really a much bigger issue which S'porean have to look at when they next go to the polls.

Anonymous said...

first singapore the nation.

then singapore, inc.

then hotel singapore.

now singapore, the brothel! come, have fun, f*** the locals and leave. compliments of the management!

Anonymous said...

dear anonymous,

if your children do indeed want to be educated overseas in the medical field, unfortunately no matter which country u go to, they impose a quota on the number of foreign students being accepted into their medical college. in canada quite a few years ago, the ratio was 95% (canadian citizens & PRs)/5% (foreigners). sometimes PRs also face discrimination.

so the point is, if singapore children get ONLY fair opportunities vs foreign students, but unfair opportunities overseas, they'll always get the shorter end of the stick. worrisome!!!

angry doc said...

Anon at September 14, 2009 6:23 AM,

Foreign medical students can and will learn about local culture during their 4 to 5 years in medical school.

Medical interpreters are a necessity which is currently not being looked into; there is no guarantee that Chinese, Singaporean medical students can speak our grannies' particular dialect, or for that matter Malay or Tamil.

As for whether or not I should want my tax money to fund my own child through medical school... well, it doesn't matter what I want. I believe medical schools should recruit the best; and if my child is not good enough to be selected by a local medical school, then maybe he or she is not good enough? I can always try a foreign medical school.

I don't think not wanting my son to be chosen over someone more qualified makes me an unfit father; I think wanting my son to be chosen over someone more qualified him makes me unfit to be a member of the medical fraternity.

Anonymous said...

i feel the need to clarify a few points

1. the bond part where i mentioned that it could be negotiated may be a misunderstanding on my part. the exact words as said out is that they can serve their residency in their own country. how long do they have to serve their bond thereafter is not clear.

2. the majority of students are currently singaporeans but Duke-NUS is actively recruiting students from the likes of Harvard and MIT
https://www.facebook.com/event.php?eid=127523764118&ref=mf

hope this clarifies some doubts

J

Anonymous said...

Hi angry doc

Lets be honest.
Truly top quality foreign students would go to US/UK.
We get the 2nd rate.
Who most likely cannot even compare with the local "2nd rate" students. I mean how many straight As students get rejected from medicine each year? In fact I know a few "2nd rate" locals who did really well at Imperial College.

And it is doubtful how much local culture these foreigner student can learn. Most expats/foreigners tend to hang around with expats. As for diversity, this is not a business school.

Ah Wang

Anonymous said...

On a related note: To all Singaporeans who are suffering from heavy medical bill co-payments or not covered under insurance or co-payment.

Go to India for treatment. The doctors are much better as they see so many patients. Plus they wont ask you to run and get a 800 SGD MRI for everything.

angry doc said...

Ah Wang,

If you think that the medical school selection process is flawed, then it can as easily choose second-rate Singaporean students over first-rate foreigners, or second rate Singaporean students over first-rate Singaporean, couldn't it?

So is the problem the medical school selection process, or do you think Singaporean students should always be selected over foreigners?

I have worked with foreigner-doctors and foreigner-local graduates - they probably know more about local health culture than most young Singaporeans these days who are not involved in healthcare.

Anonymous said...

I would rather be treated by a well-qualified doctor, local or foreign, than by a poorly-qualified doctor, local or foreign.

This statement is good only if backed up by the fact that we do not have sufficient good people wanting to be doctors.

The fact today stands that our medical schools are rejecting straight A students, by the bucketloads.

You are making a false statement which does not stand up to contest.

Anonymous said...

Foreigners pay tax in Singapore too!

Foriengers pay tax in Singapore as rental for the infrasturcture built and maintained by Singaporean tax dollars.

My question back to you is, are you lobbying your government to give ME (or all Singaporeans) same priviledges as you, a citizen, in your country, as you are lobbying for us to do so for you now in Singapore?

Hey, we'll pay tax in your country too!

So how?

Hypocritical now?

Anonymous said...

The Singapore government cannot expand NUS medical faculty any further due to physical constraint.

Really? I thought we paid millions for early planning!

angry doc said...

"The fact today stands that our medical schools are rejecting straight A students, by the bucketloads."

And you are assuming that straight A students make the best medical students or doctors.

Anonymous said...

And you are assuming that straight A students make the best medical students or doctors.

Oh! And I believe NUS is also rejecting non-straight A students by even more bucketloads!

Anonymous said...

I am simply awestruck by the arrogance of foreigners retorting that paying tax entitles them automatically to handouts from the government.

Let me explain why Singaporeans are so angry besides the obvious sticking point of NS which has been raised to the death.

Firstly, for those who come here to work, how many of them are seriously wanting to make Singapore home for themselves and their offspring? Are most of them not here because they can earn more in Singapore than elsewhere? If so, what is the big deal about the tax? Not to mention the extremely low rates compared to other countries.

Secondly, many of those working here hail from a country where living costs are a mere fraction of that in Singapore. They have the luxury of retiring back in their countries comfortably after they have earned enough money in Singapore. For Singaporeans, they have no such option. This issue, coupled with the increased competition (for jobs, resources, space, etc), contributes to the frustration felt by Singaporeans. Most foreigners would not empathise with this because they come from a much bigger country where they can always fall back on.

I have no arguments with foreigners wanting to come to Singapore to earn more money. It is the government I am angry with for mishandling the issue of immigration. Maybe "mishandle" is putting it too kindly, I think classifying it as treason would be more befitting for the situation now can be regarded as an invasion.

Anonymous said...

Many local university tie-ups with foreign institutions have no real purpose other than to improve the prestige of the local university. Of course they want the 'best of the best' to be their students. Where best is defined as 18 year olds that are somehow judged worthy. There is no more noble goal like to develop the local medical talent pool or to exchange research.

The real problem is that the local demand for medical education far outstrips the supply. Part of the problem is the perceived prestige of being a doctor. The other part of the problem is the quota in the number of places in medicine every year.

If a local's dream is to become a doctor, and they do not get accepted into NUS, they should seek out alternatives. The admissions process is oversaturated with other 18 year olds (foreign and local) who only want to be doctors because it is 'prestigious'.

The saddest thing is, many of the admitted 18 year olds' greatest accomplishment in life would be to get into a prestigious course in a prestigious university. Unfortunately, they all end up being mediocre professionals.

Anonymous said...

Angry doc wrote:
"As for whether or not I should want my tax money to fund my own child through medical school [over a foreign student]..."

That's not what I asked. Please do not misrepresent my question. What I asked was:

[Quote]
"Do you want to spend your hard-earned money from your medical practice to sponsor your less-qualified son for his costly medical school education given that he got "only" ABB in his A-levels,

.. or do you prefer to deny your son of his ambition because you prefer to spend your hard-earned money to sponsor a more qualified young man unrelated to you, with AAA in his A-level, in the hope that one day, after he becomes a doctor, you can adopt him as your step-son and he will some day call you step-dad?... may I know what the word "family" means to you?
[UNQUOTE]

So, please do *not* tell me about your political view of how you think the country should be spending your tax money, because that's not what I asked. Instead, tell me directly how within your family, you will be spending your hard-earned money from your medical practice.

To put it in multiple-choice:
Within your family, will you use your money (i.e. family savings from your medical practice income, not tax money - you can use tax money to pay for your son's NUS tuition fee at the bursar's office meh?) to support:
(a) your son with grade ABB at A-level, or
(b) unrelated young man with grade AAA at A-level,
through medical school?

Answer me honestly:
Are you sure this is how your family works: instead of choosing (a), your family will, as a way to do (b), advertise in the newspaper to find the young man with the best A-level in the world, and then support this person through medical school with your family savings from your hard-earned money from your medical practice, and tell your son to go fly kite and to forget about getting any family money from you? And furthermore, the way your family values work is such that within your family, "wanting my son to be chosen [by you to be the one to be supported through medical school with your family savings derived from your medical practice] over someone more qualified him makes me unfit to be a member of the medical fraternity?"

Pardon me again, what kind of a father does that makes you if this is how your family makes its decision about whom to spend the family's savings on?


A country is a big family and citizens are family members. No?

Anonymous said...

anon September 16, 2009 9:10 PM
> The real problem is that the local demand for medical education far outstrips the supply.

That's not a problem. Singapore has far fewer doctors than required of a 1st-world country!


> If a local's dream is to become a doctor, and they do not get accepted into NUS, they should seek out alternatives.

Indeed! And the alternative is to vote out PAP which has underestimated the number of doctors required for nearly 20 years (George Yeo's healthcare report of early 1990s) despite medical professionals telling it otherwise, realised its mistake only recently, but still refuses to train enough doctors (Duke is to train clinician scientists, not practising doctors), and prefers to import cheap already-trained foreign doctors by lowering medical practice license criteria instead!

Anonymous said...

Dear angry doc

If u are still reading this then first of all I admit my experienceSSS with foreign doctorSSS had left me with a bitter taste.

I also admit I do not know enough of the selection process for NUS Medicine to make a judgement.

However, I do know that too many aspiring local doctors are not given the chance. We will never know if they could have been a great doctor or not ... simply because they were never given the chance. If our people are our greatest resource then this wastage of potential is unforgivable.

Ah Wang

angry doc said...

"A country is a big family and citizens are family members. No?"

I don't think so. My family are my family, and I won't spend a cent on someone outside my family that I don't have to or want to, Singaporean or foreigner. I don't care, for example, if the bus driver is a Singaporean or a Malaysian - the safest driver should be the one driving the bus.

I think you are carrying the analogy too far by saying that just because we take care of our own family we should give all the places to medical school to our own family. That is called nepotism, and we all know what happens when we give jobs to our own family whether or not they are the best-qualified just because they are family...

I ask in return: when you are sick, do you want to be treated by a Singaporean doctor, or a foreigner doctor who is better than him? Shouldn't the best man do the job, regardless of nationality?

Anonymous said...

if we were to follow the trend of thought by angry doc, how are we to expect industries to develop in the first place?

If everyone adopted such a thinking, all developing worlds should be using the doctors from the States since they are one of the best in the world.

To actually develop our field of medicine, it is vital to build up a pool of talents of our own people. Is that not how the States in the first place build up their industry?

angry doc said...

You are conflating the issues here.

Even if your aim is to develop our own medical system, the question of whom to admit remains.

Now I agree with RJ and Mr Wang that if the state subsidised medical training, then it has the right to demand something in return from the medical student, in this case in the form of a bond or refund. This should apply to both locals and foreigners equally.

Now assuming two candidates, one local and one foreigner, both of whom are willing to serve the bond, which one amongst the two should we pick? The Singaporean simply because he is Singaporean? Or the better of the two, regardless of their nationality?

Ted said...

People like Angry Doc hails from the same lineage of 'thinking patterns' as those of the MIW...nay, it's more simpler, he is one of those who buys into the arguments put forth by the elite, and is willing to defend it because it is rational to do so. For them to do otherwise, is indeed irrational and unthinkable. For such persons, there are no such things as a true country.

Anonymous said...

Obviously when you're in cahoots with the elite the rest of the poor don't matter any more. It would be otherwise "rational" to keep up the rhetoric with self delusional techniques in hope that the truth won't be uncovered...

The evidence is on a platter for all to see. Perhaps some people just have their eyes plastered :)

fooey

Michael said...

Instead of launching into personal attacks against the good (angry) doctor, consider a few things:

A) When purchasing products, do you not automatically pick and choose to find the best value for money?

B) When thinking about your loved ones' lives, or even your own, do you not agree that you'd want the best doctor there is?

C) If the above two questions, answered independently from all the holier-than-thou moral high ground that has been taken in this discussion, are "yes", then is the angry doctor wrong?

I do not see the angry doctor as saying that citizenship should be useless when it comes down to selection for medical students. I see his comments as a very simple "this should be meritocracy at work" - as it should. For whatever reason it may be (for earning rich sick people's money, or for our own survival's sake), we all want the best, most competent, most compassionate doctor treating us. If the issue was not one of foreigner vs. local, but one of local vs. local, would his arguments suddenly make much more sense?

I would personally prefer two separate schemes for assisting prospective medical students, foreign or otherwise, with correspondingly different obligations to be repaid by the students after their course of studies are over. I do not want to disadvantage good local students who can end up becoming medical legends in their own right, but neither do I want to deny other deserving students the benefit of going through our medical education system, and, if so, spreading the good name of NUS and Singapore as a medical hub. Both ways end up benefiting Singapore as a whole - it just so happens that right now, the system seems to be purely meritocratic (or unfair to citizens, depending on one's world view).

Anonymous said...

I am a medical student in NUS and for better or for worse, I'll be working here once I graduate. But I think ALL singaporean doctors should have a stint working overseas, as opportunities in singapore are honestly limited. It is said that we have a shortage of doctors, but from my perspective, that isn't the case. There is a ridiculous amount of competition for a myriad of specialities, to the point that if a locally trained doctor ever wants to specialise, he/she MUST head abroad to pursue an MRCP/MD.

Anonymous said...

hey say a NUS trained doctor, who is supposed to serve 6 years of bond, serves 4 years, and then breaks his bond after that to head overseas, how much will the monetary penalty be?

PMG said...

I don't know. My friend is in Duke-NUS and she is a local. Could it just be sour grapes for not getting in?

I don't get the problem with equal treatment though? When I studied overseas I competed equally with Americans.

I am sure Duke-NUS students who are foreigners pay higher fees, and if not, they are bonded just like our NUS students.

Mr Wang Says So said...

1. No, it cannot be sour grapes because J has just applied. He hasn't been rejected yet.

2. See comment at September 14, 2009 6:56 AM. In the USA, Duke itself places a firm limit on the number of places for foreigners. How can there be equal treament?

3. No, they do not pay higher fees.

Anonymous said...

1. Annual Fees:
S$35,000 for Singapore citizens,
S$35,600 for Singapore Permanent Residents and
S$38,000 for international students.
Loans are available to matriculating students of any nationality for the purchase of laptops and to finance tuition fees. The Tuition Fee Loan (TFL) covers up to 90% of tuition fees payable by Singapore citizens.

2. Service Commitment
4 years for Singapore citizens
5 years for international students and Singapore permanent residents
The period of your postgraduate training overseas however will not be counted towards your existing service commitment.

3. Duke University Medical School
The Duke University School of Medicine places a high priority on need-based financial assistance for its students with a particular emphasis on grants and low-interest loans. US citizenship or permanent residence visa is required of all students receiving federal or institutional aid through the school.

Couldn't find data on quota for international students.

Anonymous said...

"(4) Foreigners CAN serve their bond in their countries if their families are not in singapore (although this is subject to approval, it makes you wonder why bond them at all?)"

I am very surprised by this...

Anonymous said...

J has stated wrong information about serving bond overseas... service commitment will be served in Singapore... That's how I understood it initially...

please refer to

http://www.duke-nus.edu.sg/web/admission_faqs.htm

You see, not everyone can be a doctor. You have to be smart, and in addition, have the aptitude. Attracting overseas students is a good idea. With the bond, they will stay in singapore for at least a couple of years.

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