The Medical School and the external economy - at what price?

The discussions about the medical schools and the training of doctors need to be viewed from another perspective - the need to service the external economy. This is an unfortunate reality of Singapore life,....and possibly existence. MM Lee KY has been very blunt about this. Back in 1992 he already made very clear, 'Today's peace and plenty would come to a halt if Singaporeans do not venture overseas to build up an external economy .... Singaporeans should not be distracted by domestic issues to the extent that they ignore the danger of being left behind in the economic race.'

That the medical schools in Singapore are being positioned for the external economy is without doubt. That we are recruiting and staffing the hospitals with so many doctors, is without doubt for the needs of our external economy. The training of physician scientists is not for our domestic patients but to meet the needs of another aspect of our external economy.

Is it wrong? I don't think so. MM Lee is right that our small island state will be swept aside by the tsunami of globalization if we do not find a way to expand our external economy.

The fundamental question is - what is the price we are prepared to pay as a society?

Therein, I believe, lies the problem. I am not so confident that our decision makers at the present, have a good appreciation of what the price is that we are paying to achieve certain numerical targets. It's the curse of a management approach that is based primarily on 'metrics'.

Our medical schools (no matter what their PR machinery tells us) are poorly resourced to produce the numbers of doctors required. Whatever resources that have been allocated to the educational mission tends to get 'stolen' by more high profile and eye-catching needs of academic research staff and facilities. You do not need to go very far to verify my comments. Speak to any of the medical teachers on the ground (not the policy makers obviously, lah!) and you pretty much get the same sense of pessimism and discouragement, and the perception that education has not only been devalued, but the product has already been severely degraded. All this despite soaring school rankings etc.

Why the discordance? Simply because management focuses on delivering according to a demand set by certain 'metrics'. Staff-student ratio? Looks good on paper, but no one needs know a substantial number of these staff numbers are no-intention-to-teach high profile researchers. No support or recognition for educators? Who says? Look at the number of medical pedagogical activities that have been organized!! (A little bird across on the ridge intimated with a bit of eye ball rolling that the school there is setting up a 'Teaching Academy'. Why? Mainly I believe, as a very public demonstration of how they recognize their educators. Another feather in the cap for the metrics champions.)

So here is a bit of a hint for our Ministers of Health and Education - please go ahead and build our capabilities to meet the globalized challenges, and our external economy, but please don't ignore the substance of what we need to try and do for our own people. It is not all about meeting the 'metrics' for an external demand. Many aspects of the product quality cannot be readily codified into check boxes. Many people on the ground will be ready to give you evidence of how the environment is being rapidly and alarmingly degraded, to the point where they are genuinely concerned for the future.

Do we need a third medical school? Of course we do. We desperately need a third school, because we need a school that will bring us back to basics. We already have two high profile schools for the external economy. We need one to look after domestic needs. It's not too much to ask for a school that will train good local doctors for our own domestic health care needs. The Tan Tock Seng Hospital is an excellent campus for this effort. If this third school were to follow the same 'educational' mission that has become the rallying cry of the first two schools, then I think we would have totally lost the point.