Dental Registration (Amendment) Bill
Mr Louis Ng Kok Kwang (Nee Soon): Sir, we are facing a supply crunch in dental care. It has become necessary for Singapore to open its doors to graduates with foreign degrees in dentistry to supplement our locally-trained dentists.
As early as 2017, the Ministry recognised that there were not enough locally-trained dentists to handle all the demands for dental care and set the goal of achieving a ratio of one dentist to 2,200 people. In doing so, it is also important to ensure that there is some standardisation in the dentistry care that is provided in the industry.
This Bill helps to ensure that we strike the right balance between opening our doors and ensuring consistency in the profession.
I have three points of clarification.
My first point is on the implementation of the qualifying examination for foreign degree holders. Currently, SDC already administers a qualifying examination for graduates with foreign dentistry degrees from universities not specified in the Schedule to the Dentistry Act. The amendment to section 14A will expand this requirement to all graduates with foreign dentistry degrees, whether specified in the Schedule or not.
The SDC’s website states that an applicant only has two attempts at the qualifying examination which must be taken within 12 months of each other. The feedback from the ground is that the qualifying examination is very stringent and the failure rates are fairly high. I agree that we should set the bar high for the profession. The fact that we have a number of graduates who are failing the qualifying examination is not a reason to lower the bar. However, we should consider giving more time. With more time to practise and study, with more opportunities to attempt the examination, many dentistry graduates may eventually qualify and help alleviate the supply crunch facing the industry.
Can the Minister share if the Ministry is considering increasing the number of attempts allowed at the qualifying examination? Can the Minister also share if the Ministry is considering increasing the duration of 12 months between attempts, even as a temporary measure, considering the present circumstances of the pandemic? In addition, can the Minister share whether there are plans to provide increased support or training programmes for those who are struggling to pass this examination?
Dentistry is an extremely specialised degree and these graduates have spent many years applying themselves at it. It would be a shame to end their aspirations after just two attempts at the qualifying examination, especially when it is always possible to improve.
My second point is on the alternative careers for Singaporean graduates with foreign dentistry degrees. While there is likely to always be a proportion of graduates who are not able to pass the qualifying examination, this group of graduates may, nonetheless, possess some meaningful skills from their years of higher education.
Can MOH share if there are alternative pathways within the dentistry industry where we can channel this group of graduates into, so that these graduates can, nonetheless, pursue a career in this industry and help, again, to reduce our supply crunch?
My final point is on the present status of the dentistry industry. It is apparent from the 2019 Dental Association survey that we are some distance from easing the supply crunch. Can the Minister share more details about its progress in meeting the goal of the ratio of one dentist to 2,200 people? How effective has the measures adopted since 2017 been in easing the supply crunch? Are there plans to further increase the local intake of dentistry students to meet the population’s dentistry care needs?
Sir, notwithstanding the above clarifications, I stand in support of the Bill.
Dr Koh Poh Koon (The Senior Minister of State for Health): Mr Deputy Speaker, Sir, I thank the Members who have spoken for their support of this Bill. I will address the queries that they have raised in their speeches.
In my opening speech, I outlined the need for a steady supply of dentists each year to meet the expected demand for dental services by Singaporeans.
Mr Yip Hon Weng expressed concern that we need to increase our number of dentists in Singapore. Singapore indeed has a lower ratio of dental professionals per capita as compared to the Organisation for Economic Co-operation and Development (OECD) countries.
Hence, the DRA Schedule was revised comprehensively in 2008 to allow for the registration of a wider range of foreign dental qualifications. The dental workforce has experienced a 3% to 5% year-on-year growth since then.
Let me now come to the issue on the present status of the dental workforce raised by Mr Ang Wei Neng, Mr Louis Ng and Mr Yip Hon Weng.
To ensure adequate supply and continuity of dental care for Singaporeans, we have also increased our dental training pipeline to meet the growing dental care needs of our ageing population and to ensure a target ratio of one dentist to 2,200 people or 0.45 dentist per1,000 population by 2030.
The student intake into the NUS Faculty of Dentistry has historically been derived based on targeted dentist to population ratios.
Predicting how many dentists we will need in the future is actually not a very easy task. There are factors to consider, including population demographics that evolves over time, the different dental awareness amongst the population and also the health-seeking behaviour of our people.
Singapore currently has 0.84 visits to dentist per capita per year. This is low compared to the average of 1.3 in the OECD nations.
We project an increase to one visit to dentist per capita per year by 2030 and with that, we will require a ratio of one to 2,200 dentist by 2030. The annual intake into the NUS Faculty of Dentistry has increased by 36% from 44 in 2008, to 60 in 2018. Based on our service planning parameters, with the increased dental student intake of 80 this year, we expect to be on track to reach a target dentist to population ratio of one to 2,200 by 2030. And we will of course continue to look at the evolving needs and to adjust the NUS Faculty intake where necessary.
As pointed out by Mr Yip Hon Weng, it is important to have competent and well-trained dentists in Singapore. I could not agree more. All of us who ever see a dentist will want the dentist to be competent.
Currently, foreign-trained dentists who have graduated from the universities on the DRA Schedule can apply to register to practise in Singapore if they fulfil the requirement to secure employment with a dental clinic or a healthcare institution, which is largely driven by market forces. This employment requirement will still be applicable when the new measures come in force.
Given the high degree of variability in overseas clinical practices and the dental curriculum of overseas Universities, based either on the DRA Schedule or otherwise, the qualifying examination is therefore an important assessment to determine the clinical skills and competencies of a dentist, which are fundamental to the practice of dentistry and thus would ensure that the quality and competencies of foreign-trained dental graduates who are eligible to register and practise in Singapore remain high.
The qualifying examination, which is administered by the NUS Faculty of Dentistry, is benchmarked to the final-year professional dental examination that locally-trained dentists are required to pass before they can obtain their Bachelor of Dental Surgery degree from NUS. As such, the qualifying examination should be required for foreign-trained dentists applying for conditional registration, irrespective of their nationality.
I turn now to address Dr Shahira Abdullah's and Mr Louis Ng's queries on the number of attempts allowed for the qualifying examination.
To recap, the qualifying examination comprises three parts and the candidates will be provided with qualifying examination syllabus and related preparatory materials.
For foreign-trained Singapore Citizens and Permanent Residents who pursue dental qualifications found in the DRA Schedule and wish to practise in Singapore, there will be no cap on the number of attempts to pass each part of the qualifying examination.
For other foreign-trained dentists who pursue dental qualifications found in the DRA Schedule and who wish to practise in Singapore, there will be a cap of two attempts to pass each part of the QE, with each second attempt having to be within 12 months of the first attempt. This has been the practice currently and there will be no change to this. Historically, in the final Bachelor of Dental Surgery degree examination here in NUS, over 90% of local students passed on their first attempt and close to 100% passed by the second attempt.
Hence, a two-attempt cap for non-residents which is the current practice, is a reasonable benchmark for ensuring the standards of those taking the qualifying examination is on par with our local graduates.
For foreign-trained dentists, irrespective of nationality, who pursue dental qualifications not found in the DRA Schedule and wish to practise in Singapore, the SDC will review their applications on a case-by-case basis and allow dentists of good repute who meet the requirements to take the qualifying examination to assess their competency to practise in the local context.
Dr Shahira Abdullah asked how the SDC assesses the eligibility of foreign-trained dentists who do not hold a Singapore degree or a degree from a university specified in the DRA Schedule, to sit for the qualifying examination.
As stated in the DRA, this is left to the SDC's discretion. The SDC has generally allowed foreign-trained dentists to take the qualifying examination so long as the university from which they attained their basic dental degree is recognised by the respective dental regulatory body of the country. The teaching medium is in English, failing which the dentist must take and pass an English Language proficiency test. And thirdly, if they meet other requirements, like having an offer of employment and whether the foreign-trained dentist has a connection to Singapore, such as being a Singaporean/Permanent Resident (PR) or married to Singaporean/PR or children of PRs, for example, as published in the SDC's website.
Mr Yip Hon Weng was concerned about the timeline for the implementation of the qualifying examination requirement as this may affect existing overseas Singaporean dentistry students.
I think it is a fair concern. But I want to reassure Members that there will be a transition period of seven years whereby foreign-trained dentists will still be able to apply for conditional registration under the existing regime under the current DRA, as the implementation of the qualifying examination is intended to only be effective from 1 January 2029. This means that students who are currently enrolled in, or have secured places in dentistry courses overseas and will graduate before 1 January 2029, as well as foreign-trained dental graduates who already hold basic dental qualifications from universities on the DRA Schedule will not be affected by this change and will be considered for conditional registration to practise dentistry in Singapore if they fulfil the requirements under the current DRA.
Mr Yip Hong Weng has asked for clarification on why the Ministry does not just refine the current DRA Schedule by removing universities that do not produce graduates on par with local graduates, instead of imposing this qualifying examination.
In relation to the DRA Schedule, the SDC has reviewed local and overseas practices to assess a clinical competence and eligibility of a dentist for registration.
Jurisdictions, such as Canada, Hong Kong SAR and Thailand have adopted a national examination regime for foreign-trained dentists. Countries, such as Norway and Germany, use a Schedule of schools with exemptions on a case by case basis for non-citizens. Countries, such as Denmark, Ireland, Sweden, United Kingdom, United States of America, Australia and New Zealand have adopted a hybrid of Schedule and national examination, based on citizenship, location of dental training or licence. And as Dr Shahira Abdullah has pointed out, the QE is, in fact, present in many overseas jurisdictions and with these amendments, Singapore would be in alignment with the rest of the world.
Additionally, the SDC has reviewed the international rankings of the 89 universities in the DRA Schedule.
Most of the top ranked schools in the latest international rankings, which are primarily based on academic/employer reputation and research citations, are not in the DRA Schedule. Together with the variation in dental practices and training across overseas Universities, international rankings would therefore be less relevant for the purpose of removing universities that may not produce foreign dental graduates on par with local graduates.
Given that the majority of our foreign-trained dentists have graduated from a selected number of foreign dental schools, the SDC will curate a more concise list of recognised basic dental qualifications to ensure the relevance of the Schedule. We will remove 27 schools that SDC has not received any registration over the past 12 years. The list of overseas dental schools and universities in the Schedule will be reduced from the current 89 to 62. The SDC will make available the revised Schedule by end 2021.
Sir, I would like to conclude by addressing Mr Ang Wei Neng's query on making dental services affordable, especially for our ageing population.
I must clarify that, in contrast to what Mr Ang Wei Neng has said earlier, MOH actually has no guidance for a twice a year visit to a dentist. In fact, we are already moving to a risk-based approach, which is what is practised in the UK as well. For example, those who are deemed to have low dental risks actually may only need to see the dentist once every two years. So, this is more of a risk-based approach. And in the context of our local practice, we also have upstream basic care given to students in the schools. So, it is to be seen in the context of holistic dental care eco-system and not just at the primary care level, when the person has become an adult.
MOH monitors and reviews primary care dental capacity provided by private CHAS dental clinics and public polyclinics, both of which provide subsidised dental services. There are currently over 800 CHAS dental clinics islandwide.
Pioneer Generation, Merdeka Generation, as well as Community Health Assist Scheme (CHAS) Blue and Orange card holders enjoy subsidies for selected basic dental services at private CHAS dental clinics. Singaporeans can also look forward to dental services in the upcoming polyclinics, such as Bukit Panjang and Eunos Polyclinic which are scheduled to open this year.
Sir, I would like to assure Singaporeans that MOH will ensure that dental care will remain accessible, affordable and of good quality by competent dentists.
Mr Deputy Speaker, I would like to express my gratitude to the Members who have spoken on this Bill. Their questions and comments have provided valuable insight on the areas that we should focus on when implementing these measures. I am heartened at their support.
I should reiterate that, as I mentioned in my speech earlier, for these proposed measures to ensure the continued quality of foreign-trained dentists seeking to practise in Singapore, we will need the support of the dental community to help implement and operationalise these amendments.
I am confident that these amendments will go a long way to ensure the continued high quality of foreign-trained dentists to complement our dental workforce in Singapore.
Source: Hansard
