Salma Khalik, Senior Health Correspondent

Looming shortage of doctors to deliver babies

Singapore is facing another baby crisis - just as the number of babies born here rose by 2,000 last year from the year before, reversing a worrying decline. While more couples might be willing to have babies now, there could be fewer doctors willing to deliver them in the future.

This follows a change in the terms of doctors' insurance plans such that they will no longer be protected against lawsuits once they stop paying for coverage. Given the high cost of continued coverage, many feel it is not worthwhile to carry on.

A person has up to 24 years from birth to sue a doctor for any negligence or accident that caused permanent damage. Compensation can easily top the million- dollar mark.

Protection against such suits does not come cheap. Obstetricians now pay to the tune of $22,045 a year for coverage. To continue paying this amount for 24 years after retirement would mean stashing aside more than half a million dollars - and that is provided the fees do not rise.

Already, a quarter of obstetricians are saying they plan to stop delivering babies once their current coverage under the Medical Protection Society (MPS) is up for renewal - and that is within the next 11.5 months.

These are generally older and more experienced obstetricians who had expected to work for perhaps up to another decade.

One obstetrician said that for a doctor with five years or less of working life, "it really makes no sense" to continue, as "he could never earn enough to cover for the extra years of indemnity after he ceases all obstetric work".

Younger doctors, he said, can start charging patients more to accumulate enough to pay for continued protection after they retire. One doctor said he will likely have to double his fees to do so.

Unless this issue of protection for obstetricians can be resolved, and quickly, the baby boom could easily fizzle out, as young couples worry about the higher cost and the possible dearth of experienced obstetricians.

Perhaps the Ministry of Health (MOH) can step in to provide the post-retirement protection that will give obstetricians peace of mind - the same way it did for citizens with MediShield Life.

Offering such protection is not a commercially viable option, or London-based MPS would not have made the drastic change - not just in Singapore, but also in other places such as Hong Kong, Malaysia and South Africa. So trying to interest an insurance company is not likely to be the solution, given the small number of just over 300 obstetricians here.

In fact, 15 years ago, there were three organisations that doctors here could turn to for coverage. But one of them, Australia's United Medical Protection (UMP), went into provisional liquidation in 2002 when it was unable to meet the claims against the doctors it covered. The 1,500 doctors here whom it covered were left in the lurch. They had to scramble for coverage, not just for future cases, but also for any problems that had occurred in the past.

Most turned to MPS, even though at the time NTUC Income charged lower fees. It was because Income had a cap of $5 million on its payouts, so anything in excess would have had to be borne by the doctor. It is rare for payouts to exceed $5 million, but most doctors did not want to take the risk.

Today, MPS has cornered the market with coverage of more than 11,000 health-care professionals here. So, bringing in a commercial player to take on what the not-for-profit MPS has decided to drop is not likely to work.

In the national interest, MOH could provide tail cover for doctors who have retired by getting all practising obstetricians to contribute to a pool of funds yearly.

Last year, obstetricians each paid MPS $36,000 for coverage. With the reduced coverage, the fee has gone down to $22,045. At the very least, obstetricians should pay the difference into the MOH pool. But like MediShield Life, it should be used to cover only big bills. So doctors should be liable for a "deductible" - to be mutually decided on.

MOH will very likely have to contribute to this pool - but getting obstetricians to continue working without undue stress is in the best interest of the nation.

Some countries have legislated caps on compensations that can be paid to affected babies. Singapore might want to introduce this. But the amount has to be fair to the child.

An alternative solution is to let obstetricians raise their fees, and for the MOH to help less well-off families with a "delivery bonus" - much like the Baby Bonus to spur couples to have more children.

But going this route would work only for younger doctors, who have many more years to accumulate enough for the over 20 years of additional coverage they will need post-retirement. It will not stop those who are already in their late 50s from calling it a day.

A recent poll by the Obstetrical and Gynaecological Society of Singapore, in which 231 doctors took part, had 140 of the 311 registered obstetricians - almost half the practising obstetricians here - saying they will stop delivering babies within the next five years.

Of course, couples could turn to midwives instead. There were 1,385 registered midwives here at the end of 2013. Singapore can then maintain a core of obstetricians for problem births. Since they would deal largely with more complicated births, their fees would naturally be much higher.

Another scenario is to increase the number of foreign obstetricians practising here - who will leave the country when they retire. But this would mean babies delivered by them would not be able to seek redress should something go wrong during their delivery. That would certainly not be in Singapore's best interest.

Whatever the case, obstetricians should not be left to carry the baby on their own - it is a national crisis that requires a national solution.