Thank you to An Old Friend, who contributed this topic suggestion.
"Hi moderators, wondering if we could have a discussion on The Practice of Medicine (eg Parson's Sick Law) vs Service Quality and Standards (eg ISO) vs cost and the conflicts they present?
Personally I feel that the delivery of medicine is not the same as the delivery of service in other industries, eg hospitality or airlines.
Secondly, the expectations and cost factors.
For example, while there is always this drive towards "service excellence" in every organization, the quality of the service is different depending on the price you pay for that service. However the management do not look at it that way. They look into every complaint in the same way in every organization. It seems to be left to the customer to decide what his expectations will be (sometimes this can be tempered if he is paying a low price). But it seems that in healthcare, free seems to be the price everyone wants to pay so no luck having any pared down expectations subsidized or not.
Case in point. How do the management of SIA and Singhealth weigh their quality standards? I bet they both want "service quality excellence". I don't see SIA rates being cheap though. Same with ShangRi-La Hotels.
It is extremely difficult if the government does not control the expectations of the people when it comes to subsidized healthcare, and yet want to control cost. The system is extremely taxing on the staff who provide the service. They are sandwiched between trying to give "world class service excellence", but keeping costs low."
spacefan
I will post my reply first. Perhaps the rest of the panel can add their comments by editing this entry.
I fully agree that healthcare in Singapore has a distinct slant towards service provision, and that patient expectations aren't being managed sufficiently.
Conversations with people from the United States, Canada, Australia and the United Kingdom reveal a very different mentality - they understand the constraints of the public healthcare system based on how much less it costs the consumer.
The ER is a common discussion point - partly because I'm an ER physician. I recall a Canadian couple who recounted an 8-hour wait to consult a doctor about an elderly mother's hip fracture. When I told them an 8-hour wait in our ERs will guarantee a major riot - not to mention a reprimand from MOH, followed by interventional measures - they looked shocked and described this as "grossly unreasonable", especially after I told them we see an average of 400 cases a day, about twice the ER attendances in these countries.
The same goes for Americans and Brits. They know what to expect and usually kick up a fuss only if mismanagement is involved.
One might argue that since the Canadian and UK governments provide free healthcare for its citizens, patients have no cause for complaint.
But Singaporeans also receive substantial subsidies, and have easy access to tertiary hospitals where high-quality medical expertise and technology are readily available ( unlike rural areas in larger nations ).
Even a B2-class patient can be listed for an elective operation within weeks, compared to someone in the UK who waits an average of 12 months for a routine hernia repair or cholecystectomy.
The definition of "service excellence" varies according to the individual. For some, waiting time is a huge factor ( and one of the most important key performance indicators across the board ), while others may pay more attention to, say, the staff's demeanour.
But there's no denying that few subscribe to the idea that "the quality of the service is different depending on the price you pay for that service". In my 10 years within the public sector, I've encountered numerous patients ( and relatives ) who demand a level of service which is better accomodated in a private institution. But when I suggest they seek an opinion at such hospitals, they retort, "Why should I pay more?"
They want immediate scopes, cardiac scans, MRIs, consults with senior specialists. They criticize our "ridiculous policies" of arranging early clinic appointments, even for clearly non-urgent conditions. They start screaming bloody murder when they don't get sent to the ward within 2 hours, even when we explain that the hospital is full and beds can only be emptied when patients are discharged.
Is it because the government isn't controlling the people's expectations? Perhaps, to some extent, this is true, and is reflected by how MOH prioritizes its list of KPIs. After all, waiting times do nothing for a doctor's frazzled psyche, and only serve to pacify and impress the consumer.
The media also plays a part, regularly churning out statistics comparing one hospital / polyclinic with another. Let's not forget the dreaded Forum Page, which every HOD / CEO pores through first thing in the morning, hoping s/he won't see his/her department or institution fingered in a complaint letter which may / may not contain reliable facts.
The evolution of healthcare towards a service industry was probably also accelerated by marketing efforts that trumpet Singapore as THE centre for world-class medical care, including public hospitals in the mix. How much this has affected local perceptions, however, is hard to say.
I wouldn't go so far as to state that "in healthcare, free seems to be the price everyone wants to pay so no luck having any pared down expectations subsidized or not." I do ( occasionally ) meet patients who demonstrate a good understanding of our limitations - and it's no coincidence that many hail from the older age and lower income groups.
Based on personal experience, the majority of those who voice dissatisfaction are the well-educated, more affluent and younger people. I'm especially wary of those who come armed with information from the Internet or "a doctor friend / relative" or "a friend / relative who also has this condition or knows someone who does".
Another contributor to unreasonable expectations? Whether it's deliberate or not, I've had GP referrals asking me to arrange scopes / MRI scans / consults with specialists the very same day the patient comes to the ER.
You can see how this causes problems when the patient thinks I'm trying to pull a fast one, since his/her family physician of XX years, whom s/he trusts whole-heartedly and who can do no wrong, is being contradicted by this idiot of an ER physician.
Anyway, I'm nowhere as good as Angry Doc and Gigamole where in-depth analysis is concerned. Just offering a view from the trenches.
angry doc
This is not really a 'medical' issue, so I can't claim that my analysis is an accurate one...
There are a few issues being brought up here, from the question of cost and affordability, to quality of "service", and also timeliness of access to care. People want "Better, Faster, Cheaper", and it seems that no one is willing to tell them that they can't have all three.
Good healthcare requires considerable resources, and since resources are limited, healthcare must be rationed. Longtime readers of my blog will know that I used to be an advocate for rationing by needs and not means, but over the years I have changed my views on the topic.
My current views on the topic are set out in the comments section of this earlier post.
Put simply, subsidised healthcare not backed by the moral courage to demand accountability from patients distorts the true value of healthcare and is ultimately destructive to the morale of its providers. We are in the state we are in today because the public thinks they can dictate what resources they wish to consume from the system based solely on the fact that they hold a ballot, and no one tells them otherwise.
Many doctors remain within the public system because they have no choice - they are either bonded or under traineeship - and others remain because the public sector offers them things of value which they cannot obtain in the private sector, such as research or teaching opportunities. No one, however, chooses to stay so they can be told how to do their jobs by laymen. Whatever the reason, as long as we choose to remain in a subsidised healthcare system where laymen's "concerns" are allowed to override our clinical opinions, we are helping to perpetuate it.
I will end by repeating the quote I posted in the earlier thread:
"I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy.
I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn't."
100 comments:
Whoever who wrote that is obviously not Singaporean.
Firstly it is unethical to think that way.
Secondly it is unbecoming of a doctor to think that way.
Thirdly, it erodes the trust that patients place in their doctors.
SMC would take this doctor to task.
That's the problem you see. We ourselves as a professional body are actually on the same side as the enslavers.
We want to perpetuate this idealistic unrealistic fantasy.
I can understand why the politicians do it. I can udnerstand why the businessmen who run hospitals and practices do it.
I cannot however understand why doctors want to enslave their own and themselves.
Faster, better, cheaper, safer. TTSH's motto?
Somehow I suspect it is a fantasy to achieve all four at one time in health care. Maybe even in anything.
We must remember the point about safety. It is not so simple as ensuring safety in a manufacturing line. You only need to focus on the points of contact between human and safety hazard in the manufacturing arena.
In health care the "product" is a human being. The health care worker is also a human being. There are literally hundred of points of contact.
I think it might be possible to do at most 3 out of the 4, mostly 2 out of 4. Ie faster and better or cheaper and better....you work out the permutations.
But it is an interesting cycle. Because for administrators it is a very good cyclical system to work on projects.
Work on some QIP to make is faster and cheaper....then realize it is not so safe and not so good, then do a QIP to make it safer and better, then realize it is slower. And the cycle goes on. Always got work to do.
As it is, are patients overall happier with the health care system today than it was 20 years ago? Or are people getting more unhappy?
With the amount of complaints we see in the papers, perhaps the latter. So where's the progress? Me thinks all we have done is raise expectations in an neverending upwards spiral.
That's a quote from Dr Thomas Hendricks isn't it? A fictional character from Ayn Rand's "Atlas Shrugged". I would like to suggest to the authors of this post to properly attribute that quote, lest anyone misunderstands and thinks that it's quoted from a local doctor.
In this era of spite and mistrust, there's no such thing as being too careful.
Angry doc strikes a cord in me when he/she said this: Many doctors remain within the public system because they have no choice - they are either bonded or under traineeship - and others remain because the public sector offers them things of value which they cannot obtain in the private sector, such as research or teaching opportunities. No one, however, chooses to stay so they can be told how to do their jobs by laymen. Whatever the reason, as long as we choose to remain in a subsidised healthcare system where laymen's "concerns" are allowed to override our clinical opinions, we are helping to perpetuate it."
Bravo to him for speaking up! It's useless to increase the medical intake if you have no idea where the problems lie. Those admin folks should be doctors to know what doctors are thinking.
A professor once told me that he has seen many a young doctor who chooses to go into administration with bold ideals to change things for the better for his fellow colleagues.
However after exploring the corporate/admin jungle, he realizes that to get ahead in his field, the things he has to do have nothing to do with improving the lives of the clinical doctors.
A few golf games later with the directors, he becomes one of them.
Admin folks will be admin folks.
Another senior consultant referred to them as viruses. You get one administrator to take care of something, he turns that something into something bigger and more important, gets promoted and then hires another administrator to help him. And so they replicate.
Makes you wonder how much the non-medical staff headcount has increased over the past 20 years versus the medical staff headcount?
Many doctors remain within the public system because they have no choice - they are either bonded or under traineeship
In that case, can we lower the salaries of doctors so that we can lower healthcare costs in Singapore? Surgeons earn millions from patients. Not every doctor is as noble as Dr Ng Eng Hen who now earns less doing more as a minister.
This way Singaporeans will no longer fear falling sick and unable to pay their medical bills.
Can afford to die but not afford to fall sick in Singapore.
From
A concerned Singaporean
"... Singaporeans will no longer fear falling sick and unable to pay their medical bills."
That, concerned Singaporean, is exactly the kind of thinking that I am against.
People should fear falling sick, and take steps to keep themselves healthy.
People should fear not being able to pay their medical bills, and set aside money for them.
To ignore your own health and then expect cheap healthcare paid for by others through taxation when you fall ill is immoral.
Look at the comments of A concerned Singaporean. He/she thinks that cost of good medical care can be lowered at the drop of a hat, and it goes without saying that besides cheap, he/she wants it to be good and fast as well. Very typical indeed. To give a very crude example it is like going to buy a car, and he/she wants a BMW or Mercedes, expects fast and personalised service, and only wants to set aside a budget of 50K for it. Just not possible i'm afraid.
I have to agree with Angrydoc that people need to be more responsible about their own health and plan appropriately in both health and financial aspects.
To angrydr
U are very unkind as a dr as not everybody can avoid falling sick.
I hope SMA strike you off as you are bascially worse than most of the greedy and selfish doctors.
We should follow USA and cut the pay of greedy doctors who think they are God.
Administrators are there to keep drs from bankrupting the system. Drs will just increase their own salaries if they are in charge.
http://www.salary.sg/2008/best-paying-jobs-in-singapore-2008/
Surgeons are paid $30K a month and they are responsible for the high medical costs in Singapore.
Lucky our health minister is an engineer by training and not in cahoots with all of you greedy doctors
Perhaps the answer to that is health insurance like what we already have in place. It subsidises health care in a different way as the premiums are based on one's lifestyle, and so may be fairer to doctors who would like to be paid for their work and also patients who would like to pay for what they need. It might be fairer still if insurance premiums were adjusted according to the patients' means as well as their lifestyle, so that the aged and poor are not burdened too heavily.
Hmmm surgeons are paid $30k a month. That works out to be $360,000 a year.
Ministers have their salaries benched to the top earners in Singapore.
Here is the list from Straits Times
* Lawyer - $4.29 million
* Account - $3.72 million
* Banker - $3.33 million
* MNC - $2.70 million
* Local Manufacturer - $2.30 million
* Engineer - $0.62 million
This is the range of salaries for the top earners
* Lawyer - $1 million to $6 million
* Accountant - $1 million to $6 million
* Banker - $800k to $6 million
* MNC - $300k to $4 million
* Local Manufacturer - $250k to $3 million
* Engineer -$200k to $800k
A minister's salary per annum is more than $1 million.
Looking at the list, surgeons are not in the top earners categories in Singapore.
But that is beside the point. There are so many more people making more money than doctors. But yet few people make a fuss about it. Why?
Why do you begrudge doctors what they earn?
Do the vast majority of doctors do scam work that swindles patients?
Healthcare costs are not just about the salaries of doctors. We have many other non medical staff as well. Medical equipment and drug costs are also very high.
If anything the salary of doctors has stagnated. And given the fact that other professions have powered ahead (see the list above), doctors salaries have declined relatively speaking.
30 years ago, I am sure doctors would be among the top 5 earners in Singapore. No longer so.
I hope this makes some of you happy out there.
As I had pointed out in my suggestion to the moderators to start this discussion, the expectations of the public are simply insurmountable.
"U are very unkind as a dr as not everybody can avoid falling sick."
Certainly, but it is also a fact that many of the chronic diseases can be prevented with lifestyle modifications. Should the fact that some diseases are not preventable be an excuse for people to not look after their own health?
And if you know that some diseases are not preventable, why shouldn't you set aside some money for medical bills? Many things in life are inevitable, like hunger and death - do you expect others to subsidise your food and funeral expenses?
You call me unkind, but you don't want "kindness"; you want to be excused for not looking after your own health and not saving money to pay for healthcare. You want others to take responsibility for your health, when you won't yourself.
You demand kindness from doctors, but what do *you* bring to the table?
Your kind of thinking is the product of a subsidised healthcare system that does not require accountability from patients. Your kind of thinking is why subsidised healthcare must fail.
Vince, old friend,
Typical thinking indeed. :)
People like concerned Singaporean expect us to put in effort to become and stay current as doctors, yet are unwilling to pay us our dues - will they do a job like ours and take less pay?
Is it "unkind" to demand to be paid what we are worth? Well, let's turn the question around: what right do you have to demand that we be "kind"?
Too long have the profession been held hostage to the ideal that we must be "kind". I reject that. We have a duty of care, we have a code of ethics, but we do not have an obligation to be "kind", especially since "kind" just happens to mean acceding to whatever demands you are making on us.
You mentioned Parsons' Sick Role in your post, old friend, and I think it's something we need to continue to bear in mind. The current subsidised healthcare system allows patients to demand all the rights due them under Parsons' model, but not take up any of the obligations. This is the cause of many doctors' unhappiness. This is why subsidised healthcare must fail.
Doctors are also human, we get frustrated just like any other person. If those people think that doctors lead such good lives and get paid such big salaries, why don't these people strive to be doctors themselves? Frankly the public perception that doctors make a lot of money is misplaced. Yes, we live comfortably but as another poster posted above, doctors are hardly top money earners. I am not a surgeon myself but I know the amount of training and work that surgeons put in, so if they earn much more than me, so be it because they have made that choice for themselves and worked hard for it. Learn to live with your life choices and be happy with it. To be jealous of doctors and to attack doctors who are mainly just trying their best to help patients is frankly not the most matured way to behave.
Subsidised healthcare still has its role here.
The thinking behind the 3Ms was good and I'm very sure many Singaporeans have benefitted from it throughout the years.
Many would no doubt have landed up in greater trouble for not being able to finance their hospitalisations without medisave & medishield.
It is precisely the realisation that many Singaporeans cannot be 'trusted' upon, by themselves, to save up for their own health financing that there is a role for Medisave.
It appropriates a percentage of CPF contribution every month to be used when one needs to pay for expensive hospitalisation bills. I think this concept of health savings account is a good one and which many Western countries are studying and hoping to put in place.
With medifund, even those who are facing financial difficulties will have a safety net to ensure they still get cared for in the hospitals.
However, I agree whole-heartedly with some of you that with any system, there's bound to be limitations---in this case accessbility/waiting times. Personally I find the waiting times for non-emergency consultations fair and adequate. If someone wants to 'jump' the queue and has their non-emergency conditions checked upon 'urgently', there's always private sector specialists / as private paying patients in the restructured hospitals.
I always remember this anecdotal quote I've heard before, "If you can pay like a King, by all means have the best and the fastest....."
I think NUS has failed in producing doctors like angrydr who obviously is in it for the money and not to help poor patients get better when they are sick
"You demand kindness from doctors, but what do *you* bring to the table?"
If money is so important, go be a banker or lawyer. Doctoring is a calling and should be restricted to the caring so that they need not resort to exhorting huge amount of money when patients are sick and desperately in need of care.
What ever happen to the kind and patient doctors of the past? Why are there doctors like angrydr who blame patients for getting sick and demand his "dues".
Lucky for us, our far sighted government has decided to flood the number of specialists in Singapore by shortening the training.
Let us pray that greedy and uncaring doctors like angrydr will change profession when he no longer finds it profitable to remain as a doctor.
by angrypatient
before i start, i must say that I am not against the subsidy of healthcare. but it is true that healthcare in Singapore is abused by the very people it is supposed to help.
how many people visit the A&E in the middle of the night for problems which can wait, or simply for problems which they couldnt be bothered to do anything about till the last minute?
for the people who have numerous diseases, how many of them can actually be prevented by simple lifestyle changes? think heart disease and diabetes.
people should be made to take responsiblity for their healthcare. for far too long have doctors been made a scapegoat for poor health of the patients. In some cases, what can doctors do if the patients refuse to help themselves?
It is one thing for doctors to be kind, but it is another thing to expect doctors to give up everything they have for the sake of helping people who don't help themselves. for the amount of work that doctors do, it is unfair to expect more without wanting to pay more.
subsidies are important and must stay, because not eveyrone can afford to pay. but lowering healthcare costs in the face of worldwide inflation and rising healthcare costs in almost every country is impractical. Do people think singapore is immune to such global infulences.
The way to go is not to cut costs per say, but rather to lower the abuse of healthcare.(i count not taking care of oneself as abuse as well)
It looks like this new residency system is a way to flood the system with specialists.
Supply and demand laws dictate that should lower the increase in salaries of specialists. At least the median specialist salary should stagnate enough.
That would be good for healthcare costs.
I was talking to someone (non-medical) about this. His immediate reply was "Good! You doctors are making too much money already! It's about time the government did something about it"
I don't get it. It seems like it is a crime that doctors are well paid.
Is it a crime? Explain to me how much you want doctors to earn? How much should a surgeon earn?
Someone once told me he felt that doctors should earn no more than taxi drivers. But he did not explain why. He just *felt* that way.
So much anger. So much begrudging.
Why do greedy drs miss the point?
You are not supposed to be making money out of patients who are suffering!
Everytime I see a specialist, the nurse will ask me whether I have insurance or not. She suggest I go polyclinic as she thinks I can not afford to see the private specialist. I feel so insulted.
If that specialist is so rich, why can't he treat me for free or charge less? Did he go medical school to become rich or did he go medical school to help the suffering.
I am disappointed with the private healthcare in Singapore and hope that the flooding specialists will ensure specialist care remains affordable in Singapore.
angrypatient,
I anticipated your kind of reply when I wrote my comments.
"... angrydr... obviously is in it for the money and not to help poor patients get better when they are sick"
I help patients get better when they are sick. I am good at what I do, I am proud of what I do, and I do not feel guilty being paid the amount I do to do the work I do.
If you stop paying me, I will stop doing what I do, because I need money to pay my bills. I am not ashamed to admit that. Ask any doctor you meet if they will work for free, and see how many say they will.
"Doctoring is a *calling* and should be restricted to the *caring*..."
Typical words used by those who wish to blackmail us into giving more without paying more in return.
Well, here's news for you: caring is not going to make patients better. Good medical knowledge and skills, good medical equipment, and good medicines do. These are things of value. Why should anyone expect to receive them without offering something of value in return?
"... so that they need not resort to exhorting huge amount of money when patients are sick and desperately in need of care."
Am I "extorting" huge amounts of money? Do you even know how much I make? What, in your opinion, is a reasonable amount for me to make, so that I will not be "extorting"? If the sick are "desperately in need of care", and I care for them, how much should I get paid?
"Why are there doctors like angrydr who blame patients for getting sick and demand his "dues"."
Because oftentimes patients are responsible for their illnesses, and because all men who have something of value to offer deserve something of value in return.
"Lucky for us, our far sighted government has decided to flood the number of specialists in Singapore by shortening the training."
Against an also rising population of patients. What makes you think demand and doctors' pay will become lower? :)
"Let us pray that greedy and uncaring doctors like angrydr will change profession when he no longer finds it profitable to remain as a doctor."
And leave you with only those who can only deserve the lowly pay?
You don't want to pay for quality healthcare, yet you want to receive it. To that end you call medicine a "calling", and accuse those who will not trade with you in those terms as "uncaring". You seek to use our virtues to bind us to service. Well, I reject your construct, and I call for more doctors to do so too.
"You are not supposed to be making money out of patients who are suffering!"
"If that specialist is so rich, why can't he treat me for free or charge less?"
I'm sorry: are you serious, or are you being sarcastic.
I really can't tell.
May I suggest that the moderators do a poll on the blog site to see what level of pay for doctors is *acceptable* ?
"If money is so important, go be a banker or lawyer. Doctoring is a calling and should be restricted to the caring so that they need not resort to exhorting huge amount of money when patients are sick and desperately in need of care."
This is the sort of begrudging that only applies to the professions that evolved from the vocations the Catholic Church used to provide.
Health care (read healing monks), leadership (read the clergy) and teaching (read the christian brother schools and convents).
And so it is ok for bankers and lawyers to make obscene amounts of money, but not ok for doctors to earn a good salary.
Why? Because in the vocations in the past all these were provided by the Church for.....err....FREE.
I'm a Polyclinic doctor. And I earn less than a teacher. I guess that puts a smile on everyone's faces.
But it's ok because I do view my work as serving the people. I trade on the financial markets during out of office hours and make far more money than what I earn from my day job.
I know what some of you will say. I should work as a doctor for free then.
Well then maybe we should ask bankers and anyone who is rich enough to study medicine and be doctors!
"The way to go is not to cut costs per say, but rather to lower the abuse of healthcare.(i count not taking care of oneself as abuse as well)"
Well, that simply won't happen, my colleague.
No one has the moral courage to combat abuse. You cannot cut cost by lowering abuse rate - you can only lower abuse rate by *raising* cost.
If it cost $60 to see a GP for a minor illness, how many people will continue to visit one to get an MC on a day they don't feel like going to work when they are not actually ill?
If a nebuliser treatment cost $200 a cycle, how many patients with COPD will continue to smoke? (For that matter, if a pack of cigarettes cost $50, how many smokers will still find it "impossible to quit"? How many teenagers will be able to afford it?)
The equation is simple: something of value in return for something of value.
Healthcare has value. If you want it, you must offer something of value in return. This can be either taking care of your own body, or there being no other convenient measure, money, which is the accepted currency for value in our society.
You cannot stop abuse - you can only make it so costly for them they would rather take better care of themselves.
"I'm a Polyclinic doctor. And I earn less than a teacher."
I think I know which cluster you work for... :)
"I trade on the financial markets during out of office hours and make far more money than what I earn from my day job."
I am calling you a liar - you probably trade during office hours too! :)
But seriously, do tell us if your patients at the polyclinic hold the same sort of opinion as the people who have posted on this thread.
To angrydr
I think you should not be so honest in the public.
"If you stop paying me, I will stop doing what I do, because I need money to pay my bills."
This statement sounds overly harsh even if it is true.
There is a certain public image that doctors are supposed to project.
My 2 cents worth.
Fellow Singaporean doctor
I think patients who go to the Polyclinic know that the doctors are lowly paid.
While most are financially challenged there are some who definitely earn more than the doctors (eg teachers) Haha!
So the patients don't begrudge them so much. (What's there to begrudge when they earn less than you right?)
I think this is what people want with specialists. They want the specialists to also earn roughly about the same as them. In other words middle class salaries.
There are many aspects and problems with healthcare. High expectations. Campaigns to have low wage doctors. etc etc
I think the government has hit the jackpot with this new residency program.
From what I have heard, there are ample training posts for most. So everyone gets to train to be a specialist. But not everyone will be a consultant. Increases the competition, supposedly produces better doctors that way.
But from the economic point of view it also means increasing the number of specialists overall.
What happens to the many specialists who cannot get a consultancy post then? Well they go private. And then that increases the competition in the private sector.
It is already happening. While you might paint a very rosy picture of the private sector, you won't understand what it is until you get there. No bed of roses. Competition is very fierce.
Despite the increase in Singapore's population, I think the overall effect of this new scheme is that there will be a rapid surplus of specialists trained per year and after several years we should see some of the aforementioned effects on cost.
Put it this way. Now with it being straightforward that you have a chance to be a specialist but just that there is no guarantee of a consultant post, almost every medical student will choose to be a specialist. No more GPs.
And I don't for one bit believe that the government is silly enough to do this and allow healthcare costs to spiral because of the increasing number of specialists.
Slightly bigger pie. Just have a lot more people to share that pie.
The problem of too few HOs and MOs to do the "dirty work" is also solved now that effectively, each new graduate dr will have to be HO/MO for 5 years.
This is not the end of medicine of course. But things are just going to get tougher. Perhaps it is also good because then we can truly have all those people who don't need any money from medicine to be doctors.
angrydoc, you ever work in polyclinic or not? Where got time to trade stocks!? Don't be crazy man.
Fellow Singaporean doctor,
Obviously things like this need to be spelt out because there are patients who ask:
"why can't he treat me for free?"
Why should we perpetuate the idea that it is OK for them to make such demands on us as if it were their right to, while our lot is only to give because we are "kind" and "caring"?
"If that specialist is so rich, why can't he treat me for free or charge less? Did he go medical school to become rich or did he go medical school to help the suffering."
I really find it incredulous that someone can actually post something like that. I don't know whether to laugh or to feel sorry for the person who wrote the above quote.
On another note, from the few posts of non doctors, even with our relatively low cost of health care compared to many other developed nations, it is apparent that a lot of the public are very angry and frustrated with health care cost and seem to think that it is mostly attributed to doctor's salaries and are calling for doctor's salaries to be reduced. I can only foresee more complaints and begrudging in future, as like one poster previously said, that the expectations of the public are simply insurmountable.
Actually, I do earn enough for me needs, and I'm not asking to be paid more despite what I wrote earlier.
I am asking for healthcare costs to become higher to reflect its true cost and value, which in the context of our country means less healthcare subsidy.
I think if someone who sees me at a subsidised clinic can accuse me of 'extorting' money, something is very wrong with the way we price and value healthcare.
To: angrydr
Let put it this way, you have a blog. They can trace you and suspend you for saying things unbecoming of a doctor.
Anyway, hope you dont get into trouble. Dont waste your time on the public who thinks that doctors are greedy.
It is our conscience that is important
Regards
"Why should we perpetuate the idea that it is OK for them to make such demands on us as if it were their right to, while our lot is only to give because we are "kind" and "caring"?"
Dear angrydoc,
......it is because this what doctors do!
Your own doctors also feel that way. Shame on you angrydoc. I believe that the majority of doctors are good and they would happily work for low wages because the non-monetary rewards far outweigh the monetary.
Doctors should just take whatever salary they are give. Trust the government give you a fair money. We angry is with the government over-paying doctors. Pay too much lah.
Medicine is still a calling for you doctors mah? If is, then honor traditions lah. If not, then all admit and move on. You cannot one moment have one doctor talk about face the facts of life another time is talk about high esteem blah blah.
You all seemed confused lah. So be doctor is want to help people or earn money? You can say can be both. ok lah but say the truth.
Which more more important to you angry doc? Your salary or helping people?
To angrydr,
You are a doctor and obviously to you, healthcare cost is low in Singapore but many Singaporeans are not rich and they feel it whenever they see a doctor whether it is subsidised or not.
I do hope that you belong to the minority as most of us want healthcare costs to become lower with more healthcare subsidy.
If you are rich, please dont show off and boast that you can afford healthcare in Singapore. The fact is many Singaporeans fear falling sick as they would not be able to work and their meagre savings will be used up by hospitals and doctors.
"They can trace you and suspend you for saying things unbecoming of a doctor."
Suspend me for saying I will stop working if they stopped paying me?
I woud like to see that... :)
"We angry is with the government over-paying doctors. Pay too much lah."
Really? So how much do you think I make? How much do you think I *should* make?
"... most of us want healthcare costs to become lower with more healthcare subsidy."
You would, wouldn't you? I too would like food, petrol, clothing, property, utilities etc. to be cheaper with more subsidy, never mind who pays for the difference.
"The fact is many Singaporeans fear falling sick as they would not be able to work and their meagre savings will be used up by hospitals and doctors."
They fear falling sick, but what are they doing about it?
What do they do to reduce their chances of falling ill?
How much do they put aside for healthcare expenses each month?
You paint the picture of an impoverished population who can do little to fend of diseases and risk dying for a lack of medical care, but in reality we have a large middle-class population at risk of chronic diseases which can be prevented or controlled with lifestyle modifications.
You talk about needs and entitlement, but not about responsibilities.
"Doctors should just take whatever salary they are give. Trust the government give you a fair money. We angry is with the government over-paying doctors. Pay too much lah."
Another incredulous comment. So your boss or the government also can give you whatever salary and you will accept? So what kind of work do you do and how much are you paid? Should your salary be reduced as well? How do you know the government is overpaying doctors? Do you have any figures to back you up?
I swear, Vince75, sometimes I can't tell if these comments are genuine, or just trolls trying to irk us. :)
"Doctoring is a calling and should be restricted to the caring so that they need not resort to exhorting huge amount of money when patients are sick and desperately in need of care."
I wholeheartedly agree with this, just that people should not use this to apply to the private sector specialists/GPs.
If you are "sick and desperately in need of care", as grave as your situation is, you can simply seek treatment with any public A&E where you can have a battery of tests including CT scans and blood tests done at a fraction of the costs that they would be normally. You will be attended to in good time, though not immediately. No patient is denied treatment even if he cannot pay. There is no doctor to "exhort" (sic) money directly. We are not paid per patient. And we are already paid less than any government stat board degree holder of similar years of experience.
You may then be admitted with a heavy government subsidy. You will then be investigated and treatment administered as the urgency and priority of your case entails.If you need a scan or treatment urgently and with high priority; rest assured, it will be arranged with great haste. In other words, if you are "sick and desperately in need of care.", care will be given appropriately asis medically indicated in any public hospital/polyclinic.
This is where the problem arises. The practice of medicine has evolved from simply providing care to patients as doctors deem fit, to patients expecting a full workup aspatients(and family members) themselves deem appropriate--a full fledged service industry. Maybe its a Singaporean kiasu mentality. Maybe its a government policy backlash by transforming hospital service policy as so. So many patients these days complain because of the long waiting time for non urgent investigations or treatment. We are still providing the best available care. Its just that patients fail to accept that their case is just not as urgent as others' are. Its actually quite selfish, really, to kick a fuss to be at the head of the queue when to do so means somebody with a more serious condition would be denied of that priority slot.
Enter the private specialist/GP. You pay several times the rate over subsidised care. But your investigations and treatment can be rushed all within a matter of hours in a more comfortable setting. You are paying for an additional service to accelerate the treatment and investigation outcome; the urgency of which may not be strictly medically indicated. You are paying for convenience, comfort, and kiasu/kiasee-ness. The outcome usually is the same. Both sides of care will relieve the sick and suffering.
The public should not begrudge those in the private sector for charging high rates. Its not extorting money. You're willingly paying for immediate service and a specific comfort level of care.
The standard of care in the public sector is of international standing. It is fairly affordable (to generalise) but i'm well aware that affordability is subjective and warrants an entire discussion in itself. But no extortion goes on in either side. We all strive to relieve suffering as we have sworn to. And we will do our best.
do health administrators take some sort of pledge before they start work?
What about health minister?
After all they are really the ones who can directly control health care costs as they formulate policies.
Health administrators also earn a lot of money. Is it better to pay them more than doctors?
c,
Nobody chooses to fall sick. Spending on health care when sick is like being forced to do so. Why should we be made to pay so much for something I never wanted? I need it. I don't want it. That is why we feel so unhappy. And doctors are earning too much that is why the costs are so high.
It is very sad when we see rich people who are sick getting better treatment. Doctors all talk about equality and how they are here to help and care for the sick. But they will care for the rich sick better and faster.
This is something difficult to stomach. And when we listen to doctors proclaim all their morals and values it becomes a joke.
"Nobody chooses to fall sick. Spending on health care when sick is like being forced to do so. Why should we be made to pay so much for something I never wanted?"
Well, no one chooses to become hungry, so by your analogy spending on food when hungry is like being forced to do so, and you should be unhappy with farmers and bakers? I mean, Breadtalk is big business, isn't it?
People fall sick. That is inevitable. What are you doing to reduce your chances of falling sick, and if you know you will fall sick, how much are you putting aside to pay for healthcare? Or do you expect others to pay for your healthcare? Or do you expect to receive it for free?
"... doctors are earning too much that is why the costs are so high."
"It is very sad when we see rich people who are sick getting better treatment."
So in your ideal world doctors earn little and the rich cannot buy better treatment with their own money?
By what right do you dictate how much a doctor can earn by offering his knowledge and skills?
By what right do you dictate that the rich cannot buy better things in life with the money they earned?
I agree with you man
If doctors are willing to lower their salaries, I am sure healthcare costs will spiral downwards.
Look at US and you see why they are trying to control the salary of doctors there.
Quotes from Obama
“Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. ... The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out,'” as the President addressed a prime time news conference, adding, "Now, that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change; maybe they have allergies. Maybe they have something else that would make a difference
“Let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.”
Let me further illustrate how morally untenable the position of some laymen hold here are:
You value your health, yet you do not want to pay for it.
You value your money, and you would rather spend it on other things than healthcare.
Yet at the same time, you do not wish those who provide you with healthcare the benefits of having more money.
You do not wish those with more money than you to be able to buy better healthcare.
In short, you want money and the benefits it can bring you, yet you do not want others to enjoy the same.
Don't you think you ought to re-examine your position?
I think C has said it very well with his illustration of public and private service.
But yet there is a guy who says:
"Nobody chooses to fall sick. Spending on health care when sick is like being forced to do so. Why should we be made to pay so much for something I never wanted? I need it. I don't want it. That is why we feel so unhappy. And doctors are earning too much that is why the costs are so high."
The guy above obviously does not value health but yet knows that he needs it and does not want to pay so much. Well if he does not want to pay so much, there is always the polyclinic and A/E available for settling minor and more serious/urgent cases respectively. Just that waiting time will be longer (of course waiting time will be reduced if the case is truly urgent in the A&E) and service may not be so personalised but treatment will be adequate and appropriate. Is it so difficult to understand the trade offs?
How can everything be fast, good, safe and cheap at the same time?
Hi angrydoc, spacefan!
You guys are still around!
Things looks like they have gotten worse haven't they?
Take care.
With regards to the quotes from Obama, there is this reply:
http://docsurg.blogspot.com/2009/07/blog-post.html
with all this talk about how much doctors earn.
seriously, do you all have any idea how much we earn? do you all have any figures to back you up?
the public has this impression that doctors earn a lot, and cannot seem to shake off this long expired myth. Take a look at the salaries that top doctors earn, and you realise they earn peanuts compared to other professions.
what you all have is simply long outdated figures from decades before, when it was true that doctors did earn qutie a fair bit, but times have changed so please move on.
I am not complaining that doctors earn too little, but rather, people should stop accusing us of behaving like thieves. We work hard for a living, just like anyone else.
To keepad
Someone actually compiled data on 100 best paying jobs in Singapore
http://www.salary.sg/2009/100-best-jobs-in-singapore-2009/
1. Specialised surgeon - $27,977
2. Managing director - $26,444
3. Personal banker - $20,238
Look at number 1 and I rest my case.
Even personal banker earn less than a surgeon.
Regards
The pay structure for bankers is heavily dependent on their bonuses.
The salary above does not include bonuses.
Bankers tend to have bonuses ranging from 6 months to 18 months.
Same for MDs. Surgeons rarely get bonuses. You go do the maths.
Someone posted that the Ministers peg their salary to the top 5 earners in Singapore. I distinctly remember doctors were not in the top 5.
I doubt the accuracy of the list.
General Physicians are listed as earning $6,085.
Chinese physicians, on the other hand, earn $7,043.
So who are greedy and uncaring now? :)
Since the guy wants to use the list as truth, then let me state there are definitely much more general physicians than specialised surgeons. So are doctors as a whole still considered highly paid?
Hey Angry doc
I am a chinese physician and I find your remark offensive.You should compare specialised surgeon pay of $27k to our pathetic pay of 7k. That is almost 4 times our pay.
Stop calling us greedy and uncaring!
医者父母心
We work hard for a living also and we still send our patients to you for mc so stop looking down on us!
Anon,
How can you claim "医者父母心" when you earn more than General Physicians, who are already earning too much?
By my readers' logic, that makes you less caring and greedier than 'western' doctors.
Perhaps you should take my readers' advice and treat them for free or for less.
As a layman, I agree that doctors nowadays do not earn as much as similar grade doctors say 30 years ago. However, this does not mean they are presently not comfortably paid, as angry doc admitted.
Everything is relative, really. Imagine the average income of a doctor in country A is $X while other graduates are paid $0.2X. Now imagine another country B where doctors are also paid $X but other graduates are paid $2X. Assuming the cost of living in both countries is the same, the doctors in which country will feel "under-paid"? The moral of this story is: Do not compare, try to be contented with what you comfortably earn and you will live a happier life, with less anger.
Be a little more compassionate with some of your patients who mistakenly think that a doctor's pay is the only thing that pushes up heathcare cost. There are too many other factors for an ordinary patient to understand. They are just expressing their frustration with the system, that's all. No need to take it too personally.
Everything is personal, Faircomment.
The posters call me greedy, unkind, and uncaring, and I am still supposed to be "compassionate"? Isn't this the same kind of thinking behind those who call for doctors to be paid less because it's "a calling"?
I reject that. I take every accusation made at me personally, and I call for those who make them to substantiate their accusations.
"Be a little more compassionate with some of your patients who mistakenly think that a doctor's pay is the only thing that pushes up heathcare cost. There are too many other factors for an ordinary patient to understand. They are just expressing their frustration with the system, that's all. No need to take it too personally."
Well Faircomment, most of the time we try not to take it personally, but there comes a time where a stand must be taken against some of these wrong beliefs of some laymen, which if allowed to perpetuate will result in more negative perception. And it's hard not to keep it personal when these people use harsh words :)
And coming back to expectations and service quality, it's not uncommon for harsh words to be uttered especially in the public healthcare sector where the staff have to put up with so much nonsense as depicted above in the main post by spacefan and many other scenarios not listed.
Hopefully these people can be educated appropriately with respect to their expectations in time to come.
Well Vince, they won't take care of their own health and don't want to pay for healthcare, but expect us to be "kind" and "caring".
They want to spend their own money on other things in life, but expect us to earn little, and expect our tax money to subsidised their healthcare.
They won't get their facts right before levelling unfounded accusations at doctors, but expect us to be "compassionate" when we point that out.
Such is the moral bankruptcy our subsidised healthcare system has produced. What makes you think their expectations will change as long as things remain the same?
Subsidised healthcare must fail.
To angrydr
Who the hell do you think you are?
Why do you assume the sick spend their money on other things in life?
The fact is nobody wants to be sick. Nobody plans to be sick and whatever subsidy our PAP master gives us, we are eternally grateful for their help.
For a nobody like you to suggest removing subsidies for us piss me off.
You should see a doctor to have anger management and stop inflicting misery on your patients.
I hope SMA trace your blog and kick you out of the profession.
You are not fit to be a doctor!
To the chinese physician,
In case you are still reading, I would like to clarify that my comments directed at chinese physicians are not meant to offend, but to illustrate the absurdity of the view held by some of the readers.
I do not look down on chinese physicians becaue of how much or how little they earn, although if you read my blog you will know my views about TCM.
Thank you.
Anon, are you here to point out factual and logical errors of my arguments, or are you here just to tell me you don't like what I am saying and to wish me ill?
"Why do you assume the sick spend their money on other things in life?"
I do not assume, anon, I know. I know because I see patients. I see the lifestyle chocies they make. I see the way they spend on non-essential things, and then complain that they cannot afford healthcare. I see them spend on things that are injurious to their health, and then demand waiver or Medifund when they fall ill.
They smoke, they drink, they eat unhealthy food, all of which they gladly spend on, then complain about the costs of medicines.
Their excuse? They didn't *plan* to be sick.
Why do people keep repeating the fact that "nobody wants to be sick" as if it were an excuse to relinquish responsibilities for one's own health and healthcare?
Nobody wants to be hungry. Nobody wants to be homeless. But at the end of the day, you *know* you will be hungry, and you know you will need shelter.
What are you doing to take care of those needs?
You work, you earn money, you save some of that money, and you pay for what you consume.
Why should it be different for healthcare?
Nobody plans to be sick?
So what?
You not planning to fall sick doesn't change the fact that the things which are required to make you better *cost*.
If non-intention is license to absolve oneself of having to pay for what one needs, does that mean that I can take food from the farmer or baker for free, because I didn't *plan* to become hungry?
Does that mean that the chef should cook for free for me, or not expect to make a profit from cooking?
Does that mean that *you*, or other taxpayers, should subsidise my food, because I didn't *plan* to become hungry?
You haven't pointed out any factual or logical error in my arguments, anon, but only further exposed the moral bankruptcy behind the thinking of those who demand subsidised healthcare.
Thank you for commenting.
hey everyone, i wrote an article in a blog about this. i'm posting an excerpt from the article here.
For one, the fees for medicine are exteremly high as compared to other faculties. Based on the latest figures obtained from NUS which can be found here:
https://share.nus.edu.sg/registrar/info/ug/UGTuitionCurrent.pdf
Fees per annum hover around $100 000. After the grant from the government (thankfully), it drops to around $19 000. In 5 years, that would make roughly $95 000.
The last I heard, the best way to earn money is to not be owing any in the first place.
Given that the medical faculty in Singapore does not discriminate its admissions, most medical students would have to work to pay off the $95 000. Let us then look at the pay that we all get/will be getting.
Check out this article from the MOM website:
http://www.mom.gov.sg/publish/etc/medialib/mom_library/mrsd/row_2006.Par.60775.File.tmp/2006Wages_table11.xls
Not too bad I guess, slightly above what are all our friends are getting but throw in the mountain of debt we have to clear, and you can understand why things aren't as simple as they look.
At this rate, the only ways to clear off the debt yourself ASAP is probably
1. strike TOTO/4D. but given that you probably used up all your luck trying to get into medical school, option 2 would be a better choice
2. if you're the kind looking for instant gratification, robbing a bank would be useful I guess
Assuming you do strike lottery or rob the bank. Money doesn't come easy as a doctor. Again, check out these numbers from MOM.
http://www.mom.gov.sg/publish/etc/medialib/mom_library/mrsd/yb_2008.Par.65502.File.tmp/mrsd_2008YearBook_7Jan09.pdf
As a general physician, you take home around $5000. It's not bad I would say, compared to other professions on the table.
the bottomline is, like i've mentioned, we all work hard for a living. we don't rob the poor, or feed off the rich. Singapore is a meritocratic system that rewards those who work hard with money. Why should we be any different? after all, don't we all live under the same laws?
Indeed.
They need a product they cannot themselves produce, yet are unwilling to give something of value in return; what is more, they do not wish those who produce the product rewarded.
Why shouldn't they give, you ask? Because they didn't *plan* to fall sick, they answer.
Why shouldn't we be rewarded? Because ours is "a calling", they reply.
They want all the benefits of the system, without the responsibilities, while we must bear all the responsibilities, but receive none of the benefits?
I reject that. I reject the system.
keepad,
You post also exposes the myth that the medical profession "owes a debt to society".
"What debt?" I ask.
Do local grads not serve a bond, or if they do not, do they not pay their bond?
If we are paid with tax money, are not other government employees?
If we make money off others' needs, do not also those who produce food, clothing, shelter, and provide transport?
If we owe a debt to society, then we all owe an equal debt - why should our payment be more onerous?
(Actually, I do think that we owe a debt to society - I'm just waiting for a doctor to point it out here.)
I think some comments by Singaporeans here are ridiculous.
They want excellent healthcare from dedicated, well-trained doctors BUT would like doctors to charge them bargain prices.
I wonder if they carry the same logic to their financial managers or lawyers.
BE REALISTIC ! - Doctors spend from 5-10 years training before they start making decent money on par with their peers in other industries. Doctors have every right to be paid what their education and training is worth ! We have to provide a decent standard of living for our families too !
In most developed countries doctors earn 3-5 times national average wage. Taking a look at our doctors salary we are NOT well paid !
If Singaporeans think healthcare is expensive LOBBY the government. We sit on billions of dollars of investments that they throw recklessly at useless companies (Citibank, ABC Learning etc). Ask for free healthcare!!! But becareful what you wish for. Cheap healthcare never equates to good healthcare.
On another note I wonder why Spore doctors do not strike against the government ? Group together and lobby for better wages/work environment. Aussies do it all the time and get what they want. Its called industrial action. I'll like to see LKY pull the same trick on us like he did with the SIA pilots. Sure kick us all out and replace us with FT doctors. Let's see how that will work out lol.
The days of the altruistic doctor is over. Time to stand up and fend for ourselves.
Dave is another greedy doctor who want a pay hike.
He should be suspended from SMA for inciting doctors to strike against the government. Luckily, the majority of doctors I met so far are not like him and serve their patients well and not squeeze every cents out of their patients.
I hope LKY takes note of his open challenge to him and strip him of his medical license.
We need more altrustic doctors and not selfish doctors like Dave.
A strike in the conventional way won't work, Dave - if anything doctors' pay in the public sector has increased tremendously over the past decade, but you cannot say the same of the morale.
The problem with the system lies not in how much doctors are paid, but in how much patients are made to pay. Merely increasing the doctors' pay without increasing how much patients pay will not alter patients' expectations and health-seeking behaviour. In fact, all that does is to increase the taxes we pay so they can continue to abuse the healthcare system at the current fees.
As long as the true cost of healthcare is hidden from patients, as long as patients are shielded from the true cost of healthcare, the true cost of healthcare will be distorted, and you can continue to expect a continued pattern of people being irresponsible for their health while expecting others to pick up the tab.
Fortunately, we already have a means of striking, and that is leaving the system. If every doctor who is no longer compelled to remain in the system quits it and enters the private sector, then the system will fail.
Pay may not necessarily be higher in the private sector then, but then you will be able to charge a fee you think you are worth, and you have the right to not see any patient who does not compyl with your advice (yes, except in emergency situations you are not compelled to continue a doctor-patietn relationship you do not wish to).
When the subsidised healthcare system becomes an unpalatable one, and when the private healthcare system demands that you either take care of your own health or pay heavily for it, then will they feel the effects of our 'strike'. Only then will they alter their behaviour.
So you see, ironically, improving conditions in the public sector in fact leads to worsening of the problem!
The subsidised healthcare system must fail.
@ Anonymous
There we go, another zealous government supporter who considers anything that opposes the policies of the bureaucrats and politicians and LKY unquestionably blasphemy. If you think medicine is all about professional volunteerism, I have seriously nothing to say to you. And if you really want to bring up the issue of LKY, I hope he stops imposing his whims on an entire society. He should have stepped down a long time ago.
In any case, I think it is unrealistic for us to strike. Our industry is extremely critical and even a single day strike will have disastrous consequences. Anyway, it is typical in other countries to try every recourse before resorting to a strike. We need to pressure the government to open up to criticism and feedback instead of forcing their policies down doctors' and patients' throats.
Just a frank word of warning to all the doctors posting here.
Be careful. This blog is monitored closely.
Some of the things being written here are extremely inciting.
Take heed of my warning.
From what I know, doctors will never have the upper hand. There is no point in writing these things if you are not prepared to back it up with action. And from what I know about Singapore doctors, it is they are self centered. Threaten their individual well being and they will back down individually.
Forget it guys.
i think medical school fees have gone up rather significantly over the years, and the so called increase in doctors' salary simply isn't comparable. won't be surprised to find that medicine faculty produces the largest proportion of graduates with huge debts.
"i think medical school fees have gone up rather significantly over the years, and the so called increase in doctors' salary simply isn't comparable."
I don't see your point. A doctor doesn't have to look at how much the tuition fees have gone up over the years, only how much he paid when he was in medical school.
If I had to pay *today's* tuition fees with the houseman pay *I* got, it would have been a hand-to-mouth existence; but I didn't have to.
Certainly your total salary in the first year exceeds the fees you paid in your first year in medical school, and it can and will go up from there.
I don't think we should harp on how high tuition fees (after grants) are given that our careers as doctors are easily five times or longer than our stints as medical students, and how by the end of your fifth year as a doctor your annual salary is probably double your annual tuition fees, and by the end of your tenth at least doubled again?
For once I agree with angry doctor.
Stop using your high tuition fees as excuse to extort money from your poor patients.
High tuition fees equal high subsidises from our government and the least you can do to repay PAP is not to ask for pay hike especially when our economy is not doing well.
If doctors all take a pay cut, this will reduce the medical expenditure of Singapore and patients will not need to pay so much to seek treatment.
http://polyclinic.singhealth.com.sg/OurServices/FeesandCharges/
Now in polyclinic I have to pay $9 to see a doctor. That excludes x rays, blood tests, and medications.
I do hope whoever is monitoring this blog takes my suggestion seriously and cuts the fat in doctors salary so that healthcare remains affordable to poor Singaporeans.
From a hopeful Singaporean
Well, hopeful Singaporean, I disagree with your conclusion.
You tell us that it costs $9 to see a doctor at the polyclinic; this makes we asks two questions:
1. How many percent of your total bill is this $9? If this is not the main bulk of the bill, can you honestly say that cutting doctors' pay will make a big difference in your medical expenditure?
2. Even if we assume that the $9 consult forms the bulk of your bill; how often do you see a doctor?
You will need to see a doctor at the polyclinic at least once a month to chalk up a bill of over $100 a year!
Is $100 a year an "extortion" to you? I am pretty sure you spend more than that on kopi during lunch each year.
Now assuming you do see a doctor once a month, and assuming that doctors cut their pay and consult by 50% (a simplification, since the consultation fees pay for more than the doctors' salaries, but also overheads like utilities and cleaning), this means that you stand to save a whopping $54 a year, or roughly $1 a week!
So are you saying that men and women who have spent 5 years in medical school and many more keeping up-to-date with medical practices should have their pay halved so you can save $1 a week?
Are you honestly saying that this $1 a week makes the difference between healthcare being 'affordable' and unaffordable'?
At the end of the day, is your annual medical expenditure something you cannot afford, or is it something you would rather not spend on? Or do you just want to see people who make more money than you get a pay cut?
Hey angrydr
What is your problem?
Polyclinic charges are low because of government subsidies.
I think annoy is refering to private specialist fees and private GP fees.
If doctors in the private sector cut their pay, soon government may be able to fully subsidised primary care and specialist care in the public sector.
The migration of patients from private to public will cause competition to intensify and lower healthcare costs in both private and public sector.
Soon, patients will no longer fear falling sick and becoming a burden to their family.
Go get an economic degree and stop making a fool of yourselves.
Self professed health economist
Thanks, self-professed health economist.
Let me see if I get what you are saying:
1. Doctors in private practice cut their fees because they want to make less money.
2. Government respond by making subsidised healthcare free, because they want the public healthcare sectors to make even less money than the private sector.
3. Patients migrate from private to public healthcare because it is free. This increases competition in the public sector, who offer even free-er healthcare.
4. The increased competition in the private sector causes doctors to lower their fees even more, but this doesn't matter because they are competing against free healthcare in the public sector.
5. Despite the lowered revenues, the quality of care remains, proving that free, good healthcare was possible all along, except that doctors were a greedy bunch who expected to be paid for their work.
6. Singaporeans no longer fear falling sick and becoming a burden to their family.
7. You get your Nobel Prize in Economics, and Obama hires you as Secretary of Health.
Let me ask you something: can you think of a solution to the problem of Singaporeans fearing falling sick and becoming a burden to their family that does NOT involve other reducing other people's pay or increasing tax spendings?
Thanks.
In fact, lemme guess:
Your solution to housing costs is to have private housing developers charge less for their houses, and for government to fully subsidise housing.
Your solution to transport costs is to have private transport providers charge less for their services, and for government to fully subsidise public transport.
Your solution to food costs is to have private hawkers and restaurants charge less for their food, and for government to fully subsidise food.
Why are you wasting time on this blog? You should be working for EDB or the Finance Minstry or something!
I think there are a lot of clowns commenting in this blog.
Let us not waste time arguing with them.
A lot of green eyes around who complain against doctor's pay, foreign talents stealing their jobs and lack of job security.
Go get some health insurance if you are scared of healthcare costs.
There is no free lunch in this world and get out of my elite uncaring face!
It seems self professed health economist is living in a dream world of his own. His solution is to charge less so everyone will be happy, simplistic but amusing at the same time. He should strongly consider lowering his own salary/profits too so that the clients or people that he is servicing will also be happy too. I wonder why Obama is having so much trouble with healthcare costs in USA when there is someone so brilliant in Singapore to help solve all the problems.
Self professed health economist also said: "I think annoy is refering to private specialist fees and private GP fees." But it is obvious that the previous anonymous poster was NOT referring to private fees when he wrote "Now in polyclinic I have to pay $9 to see a doctor".
It's sad how some ppl can be completely unappreciative towards those who work hard to provide healthcare services, both doctors and nurses. Speaking as if all doctors are evil. Harping on cutting the doctor's pay like it is the only thing that matters, the only problem that exists, the only solution to attain affordable healthcare. Years of education have succeeded to produce a breed of self-centred,single track-minded individuals who accept statistics indiscriminately, ever ready to criticise, but not in the most constructive manner. We should drop this topic on doctors' pay. It's a pointless argument and I like to think that these misguided ones do not reflect the opinions of the public majority...
Hi Annoy
I dont think anyone has a grudge against nurses who are paid lowly and are the backbone to the Singapore healthcare.
What most people are against are greedy doctors who sell sleeping pills, slimming pills, cough syrup or those who provide unproven therapy like the plastic surgeon recently. Even Prof Satku also condemn his action.
It would be nice if you stop thinking too highly of yourself.
We are not self-centred, single track-minded individuals. If doctors cut their salaries like in UK and US, the savings in healthcare will go to the poor patients who cant afford healthcare currently.
Those who calls for a reduction in medical fees are those who care for society as a whole especially those from the lower income.
As for greedy doctors who prey on their CPF and medisave, I shall not comment further.
Educated, not self-centred Singaporean
"What most people are against are greedy doctors who sell sleeping pills, slimming pills, cough syrup or those who provide unproven therapy like the plastic surgeon recently."
And how do these doctors make healthcare unaffordable to the poor?
To the educated Singaporean:
There's really no need to be upset if you're not one of those self centred, single track-minded individuals i was referring to. In fact I'm on the your side 'cos like yourself, i am against greedy doctors who do not practise good medicine as u've described. I don't think highly of myself, but i do have low regard for those who call for doctors' pay cut on the pretext of being concerned for our society. Doctors are a part of our society too and they work hard for a living.
I'm unconvinced, honestly. All that sentiment does not justify you stereotyping doctors who ask for better work conditions as greedy and self-centered. As a health consumer, you should show care and concern for your health by not overworking your doctors with unnecessary demands for better service and lower costs without allowing them due compensation. You can say that you don't think highly of yourself, but clearly you think otherwise, for you think yourself able to dictate how healthcare should be run without understanding the perspectives of all stakeholders. You're not the government, and even the government does not dictate everything.
angry doc: I SALUTE YOU!!!
you have voiced out the thoughts/ unhappiness of us lowly juniors.
I do suggest that these whingers here (who complain about the health care providers) should go and see a sinseh jikalau tiap tiap hari kow peh kow boo! ;)
To ouny01:
i'm not sure if your comments are in response to what i wrote dated 20 Oct 10:22. I'm rather bemused... wonder which part of the message gave the impression that i'm stereotyping doctors or even dictating how healthcare should be run. In any case, your points are noted.
:). I m an MO with a public sector.
Healthcare is SG in expensive compared to malaysia. Dr in malaysia getting 2/3 my pay pre- conversion. I work 45 base hours, + 24-36 hours extra (call etc) to get my salary. My point is that even i am paid more in SG, i dont feel rich.
My brother in malaysia works the same hours as me, but he can sleep on his call, i work non stop most of the time :( My expenses are way more than him, i spend $3000 a month on transport, rental, food utilies, insurance, family expenses. My brother on the other hand spend abt RM1500 - he has free housing as he is outstation, and pay for petrol and his car instalment.
Can you label me as greedy? I am earning more but spending more as Sg is high expense country. After dedecting all the expenses I am left with $1000++ only. I am renting HDB, use public transport and eat out most of time like most SG.
My grouse is that despite working hard, taking care of patients and abuses from the public, i still cannot afford to get my own place to stay.
Pls keep in mind that the Drs are top of the cream, only the best of the best can get into med school, do we need to at least paid slightly above the median wage for our effort? If you feel otherwise, lets close the medical school, quit and do finance to get better pay :) You can always import FT from india for the hospital.
Cheers and good luck.
Ps: my banker classmate have their own penthouse and he is not even the top of the class.....
So what is your point?
You want more pay?
You want healthcare in Singapore to increase further?
Why are you the only Malaysian that complains that you are not better off in Singapore?
Go back to Malaysia if Malaysia is so good!
PAP stop recruiting ungrateful foreign drs to Singapore and retain more local doctors!
Kudos to angrydoc for having the boldness to air these politically incorrect but well-founded views.
Among the many valid points already mentioned, the government has emphasized certain "quality indicators" that serve to appease the consumer, whilst bringing about (at best) questionable clinical benefit, and increase health care costs for all.
There needs to be an honest conversation in Singapore society about the real cost of health care. Singapore's public health care system provides decent care to Singaporean's and more often than not kowtows to the patient as consumer.
The public has to accept that as in most things one cannot have one's cake and eat it too. If one hopes for a certain service quality as a consumer of healthcare services, one must accept the costs that comes with it. In the public healthcare realm, the patient has every right to expect satisfactory and timely medical care. While satisfactory and timely care for a heart attack should be a 90' door-to-balloon time, waiting 24 hours at an A&E to get a superficial finger laceration or a URTI attended to would not be untimely, nor unsatisfactory from a medical perspective.
That the MOH/Minister may comment on the importance of the "right-siting" of health care and yet is not forward in chiding the public and battling public opinion is unfortunate at best, and duplicitous at worst.
The worst thing that can happen is for more Singaporean Drs to become disenfranchised. If not the McDonaldization of Singapore public healthcare will occur... patients will get their Big Mac (no filet mignon here) with a mandatory smile (hopefully without added ingredients)
Waiting 24 hours at an A&E to get a superficial finger laceration is definitely not acceptable!
This is ridiculous. How will we the layman know whether it is serious or not.
If A and E is really short of medical manpower, then just hire more foreign doctors to reduce the workload.
I doubt anyone of us will ever think waiting 24 hrs for minor complaint is acceptable.
Another point to make is that at a and e, we pay the same rate. Why should I have to wait so much longer even though my problem may not be as serious?
Let's hope that MOH make the right decision and open up the medical field so that we can see more foreign doctors in Singapore. They will have to work under the supervision of local doctors who will help them learn local customs and dialects so they can communicate with the older generations.
Look,I don't think the point is to take the 24-hour waiting time for non-emergency so literally nor is it helpful to raise piecemeal suggestions like opening up the medical sector to more doctors (foreign or local) without having a proper discussion on the implications vs costs vs benefits discussion.
If you have ever worked in the public medical sector, you would realise that everyone is working with scarce resources and time (and getting scarer still with the increasing demands placed on the system). Whilst you may consider your time valuable, your neighbour may regard having low taxes and low cost healthcare more important. At the end of the day, that's the trade off.
Perhaps it is more important to ensure that the limited resources are spent efficiently and purposefully. That, is a systems argument.
Leaving aside examples of rogue professionals, I guess my point is that there is no reason to direct frustration towards (all) doctors because (1) there are ALWAYS exceptions to generalisations* and to make any definitive statements is to reveal ignorance of the other picture; (2)doctors are people with lives and obligations beyond their work and its hardly a fair argument to expect them to except the argument that they should ask for less pay because they are in a morality-based profession (as opposed to capitalist-based).
I think there is no dispute that public medical workers (doctors included) work really really hard so some appreciation and understanding is in order. (see * above)
To anonymous poster above,
At the public/restructured hospital's A&E, your condition will be triaged appropriately. Those urgent cases (eg suspected heart attacks) will be seen first. However, if your condition is minor (eg a superficial laceration just to use back the same example), waiting time can be up to a few hours during busy periods.
If you can afford it, you can go to the private A&Es (like Gleneagles or Raffles), waiting time will likely be shorter.
As for increasing manpower, .. well that would increase health care cost wouldn't it? Already so many people complain that's it's 'expensive'.
"... at a and e, we pay the same rate. Why should I have to wait so much longer even though my problem may not be as serious?"
Wow.
So is it acceptable for the rich man to pay more to be seen earlier?
Or is it more acceptable to you that the poor pay less, but is seen earlier?
Or should the guy who has a finger laceration who came 2 hours before you be seen before you, when you have an amputated hand?
Or is "first come, first serve" always the best priniciple for you?
To Vince75
Are you stupid or what?
If we hire more doctors at lower pay, why will medical manpower costs increase?
I think we should start lowering the salaries of doctors so that medical manpower costs will decrease. The savings can be used to hire more doctors from overseas.
This will help reduce workload for doctors and keep medical manpower costs management.
"... at a and e, we pay the same rate. Why should I have to wait so much longer even though my problem may not be as serious?"
haha, what a joke! wonder what this smart chap has to say if he gets a heart attack one day, but has to wait simply because a poor guy with cough came in minutes before him. After all that guy is paying the same rate....
pathetic.
A typical selfish Singaporean.
Pay for a mrt seat and refuse to give up for the more needy.
Something is wrong with the education of Singapore!
"If we hire more doctors at lower pay, why will medical manpower costs increase?
I think we should start lowering the salaries of doctors so that medical manpower costs will decrease. The savings can be used to hire more doctors from overseas"
If you lower the salaries of doctors, which doctor would want to come here and for lower pay and more work?
public doctors would just leave to join the private sector, and by then please don't complain that the government is hiring too much foreign talent and that you hardly see a singaporean doctor.
To all,
I represent those who feel that greedy, overpaid doctors are the reason behind high healthcare costs. To tackle this problem at its source, I propose the following:
1) Ban people from top JCs/polys from entering and practising medicine. This way, they won't perceive themselves to be underpaid when they compare with their banker/lawyer/teacher/other professional or executive friends.
2) Ban poor kids from becoming doctors. The poor have dangerous aspirations for breaking into the middle-class, and will thus have the seeds of greed planted in their heart.
3) Ban rich kids from becoming doctors. The rich will want to sustain their current standards of living, and have been greedy since birth.
4) Ban all those with families, or who have plans for setting up their own families, or those with any form of debt. People with dependents or liabilities will be compromised and fight for higher wages.
5) Taking all the above into account, I propose that only orphans be made doctors. Even better, we should only take in orphans from state-run institutions, who have been financed wholly by the state and thus obliged to serve the public to repay their enormous debt to us, the taxpayers.
6) To prevent their corruption, all doctors must live separate from the community, away from temptation. They will be like the priests/nuns/monks of yore, living off the food scraps that our patients can't stomach, dedicating the entirety of their lives to the welfare of their fellow man.
7) I also propose that we harvest the organs of those who are no longer able to work. This way, there is an incentive for them to keep on working, and we can also solve the problem of transplant organ shortages in the same breath.
The above can be generalized to other professions which the public has deemed to be greedy and overpaid e.g. ministers, bankers, lawyers, teachers.
overpaid is a simply oversubscribed term, as if the public can provide a figure that's acceptable to every man on the street...
maybe they should simply say "greedy doctors who earn more than me, are the reason behind high healthcare costs.
Finally, a voice of reason! Cramo has truly said it well!!
It is much easier to ignore economic principles when considering how doctors should be compensated, than to consider them as regular people with families to raise and bills to pay. We should just extrapolate the principle to other needs, let's have free housing, free food, free transport.
Well, we've reached 100 comments. I don't think we've succeeded in convincing each other of our points of view, but we did bring to fore the difference in expectations between doctors and the public.
Thank you for contributing.
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