This question was floated at a yakking session at the lounge the other day: should a doctor (or medical group) provide any treatment that a patient requests, as long as he/she is willing to pay for it?
We are not talking about the situation where a doctor offers "unproven" or experimental therapy (although this is probably still the more common situation here - I even know several patients that traveled to Shenzhen for their p53 gene therapy), or the well known but yet controversial healthcare inequities that arise when patients who can pay more get better care. Rather, internet-savvy and/or well-educated patients nowadays may request for medications or therapy that they believe might help with their conditions/illnesses.
This may be particularly difficult when patients have a terminal disease. What do you do when you know that whatever you provide (especially if it is the therapy requested by the patient), the patient will (99%) die without necessarily having meaningfully extended his life?
Some doctors go ahead with the requested therapy, reasoning that the patient knows what he/she is getting into, and anyway, the therapy will only be provided elsewhere (by rival doctors) if said doctor rejected the request. A rare few try to talk the patient out of it, and refuse to provide that therapy when counseling fails. In the private sector, I suppose the equation is more straightforward. There is a chance for a miracle (always good for one's conscience) and anyway, there is revenue to be considered. In the public sector, this is more troubling because resources (doctor's and other healthcare professionals' time, hospital bed and other services) that might be better utilized elsewhere are taken up by such cases - even if this was an A1-class patient. But then the public sector might well be accused of NHS-style practices...so where does one look for an ethical compass in such a situation?
Consumerist Healthcare
Sunday, January 24, 2010 | Labels: consumerism, experimental therapy, healthcare
Subscribe to:
Post Comments (Atom)
57 comments:
A few points :
1) Healthcare is a service industry. We send doctors and staff for service quality training. The customer's satisfaction is paramount. While the customer is not always right, we must not make the customer feel they are wrong. Usually the focus is to try to work according to what the customers wants.
2) Prior to recent changes, SMC would not investigate unless they received a complaint. A customer who has received what he wants is less likely to complain. See point number one.
3) There are certain caveats in healthcare. Some things are laid out clearly eg excessive use of BDZs. Also some treatments will do more harm than good, even death. In such cases it is hoped that doctors will exercise judgment and reject such requests and explain why. However we can understand from points number one and two why some doctors lose track of what they are supposed to do.
4)The medical profession has lost its moral authority. It is now the healthcare service industry. Not the "medical profession". There is a difference. The control of the industry falls in the hands of non doctors. The "professionals" are at their bidding. Non doctors can hold clinic licenses. They "order" employees who are "professionals" to do their bidding. The "professionals" are made to choose between losing their job or pushing the boundaries. In the event of legal issues raised, the "professional" is liable but not the businessman owner.
I know a 40+ year old woman who was diagnosed with metastatic lung CA 2 years ago, with a guarded ( i.e. poor ) prognosis. She and her husband were already seeing an oncologist at public hospital A, but requested I set up an appointment with another oncologist at public hospital B so they could get a 2nd opinion.
When they finally decided to stick with the specialist at hospital A, the reason given was that the 1st doctor was "more optimistic", and therefore willing to institute aggressive therapy to prolong her life.
She was initially given 6 months to live, but has survived 2 years already. However, she's undergone countless rounds of chemo- and radiotherapy, and a few surgical procedures as well.
She now ambulates with some assistance, but is so frail that she stays home most of the time.
I've often questioned the oncologist's aggressive approach to her condition, but it's obvious that the patient and her husband approve of this line of management, and even give testimonies in church that her extended life span is testing her faith but also a gift from God.
Fortunately for them, her medical costs are being borne by her husband's employers, and she is an A class patient.
In this case, their religious beliefs probably played an important part as well.
Every customer has different expectations, needs and wants.
I believe that in medicine they also teach you this concept. Ideas, concerns and expectations.
You cannot pigeon hole every customer and assume they want the same thing. Customers need to feel that they are given choices and alternatives.
Doctors need to understand this.
Sorry just to add something.
This is not personal against any doctor. But the way doctors talk sometimes just makes me think they assume that they should be high wage earners.
Lower healthcare costs is better for everyone in the country. Lower wage costs of doctors, consult fees etc is better for the people. Agree or disagree? The only people who do not like it is of course the doctors earning the reduced wages.
In Singapore, there are no medical profession unions to "fight". Which is a good thing as it allows us to control the supply demand curves almost at will. In other countries this is a bit more difficult because the doctors stand united and threaten to go on strike etc. However even then, there are ways to control these professionals.
In Singapore? Just give it another 20 years. We will have a world class healthcare system just as good as any, but at 30% less cost. I am confident MOH will be able to achieve this.
It will be better for the vast majority.
"Lower healthcare costs is better for everyone in the country. Lower wage costs of doctors, consult fees etc is better for the people. Agree or disagree?"
Sure. The same can be said for almost everything else, can't it?
Lower legal fees, lower transport costs, lower utilities bills, lower housing costs, lower garbage disposal fees, lower electronic prices... and don't get me started those football players!
The world is just full of people who are out to gouge us when they should be providing all that stuff to us for a fraction of the cost, isn't it?
What do *you* do for a living and how do *you* sleep at night getting paid the kind of money you are paid when you should be earning less?
Sure, MOH can lower doctors' wages if they want to.
Result: dwindling numbers of local med school graduates ( med school costs are skyrocketing ), more doctors leaving public service ( MOH can't control private practice ), and only FT docs left at the polyclinics and restructured hospitals.
I'm quite sure MOH will have the foresight to avoid such a disaster.
There will come a balance. It's not about lowering it to a stage where no one wants to be a doctor. It's just a matter of balancing what type of people you want to attract.
There will still be people willing to be doctors at lower pay scales. Don't have to be all FT docs.
There won't be any disaster. The key word is do it slowly and gradually.
I think Minister Khaw Boon Wan is on the right tract.
Oh and angry doc, don't get angry. This isn't personal. You are right. Ideally everything "should" be cheaper. So why isn't it so?
The answer is that some of these moves to make things cheaper rely on government policies. And sometimes it makes no sense to push in these directions if it doesn't fit your agenda.
Ask yourselves, what is it the bulk of people in SIngapore want when it comes to healthcare? High healthcare costs? Or lower healthcare costs? It's not the same as say in the pharmaceutical industry. If they do well, it contribute to the economy. Shareholders are happy. Jobs are created.
Healthcare is a sector that will always be watched closely for economic and political reasons. And then you guys don't have a union.
I see doctors going the way of teachers and perhaps engineers. Previously well paying and well respected. Today very much just run of the mill upper middle class jobs. And because of the "service industry" push, the "respect" equation has shifted a lot to the customer's end.
While I do not hope to see advertisements on TV trying to get people into medicine, I do think there is no need to limit supply of doctors.
the comments above are kind of disappointing. while I can understand where anon @20:36 & anon @21:52 is coming from, I think you have to bear in mind that you get what you pay for.
just a personal viewpoint for you to understand the real situation with the average public sector doctor:
like everyone else, I need to feed my family. I don't seek high wages, but I need enough to get by. I'm paid what an average uni-grad civil servant (non-scholar) is paid... my teacher ex-classmate is surprised that I earn about as much as he does, except he started working 2 years earlier, and has a uni tuition fee loan that is 20% of mine to pay. I spend 70hrs /week on average in hospital... far more than an average civil servant at work. are you surprised? don't be, coz only the top notch surgeons and private sector senior doctors earn big bucks, and they're the minority.
I've got 24 hrs a day. so after taking away time for work, sleep and the odds and ends of travelling, meal times and other necessities of life, I'm left maybe 5 hrs a day. what do I do with this 5 hrs?
there's the competing demands of family time, personal time, and studying to become a better doctor. or ... moonlighting to try to earn just that little bit more to pay the bills. which was what I did at a certain point of my life, just so that I could pay my bills. paying doctors less will just mean more of us doing the latter to try to get by.
so who ultimately suffers? it's our patients, because that time is not spent on self-education to be a better doctor. the people who suffer are my family, who get to see me less.
sure, you can get cheap health care. that's already available across the causeway and up in Thailand. but if you want your doctors to be good competent doctors, you're going to have to factor in the costs of paying them adequately to train to become better doctors.
what I think you really should want is a doctor who is competent and knowledgeable. not one who is demoralized, clueless, but able to sweet talk you with good customer service.
~medicalgrounds~
I agree with you, except that I never really thought of engineers as being well-respected...
Hi medicalgrounds,
While I sympathize with you, those problems you highlighted can very well be applied to other people working in other fields as well.
Teachers bring home a lot of their work. So while they don't spend as much time as you at the work place, their home is their workplace.
Everyone has bills to pay.
I think what you are trying to say is this :
I am a doctor. I spent a lot of effort and time to become a doctor. I expected a better salary and life for my efforts. Unfortunately I realise I am getting the same as what some of my peers are getting despite what is perceived as less effort and time invested by them during their student days.
This is your disappointment speaking. Well there's nothing really wrong that the reality has hit home for you.
People choose to do what they do for various reasons. Why should we maintain that becoming a doctor equals big bucks and a good life? At the expense of high cost to us?
You have a choice medicalgrounds. You can do something else that gives you more time and less pay. It's your choice. It's not going to be easy. There will be pros and cons. But nobody forced you to do medicine.
well, should patients be treated as customers? and is there a difference in being a patient and a customer?
I think if you ask any CEO of any hospital of healthcare group you will get the standard answer.
All staff in good organizations in service industry are sent for service quality courses.
A patient is a special type of customer. But nonetheless still a customer.
The only people who seem very against this sort of definition are doctors. But I think things are changing.
It seems like there are 2 schools of thought here - patient is a customer vs patient is not a customer. Or in other words, healthcare is a service industry vs healthcare is not a service industry. If doctors see Medicine as a typical service industry or patients as merely customers, then imagine the following scenarios that can quickly materialize:
1. Customer Pt says, "Doctor, I am afraid that I have no money to see a doctor. But I have really bad chest pains. Please help me."
Service doctor's reply, "No money, no talk. A hotel is not going to give you a room for free or a restaurant is not going to serve you food for free."
2. Customer pt says, "Doctor, I want liposuction for the little bit of fat I have."
Service doctor says, "Okay, no problem! It may kill you but if you are willing to pay for it, by all means."
It wouldn't take a genius to work out that Medicine is NOT a service industry. If it was, then the MOH would not have to provide subsidized healthcare and worry about healthcare economics + equity. If it was, doctor's membership to the SMC should be optional (e.g. look at the Estate agents).
Of course, if patients would like to be treated like a customer (like how they get treated by banks, restaurants, car dealers, etc), then we should be prepared to subject ourselves to the market forces of the "healthcare service industry". Are we prepared to have doctors treating us as merely customers, with whom a business transaction forms the basis of the consultation, or would we be preferred to be treated as patients, with doctors having a duty of care toward us? Be careful what we wish for.
to anon @ 08:31
=) sadly, no. what I'm saying is, I would like to treat my patients with a good standard of medicine.
I would like the govt to pay us adequately (doesn't have to be well.. just pegging us to the civil service would be a great improvement), so we don't have to worry about where the dough is coming from, and spend our efforts instead on optimising patient care.
you're right that there's disappointment. I used to believe that there's an unwritten social
contract, where I do my best for my patients and the society, and the govt will take care of my necessities... this doesn't seem to hold true anymore. it only seem to hold true for the political arena ... after all, we can't afford to have corrupt pple entering the govt right?
~medicalgrounds~
Patients are customers lah.
Customer satisfaction surveys.
Customer feedback forms.
We deal with complaints same same as other service industries also.
Put it this way lah. patient is special customer.
No money got to serve as customer also. Got money also cannot anyhow fleece.
Doctors got the short end of the stick in all areas of this customer.
I have a friend who is a first year medical officer
She is paid $9600 a month.
If this is not well paid, I dont know what is.
BTW, she is not even top of the class.
Drs dont be greedy and dont show off. There are patients who are not well off and can afford to pay $50 for breast screening.
I want her job. :)
1st year MO earning $96000 a month?
In Singapore? Working in govt hospital?
Come on. Don't have to lie until like that lah. We doctors are stupid but not THAT stupid.
By the way for doctors to know....
1st year intern at JP morgan investment banking....take home pay is about $8k a month. Not including bonuses.
We all know what 1st year MOs in MOPEX earn lah.
And no way is it anywhere near $9600. That's the problem. People have this idea doctors earn so much money because of the way specialists flaunt their wealth.
As far as I know, first year MOs don't even earn half of $9600.
Interesting to learn that a first year intern at JP Morgan can be earning $8k.....
(And if I recall correctly, the global financial world was brought to its knees just about 15 months ago by many more senior investment bankers...their annual compensations are certainly way out of what we are talking about here....)
I guess it's quite clear what society as a whole value more and what the employers in market are willing to pay for.
(It would be interesting to compare what a first year intern portfolio value is compared to the number of lives which may be adversely affected by the quality and experience of a first year MO...)
I guess a career in finance and trading is certainly more lucrative not only at the senior management levels, but also at relatively junior levels as well.
Certainly kudos to the local medical school graduates who have given up so much financial rewards for their 'callings'.
Healthcare is not a birthright and one has to pay and budget for it just like any other necessities in life---food, water, lodging, transport etc.....
For those who really have difficulty paying their medical bills in the public hospitals, there's always medical social workers who they can approach. These professionals can best advise them on avenues for social support services.
I am a 3rd yr MO working in the polyclinic
I dont do night calls
My pay is $9600+ after the recent pay hike by MOHH.
I am shocked that someone 2 yrs my junior can actually earn 9k+.
All local graduates from NUS has a bond which works up to 5k a month for me.
So my 9.6K is (4.6k + 5k bond)so actually drs especially local graduates are paid a lot more than first yr morgan stanley.
We should raise the pay of foreign graduates!
Heh.
By that calculation, you actually suffer a catastrophic pay-cut when you complete your bond.
crazy one.
Count in bond as part of pay ar?
please lah don't be nuts, go round telling people your pay is 9.6k (4.6k + 5k bond) just to satisfy your own ego as a doctor (cos pay too low no face right)
Please tell the real pay that can be used to apply for an actual housing loan from bank hor.
You go apply for housing loan tell bank my pay is 9.6k a month (4.6K + 5k bond) see what you get from them hor!
Crazy one.
Just to clarify, local graduates are heavily subsidised for medical school so they are bonded for 5 yrs.
Yr pay is low because yr education is heavily subsidised,
The unfairness is when foreign graduates come to Singapore and get lower pay for doing the same work.
I think the moderator should remove rude and unconstructive remarks.
The cost of educating a Singapore medical undergraduate is almost as high as educating a Singaporean in Cambridge medical school. A former dean of medicine sent his son to NUS and daughter to Cambridge. The costs were the same (if you take out the "subsidy").
NUS medical school as expensive as Cambridge.
So that is how the public thinks. This is a new one for me. Apologies if offended anyone.
See doctors? You are all over paid! Got 5k every month cos NUS med school was subsidized! So houseman pay is $2k+ + $5k = $7k+!!! Wah!!!
tsk tsk tsk. Govt pay too much liao.
It is interesting. Why not government from now on just NOT subsidize medical students. No point lah. Why waste money like that?
Don't subsidize these students. Don't need to bond them. This system will be so much better and save us more money.
Right anon @26 January, 2010 12:55?
Hey I come from a poor family and
If not for the generous subsidy by MOH, I would not have the chance to enter medical school.
Just because u can afford to go to NUS without subsidy does not mean the poor can too!
Taking the bond into consideration, our starting pay is indeed one of the highest in Singapore!
Haha.....
I think Anonymous would be pleasantly surprised that upon finishing his bond, his pay is not +5k.
I'll bet that it will not even be +1k from his last drawn salary.
Anyway, it's a free market.
Value propositions are different for each individual and people will continue paying for what they believe in. Some may be willing to pay $x for consultation fees whilst others may be willing to pay $x+y. At the end of the day, market forces will shape the profile of future generations of doctors and any other professions.
Majority of Singaporeans will have no qualms/worries about walking into a neighbourhood GP clinic (private) to seek treatment when ill.
I'm not sure about other readers, but personally I'll certainly think twice before entering a lawyer's office for a consultation.
ok lah.
Then put it like this.
Subsidy and Bond is optional.
You want you take subsidy and bond. You don't want, then pay full price no bond.
Wah don't take subsidy means end up starting pay $5k less hor? Jia lat!
I think it's a big mistake to link the subsidy and pay together.
Pay and subsidy is a separate matter.
The subsidy is covered under the bond period and penalty for breaking bond.
Pay is a totally separate matter.
The organisation as a whole only pay you for your pay.
If you choose to break your bond, then the liquidated damages based on the bond remaining will be calculated.
Please do not inflate your own 'ego' or self-worth by adding both of them up.
Your pay is what you see on your payslip and what you and your organisation contribute to your CPF account.
Nothing more, nothing less.
I beg to differ
The pay is low because u are under bond because u accepted a subsidy of 5000 a month while u were in medical school for 5 yrs.
Whether u break bond or not, u still enjoy the subsidy and u should be paid less than market rate because of the subsidy.
Going by your logic of doctors being paid under market rates due to the subsidies, shouldn't their pay be adjusted by the same amount when their bonds end?
I'm quite sure that doesn't happen.
I can see some logic to anon's view.
You see as doctor you are here to serve.
We subsidized your medical school fees heavily to let you be a doctor to serve us. So be thankful.
The people win once again. Bravo!
At first I LOL'd. :D
Then I was like O_0 ...
Anyway, you guys had better start using nicknames or we will have difficulty figuring out which anon you are talking about.
Hi I am anony1 and I would like NUS Medicine to stop admitting losers.
Losers who cant differtiate between pay and subsidy.
It is these losers who cause our salaries to stagnate!
Let's kick losers out of medicine.
The same losers who work OT without asking for more pay.
We should all unite and screw these losers.
Leave at 5pm on the dot.
Dont do extra!
No lah it is not these people that make medicine the state it is in now. Actually we doctors have let non-doctors be in control over us.
The above logic is severely flawed. Let's look at hard figures just to lay the cards on the table and be clear about what we're talking about.
1) House officers used to be paid approx $2500/mth in my time.. not sure what it is now. This is before CPF, which is about the same as our night duty allowance, so take home is about there too.
2) 1st Yr MOs get a pay jump somewhat (take heart juniors!). Basic pay is about $3500/mth, with CPF & call allowance cancelling each other out. Think our friend-who-can't-do-math above must have done pretty darn well to average a 10% increment /year. Not everyone gets this much, and I think we all agree that this yr's 1% is crap. You might want to push back any plans to get married/ have babies/ buy your Cherry QQ.
3) That university 'subsidy' our-friend-who-can't-do-math above includes in his pay is used to pay for a degree of which 60% is spent OUTSIDE the university in the hospitals. And the hospitals don't get paid much to teach us... some of us have checked. Last I heard, NUS has yet to justify how they spend our tuition fees. I'm keeping a lookout for gold taps.
4) If you want to include government subsidies in your pay, then I think the average government scholar gets maybe $5-6K + what ever the value of their university education is. We're great value for money in comparison.
5) Personally, I prefer to think of it as how much effective take-home I get. For some of us from humbler backgrounds, we have to set aside maybe 1000/mth to try to clear our tuition fee loans in 15 years. So I was getting by on 1.5K as a houseman... thankfully, things are better now. Clearly, doctors' pay does not contribute much to rising health care costs.
Local medical school fees subsidised?
Think again.
Here's some numbers to go through.
1. What Cambridge charges LOCALs:
http://www.cam.ac.uk/admissions/undergraduate/finance/tuition.html
5 years: GBP 3,290 x 5 = GBP 16,450
2. What Cambridge charges INTERNATIONAL STUDENTS for doing medicine (NO BOND applicable):
http://www.cam.ac.uk/admissions/undergraduate/international/finance.html
3 years of Pre-Clinical: GBP14k x 3
2 years of Clinical: GBP26k x 2
Tota: GBP 94k
3. NUS Fees for LOCAL students
~SGD $19k x 5 : SGD $95k
Approximate bond fee of 5.8k x 12mths x 5yrs : 348k
Total cost of studying medicine to a local student: SGD $443k
It really leaves one wondering if there indeed is any significant subsidy for local medical students in doing the course locally when comparing like for like / local vs local.
Even without factoring the bond fees(if applicable), it's GBP 16.5k vs SGD 95k.
Cambridge charges a premium for International students and even that pales in comparison to the total costs of a local student if we are to add in the amortisaion value of the bond.
Prof
Hospitals are given a subvention to treat subsidised patients. So yr school fees help to bring down healthcare costs.
Cambridge: GBP 94k
NUS: 100K Singapore dollars
It is because of this, I argue that foreign graduates should be paid more so that they can be attracted to Singapore.
I hope that MOHH will raise the pay of foreign graduates or it will not be sense for them to work in Singapore.
Foreign graduates getting higher pay? I see no reason for that.
Fees for studying at Cambridge: GBP 94k (no bond)
Fees for studying at NUS: SGD 443k (inclusive of 5 years bond amortisation value)
You cannot compare GBP 94k vs SGD 100k.
SGD 100k is the out of pocket payment to NUS.
(SGD 100k has not captured in the bond value which all the students have to sign up for.
For those who wish have no bond, they'll have to option of amortising it upon finishing HO year. The value is ~SGD $348k from the approximate calculation shown above.) This value will be worked down to zero upon completion of working 5 years post-HO.
To add on,
The local grads DO NOT get an additional $348k over 5 years upon finishing their 5 years bond.
So why should foreign grads be treated any differently?
In any case, I've deviated off course.
The point I wanted to make is---we got to go through the figures to really decide if local medical school fees are subsidised/heavily subsidised.
I have seen many other comments and people bringing this point up when they have no evidence/basis of comparison.
If Cambridge charges local students a total of GBP 16.5k over 5 years and our locals studying in NUS have to pay $100k (on top of an additional $348k bond), is there really any substantial subsidy?
On the contrary, I would argue that local students are already doing their bit for the whole public healthcare system by working off those 5 years.
How that huge bond amortisation value came about is certainly not made known to me since the total costs for a local student is much more than what a recognised overseas university charges for international students with presumably no subsidy for foreigners.
Dear Prof,
we will take your recommendation into consideration.
Currently, foreign graduates get housing allowance as below
•$850 per mth
•$640 per mth(1stYr SPR)
•$425 per mth(2ndYr SPR)
•$0 per mth(3rdYr SPR)
We hope that bloggers do not abuse the system and badmouth our wonderful healthcare system which is ranked highly in the world.
We are conducting recruitment talks to KL and UK soon so we do hope that bloggers paint a more realistic picture of work in Singapore and not a biased one to make our work difficult
Regards
Dear anon @ 28 Jan 2010 13:09. R u the same guy who got blasted at salary.sg?
Please lah. Nobody bad mouthed the Singapore system. People merely shared what the bad aspects of the system are. Overworked. Underpaid.
Of course there are good aspects that come directly out of that. Good training by being overworked. Well trained mentors to learn from.
All these are truths. Just because the truth ain't nice doesn't make it bad mouthing.
What you guys do when you go on recruitment drives is paint an unrealistic rosy picture for these young doctors, which isn't totally fair to them. It is the internet and freedom to share information that makes you work for your money.
No point attracting young doctors with rosy expectations to work a few years and then drop out or give more dissent to the management.
Our leaders have already talked about focusing on training and developing Singaporeans and pushing down the pace of influx in foreign workers. Shouldn't this apply to MOHH as well?
Thank you Prof for sharing. Those are the facts. I heard this some 10 years ago and up till this day, no one can really show factually where all that $300K+ goes to in educating a young doctor.
Dear anon @28 January, 2010 10:53. You mentioned that the school fees local grads pay goes to subsidize healthcare for patients? This is an amazing policy if that were true.
It would even be more amazing if you counted in the "subsidies" of over $348K.
Imagine this. $348k is given as subsidy to educate each young doctor. Part of that money is used to subsidize healthcare? Then shouldn't the bond value be $348k - subsidy to healthcare? Why should the subsidy for healthcare end up in the medical student's liabilities account?
Well suppose we said it was all factored in. Then it is most interesting that the same dollar can have TWO purposes. To subsidize educating a doctor and to subsidize patient healthcare. Talk about stretching the dollar.
1. I think the point brought up by some bloggers regarding the bond fee being used to subsidise healthcare is also questionable.
I have never heard that officially from MOH/NUS.
2. Anyway, my friends handling projects would always like to present using 'total cost of ownership'(TCO) for their projects.
I shall borrow that term for ease of illustration here.
TCO of a local Singaporean doing medicine in NUS: ~SGD $443k
(348 + 95)
TCO of a local UK citizen doing medicine in Cambridge: ~GBP 16.5k
TCO of a Singaporean going to Cambridge to do medicine: GBP 94k
SGD $443k vs GBP $16.5k does seem like quite a big difference.
(For what we're paying locally, we could have sent at least 3 Singaporeans over to Cambridge for under-graduate training.)
I can only come up with some possibilities off my head:
Either NUS is charging our medical students really high school fees or that the government subsidy for students doing medicine here is really small compared to UK.
3. In any case, with Duke-NUS coming up and talks about a third medical school in Singapore in the near horizon, the intent is quite clear that we need much more doctors in public service to look after the rapidly aging/expanding population in Singapore.
In that case, would it make more economic sense to send more of our students overseas to be trained instead?
Eminent overseas medical schools where we sent our brightest for specialist training seem to be able to train our under-graduates at a fraction of our costs.
If numbers are what we need now, it seems 'cheaper and faster' to get our young aspiring medical students trained up overseas till we get our new medical schools up and running.
Just sharing some personal thoughts based on some readily available information.....
Hi prof, I doubt that will ever be a reality.
A very likely reason is that the true cost to train a doctor in Singapore is probably a fraction of the SGD$94k collected from each medical student.
NUS makes a hefty profit from the medical school fees.
The bond is merely an imaginary number put up to discourage or more aptly prohibit young doctors from leaving the service early. You thus have cheap medical doctors to work for you for 5 years.
As someone who is about to break 2 yrs of bond (120K), the bond is REAL! not imaginary.
Have u ever wondered who pays for the salaries of the prof and research?
Or all those new buildings that are sprouting up all over Kent Ridge...
For years, the "real cost" of medical education has been discussed and even petitioned by previous batches of medical students and not once has the relevant authorities been willing to give an approximate breakdown of the expenditure incurred. It is no secret among the medical community that the "real cost" is probably much less than what is actually charged in terms of the payment to NUS + bond. After all, the first 2 years (in my time) was preclinical (structured teaching within NUS itself) with the rest of the 3 clinical years spent in the various hospitals. During the clinical years, we were pretty much left alone to clerk cases/attach ourselves to clinics/OT etc with some tutorials and lectures thrown in here and there, hardly a very expensive thing if you ask me.
Unfortunately, the true cost will never be revealed. A similar story will be that of HDB flats where the actual cost will not be revealed suffice to say that the price will be "based on market rates".
It's all revealed.
Drs should go learn accounting and finance instead of sprouting nonsense here.
http://www.nus.edu.sg/annualreport/nus_ar09.pdf
Tuition: 250 million
Other income: 175 million
Expenditure
on manpower: 745 million
Depreciation: 200 million
Other opetating 603 million
expenditure:
Operating Grant: 900 million
To anon 29 Jan 12:01
The above annual report shows that for the whole of NUS, it does not give us any insight at all regarding the cost of medical education.
To anon 29 Jan 2010 12:01. I am sorry to learn that you think that doctors are sprouting nonsense here. Could you show us where can we find the "accounting and finance" info on medical education please? Many doctors are very keen to find out this info and you might just be the genius to help us do so. Thank you (and I wish we doctors were half as smart and resourceful as you).
vince, I think anon was trying to tell us that the cost of educating doctors in Singapore was more than 1 billion a year. I guess most of us would have believed it. Right?
I always thought drs are smart but how dumb can you get?
Nus is loss making so if nus is making obscence profits from medical students, how come it is still in the red.
Even if medical education is profitable, the profit need to be allocated to the Science, Nursing, Pharmacy students and obviously NUS is in the red loh
Wake up yr idea drs!
Stop complaining cause u all enjoy the greatest subsidies.
300k+ per student.
No wonder drs are the elites.
"Nus is loss making so if nus is making obscence profits from medical students, how come it is still in the red."
At first, I LOL'd.
Then I LOL'd even more.
In reply to the original blog post, I think that if I were the doctor, I'd still carry out the procedure if the patient still insists on getting it, even though I've told him/her that there would be a slim chance of recovery.
1) Who are we to say that it will not help at all? Even if in theory the procedure would not help the disease condition, the placebo effect may actually alleviate it.
2) More importantly though, the decision also concerns the psychological impact on the patient and his family. I guess it gives them a sense of 'closure' and would help them deal with the outcome better, knowing that they've done the best that they could. While this move may not make economical sense, it's worthy to give it a shot, because of the added psychological comfort.
3) Because of (2), I think if there is ever such a dilemma, it probably means that healthcare is under-funded.Targeting the issue of funding is better than having to face trade-offs in healthcare.
-chenny
Post a Comment