It is about the time of the year when senior specialist doctors in the public sector consider leaving - or have just left - for the private sector. The timing revolves around consideration of annual bonuses, etc.
The number choosing to leave does not seem to have gone down over time, despite efforts at public sector hospitals to achieve parity of income (especially for surgeons). A significant part seems to have been played by Healthway Medical Corporation Limited in recent times. Good luck to those who have gone out to join their clinics (or perhaps good luck to Healthway for this venture?)!
For the majority, it is no longer quite about the money, but rather, hospital push factors. Many in the early days (and some even after many years) of private practice feel that they have returned to their "roots" - doing what they have been trained to do and providing real individualized medical care. Not being forced to do a modicum of research (or to pretend to enjoy/espouse it) or to sit in time-consuming committee meetings is a heady feeling. Being able to spend more time with one's patients rather than having to deal with administrative grouses about "patient waiting time" (because clinics get overloaded with patients - several of whom are slotted at 10-15 minute intervals like a factory line) feels just great. The whole great balancing act of clinical service, research, education, and administrative duties can itself be overwhelming, and most do not have the power to change this very much (without appearing to be prima donna's, for example).
There are the drawbacks, of course:
- One can get called back at any hour of any day.
- One does have to pander more to one's patients.
- Bad debts can accumulate and they are one's problem (unless one is in a large group with administrative services to deal with these things).
- One can rarely deal with complex multi-disciplinary medical problems the way that tertiary public sector hospitals are able to.
- Regulatory oversight of the private sector is poor (although some may see this as a plus).
- One has to get over the guilt trip that some may feel for no longer treating the "poor and underserved".
Private specialist care is evolving rapidly into group practices and multidisciplinary practices - perfectly understandable given the nature of the market - and this may offset some of the drawbacks above. All in all, most people are happier once they have left the public sector, although working up the courage to leave can be nerve-wracking.
29 comments:
People who quit are ungrateful and greedy.
We should lower the pays of private specialists so that more will stay in public sector.
The sheer waiting time in public hospitals is crazy.
I have chest pain and they refer me to heart doc but the appointment is 3 months later.
When I protest, they say to go a and e.
So instead of me going to hospital for check up, they want me to go there when i collapse and be carried there in a and e.
I will be lodging a complaint to our dear minister of health soon.
You didn't mention one important point about private practice.
It's all about profits. And don't those guys who joined Healthway know it!
Anonymous #1: I think what you mean is that we should increase the salaries of doctors who stay in the public sector.
Can't possibly "lower" the pay of those in the private sector.
Hi
if we increase the salaries of doctors who stay in the public sector, healthcare costs will rise since Singaporeans will bear the costs.
To lower the salaries of doctors in the private sector, MOH can publish recommended charges for specialists so there will not be overcharging.
To further reduce costs, I suggest to have physician assistant and nurse practioners to do the work of Gps so Gps can train to become specialists and further increase supply of specialists :)
Publish recommended charges for specialists?
That's what the government ruled as anti-competitive when the SMA published similar guidelines for GP charges!
Think of healthcare costs like housing costs. The government is approaching it in the same manner.
As a doctor myself, I know many of the specialist who have left for the private sector. I respect many of them not only as professional colleagues but also as as friends. When I grow old and fall ill one day, I can trust them to care for me. Why did they leave? Simply because life in the public sector has become unbearable. And one of the most annoying things in the public sector are cheapskate patients who demand the world (and make life difficult for staff) on subsidized rates. Try showing a little more gratitude and a little less animosity to your doctors who are struggling to cope with huge patient numbers (which is no fault of his) and he/she might be less compelled to leave the government service.
who are u calling cheapskate?
Subsidised patients are still patients.
We are subsidised by PAP and all of us pay taxes.
So stop using the huge patient load as excuse for poor medical care.
I hope doctors are not as self-centred and self serving as you.
I want professional drs who treat me as patients and not as money bags!
A cheapskate is a person who is reluctant to spend money, sometimes to the point of forgoing even basic comforts and some necessities.
Healthcare is a necessity and cheapskate refers to people like you who is rich enough to afford healthcare but choose to compete with the poor and needy for subsidised healthcare.
Those patients drive big cars to polyclinics and demand free parking space. If u can afford to drive big cars, how come must go polyclinics.
These patients game the system by getting private specialist appointments and then go to polyclinics to downgrade them to subsidised appts.
These patients are the cause of long waiting time, increase workload and increase complaint letters.
The poor and needy dont complaint as they are grateful to PAP for providing them with affordable basic care.
It is the rich and cheapskate who complain that care is lousy without considering that it is highly subsidised.
Go see private Gps and specialists and stop flooding the polyclinics and public hospitals!
from a poor and needy patient
Yes, I can say that it's the poor/needy/elderly who don't complain as much as the richer or those who are so called more educated. Even though they are not so educated, I try to spend more time with these patients and explain to them more about their condition and often they are grateful and I felt that I've spent my time with them fruitfully.
It is a fact that many middle class or even upper middle class people will still come to polyclinics and public hospitals because of the affordability and relatively good service (of course no match for private practice but that's something different altogether) for the price. But just because they may be wealthier or more educated it is not right to demand service quality that is comparable to that of the private sector. As it is, healthcare workers in the public sector are overloaded so do have some understanding for them (by the way I'm not working in the public sector now although I was working there a few years ago).
I'm a Singaporean studying medicine in Australia. From the posts and comments in blogs like this, it's no wonder why most of us want to stay and practice in AU/UK. Don't take me wrong, I enjoy Singapore medical blogs as they provide me a better picture of the health care system in Singapore. I used to think I'm second rate for failing to get into NUS but now I see it as a blessing in disguise.
I do think that some Singaporeans are cheapskate. To 'who are you calling cheapskate' I ask, how much do you spend on cable tv/broadband/cell phone and how much do you spend at the doctor's? Singapore doctors are paid peanuts compared to doctors in other developed countries. A new doctor in Singapore makes $2700(?) a month working 80hrs a week, a secondary school student can make more per hour working at starbucks.
I do not think that health care is a right, it's a privilege. It's a privilege that the Singapore government extends to all Singaporeans at subsidized rates. Just look at the US system (before the recent crappy reform), the only way for a non-privately-insured patient to 'afford' a doctor's visit is to go to A&E under a fake name and address. I'm not going to graduate with almost half a million in debt so that cheapskates can exercise their 'right' to health care. Health care is like any other necessity (don't confuse with right); want a nice home, pay for a condo, want a nice form of transport, pay for a BMW, want nice food, pay for shangri la. Want first rate health care, PAY FOR IT.
Thank you, overseas singaporean. If this blog manages to dissuade you from entering our public healthcare system, then I consider it one small victory.
We receive many comments from people who think it is their right to have cheap and good healthcare and caring doctors; I never censor or delete any of these, because I think it is important that our profession sees the great divide between their expectation of how a healthcare system should work and ours. Hopefully my colleagues will see the futility in trying to support a flawed system. Hopefully they will realise that subsidised healthcare must fail.
Don't forget that subsidized medical education is also part of the subsidized healthcare system.
angry doc, I really enjoy your blog as well, I hope you post more often.
It's not just blogs like this and our friends in NUS/housemanship that dissuade people like me to stay away, more recently the health minister's pre-employment grant really ticked me off. Well something is better than nothing for those determined to return to Singapore anyway but its the way they phrased it that I find demeaning. I wrote a short article http://ubercoolkia.blogspot.com/2010/04/joke-and-insult.html to vent my frustrations, I referenced one of your posts somewhere in there.
A little late here, but Fox is right. To add on, the per capita subsidy rate for NUS medical students is higher compared to non-medical courses; in other words, non-medical students are subsidizing medical students. NUS and the other state universities get a government funding amount for every student enrolled in the various courses. NUS medical school, despite having a very small student population, gets disproportionate amounts of money because they get huge funding by teaching large life sciences courses to non-medical students, in other words, NUS medical school and its trainee doctors are subsidized by the teaching of non-medical students. One of the largest donations to NUS ($100 million), causing the change of the name of the medical school, had a matching government grant, meaning enormous tax dollars are set aside just for one school of a few hundred students. All these subsidies for doctors who end up paying the same tax rate as non-doctors of the same income bracket who were subsidizing trainee doctors early in life and who end up with higher long-term earning potential compared to non-doctors who were subsidizing them. Put simply, locally-trained doctors (the bulk of all doctors in Singapore) have something in common with poultry in some countries: both are products of subsidies.
I like the way you think, angry non-doctor.
Just two points for you to add to your equation though:
1. How much of the funding to the medical school actually goes into medical education?
2. Local medical grads are bonded for 5 years. The bond may also be bought off.
Dear Angry Non-doctor,
Nice name! Anyway, a couple of points to raise here:
1. I graduated from a UK university. Do you know that it was cheaper for me to study in the UK (inclusive of airfares, accom, food, holidays, etc) than in Singapore (taking into account the cost of the 5 yr bond). I wonder how much of what is published actually reflects the TRUE cost of education at NUS Med School. In other words, bond value/published non-subsidized fee does not equal TRUE value of subsidy. Shocked to hear that?
2. Locally-trained doctors no longer form the bulk of doctors in Singapore. See here: http://politics.sgforums.com/forums/10/topics/387840
Sorry, I can't find the official MOH stats. Maybe you can try to go through the hansard of parliament to find a record of Mr Khaw's update to parliament. Anyway, I guess if you want cheap healthcare, you can always petition your MP to import more FT doctors from non-English speaking countries. Maybe you can even ask to scrap the "funding-intensive" outfit called the YLL School of Medicine? I am sure you will get much cheaper doctors. Only problem is that there is no guarantee of quality or English proficiency. But hey, since when is that a problem? As long as they are cheap, it's okay hor? :)
to add some stats to anonymous UK doc's post:
YLLSOM's claimed annual fees: SGD107
YLLSOM students pay: SGD19k/yr
Gov's claimed subsidy: SGD88k/yr
compare this to:
Harvard medical school: SGD57k/yr
Hopkins: SGD42k/yr
Edingburgh: SGD57k/yr
NUS has most probably the most expensive medical school IN THE WORLD
I feel healthcare being a "right" or a "privilege" cannot be dichotomized so clearly. It's so very grey....
The fees from NUS is to put it bluntly, a "scam". I don't feel that it cost 80k a year for my education, seriously... it's probably just to make everyone look and feel good.
NUS is expensive but PAP subsidies more than 80% of the school fees.
It is a shame that we have doctors that shout at patients in Singapore.
We should be screening medical students more throughly and not anyhow admit students to be doctors.
http://singaporeseen.stomp.com.sg/stomp/sgseen/got_service_or_not/389930/Doc+yelling+at+woman+with+baby%253A+He%2527s+a+relief+doctor.html
So....doctors can't get frustrated? They don't have a breaking point?
I think the general public opinion of doctors is that they are
1) All rich
2) Very kind, understanding ,patient, forgiving, altruistic, considerate, polite, gentle
3) Strong, powerful, intelligent, wise, energetic, healthy, brilliant
4) nearly infallible ,trustworthy
doctors breaking down? That's like thinking of President Obama crying like a baby! Impossible!
singaporean doctors are very well respected in Australia and they do clear the AMC exam with minimal hassles.
Many rural towns or areas of need are crying out for doctors.
drs who have just cleared their NUS MBBS exams/ FRCP exams will clear the Australian Medical Council exams with little difficulty
Factors aggravating shortage of doctors in public sector:
- artificial cap on number of doctors produced each year
- medical tourism
- lack of subsidy in public sector medicine
- lack of price control in private sector medicine
How convenient: all the faults lie with other people but not the patient himself!
What about:
- lack of sense of personal responsibility for one's own health?
- failure to take care of won health?
- failure to put aside money for healthcare needs, thus transferring the burden to the state subsidised healthcare system?
"lack of sense of personal responsibility for one's own health?"
So, having a sense of personal responsibility for one's own health will solve the shortage of doctors in the public sector, huh?
"failure to put aside money for healthcare needs, thus transferring the burden to the state subsidised healthcare system?"
The state subsidized healthcare system in Australia, the UK and New Zealand, which many local doctors are so keen to move to, is even more heavily subsidized than Singapore's. Proportionally, patients pay less for their healthcare out of their own pocket in Australia.
Yay, just one comment was all it took to expose this blog and its blogger as a load of emotional and baseless opinions. None of these are factual or supported:
"- lack of sense of personal responsibility for one's own health?
- failure to take care of won health?
- failure to put aside money for healthcare needs, thus transferring the burden to the state subsidised healthcare system?"
http://www.livingin-australia.com/income-tax-australia/
Please back up the assertion that
- lack of sense of personal responsibility for one's own health?
- failure to take care of one's health?
- failure to put aside money for healthcare needs, thus transferring the burden to the state subsidised healthcare system?
are aggravating the shortage of doctors in Singapore.
Hong Kong residents pay proportionally less out of pocket for their healthcare than do Singaporeans. And their doctors are better paid too.
So, obviously, the Hong Kong people must be suffering under a crushing tax burden...
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