The exodus of doctors from the public sector continues to draw attention, as evidenced by recent Straits Times articles and Forum Page letters.
I'm glad that the ST's original feature - which suggests that money is the predominant draw to private practice - was quickly rebutted.
An invitation to a "physician engagement" luncheon 2 weeks ago helped debunk the myth further. With approximately 12 clinicians and 5 senior administrators ( also medically trained ) in attendance, it was a candid affair, allowing us to share concerns from the ground and suggest changes to ensure equal recognition for all areas of expertise.
While institutions currently favour those who conduct research, others who perform clinical duties full-time should not be overlooked. After all, without the latter serving as the department's backbone, the former may not be able to continue with what they're doing in the first place. What's the use of pioneering some new-fangled therapy, when there's no-one left to see patients in the wards and clinics?
Another issue that was highlighted: constraints imposed by the new residency programmes, especially in high-volume areas like polyclinics. Due to the stipulated limits on patient loads and working hours, it's obvious that non-residents will be required to bear the extra burden of clearing the backlog. This may in turn breed discontent among colleagues, resulting in more resignations.
One surgeon even remarked that the narrow scope of training for residents might render them less competent in the long run, compared to their predecessors who underwent the proverbial baptism of fire. And I agree with his prediction. Seeing few patients = less experience = poorer clinical judgment and procedural skills = suboptimal patient care.
And for the benefit of the administrators and corporate communications personnel: suboptimal patient care = more complaints = more lawsuits = hospitals lose more money settling out of court.
While the luncheon was attended by consultants, I hope that registrars are or will be included as well. Because they're the ones who tend to be treated like slaves, working inhumane hours, getting arrowed for everything, and unable to say no as they're the most junior in the department and are too afraid to offend their seniors.
As for the medical officers, they generally have it pretty good these days. Even the non-residents get to do half-calls, so instead of working 24- to 30-hour stretches, they come in at 9pm and go home the next morning. House officers also benefit from ECG technicians and phlebotomists in the wards. I never enjoyed any of these luxuries!
So it remains to be seen whether changes will be made, and how soon they will be implemented. I'd like to stay optimistic for now, and have faith in at least one of our leaders ( who was present that day ).
Let's hope it won't be another case of "all talk, no action".
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5 comments:
Exactly. For issues #1 & 2, who is going to do the REAL work?
Issue 2 : We'll see in 3 years when the residents turn registrars if this sheltered generation can function at that level.
If not, more load will be shifted up to the consultants and probably more resignations.
The course had been set, but it takes years to see the results
'House officers also benefit from ECG technicians and phlebotomists in the wards. I never enjoyed any of these luxuries!', - I think this mentality is outdated. Whether you have enjoyed such support in the past does not equate to if the system should move on and have such support for the newer doctors. It's time to move on and improve on such things. It's like older generations complaining about the newer gen soldiers "During our time.... etc etc".
While i agree that there are more doctors leaving for the private can be due to many reasons, i think the residency program is going in the right direction. Its a transitional period, hang on and see how things changes in the long run. Seeing fewer patients doesnt always equate to lesser experience and poorer clinical judgement. Look at the doctors in the USA and Australia, they have lesser patients yet they are also great doctors! The USA has residency program with working hours limit, but does that means they are not as good as singapore's doctor?
We have to move on...
the mentality is certainly *not* outdated.
If my housemen now enjoy the benefits of having phlebotomists take the blood for them, then I expect them to recognize that their role has shifted - and that the onus is now on them to take responsibility and ensure the blood has been taken early, and that the results are likely to appear in time for review by the end of the day. The physical act of taking the blood is now replaced by dropping by the bedside or placing a phonecall, and perhaps taking the blood themselves at noon when it is becoming apparent that the blood results will otherwise be too late for practical use the same day.
Sadly this is sometimes not apparent to the housemen, who just take for granted that someone else will take the blood, fullstop. And when its not ready at the end of the day, it's not my fault. who gives a &&&* about the patient.
The mentality still holds - the mindset must change.
I am surprised no one ever talked about firing all the old tyrants in the medical establishments so that younger specialists will stay on. I believe that is the one best thing to do to make doctors stay on in institutions.
When old tyrants make a mess or create a scandal, hospital managements either choose to ignore everything or give these guys new portfolios or new titles to distract them.
At a recent overseas conference, a group of specialists of varying seniority in private practice were gossiping. And it turns out 3 of them left a major hospital for private practice because of the same tyrant who is still having a great time in that same department. These specialists range from the late 30s age group all the way to 50 plus years old. So how many more left because of this one tyrant who has become a monument in the hospital? Time to kill a few sacred cows, a toss out a few tyrants.
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