A Shift In Focus, Please

There's been some debate in the ST Forum recently, following the publication of an article which compared prices between public and private hospitals.

Here's a letter published in today's edition: 

Doctors leave public sector for reasons other than money 


DR GERARD Chee's most obvious conclusion from the report ('Private versus public hospitals: More than twice as costly'; last Friday) was 'how poorly paid public hospital doctors are', as reflected in the lower cost of public health care ('Bill comparisons may not reflect true cost differences'; Tuesday).


This seems inappropriate. To put things into perspective:


The medical profession, both in the private and public sectors, is among the most respected and well-paid here. We should be cognisant of and grateful for this privilege.


The relatively lower cost of public health care is a reflection of government subsidies, and does not mean that doctors in this sector are poorly paid.


Doctors in the public sector are amply paid for the duties and responsibilities they assume and the time spent doing so. But their salaries have far less correlation with what patients pay than what the Government thinks they are inherently worth - which is a lot.


Within 10 years of public service, most doctors can earn six-figure annual salaries - not exactly a pittance for performing mostly unspectacular routines.


Doctors leaving the public sector cite work-life balance, administrative hassle, office politics and poor leadership as the main reasons for doing so.


So Dr Chee is wrong to ascribe pecuniary reasons solely for the exodus of doctors from public hospitals to the private sector.


Dr Yik Keng Yeong




Speaking from the perspective of a specialist who currently works in a public hospital, I fully agree with Dr. Yik's comments about salary.


And since the institution and department I belong to is bleeding badly in terms of senior manpower, I can also confirm what he says about reasons so many leave for private practice.


However, I feel that the persistent focus on Why Doctors Run Away From The Public Sector neglects an important group of people, i.e. Those Who Stay In The Public Sector Long-Term But Don't Go Insane.


I don't recall ever coming across a study which analyzes the 2 groups in detail, but doesn't anyone wonder why specialists who can easily set up successful private clinics opt to stay put?


I admit that I've strongly considered private practice as well, but somehow never took the plunge. The hospital's efforts to retain talent have so far included meals with the big guns and significant bonuses, but just last week, I felt frustrated enough to contemplate taking a month of no-pay leave or scheduling an interview with another institution, after another stoic colleague jumped ship and my already deflated morale sank to an even more abysmal level.


A week later, I'm still here, working full-time. The patient loads are ridiculous, leadership remains wobbly, and I'm fully aware that greener pastures exist elsewhere. 


But I think about the reasons I joined the medical profession, one of which is to serve the underprivileged. People who depend on the public sector for their medical needs, who deserve good-quality healthcare regardless of their financial status.


Rest assured that I am not criticizing those who've joined the private sector. It is a personal choice and often a difficult one, and it is your right to do what you feel is best. 


However, I think someone - MOH? individual hospitals? - should conduct an in-depth survey targeting specialists who stay in the system, to find out what differentiates them from those who leave.