Wednesday, February 07, 2007


Disclaimer: The opinion expressed in this entry is solely that of aliendoc’s, based on experience in both public & private sector. It in no way reflects policies or opinions of the Powers That Be.

There has been much discussion the last few weeks about MOH making it “easier” for foreign doctors to practise in Singapore. This is supposed to address the shortage of doctors in the country.

There have been arguments & questions raised on why & whether there is actually a shortage at all, especially in the private sector. No, I don’t believe that there is a shortage; it’s a dog eat dog world out there especially in GP-land*. (*I exclude aesthetic practitioners in this group, as I believe they are a different species from what one would perceive as a typical GP…but then, that is whole different kettle of fish altogether ☺. I also exclude doctors who are employees of a larger medical group – this will be expounded upon later.)

Doctors are not businessmen. We were not taught a module on business strategies & economics in medical school. Hence, GP’s end up “killing” each other trying to get a “market share” of patients. They undercut, sign on with HMO’s & MHC’s (whatever you may call it, these 3rd party administrators exist for the sole purpose of making money) just to make ends meet. Business consultants would probably cringe if they saw the kind of decisions that have been made by some of these doctors.

As for the larger medical groups, it’s a different story altogether. Speak to any of their operations managers or HR manager & you would probably discover that recruiting & retaining doctors is a difficult task. Many have a high turnover rate; take a look at the SMA newsletter & you’ll see what I mean - ads repeated issue after issue, seeking doctors to join them.

On the flip side, you have the government polyclinics – obviously overcrowded & evidently understaffed. Junior doctors in hospitals are also lacking (although this may have improved the last few years with increasing medical school intake).

So why the shortage in the government sector? Simple: doctors leave after they complete their obligatory bond. And why do they leave? Perhaps they seek the almighty $. Or they want some autonomy in how they practise. Or they are just sick of the bureaucracy. Like it or not, there is still a strongly hierarchical structure (not to mention the politics!) in the government departments (call it NHG or Singhealth, call it what you like, but in the end, it works the same way ☺). It is hard to be heard unless you go through the proper channels (i.e. somewhat of an obstacle course where you have to clear a few obstacles before reaching the finish line, if at all).

And how would you explain the medical groups’ dilemma of finding & keeping doctors? My take is that doctors working for these groups have very little say (if at all) in how certain patients (read: those under very restrictive HMO/MHC contracts) are managed. After all, these groups have to answer to their shareholders & clients (note: I use the word "clients", not "patients") & the bottom line is VERY important after all (sarcasm intended). So, see as many patients as possible, get as many contracts as possible, & save money for the clients (the companies who contract with them to look after their employees). End result is that doctors will use this as a stepping-stone, a temporary job before they venture out on their own to compete with their colleagues for patients, and the vicious cycle continues.

So will letting in more foreigners in do the job of resolving the numbers problem? Probably partially & temporarily, especially in the government sector & in the medical groups. But it won’t help the GP’s out there who will still be struggling to stay afloat, competing with each other, & forced to charge miniscule amounts for consultation fees.

So if the big wigs want to look at the long term problem of shortage (I prefer to use the word, skewed distribution) of doctors, they will need to examine the causative problems first. Otherwise this will just be another fire-fighting scheme, which does not prevent another fire from starting.

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