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I do feel that Singapore GPs/FM are less skilled compared to our overseas counterpart, mainly due to the geography and structure of our healthcare landscape. (disclaimer: I am a local grad, currently FM resident, that has never been trained overseas.)
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The Biggest reasons for this in my opinion is the ease of accessibility to tertiary care in the local context
- For e.g
> which GP in Singapore will deliver a baby when the tertiary obstetric centers (
NUH/KKH) are at most 30 min away
> even for simple surgical procedures like abscess/removal of lumps, most GPs dont do it (I know some do, but most, esp those in OPS dont and simply refer them on)
> I mean we are all taught how to perform delivery (of babies) and I&D during residency training, but if you don't practice it, you will become deskilled eventually.
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- There is also a tendency to over refer patients.
I mean when I was running clinics during my rotations in ortho, ED, I do encounter many referrals which are inappropriate in my opinion
- For e.g referring asymptomatic patients with BP of 170-180 systolic or BSL of 18 (when it is measured post prandial) to ED
- Referring patients with mild OA knees/2 week history of back pain (with no radiculopathy) to Ortho (Hip/knee and spine respectively)
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Of course there are also other reasons in play such as
- the nature of our patients in general (most of them do tend to prefer consulting specialists/hospital based care)
- the structure of our healthcare funding system
> most people prefers inpatient care as they can utilize their medisave. (There is a cap on medisave use for outpatient care)
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I dont think our residency program is bad, but I do feel that there is a limit to what GPs can do in singapore.
I personally dream to practice FM in a different country (preferably in rural town) but unfortunately impossible nowadays due to covid situation