Potential for mis management u mean?
As one of my old preceptors use to say, u do the greatest harm if u cannot control chronic diseases well.
Other country fp or gp is 3 year training program.
Ours is the surgical training failed to get into ent go and setup shop, part time part time do gdfm
Syringe ear very good. The rest I'm not so sure

Some other countries starting to replace family physicians with nurse practitioners and physician assistants. Cheaper. Just as good. The era of family physicians is over.
Singapore is behind the times.

better than your ‘residents’ who cant even pass exam. stuck at MBBS.

A.
The brusied ego out again.

Residents also getting smarter nowadays, all signing up for gdfm, my batch at least 1/3 have cleared gdfm, as we also know mmed is tough to pass lol

Outside private gp /fp package damn good man
My junior shared with me.
I see liao also tempted.
Simple simple see.
Write stupid memo for polyclinic to followup.

GDFM is the future. those too late can continue as MOPEX

Spoken like a true simp.
In fact nurse practitioners and physician assistants have been around for some time and FPs still have not been replaced. Nurses Shld in fact step up take over all the simple cases and clear the queue, leaving FPs to do the real FP work.

some say the true value of residency is being able to study for gdfm. good luck if they let you pass mmed.

Why u even bother to reply to trolls
Physician assistant is a USA concept.
He is just internet troll.

Nurses can't la.
The np in my clinic cannot make it one lei.
One simple chronic case they write pages and pages because they scared and need documentation for protection.
One morning hardly can see 10 case. Anything outside still need to ask senior doctor in queue and it could things as simple as a keratokantoma.

They can't tank a chronic queue.
And salary not cheap hor. Most of them anc level liao , salary is mo level.
I rather have a mo rather than a np.

They are there simply because some genius make the mistake of calling nurse a low skill workforce
Now got to map out higher level of work for them.
Much like duxton was built becuase lky and family was caught buying condo on discount.

Imho nurse do what nurses have to do. Sub speciality will be like wound care, ICU nursing, surgical assistant etc. No need train them to become mini doctors...becuase not here not there.
Pay them well. No one cares what u call them.

Ur np suck doesn’t mean all np suck.
A lot of it is to do with training or lack of seniors to guide them.


I routinely pass my cases to them. They can handle well.

I think is the training. Or the milieu. Maybe ur ops or yourself is the issue.

Agreed.

Would you trust a senior NP with more than 10+ years of clinical experience and working in a multidisplinary team?

Vs some MOs that cant even pass their exams?

The choice is clear.

What sort of doctors are in demand in sg, especially in the future? Primary care? Legions of MOs/RPs? Certain specialists (oversubscribed specialties aside)? Doesn't seem to be much info on this recently.

The problem with primary care is that it is volume based work. Primary care doesnt pay for expertise. It pays per consult. Yes you can charge more for extra time spent. But it doesnt work out to your advantage. It is better to see more patients per hour. The other thing with primary care is that it is breadth of knowledge. So much to know and discuss with patients. And because there is so much breadth it is hard to form a team to assist you.

Whereas with specialists you can be much more efficient.

Not only are people more willing to pay higher rates for specialist medical consults but you can also have a team od specialized educators or para clinical staff helping. So dr can do the medical assessment. Determine diagnosis is correct(usually referred and differentiated problem for you ) assess that there are no contraindications to the treatment you offer then explain briefly to the patient then pass them on to another junior dr or nurse educator etc.
Very *ahem* specialized.

With GPs usually you got to do most of the work. Diagnose. Investigatr from scratch. Explain differentials. Then results then what possible treatments answer objections and fears. It is A LOT of work. And from derm problem to gynae problem to pediatric to orthopedic to psychatrict to neurologic to cardiac to urologic etc how to build a support system? Even in OPS got some nurses is for DM HPT Obesity Smoking cessation at most only. Which is why..refer. but who eill pay you big bucks for referring?

So despite all the rhetoric and adulations about GPs dont fall for it. It is still more lucrative to spcialize. Look for niche markets that are not filled by existing specialties.

That is how aesthetics started. Other fringe medicine opportunities are out there one could specialize in. Singapore unfortunately doesnt have rural centres where there migjt be demand for specialist GPs in anaesthesia or obstetrics or surgical assist.

Internal medicine. Some IM departments are so desperate that they are hiring locums whereas polyclinic are oversubscribed nowadays.

Desperate for rps right.
Not desperate for cons

this guy gets it.
specialize in a skill is the best.
generalist work is very tough. In hospital setting at least still can blue letter left right center.
In primary care, sibei jialat. Your worried auntie comes with 10 concerns because their cousin say this , they read that on google or saw that on some TV program.
Sometimes i don't want to talk much, i stare at the computer and become the proverbial dumb doctor.
The reason is i don't want to be the helpful doctor because its simply too much work for me. Not when you are the 44th patient of the day, its 5:20pm and I REALLY WANT TO GO HOME.

Agree that gp would never be as lucrative as specialist. Quite frankly most people including myself want to become gp as we don't want to take too much responsibility. For gp, there is always a second line of defense and that is to refer.

Currently in ops, we also refer left, right and centre. I even referred subclinical hypothyroidism coz pt wants it. Make my life easier don't need explain anything. I am very often honest with patients, literally telling them I don't know how to manage their condition and hence I am referring. For example,
- most rash who don't respond to steroid cream
- abnormal blood tests that are not thyroid, dm, or lipids. Like plt high, refer haem. Coz I tell pt I don't know what is the cause.

Private gp even better, do whole load of screening, tell pt "results abnormal but they cannot manage, better and cheaper to go ops. "- like literally.. (I agree with the cheaper part but still...)

On my first day in ops, one of the senior doctors told me. You MUST practice within your circle of competence and refer any case you are not confident of managing. (This is stated in smc ethical code of conduct)
He also adds that everyone circle of competence is different.
Reading in-between the lines, I think he essentially meant just refer everyone if I cant manage. Don't take unnecessary risks as if manage wrongly he need to handle complaint lol.

Exactly! Totally right! Plus how are GPs paid? Not by difficulty and complexity of case but by a set amount per patient. No difference is easy follow up refill meds vs new strange first presentation suggestive of multiple sclerosis or scleroderma

In other words even if you are essetially providing specialist level care they are paying you low level generalist cheap skate rates. Thats how they save money. On the back of your hard work and good heart.

Sorry man. Dont fall for it. Also all those people who say things about having pride and neing a good generalist breadth and depth knowledge jin satki.....MMed....

After 10 years honestly they will see the light after seeing their 1 millionth patient. Even if you in OPS the bonus you get is not from seeing complex cases. More like those extra projects QIP other initiatives etc.

In other words a form of 'specialization" in itself.

Take the exam. Pass the exam. But dont fall for this nonsense about being some super GP.

Exactly! Totally right! Plus how are GPs paid? Not by difficulty and complexity of case but by a set amount per patient. No difference is easy follow up refill meds vs new strange first presentation suggestive of multiple sclerosis or scleroderma

In other words even if you are essetially providing specialist level care they are paying you low level generalist cheap skate rates. Thats how they save money. On the back of your hard work and good heart.

Sorry man. Dont fall for it. Also all those people who say things about having pride and neing a good generalist breadth and depth knowledge jin satki.....MMed....

After 10 years honestly they will see the light after seeing their 1 millionth patient. Even if you in OPS the bonus you get is not from seeing complex cases. More like those extra projects QIP other initiatives etc.

In other words a form of 'specialization" in itself. Right?

Take the exam. Pass the exam. But dont fall for this nonsense about being some super GP.

This is what you are told and you tell yourself

You think specialist dont refer? They do! Refer to other specialists

It isnt that different really. Specialists can only manage within their own scope

Depth is easier to master because there is a limit. There is no limit in breadth.

Iin fact there is even sub specialist.

Do yourself a favor. Finish the mmed. Gdfm. But dot be a generalist. Specialize in something.

Even internal med....it is generalist. Dont be fooled that it is a specialty much different from GP. Slightly better cos dun do peds psych obs and gynae ortho and surgery. But a lot of work. Often dumping ground. Which is why im let gp set up admission ward to help with dumped patients.

The big con job is tellimg GPs they cam be super drs by doing mmed and can manage all kinds of complex cases "just like specialist".

Yeah classic case of generalist want to be able to tout themselves as specialist standard

But paid generalist rates. Lol!

The true specialty of GP is the breadth. The breadth of type of cases they will accept and see. Basically everything and everyone! But to kid yourself that you can have the actual breadth and depth to do so is folly.

GPs can specialize. Often taking on work at boutique clinics. Maybe doing skin biopsies for a dermatologist? Follow up of stable psychiatry patients? Sports med for eg is really one speciality that orthopods have given away so they can spend more time operating vs doing assessment and examination.There is some area of work specialists find not the best use of their time. Look for those. As a mmed you will be very qualified

Your life will also get easier. Know what to expect everyday. Same questions. Can even hire nurses to help with answering some common questions and follow up. Develop educators.

Better work life balance. Also more satisfaction (you're not referring postman anymore)

And last better $$$

What to specialize in after MMed (apart from AST routes like pall med and sports med)?
Any lobang to intro?

LOL pass your mmed then talk. if you can haha

Not to undermine the training
Mmed fm pass rate is really high

good luck this year then ;)

High?
You got percentage?
High becuase u claim so?

Hello
Other than the 2020 COVID batch where like 80 percent pass for part 2
Mostly it hovers around 50 to 60 percent for part 2
Part 1, 20 percent gone. Part 2 50 to 60 percent. Overall each batch go exam pass one u go count urself
For a first post grad exam passing rate, is not great compared to mrcp and of cse no where near mrcs
For an exit exam , it's nowhere near the high passing rates of other speciality.

Nhg a few years 100 percent means nothing. Becuase they only let resident high chance to pass go take
Sgh 60 to 70 percent, Nuh similar. Program b also not high plus last year failure also add on

High?
Ya. If u say so.

Why do they want to have such a high failure rate?

That's the problem with Singapore local exams. Over rated. Purposely fail people. Medical profession is like that. Doctors always gaslighting each other.

I challenge any MMeder who has passed 5 years ago and go take the exam again without studying again. Can pass? If cannot pass then why you need such a high standard for exam? Exams exams exams.Medical field already one of the worst. Coupled with crazy obsession with exams in Singapore. Deadly mix.

So for nhg, if you low chance of passing then how? You repeat r3?

bye bye. this year you will feel the true meaning of the MMED exam. hahaha.

Referolgoy.
The art of referring within the time of 1 minute upon seeing the patient.

Errr actually I’m from NHG.
The whole batch takes exam. Nobody gets retained / prevented from taking exam.

Talk cock. Sg paces is the real killer

I pass paces first lei and then took m.med
Paces can train for it easily because there is only so many things they can test
M.med is anything under the sun. Granted no need super in-depth but breath kills u.

Maybe its time to increase residency training to 5 years.
Then maybe the candidates know how to assess patients properly.
Dont waste time anyhow go take mmed.
Make them pay training fee to MOH like how specialists do too.
At least GDFM candidates bring a wealth of experience to the table already.

U know taking drugs in Singapore is illegal?
Becuase you sound like you are high.


Gdfm candidate bring a wealth of experience?
Hello..the group I'm teaching all hopsital baby mo. MCR divide by 5 number still bigger than mine

Your MCT number start with what number? Mine is 0.

Uncle, i mean ah Pek, do you know that mcr once after 19,999 jump to 60,000?
My mcr is 3x more than my immediate yllsom senior, though just 1 year difference.
And I’m PGY9

20,000 is for dentist, so the jump.

Since you are 5x less than current 60k, meaning mcr 12k or less
Okie so grad 2004 from nus faculty of medicine.
Okie you win since you last batch from the faculty before they change name
前辈你好，晚辈向你敬礼

I grad before 2000

Die die better get mmed

Otherwise compete with mbbs from india. 180 coming!