How is life as a doctor in Singapore?

Originally Posted by Unregistered

Is it right that in Fam Med
R1 - Pay same as MO = $5000 + calls
R2 - 5000 + 5% + calls
R3 - 5000 + 5% + 5% + calls

How about those that finish MMED come out as Fam Physician? Is it equal to Reg?

Then need farm a few years for FCFPS probably same pay grade before the next jump to AC which like what someone mention is about 13k to 15k?

Like that why don't people just go join chains and get $13k to $15k right after bond.

good point man
all the dumb ops doctor so stupid man, chains got 15k waiting for them why struggle so hard.

What is the difference between getting gdfm versus going through fam med residency in terms of recognition and job opportunities?

Originally Posted by Unregistered

What is the difference between getting gdfm versus going through fam med residency in terms of recognition and job opportunities?

why u keep asking this?

GDFM and m.med which the residency bags in the end are different creatures.
One is a 2 year part time course where u attend 3 lecture per quarter over 2 years.
End of it , u sit a 100mcq exam and 10 stations manned by a senior FP who is both actor and examiner. You ask questions, u say what u want to examine , he tell u the findings.
Each batch 250 enlist, maybe 150-170 pass? theres 1200 of them currently.

M.Med via residency is 3 years of hospital grinding of seemingly useless posting but which actually becomes very useful when u meet difficult or unique situations in outpatient settings. There's regular assessment and teaching, there's research and quality improvement projects to do. Every week u have a weekly general practice session where senior FP sits in and guide u. It influence how u practice eventually on a EBM level.
The exam is a different level. Its called NUS MBBS part 2. the MCQ is American board of FM standard ( which in US, if u pass, u become board cert liao), in Sg, after that you still have to do your clinical exam , 3 long weeks of 15 stations, damn painful exam.

In private world, ur qualification doesn't matter. ( Chains doesn't pay u a premium with a m.med if u really want to know. Raffles pays less than a 1K difference per month). Patient come to you if they like you or if the clinic u work at is part of their panel. Although i must say doing the m.med, u do really learn how to read patient and meet their ideas and expectations and nothing fazes you from women to kids to mental health or procedure. More importantly, you know what you are doing most of the time.

Some GDFMers still practices dodgey medicine to be honest because no one guides them along, they lack experience and eventually fall over to the dark side, not learning, not improving. Ive seen post GDFM year 3 polyclinic FPs ( and these are like PGY 8 guys ) who cant properly triage a AKI case.
they pick up a CDK 3 declining renal function, send for UFEME which turns out dirty with high RBC and kidney ultrasound show hydronephrosis and they treat with nitrofuratonin and refer non urgent to renal ..OMG. Hello, nitrofurantoin cannot treat pyelonephritis, not suitable for CKD 3b and hydronephrosis likely points to a structural problem that you should send to the urologist STRAIGHT. I retook a simple history and this guy doesn't drink water, had kidney stone before and have some back to front pain now and then..
But can't blame them , because they never rotate through urology before. There is no way lectures on a Saturday few times a quarter can teach you that.

in public setting, gdfm doesnt get u anywhere. in hospital, they dun even recognize it. In polyclinic , its family physician -> senior family physician -> principal family physician. I don't think i actually meet a principal family physician before. Its something u are eligible for like only like 8 years after u are a senior FP , which is like at least 5 years after u are a FP. You can't be a principal investigator for research , u can't be a chief trainer, u can however become head of polyclinic ( haha..no bluff its true, but i'm not sure why any sane person wants to do that job, other than to find an excuse to get away from wife) . With m.med, u are family physician -> associate consultant family physician -> con ( with FCFP) -> senior con. You can take on any roles. Some guys i know transit to pretty cushy jobs.

simply put. If u want to go private, just do GDFM la, u want more options and be a true blue FP, do m.med, but be prepared for hard work lo. The residency very hard imho, cos rotations all very short and learning is fast and furious with soo soo many assessments. One month u delivering babies starting to get comfy liao, next month you on the gen med ward , 3 months later u are scrubbing in on TKRs. But i had fun times, i help detort testicular torsions, did burr holes while on call and help with 5 hour lymph node clearance breast surgery. I did neuro stroke calls before and get activated for thrombolysis. In A&E, one guy came in with upper back tearing pain, lowish BP , damn cool to recognize the marfan signs and confidently tell the reg its an AORTIC DISSECTION!!! Stare down life when i did pallative and pluck fishbones during my ENT stint from a very very grateful auntie that return next day to give me a fruit basket ( that i didn't declare)

In the future, maybe, and thats my wishlist, perhaps those with FCFP can be called family medicine specialist and the rest family physician.

Ya agree. The value of fm residency lies with the multiple posting and rotations.
While first time pass rates are lower for shs fm residency, shs is better as during o&g posting, surgical posting the residents really participate

In fm residency u really get exposed to many postings that are hard to come by
Eye, ortho, ent, o&g, ed, im, geri, gs, nes, psy.. and many more

That is why mmed college program B is never as good as program A
Even though program B doctors are much older.

Ya i agree actually mmed itself is not the thing that makes fp good
But the postings.

You can also have a la jiao mo that rotates thru ten different specs six months each with gdfm

Simply put nothing magical abt mmed fm but it is just the luxury of having multiple posting to different specs.

You can try to train to be fantastic Family Physician capable of working in rural out of city area. Manage virtually everything including colored obstetrics and deliver anaesthesia and even surgery like appendectomy and ORIF.

But in Singapore realistically how is that relevant? Who is going to pay you big bucks for doing those things?

If you want to make money and have lots of patients you will realize that it is the patients that pay you. And many patients have no idea what is a good doctor.

More often it is the doctor they like. Like. The guy who listens and is on same wavelength. Agrees. Says what they want to hear. Assuring. "See him or her already feel better liao"

That kind of rubbish.

EBM? joke lah.

How many Sg patients when having a cold or flu will ask for antibiotics?

I will say that the wonderful description of the super well trained MMED FAM MED is over qualified to be a family physician in Sg. In fact quite likely if that person were to work in pre setting will be damn frustrated because the patients will want him or her to do the wrong non EBM stuff. Will disagree with his or her EBM advice. Argue that natural alternative better than pharmaceutical. TCM better than Western Medicine. And oh yes....insurance plans tying your hands. Limit caps in bill per patient including meds and consult.

You realize your extreme knowledge and training is only worth $30 or less.

Originally Posted by Unregistered

You can try to train to be fantastic Family Physician capable of working in rural out of city area. Manage virtually everything including colored obstetrics and deliver anaesthesia and even surgery like appendectomy and ORIF.

But in Singapore realistically how is that relevant? Who is going to pay you big bucks for doing those things?

If you want to make money and have lots of patients you will realize that it is the patients that pay you. And many patients have no idea what is a good doctor.

More often it is the doctor they like. Like. The guy who listens and is on same wavelength. Agrees. Says what they want to hear. Assuring. "See him or her already feel better liao"

That kind of rubbish.

EBM? joke lah.

How many Sg patients when having a cold or flu will ask for antibiotics?

I will say that the wonderful description of the super well trained MMED FAM MED is over qualified to be a family physician in Sg. In fact quite likely if that person were to work in pre setting will be damn frustrated because the patients will want him or her to do the wrong non EBM stuff. Will disagree with his or her EBM advice. Argue that natural alternative better than pharmaceutical. TCM better than Western Medicine. And oh yes....insurance plans tying your hands. Limit caps in bill per patient including meds and consult.

You realize your extreme knowledge and training is only worth $30 or less.

You are wrong. Very grossly wrong about the worth of my knowledge and training. TPA pays me only $5 per consult. And not $30.

Originally Posted by Unregistered

You are wrong. Very grossly wrong about the worth of my knowledge and training. TPA pays me only $5 per consult. And not $30.

LOL! Gosh! I remember those $20 overall bill limit plans back in 2008. Thought it might have gotten better with inflation.

Sigh. Anyway you know what I mean.

"Good" and popular doctor is usually the friendliest, nicest, never scold patient, always say the good things, say things like "mai kia" "all ok" "dont worry". Take some medicine will get better. Great PR skills. Personable. Accomodating.

NOTHING. NOTHING about EBM. In fact I say patients hate when drs throw EBM at them. Not their problem.

Originally Posted by Unregistered

You can try to train to be fantastic Family Physician capable of working in rural out of city area. Manage virtually everything including colored obstetrics and deliver anaesthesia and even surgery like appendectomy and ORIF.

But in Singapore realistically how is that relevant? Who is going to pay you big bucks for doing those things?

If you want to make money and have lots of patients you will realize that it is the patients that pay you. And many patients have no idea what is a good doctor.

More often it is the doctor they like. Like. The guy who listens and is on same wavelength. Agrees. Says what they want to hear. Assuring. "See him or her already feel better liao"

That kind of rubbish.

EBM? joke lah.

How many Sg patients when having a cold or flu will ask for antibiotics?

I will say that the wonderful description of the super well trained MMED FAM MED is over qualified to be a family physician in Sg. In fact quite likely if that person were to work in pre setting will be damn frustrated because the patients will want him or her to do the wrong non EBM stuff. Will disagree with his or her EBM advice. Argue that natural alternative better than pharmaceutical. TCM better than Western Medicine. And oh yes....insurance plans tying your hands. Limit caps in bill per patient including meds and consult.

You realize your extreme knowledge and training is only worth $30 or less.

This oft quoted example of patient wanting abx for flu and cold a bit cliché lei.
Only the china patient wants those reduce inflammation meds now a days. Everyone understand when I say abx kill bacteria, u have a virus, abx doesn't kill it. Only the ah tiong still go 消炎药 and when u ask them to translate or show pic..it turn out to be some penicillin. Got time I try to educate them, dun have time I take the chance they will complain and don't give them.
Come on la, private world , they give abx to earn money, really patient request meh. Hardly any during my locum and private gp stint. Sometimes they even say dun give me abx hor, last time the augmentin u give me cost 40 dollars.
Practice ebm is not about forcing the patient to do what u like. A lot of it is understanding their perspective. The ah ma who forever believe her cough is due to heatiness of cos don't like it when u tell her her belief is wrong. Same like Christians who hear Jesus talking to them..medically they have hallucinations lei. U go tell them that lor, see get complain or not for not respecting religious views.
Emb is about u as a doctor understanding the basis for Ur medical decision and advice and tailor it to the patient needs. If got chance, educate and explain instead of expecting the patient to 100 percent follow u blindly.
If u lend a ear and patient trust u, they will follow what u say.
Your standard as a doctor is lacking la. That's the problem. An inadequately trained fp adpots attitude like yours.

Originally Posted by Unregistered

This oft quoted example of patient wanting abx for flu and cold a bit cliché lei.
Only the china patient wants those reduce inflammation meds now a days. Everyone understand when I say abx kill bacteria, u have a virus, abx doesn't kill it. Only the ah tiong still go 消炎药 and when u ask them to translate or show pic..it turn out to be some penicillin. Got time I try to educate them, [b]dun have time I take the chance they will complain[b] and don't give them.
Come on la, private world , they give abx to earn money, really patient request meh. Hardly any during my locum and private gp stint. Sometimes they even say dun give me abx hor, last time the augmentin u give me cost 40 dollars.
Practice ebm is not about forcing the patient to do what u like. A lot of it is understanding their perspective. The ah ma who forever believe her cough is due to heatiness of cos don't like it when u tell her her belief is wrong. Same like Christians who hear Jesus talking to them..medically they have hallucinations lei. U go tell them that lor, see get complain or not for not respecting religious views.
Emb is about u as a doctor understanding the basis for Ur medical decision and advice and tailor it to the patient needs. If got chance, educate and explain instead of expecting the patient to 100 percent follow u blindly.
If u lend a ear and patient trust u, they will follow what u say.
Your standard as a doctor is lacking la. That's the problem. An inadequately trained fp adpots attitude like yours.

"dun have time I take the chance they will complain"

Ok you win lah. BTW how much you get paid for your excellent EBM ICE consult?

Wonder if your pte clinic can survive pay rent and staff purely on consult fees?