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How is life as a doctor in Singapore?

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  #2531 (permalink)  
Old 09-08-2021, 10:39 PM
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What's Ur basis for saying the sg residency is subpar? Did u train in both? Any measures done objectively in any studies anywhere? Didn't Ur racgp training teach u anything about evidence based statement?
If not, then dun bring your amdk sense of superiorty here and snub local pls. Study a few years overseas then come here and blow. If so pro, no need go overseas to study medicine Liao la. Just pass Ur racgp exam and feeling top of the world is it ? Hello...still a gp nia. What world renowned for producing mini specialist and specialist gp. Self glamourising , desperate for recognition and need for validation to be call a specialist? The racgp is still a 3 year program like almost everywhere else in the world.

Giving duodart for bph does not make u urologist. Able to deliver a baby does not make u an obesterician. Able to cut out some bcc and scc out does not make you a dermatologist.

FM training is not about acting as mini specialist. It's a broad based discipline. What mini specialist..unless u tell me u can do a angioplasty for the guy with stemi in the rural area, repair the triple AAA etc.

I'm proud to be a generalist trained by the sg fm residency. I dun need to call myself a mini specialist or be recognised as one and certainly doesn't need a racgp curriculum to serve the needs of the sg population well.
.
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.)
.
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.
.
- 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)
.
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)
.

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

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  #2532 (permalink)  
Old 09-08-2021, 11:45 PM
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Quote:
Originally Posted by Unregistered View Post
.
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.)
.
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.
.
- 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)
.
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)
.

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
Big part is patient expectation. In SG patients see no up FM. All want specialist. That's the real problem.

Anyone know of any SG dr trained in SG first then moved abroad to work permanently? Not HMDP. But actually go abroad and get licenced there and stayed there?

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  #2533 (permalink)  
Old 10-08-2021, 07:40 AM
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Quote:
Originally Posted by Unregistered View Post
.
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.)
.
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.
.
- 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)
.
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)
.

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
If u are local trained then u know the reason for the referral are

1. Patient wants it
2. For a lot of junior non trained Dr, esp those cmi rp from India, Philippines, it's easier to refer because that's the easiest thing to do Vs say, full examination, teaching self physio, explaining analgesia regime, activity moderation to the patient and then still them saying they want a referral for standby at the end.
As a resident unfortunately u have to do the full works for learning purpose. As a trained FM, I ask them quite upfront how I can help them..do you

A. Want 2 days to rest
B. Want a referral or X ray
C. Want me to manage you.

Delivering babies? When obgyn are running away from it due to the the malpractice no tail end cover situation , u as a gp want to deliver babies? Sure.

The fact of it is that gp help patient navigate the healthcare system and provide a lot of reassurance. The sooner you come to terms with it, the easier it is for you to like your job. The reality is as a gp ur skillset is flexible enough to cover a lot of ground if patient lets u. If not, move on and refer.
What you like, u can actually find in the setting of a&e. U can try NZ where urgent care is actually a speciality too.

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  #2534 (permalink)  
Old 10-08-2021, 08:01 AM
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Quote:
Originally Posted by Unregistered View Post
What's Ur basis for saying the sg residency is subpar? Did u train in both? Any measures done objectively in any studies anywhere? Didn't Ur racgp training teach u anything about evidence based statement?
If not, then dun bring your amdk sense of superiorty here and snub local pls. Study a few years overseas then come here and blow. If so pro, no need go overseas to study medicine Liao la. Just pass Ur racgp exam and feeling top of the world is it ? Hello...still a gp nia. What world renowned for producing mini specialist and specialist gp. Self glamourising , desperate for recognition and need for validation to be call a specialist? The racgp is still a 3 year program like almost everywhere else in the world.

Giving duodart for bph does not make u urologist. Able to deliver a baby does not make u an obesterician. Able to cut out some bcc and scc out does not make you a dermatologist.

FM training is not about acting as mini specialist. It's a broad based discipline. What mini specialist..unless u tell me u can do a angioplasty for the guy with stemi in the rural area, repair the triple AAA etc.

I'm proud to be a generalist trained by the sg fm residency. I dun need to call myself a mini specialist or be recognised as one and certainly doesn't need a racgp curriculum to serve the needs of the sg population well.
No need to be so defensive! You’re taking it too personally. Australia and Singapore are different countries with their own unique needs, hence the contrast in their training and autonomy of practice. It is true that the generalist in a larger country practicing in a rural locality will be more comfortable with pathologies that are traditionally managed by specialists in metropolitan setting. They will likely also have a wider procedural skillset. This is more likely to be born out of necessity, and shouldn’t be viewed as a personal attack by the insecure practitioner above!
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  #2535 (permalink)  
Old 10-08-2021, 08:45 AM
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Quote:
Originally Posted by Unregistered View Post
If u are local trained then u know the reason for the referral are

1. Patient wants it
2. For a lot of junior non trained Dr, esp those cmi rp from India, Philippines, it's easier to refer because that's the easiest thing to do Vs say, full examination, teaching self physio, explaining analgesia regime, activity moderation to the patient and then still them saying they want a referral for standby at the end.
As a resident unfortunately u have to do the full works for learning purpose. As a trained FM, I ask them quite upfront how I can help them..do you

A. Want 2 days to rest
B. Want a referral or X ray
C. Want me to manage you.

Delivering babies? When obgyn are running away from it due to the the malpractice no tail end cover situation , u as a gp want to deliver babies? Sure.

The fact of it is that gp help patient navigate the healthcare system and provide a lot of reassurance. The sooner you come to terms with it, the easier it is for you to like your job. The reality is as a gp ur skillset is flexible enough to cover a lot of ground if patient lets u. If not, move on and refer.
What you like, u can actually find in the setting of a&e. U can try NZ where urgent care is actually a speciality too.
Summarize your above into

Do what patient wants. Most patients want GP refer to specialist for the things the patient think is complicated and patients think many things all complicated.
Thats why so many referrals. Dont refer tio complaint. Best case is patients tell you what they wa t. Worst case is patient shy to say expect you to read their mind do what they want. So always ask. Can tell who is old bird GP.
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  #2536 (permalink)  
Old 10-08-2021, 10:35 PM
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How are the evaluations for medical officers performed? Is it just one C1 form for the whole of 6 months?
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  #2537 (permalink)  
Old 11-08-2021, 06:08 AM
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Anyone can shine a light on current reg call pay rate? I know MO is 220 for weekday full call which is quote little
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  #2538 (permalink)  
Old 11-08-2021, 06:42 AM
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Anyone can shine a light on current reg call pay rate? I know MO is 220 for weekday full call which is quote little
Used to be $70 in late 1990s and early 2000s.
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  #2539 (permalink)  
Old 11-08-2021, 07:00 AM
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Anyone can shine a light on current reg call pay rate? I know MO is 220 for weekday full call which is quote little
Why don’t you just ask your reg
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  #2540 (permalink)  
Old 11-08-2021, 11:17 AM
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Big part is patient expectation. In SG patients see no up FM. All want specialist. That's the real problem.

Anyone know of any SG dr trained in SG first then moved abroad to work permanently? Not HMDP. But actually go abroad and get licenced there and stayed there?
Actually the overseas-trained GPs like Australia FRACGP are considered specialists in their own right and accordingly their remuneration is commensurate with other hospital non-procedural specialists in Australia.

To answer your question, I personally know a couple of old birds NUS MBBS grads who migrated to Australia and did the FRACGP residency and gotten Australian PR visas. Its a long arduous journey considering the breadth and depth of skillsets required to be an certified Australian GP and the need to upskill in varied areas such as managing paediatric developmental milestones and immunisations, low-risk pregnancies, cervical screening, mental health counselling, diabetic insulin titration, skin cancer excision, palliative care, etc. All these are expected to be managed at the GP level by the specialist you are subsequently referring to so you don't unnecessarily overburden the public hospital system. As a GP there you follow your patient through their life cycle in providing holistic cradle-to-grave care. It may sound contextually diverse, but for those who pull through to FRACGP fellowship, GP work as described can be immensely satisfying.
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