How is life as a doctor in Singapore?

Originally Posted by Unregistered

I am currently mopex, thinking of doing fm work eventually. (Just completed gdfm, will Either aim for rp in ops or just go join a chain grp/locum once my peg bond finish)

Would like to ask seniors for their genuine opinion. (Not just fm, but all specialists, esp those involved in public health)

How would the new initiatives announced by minister Ong change the healthcare landscape in Singapore? (In terms of job opportunities, financial Remuneration and how hospitals function etc)

The 2 new initiatives I am referring to are mainly the capitation funding model and the "every Singapore to be registered with one gp" idea

I think the concept is largely modelled from overseas (esp UK) but do you guys think it will work in sg context? (I mean I am doing gm now, I can tell you we really investigate and refer a lot for very minor things, i.e a lot of defensive medicine. Also understand from my fm resident colleagues that pple in ops also sometimes demand to see specialist even for simple things that can be managed at ops)

I am just not sure the new initiatives will work out as sg pple are simply quite different (to put in a polite way) compared to UK pts from my personal experience. (Disclaimer I studied medicine in UK and worked as fy1 there)

A lot of my consultants are quite skeptical but was wondering what pple think (genuinely), and how will these affect our career choices ?

.

aiya. u want to know how ill prepared they are?
go Google capitation job
the blood clusters just start to hire people for this job now.

some scholar came up with some white paper and magically think it will work here. on paper I want to write how brilliant it is, it will be how brilliant.
trust me, sometimes I don't want to refer but I got complained before becuase I refuse to refer a lady with fey lips to NSC. 2 week history, work in air con all day.
spend so much time counseling no use.

boss say u not wrong but your communication can be better. roll eyes.
when u refuse to do what patient want, everything is your fault, medically not your fault but communication and uncaring doctor is your fault. sure.

ok. fine then..I refer lo. every bloody single thing. I want help system, system dun help me. system can go eat ****.

Originally Posted by Unregistered

aiya. u want to know how ill prepared they are?
go Google capitation job
the blood clusters just start to hire people for this job now.

some scholar came up with some white paper and magically think it will work here. on paper I want to write how brilliant it is, it will be how brilliant.
trust me, sometimes I don't want to refer but I got complained before becuase I refuse to refer a lady with fey lips to NSC. 2 week history, work in air con all day.
spend so much time counseling no use.

boss say u not wrong but your communication can be better. roll eyes.
when u refuse to do what patient want, everything is your fault, medically not your fault but communication and uncaring doctor is your fault. sure.

ok. fine then..I refer lo. every bloody single thing. I want help system, system dun help me. system can go eat ****.

cannot lah. fam med must have pride. this year onwards sab alr. cannot refer everywhere.

Originally Posted by Unregistered

aiya. u want to know how ill prepared they are?
go Google capitation job
the blood clusters just start to hire people for this job now.

some scholar came up with some white paper and magically think it will work here. on paper I want to write how brilliant it is, it will be how brilliant.
trust me, sometimes I don't want to refer but I got complained before becuase I refuse to refer a lady with fey lips to NSC. 2 week history, work in air con all day.
spend so much time counseling no use.

boss say u not wrong but your communication can be better. roll eyes.
when u refuse to do what patient want, everything is your fault, medically not your fault but communication and uncaring doctor is your fault. sure.

ok. fine then..I refer lo. every bloody single thing. I want help system, system dun help me. system can go eat ****.

Every dr goes through this eventually.
Patient autonomy trumps all else.
And is very easy for those responding to complaint to just agree with patient and give them what they want.
And it is always the dr "communication skills" need to be imrpoved instead of telling the patient that what dr did is correct and what you want is not usually what we do and not necessary and essentially "wrong".
The trouble with medicine is it is one by one. So one complaint usually traced to one dr. Easy to tekan one dr. Especially if relatively junior. Senior also can.
The system say things like dont waste resources dont anyhow refer dont anyhow investigate etc. I have never ever seen any dr get a medal for exemplary commitment to saving resources and practicng good medicine. One complaint come in then is dr need to improve communication. Or worse if missed something patient had bad outcome kena sued and disciplined. On the other hand I personally have had many complimentary letters written by patients thanking me for helping me give them what they want despite it not being the "correct" thing to do. In fact many will writr that "no other dr" will help them but I did. Does the system say hey dr you shouldnt be spoiling patients like that? Nope.
F the system la.
This whole covid thing. From covid deniers. To vaccine conspiracies. So why is it no one tell Kenneth Mak he need to have better communication skills? Or OYK? Why still so many people dowan vax? Dont believe covid is real?
Patient autonomy is a nice thing to throw out there to say patients decide etc. But what hapoens when it screws up the system?
If you are a smart dr go with patient autonomy. It is safest way to practice medicine, compassionate, empathetic, responsive, and is a going above and beyond for the patient. Sounds awesome.
Let the admin deal with the problems with patient first medicine. And they can deal with the patients. But in order for this to work drs have to stand united for patients. Advocate for patients not administrators.

Originally Posted by Unregistered

I am currently mopex, thinking of doing fm work eventually. (Just completed gdfm, will Either aim for rp in ops or just go join a chain grp/locum once my peg bond finish)

Would like to ask seniors for their genuine opinion. (Not just fm, but all specialists, esp those involved in public health)

How would the new initiatives announced by minister Ong change the healthcare landscape in Singapore? (In terms of job opportunities, financial Remuneration and how hospitals function etc)

The 2 new initiatives I am referring to are mainly the capitation funding model and the "every Singapore to be registered with one gp" idea

I think the concept is largely modelled from overseas (esp UK) but do you guys think it will work in sg context? (I mean I am doing gm now, I can tell you we really investigate and refer a lot for very minor things, i.e a lot of defensive medicine. Also understand from my fm resident colleagues that pple in ops also sometimes demand to see specialist even for simple things that can be managed at ops)

I am just not sure the new initiatives will work out as sg pple are simply quite different (to put in a polite way) compared to UK pts from my personal experience. (Disclaimer I studied medicine in UK and worked as fy1 there)

A lot of my consultants are quite skeptical but was wondering what pple think (genuinely), and how will these affect our career choices ?

.

No initiative from admin is ever intended to increase health care spending. It is always to cut.
Always remember where your responsibilities lie. Patients.
Drs are paid to see patients. You see one patient the patient pays. Doesnt matter how good or how crap your consult was. How short or long. At least in most FM situations.
There is no outcome based remuneration system.
This is why defensive medicine is king now.
Order more tests is safer also feeds into what patient wants. And in some cases can charge more. In cases of flat rate fees then is system lose money not patient also.
Medicine is all about volume.
How many patients you see.
How many patients you op.
The more you see and do the more you earn.
The outcome? As long as not bad no complications actually can already. Be competent but there is no reward for being Dr House.

Originally Posted by Unregistered

No initiative from admin is ever intended to increase health care spending. It is always to cut.
Always remember where your responsibilities lie. Patients.
Drs are paid to see patients. You see one patient the patient pays. Doesnt matter how good or how crap your consult was. How short or long. At least in most FM situations.
There is no outcome based remuneration system.
This is why defensive medicine is king now.
Order more tests is safer also feeds into what patient wants. And in some cases can charge more. In cases of flat rate fees then is system lose money not patient also.
Medicine is all about volume.
How many patients you see.
How many patients you op.
The more you see and do the more you earn.
The outcome? As long as not bad no complications actually can already. Be competent but there is no reward for being Dr House.

Is it still about volume with the new capitation model?
I think no one answered the OP question at the start. How will our healthcare change for both fm and specialist (in both public and private) once the new capitation model kicks in..

[QUOTE=Unregistered;209895]

Would like to ask seniors for their genuine opinion. (Not just fm, but all specialists, esp those involved in public health)

How would the new initiatives announced by minister Ong change the healthcare landscape in Singapore? (In terms of job opportunities, financial Remuneration and how hospitals function etc)

The 2 new initiatives I am referring to are mainly the capitation funding model and the "every Singapore to be registered with one gp" idea

---
I feel that more pple will probably go to private to get the tests that they want. (as public sector may struggle to do these tests due to lack of funding)

[QUOTE=Unregistered;210023]

Originally Posted by Unregistered

Would like to ask seniors for their genuine opinion. (Not just fm, but all specialists, esp those involved in public health)

How would the new initiatives announced by minister Ong change the healthcare landscape in Singapore? (In terms of job opportunities, financial Remuneration and how hospitals function etc)

The 2 new initiatives I am referring to are mainly the capitation funding model and the "every Singapore to be registered with one gp" idea

---
I feel that more pple will probably go to private to get the tests that they want. (as public sector may struggle to do these tests due to lack of funding)

No TPA pays $5 in pte. As long as moh pays $6 for ops, ops is more viable then pte

Originally Posted by Unregistered

Is it still about volume with the new capitation model?
I think no one answered the OP question at the start. How will our healthcare change for both fm and specialist (in both public and private) once the new capitation model kicks in..

The capitation model is just another idea cooked up by some administrator as being "a change for the better".

It means fixed budgets.

Does this sound like something that will raise dr salaries? Nope.

Likely there will be pressure on HODs to manage costs and utilization.

It is good on paper but as any dr on the ground will tell you patients dont think about their health and well being in these metrics.

The capitation is based just on.....again...volume. one resident = one patient = same amount allocated as the next person.

But hey some people are tobacco smokers. Some are alcoholic. Some are obese. Some have congenital conditions.

The assumption is all average out.

It comes at a time when MOH has released numbers indicating that the overall health of Singpaoreans is getting worse. Not better.

Likely MOH knows they are going to have to pay more. But they dont want to. So pass fhe buck down to drs to manage budgets.

Pressure will be put on performance now which is not a bad idea. But patien autonomy is still the problem. You cant simply force patients to become healthy. MOH should know with the covid vaccines.

Originally Posted by Unregistered

Is it still about volume with the new capitation model?
I think no one answered the OP question at the start. How will our healthcare change for both fm and specialist (in both public and private) once the new capitation model kicks in..

As others have alluded to above, capitation model was introduced to provide primary care at a fixed budget. With increasing healthcare costs that means something have to give, usually doctors remuneration.

So more Gs/FPs are needed but everyone share the same pie, hence the increase fam med recruitment drive you see happening now. In the UK when capitation was introduced lots of my UK classmates who were GPs migrated to Australia where the GP pay is higher with lesser working hours.

Originally Posted by Unregistered

As others have alluded to above, capitation model was introduced to provide primary care at a fixed budget. With increasing healthcare costs that means something have to give, usually doctors remuneration.

So more Gs/FPs are needed but everyone share the same pie, hence the increase fam med recruitment drive you see happening now. In the UK when capitation was introduced lots of my UK classmates who were GPs migrated to Australia where the GP pay is higher with lesser working hours.

Bait and switch strategy.
The Singapore FPs think they have it good now. See how long it lasts.
Pte sector may benefit though. Give it a few years.