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How is life as a doctor in Singapore?

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  #4251 (permalink)  
Old 23-09-2022, 09:24 PM
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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.

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  #4252 (permalink)  
Old 23-09-2022, 09:41 PM
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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.

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  #4253 (permalink)  
Old 24-09-2022, 11:32 PM
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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.

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  #4254 (permalink)  
Old 25-09-2022, 11:44 PM
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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.
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  #4255 (permalink)  
Old 26-09-2022, 07:33 PM
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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.
Internal medicine. Some IM departments are so desperate that they are hiring locums whereas polyclinic are oversubscribed nowadays.
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  #4256 (permalink)  
Old 26-09-2022, 08:04 PM
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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
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  #4257 (permalink)  
Old 27-09-2022, 03:46 PM
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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.
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.
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  #4258 (permalink)  
Old 27-09-2022, 07:45 PM
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Originally Posted by Unregistered View Post
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.

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.
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  #4259 (permalink)  
Old 27-09-2022, 08:53 PM
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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.
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.
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  #4260 (permalink)  
Old 27-09-2022, 08:54 PM
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Quote:
Originally Posted by Unregistered View Post
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.
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.
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