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Today 09:45 AM
Unregistered
Quote:
Originally Posted by Unregistered View Post
Not a FP but I would agree with this. In countries like in Canada and Australia where FM physicians are considered specialists, FM residency is much harder to get into than certain specialties like psychiatry or non-procedural IM. To provide some context in Australia where I went to medical school, the RACGP exit exams have a 50-60% failure rate.

But those countries also pay their FM physicians much higher than us, so its not a true apples to apples comparison.
huh? Since when is it hard to get into GP training in Australia? No one fails to get into GP training eventually, its just how rural u are willingly to go.
It has only become relatively harder compared to previous years due to medical student tsunami, but worldwide, FM training has always been the easiest to get into relative to other specialties. psy and pathology hold fascination for some people only, do it only if u want to do it.

Dun kid yourself.

Also, since when is failure rate 50-60%?
s://1.racgp.org.au/newsgp/racgp/kfp-2020-2-public-exam-report-now-available
81% pass on their first try.

Sg side, except for 2020 exam which was markly different due to Covid, passing rate for each exam is usually 50% of the people who made it to the clinicals. Thats about 40% of the cohort fyi. Its a high stake exam for most of us as the salary doubles after that.

FM is always the poorer cousin to the medical specialties. Don't kid yourself that FM in canada or australia or UK do a lot.

Salary more? I dun think so lei. Remember, in australia, GP are self employed. They usually do shared billing at 60-70% and need to work quite hard to make 200K before tax. While an equivalent FP in singapore employed in what is essentially an iron rice bowl job with insurance, CME, annual leave etc all accounted for makes a bit more after the lower tax in Sg.

so, again dont kid yourself.
Today 07:20 AM
Unregistered
Quote:
Originally Posted by Unregistered View Post
but we need to quickly up the game of FPs to manage the ageing population.
it's not glamorous, and we live with the reputation that people think that FPs are stupid / rejects. but it's still a pretty darn important job that deserves every bit of respect and renumeration as other specialties.
Not a FP but I would agree with this. In countries like in Canada and Australia where FM physicians are considered specialists, FM residency is much harder to get into than certain specialties like psychiatry or non-procedural IM. To provide some context in Australia where I went to medical school, the RACGP exit exams have a 50-60% failure rate.

But those countries also pay their FM physicians much higher than us, so its not a true apples to apples comparison.
Today 05:55 AM
Unregistered
Quote:
Originally Posted by Unregistered View Post
you prolly are fairly junior...

for FM - after MMed you are still FP. base pay of $10k but there's still sign on bonus and several months of bonus each month.
you become AC 3 years after MMed (so essentially you reach AC one year slower than an AIM AC: 3 years basic IM and 2 years AIM).

private chains paying 13-14k/month depending on hours - this is literally the base rate and maybe some give 13th month AWS. it will still work out to be less than an AC/C from a PHI with several months of bonuses.
some idiots also quote you 13-14k/month including employer CPF contribution of $1020. so don't be fooled by what is quoted outside.

if you open your FP clinic, the sky is the limit. it's not that difficult, but you burn your hours and nights getting it up and running.
IM senior con - yeah perhaps you could open your private gen med clinic if you have the right connections.

in hospital, almost everyone becomes a C eventually unless you leave for private practice.
in FM, not everyone becomes a C so easily. you have to put in quite a bit of work.
so most of the FP consultants are actually high flyers, clinic directors, and so on..

So conclusion,
- private chain gp pay around same as ops assuming one has mmed and progress to become AC?
- IM earns more than fm, unless fm opens own clinic or set up asthestics chain?
Today 04:06 AM
Unregistered
Quote:
Originally Posted by Unregistered View Post
not sure what's your background, but you prolly haven't worked in many different settings before.
one of the privileges of having rotated through many specialist departments, is seeing how specialists manage stuff.
everything outside of their domain, they will just shoot off a referral letter to someone else.

patient tells cardiologist about skin problem > refer derm
patient tells ortho about AR symptoms > refer ENT
patient tells gastro about headache > refer neuro
patient tells gynae about asthma > refer respi

everybody is referring all over the place. hence the need for generalists.
Just a word of caution for those gung ho generalists/FP.

Be self aware. The cardiologist ortho gastro and gynae will not help you when you screw up managing one of thei cases or missed something. They will say why didnt you refer to me earlier.?

I am pro FP and believe there is a lot of benefit to society to have a strong FP fraternity
But must also see SG culture what do patients want also? Many sg patients prefer see specialists. Sure those got many different discipline problem might be happy with FP.
Just be careful. From experience FP love to talk up very big how they can manage everything but even FP themselves have different interests and expertis and LIMITS!
Yesterday 11:51 PM
Unregistered
Quote:
Originally Posted by Unregistered View Post
u resident from which year, selling koyo to who?

Decant care to community ? Hahah, other than cardio and renal which is overworked, no one ever decant to OPS. Respi keep their very well asthma/copd patient, RHI keep their quiescent RA. Ortho keep their OA knee. Psy keep their well depression. Gastro keep their stable hep B / IBS/ gastritis. Geri keep their well aged. Everyone need to hit their numbers.
Ops doctors keep their well controlled HTN /HLD to ourselves also . Really farm out to APN/ CM all the time meh?

trust me when i tell u that when u start working after ur m.med and u need to see more than 45 patient a day, u dun have energy to be the super generalist GP. You can of course try as i did and nearly break down till i see the light.

Like what someone say, IM, FM , we all refer everywhere.
I also want to manage my patient all the way, but the system neither rewards nor permits me. I'm judged by the number of patient i see a day.

25 year old china national with 3 days dyspesia comes in for scopes as they always do. You want spend the next 15 minutes reassuring her she don't need it ( and eventually she still wants it ) or u ask her which hospital, write patient VERY keen for scope on referral, give her some omperazole , MC and send her on her way? What explore her ICE, explain the science, pls la, survival mode liao.

countless other examples.

Generalist? my foot. The people in MOH are dreaming when they give us 10 minutes per patient and expect us to manage. Oh but NOT ALL YOUR CASES are complex what. Dude, its not the complexity. Its the sheer amount of things we have to care take of. Skin dry, tongue pain, backside itchy and latest common complain, a bit breathless after my covid jab 6 months ago. Somehow the specialist only need to focus on 1 thing but the FP has to take care of ALL the things.
YOU COME AND DO 1 DAY OF MY JOB AND THEN TALK.

anyway, every man for himself
dun get too romanticsed by whatever koyo pple selling you.
u want hear my advice, dun touch FM. Be any chao specialist in hospital at least patient respect u a bit more.
you sound jaded. you from singhealth?
Yesterday 11:37 PM
Unregistered
Quote:
Originally Posted by Unregistered View Post
the people who refer everything are usually those who are the juniors (MOPEX), or those who are not well trained (no further training in FM), or the old school GPs who are only comfortable managing basic level of conditions.

within the institutions, with greater level of collaboration between the specialists and FM, more of the care is being shifted towards the community (which really makes the job of FM much harder, imagine all specialties shifting some of the load to FM).

there will always be some degree of referrals needed. but once care has stabilised patients should be decanted back to the community. the cost savings is not just in the number of referrals, but the overall management of the patient.
u resident from which year, selling koyo to who?

Decant care to community ? Hahah, other than cardio and renal which is overworked, no one ever decant to OPS. Respi keep their very well asthma/copd patient, RHI keep their quiescent RA. Ortho keep their OA knee. Psy keep their well depression. Gastro keep their stable hep B / IBS/ gastritis. Geri keep their well aged. Everyone need to hit their numbers.
Ops doctors keep their well controlled HTN /HLD to ourselves also . Really farm out to APN/ CM all the time meh?

trust me when i tell u that when u start working after ur m.med and u need to see more than 45 patient a day, u dun have energy to be the super generalist GP. You can of course try as i did and nearly break down till i see the light.

Like what someone say, IM, FM , we all refer everywhere.
I also want to manage my patient all the way, but the system neither rewards nor permits me. I'm judged by the number of patient i see a day.

25 year old china national with 3 days dyspesia comes in for scopes as they always do. You want spend the next 15 minutes reassuring her she don't need it ( and eventually she still wants it ) or u ask her which hospital, write patient VERY keen for scope on referral, give her some omperazole , MC and send her on her way? What explore her ICE, explain the science, pls la, survival mode liao.

countless other examples.

Generalist? my foot. The people in MOH are dreaming when they give us 10 minutes per patient and expect us to manage. Oh but NOT ALL YOUR CASES are complex what. Dude, its not the complexity. Its the sheer amount of things we have to care take of. Skin dry, tongue pain, backside itchy and latest common complain, a bit breathless after my covid jab 6 months ago. Somehow the specialist only need to focus on 1 thing but the FP has to take care of ALL the things.
YOU COME AND DO 1 DAY OF MY JOB AND THEN TALK.

anyway, every man for himself
dun get too romanticsed by whatever koyo pple selling you.
u want hear my advice, dun touch FM. Be any chao specialist in hospital at least patient respect u a bit more.
Yesterday 10:01 PM
Unregistered
Quote:
Originally Posted by Unregistered View Post
Dont be hoodwinked by fm.

Fm or im in the end still refer everywhere.

Ministry confirm regret it years down the road
The idea of fm is to save money.
Not to incur more money

But so many fm refer everywhere.
The hosp im and geri also refer everywhere

Primary care of paeds, geri, fm and im but
Haiz primary care isnt what it supposed to be.

Still refer everywhere
Quote:
Originally Posted by Unregistered View Post
Dont be hoodwinked by fm.

Fm or im in the end still refer everywhere.

Ministry confirm regret it years down the road
The idea of fm is to save money.
Not to incur more money

But so many fm refer everywhere.
The hosp im and geri also refer everywhere

Primary care of paeds, geri, fm and im but
Haiz primary care isnt what it supposed to be.

Still refer everywhere
not sure what's your background, but you prolly haven't worked in many different settings before.
one of the privileges of having rotated through many specialist departments, is seeing how specialists manage stuff.
everything outside of their domain, they will just shoot off a referral letter to someone else.

patient tells cardiologist about skin problem > refer derm
patient tells ortho about AR symptoms > refer ENT
patient tells gastro about headache > refer neuro
patient tells gynae about asthma > refer respi

everybody is referring all over the place. hence the need for generalists.
Yesterday 09:46 PM
Unregistered
Quote:
Originally Posted by Unregistered View Post
wa really bao sua bao hai bao ga liao... but theres one poster up there who says FM refer everything...
the people who refer everything are usually those who are the juniors (MOPEX), or those who are not well trained (no further training in FM), or the old school GPs who are only comfortable managing basic level of conditions.

within the institutions, with greater level of collaboration between the specialists and FM, more of the care is being shifted towards the community (which really makes the job of FM much harder, imagine all specialties shifting some of the load to FM).

there will always be some degree of referrals needed. but once care has stabilised patients should be decanted back to the community. the cost savings is not just in the number of referrals, but the overall management of the patient.
Yesterday 09:33 PM
Unregistered
Quote:
Originally Posted by Unregistered View Post
FM cases are honestly pretty complex.
if you work in the hospitals and see all the patients with 10 different inpatient issues.
you may not really think about what happens to them outpatient, but most of them end up in OPS / CH one way or another.

imagine having to sort out all these issues within one visit, without the luxury of slowly titrating medications and doing daily labs to monitor the outcome of your management.
you can't spend the entire morning calling up every family member to get corroborative history. you can't just order a CT scan at the slightest hint of something going amiss.
you can't just do a phone consult (at least officially anyway) to a relevant subspec to ask for help.

on top of that, having to deal with the whole person - biopsychosocial, preventive care, home environment, falls, etc
FM is the first and last line of defence for most patients
wa really bao sua bao hai bao ga liao... but theres one poster up there who says FM refer everything...
Yesterday 09:31 PM
Unregistered and some patients are poor / health illiterate that they refuse to go SOC despite counselling. and FPs have to manage them at a specialist level within the confines of a primary care setting. so it certainly isn't a piece of cake.

there will still be a place for the regular joe GP managing URTI GE, seeing 10 patients / hour. and the aesthetic doctors who do botox and fillers by the side.

but we need to quickly up the game of FPs to manage the ageing population.
it's not glamorous, and we live with the reputation that people think that FPs are stupid / rejects. but it's still a pretty darn important job that deserves every bit of respect and renumeration as other specialties.
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