FTs = Lower Salaries, Why the Increase in Hospital Charges?
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A record 247 doctors quit public hospitals for private practice last year, and Health Minister Khaw Boon Wan is not at all happy. He wants experienced doctors to stay. He wants his ministry to stop thinking it is all right if they go so long as they remain in Singapore. And he wants to fix the problems that make senior doctors so fed up they quit after decades in public hospitals.
It is a big loss each time a senior doctor goes, he said yesterday. Poorer patients lose, because they cannot afford private treatment. Young doctors lose, because they miss out on the teaching and mentoring of senior doctors who act as role models. Singapore loses too, as its target to be the region's medical hub and ' Mayo Clinic of the East but without the costly price tag' depends on having strong medical institutions with top talent. Faced with increasing competition from the region, Singapore's aspirations depend on its ability to produce top clinicians and retain the best.
Mr Khaw was speaking at the launch of a book to mark 100 years of medical education in Singapore, at the College of Medicine Building. The event was attended by more than 100 members of the medical fraternity. Mr Khaw said he was troubled when he returned to the Health Ministry in 2003 as minister to find that so many senior doctors he had known from his days as a hospital administrator had quit. He named surgeons Abu Rauff and Walter Tan, children's cancer specialist June Lou, obstetricians and gynaecologists Ng Soon Chye and Noel Leong, and orthopaedic surgeon S. Krishnamoorthy. 'These are doctors who have devoted many years of their lives to public service; good doctors and dedicated teachers,' he said. 'I had expected them to retire in the public sector. Why are they now in private practice?'
He disagreed with ministry officials who felt 'loss of doctors to the private sector is not a loss, as long as they continue to practise in Singapore'. The ministry's view has been that the departure of 100 to 150 doctors a year is only to be expected, and it is the way the public sector trains doctors for the private sector. But Mr Khaw is taking a different tack, after speaking to doctors - young and old, those still in public service and those who have quit - to ask what makes them go, and what would make them stay.
He is convinced it is not about money, and senior doctors who resigned told The Straits Times he is right. Mr Khaw found some doctors fed up with administrative duties that have piled up. He wants to cut the 'unproductive paperwork'. Some seek better recognition, others want more say in how hospitals are run, or are keen to do research and pioneering work. All this can and should be looked into, he said.
Dr Leong, a senior specialist who quit in 2001, told The Straits Times it is frustrating when hospital administrators call the shots. 'Senior doctors want a say about the direction the hospital is going. But when there are differences, the administrator's view prevails.' Younger people in top hospital positions did not always appreciate senior doctors' views either. 'We are passe, and they are glad to get rid of the fossils,' said Dr Lou, who went private last year.
Change is likely, as Mr Khaw did not like what younger doctors told him either. Many aim to become specialists, build a reputation, and then join the private sector. Younger specialists who had already left told him they had seen how senior doctors were treated and decided to go sooner. Mr Khaw said it was necessary to 'reset the career progression of our young doctors' so they will stay.
He tossed up the idea of letting senior doctors who want the independence of private practice to run their own clinics in public hospitals, seeing their own patients, in return for continuing to coach young doctors and students. He hopes to retain the top 20 per cent to 25 per cent of each year's batch of doctors in public hospitals until retirement.
The Straits Times
25 Feb 2005 -
THERE are some in his ministry who think that the migration of doctors from the public to the private sector is "not a loss", as long as they continue to practise here.
But Health Minister Khaw Boon Wan disagrees.
With a record exit of 247 doctors — 87 of them specialists — from public healthcare last year, those who lose out are not just subsidised patients, but also young doctors who would miss out on the teaching and mentoring of senior doctors, said Mr Khaw. The loss is also Singapore's. Teaching hospitals or academic medical centres — not solo practice — is where progress is more likely to be made in acquiring "new capabilities" for competing globally. So, to ensure a "critical mass" of talent in the public sector, Mr Khaw is targetting is to retain the top 20 to 25 per cent of each cohort of 300 doctors in the sector until they retire. At this "steady rate", they would eventually form a pool of 3,000 doctors. But achieving this will be a challenge, given the many reasons doctors leave the public sector for the private. Said a troubled Mr Khaw: "Several doctors whom I worked with during my previous term (at the Health Ministry) are now in private practice. These are doctors who have devoted many years of their lives to public service and are good teachers and dedicated teachers."
Speaking at Friday's launch of To Sail Uncharted Seas, a book commemorating the centenary of medical education here, Mr Khaw urged public healthcare institutions to look into staunching the drain. "It's not just about money," he conceded. For example, Mr Khaw noted that "some doctors are fed up with administrative duties" when they just want to focus on their clinical and teaching duties.
Indeed, Dr Tan Chee Eng, the former head of endocrinology at Singapore General Hospital (SGH), told Today he left the hospital last year because he was "overly-burdened" with administrative work. He had to handle the bulk of the department's paperwork and meetings, on top of his clinical work, teaching and research. The busy hospital environment also took its toll on 45-year-old gastroenterologist Dr Yap Chin Kong after 20 years in public service. The senior consultant started suffering stress-related stomach pains. "Maybe age was catching up, but I felt I was not able to take that pace anymore," he told Today. He now sees six patients a day minimum in private practice, down from 50 a day previously.
Some doctors felt that senior doctors moving out of the public sector could be good for junior doctors, who could take on more responsibilities and promotions. Said Mr Khaw: "Many young consultants who have left told me they would actually like to remain in public hospitals, but felt uncertain about their continuing employment." He asked hospitals to lay down a viable career path for senior doctors, who are often put on contractual terms after their retirement age. As for doctors who find "the independence of private practice and the freedom of being self-employed hard to resist", they could be offered to the option to stay on while running their own clinics. They could get admission rights for their patients in the private wards of public hospitals, in return for which, they could teach and coach young doctors. The scheme could be restricted to doctors who have served 25 to 30 years in public hospitals, Dr Khaw added. He also announced that the second medical school at the SGH campus would have an initial intake of 25 in 2007, set to double in subsequent years.
TODAYonline
26 Feb 2006 -
When doctors move out of the public sector, it is a loss to the country, argued Health Minister Khaw Boon Wan yesterday at a celebration to mark the centenary of medical education in Singapore
The commemorative book mentions the many excellent contributors to our health-care sector: Professors Ransome, Sheares, Shanmugaratnam, Seah Cheng Siang, Wong Hock Boon, S. S. Ratnam and several others.
Singapore is blessed to have these excellent doctors who are not only great clinicians, but inspiring teachers and mentors to their disciples. They could have made more money in the private sector servicing the rich, and could have had more time for themselves and their families. But they chose to be with their students and their patients, many of whom are from the lower income group. These are dedicated individuals who understood the meaning of public service. They found satisfaction in seeing a needy patient treated, and a young doctor properly tutored, beyond what material compensation could provide.
Regional medical hub at risk
THROUGH their dedication, we have produced several generations of top clinicians who keep SingaporeMedicine head and shoulders above our neighbours. Until 15 years ago, our status as a regional medical hub was unchallenged.
In recent years, however, our neighbours have closed the gap. Moreover, they enjoy a cost advantage. While we still enjoy a premium, it is not unlimited. If we are not careful, we will lose the regional medical hub status.
This is not unlike the competition between PSA Corp and Pelepas, or between Singapore Airlines (SIA) and the low-cost carriers. PSA and SIA have shown we can face the competition and still hold our ground. But we must be prepared to restructure and forge new strategies. In the competition to be the regional medical hub, the key is our ability to produce clinicians head and shoulders above our competitors.
Loss of teachers
FOR this reason, when I returned to the Health Ministry in 2003, I was a bit troubled by what I saw. Several doctors with whom I had worked during my previous term were now in private practice: Abu Rauff, Walter Tan, June Lou, Ng Soon Chye, Krishnamoorthy, Noel Leong. These are doctors who have devoted many years of their lives to public service; good doctors and dedicated teachers. I had expected them to retire in the public sector. Why are they now in private practice?
Within the ministry, there seems to be the view that the 'loss of doctors to the private sector is not a loss, as long as they continue to practise in Singapore'. I do not agree. The loss of good teachers and clinicians from the public sector is a big loss to Singapore.
First, it is a big loss for our subsidised patients who cannot afford treatment in the private hospitals.
Second, it is a big loss for our young doctors who will miss out on the teaching and mentoring by these senior teachers. Forging the right values for public service is critical for our medical service to remain what it is - highly competent and at the cutting edge.
After all, what is the difference to Singapore between the likes of Feng Pao Hsii and Foong Weng Cheong doing private practice in private hospitals or in public hospitals? To their patients, it may be trivial.
But to the young doctors and junior consultants, it is a big difference: the interactions with their teachers and trainers, in the wards, in the doctors' lounge, in the corridor, are an inspiration and a daily reminder of what public medical service is all about. This is how good institutional values are forged and reinforced.
All strong institutions have a critical mass of role models, who coach and mentor the young. They provide the deep roots from which we get the new shoots, branches, flowers and fruit. After a century of medical education, we have sunk some roots, but not quite deep enough.
Look at the Mayo Clinic, it has deep roots and strong branches. You can cut off several branches and the institution will continue to flourish. Against tsunamis, it will not be uprooted. Can our public medical service survive a tsunami?
Third, it is a big loss even for SingaporeMedicine as private practice here tends to be solo or, at most, limited groups. While there are notable exceptions, this model offers few opportunities for medical advancement.
SingaporeMedicine must have deep roots to compete globally. Our regional medical hub can no longer just compete with our neighbours. India has emerged as a competitor and soon it will be China. They have the talent, the ambition and the large base of clinical material for their doctors to sharpen their skills.
Competing globally requires us to continually acquire new capabilities. This means sub-specialisation, research and perfecting new skills. Progress is more likely to be made in teaching hospitals and academic medical centres, with departmental structure and rigorous peer review processes.
As the region and the world raise their medical standards, we must work even harder to remain leader. Solo practice with its attendant limitations will not give us this edge.
A perennial problem
TO BE sure, retention of medical talent is a perennial issue. I have spent many years in the health sector. During this period, public hospitals have always had to grapple with the problem of retaining their share of talent. Some years, like in the 1980s, we bled badly; in recent years, we are coping better. There are now more specialists in the public sector than in the private sector.
But talent retention is a continual challenge. It is not just about money. Medical service in the public sector is a noble career choice, a calling. While we should pay our doctors well, we must not chase the market. Whatever we decide to pay in the public sector sets the floor for the industry. It is fruitless to think we can close the gap.
The right approach is to concentrate on the basics: focus on medical service as a noble profession, build strong institutions and go all out to retain doctors with sound institutional values. The more we have such doctors, the stronger the institutional culture. The more such role models, the greater will be their influence on young doctors. As they interact with the likes of Balachandran, Tan Cheng Lim and K. T. Foo, correct values will be reinforced and a new generation nurtured.
Deepening our roots
I ASKED some young doctors how they saw their career progression. Some were candid: train hard, become a specialist, acquire sub-specialty skills, build reputation, then leave for the private sector in their prime. If this is representative of their generation, then I worry both for the public medical service as well as for SingaporeMedicine.
I worry because, while we take in 300 doctors every year, to sink deep roots, we must have the top 20-25 per cent of each cohort remaining in public institutions until they retire from medical service. At a steady state, these 3,000 doctors, spanning all age cohorts, will form the critical mass of our medical talent pool. If we succeed in this, SingaporeMedicine will be able to compete internationally, while safeguarding the high medical standard all Singaporeans, rich or poor, deserve.
We must try to achieve this. There is no single silver bullet which can solve all the issues.
Some doctors are fed up with administrative duties. They want to focus on their clinical and teaching duties. We should not unduly load them with unproductive paperwork.
Some want better recognition of their contribution. We should find a way to acknowledge their status and their achievements.
Some want to have a better say in the way their hospital is run. We should engage them and give them a productive role to play.
Some are keen on research and enjoy the opportunity to pioneer or train in new procedures. We should try to support them.
More fundamentally, many young consultants who have left told me they would actually like to remain in public hospitals but felt uncertain about their continuing employment in later years. They saw public hospitals not being able to accommodate senior doctors like Foong Weng Cheong and K. L. Tan, despite their having put 30 years of their career in public institutions. Given such uncertainty, they decided they had better start their private practice earlier, while in their prime.
We must remove such uncertainties and reset the career progression of our young doctors. They must see that we have a viable model of allowing dedicated doctors who have invested 25, 30 years of their lives in public service to remain productive in the public hospitals and retire gracefully.
Many such senior doctors, like Y. Y. Ong, Tan Ser Kiat and Low Cheng Hock, are happy to do 40 years of public service and retire in public hospitals. We should assure them there is an important role for them to play in public hospitals. We can vary the nature of their role as they enter different phases of their public service. For example, as they reduce their clinical duties, they can take on more of a teaching and mentoring role.
But some doctors find the independence of private practice and the freedom of being self-employed hard to resist. Perhaps, it is possible for these doctors to have a second career in private practice but within public hospitals, after they have served their years in public service.
Why can't we offer these senior consultants the privilege to migrate, say at age 50, from public service to private practice, without leaving the public hospitals?
They can run their private practice as they would if they were in the private sector, running their own clinics, with admission rights for their patients in our private wards. They would remain as members of our clinical departments with departmental support for their inpatients in return for the continued teaching and coaching of young doctors and trainees.
Private practice in public hospitals is not a new idea. It has been done elsewhere. We have talked about it but have worried about its impact. Will there be abuses? Will public patients be neglected?
If we restrict the privilege to the senior consultants who have put in 25, 30 years of their time in public service, of what is there to be fearful? If we start small and expand gradually as our staffing levels improve, there is no reason why existing public services will be neglected. In time, as we gain experience and confidence, we can extend such privilege to senior consultants from a younger age of 45. But I think we must never go below this age threshold.
Building strong institutions
BUILDING institutions and retaining talent are the responsibilities of hospital managements and their boards of directors. In fact, these are their most important responsibilities.
Let me challenge them to work towards the vision of what our public institutions can become. We should aim to match the best in the world in patient care, teaching and research. In Asia, we should be the best and be recognised as such by our peers, head and shoulders above all the others.
Being the best, however, does not mean tall shining buildings or the most fanciful and expensive pieces of equipment. Being the best means we have the best clinical outcomes, we invent new devices, new techniques and new processes. We do everything better, faster and cheaper than others, and patients from the region want to come here for their treatment.
In short, let us become the Mayo of the East, but without the costly price tag. Not all our clinical specialties can succeed, but hopefully a few will produce dramatic results within a few years, to encourage the rest to keep faith.
Can it be done? Some of our best students take up medicine every year; some of our best brains are in the health sector. Moreover, we are not starting from ground zero. After a century of medical education, we already have some of the assets in place. But we have to be clearer in our goal and bolder in our approach towards this goal.
Building strong institutions is a long-term endeavour, beyond bricks and mortar. It requires leadership, dedication, discipline and patience. Take a long-term view but have a clear road map so progress can be measured and, if need be, refine the strategy.
The ability to retain good teachers and good role models is the key. The ability to enlarge the pool of such medical talent year by year will track our progress.
But this must be done in a sustainable way. First, it must not clog up the medical leadership with limited career opportunities for the upcoming young consultants. Second, it must also be financially viable for the public institutions.
Adapting to the new world
AS WE look back at the last 100 years, we can be nostalgic about the good old days of the old masters like Cohen and Seah Cheng Siang. Their grand rounds were legendary, attended by all staff from housemen to consultants. That period was sacrosanct and everyone enjoyed the teaching and the camaraderie that went with it. The junior doctors who were ill-prepared would tremble in fear as they would have to present their cases to the grand master.
But as Dr June Lou lamented to me: That world is, sadly, gone. These days, when a round is conducted, half the staff are absent. I suppose we now live in a new world and we have to adapt. If we do not, we will be more disappointed, and worse, become ineffective in our mission.
I am optimistic because I still see many in the public institutions with strong institutional values: Satku, Tan Chorh Chuan, John Wong, Tan Ser Kiat, Y. Y. Ong, Chee Yam Cheng, Low Cheng Hock, Soo Khee Chee, K. T. Foo, Rajasoorya, Lim Yean Teng, Philip Eng and so many others. There are enough people around who still believe in the higher calling of public service.
But we need to ensure they have worthy successors in the pipeline. To do so, we must convince our young doctors to reset their career progression. It should be to train hard, become world class, serve the rich and the poor, teach the young, build the next generation of doctors, retire in public institutions.
Not all doctors will share this career path. But for those with good institutional instincts, we must do our best to support them along this career path.
Abridged version
The Straits Times
26 Feb 2005 -
People do not work solely for pay. To only use money to make people stay is being narrow minded and not seeing the whole picture. Then more singaporeans should leave singapore. -
why always post so long? You love to post newspaper articles here. Hey, many tell me not to believe all that is said in the local newspapers.Originally posted by oxford mushroom:When doctors move out of the public sector, it is a loss to the country, argued Health Minister Khaw Boon Wan yesterday at a celebration to mark the centenary of medical education in Singapore
The commemorative book mentions the many excellent contributors to our health-care sector: Professors Ransome, Sheares, Shanmugaratnam, Seah Cheng Siang, Wong Hock Boon, S. S. Ratnam and several others.
Singapore is blessed to have these excellent doctors who are not only great clinicians, but inspiring teachers and mentors to their disciples. They could have made more money in the private sector servicing the rich, and could have had more time for themselves and their families. But they chose to be with their students and their patients, many of whom are from the lower income group. These are dedicated individuals who understood the meaning of public service. They found satisfaction in seeing a needy patient treated, and a young doctor properly tutored, beyond what material compensation could provide.
Regional medical hub at risk
THROUGH their dedication, we have produced several generations of top clinicians who keep SingaporeMedicine head and shoulders above our neighbours. Until 15 years ago, our status as a regional medical hub was unchallenged.
In recent years, however, our neighbours have closed the gap. Moreover, they enjoy a cost advantage. While we still enjoy a premium, it is not unlimited. If we are not careful, we will lose the regional medical hub status.
This is not unlike the competition between PSA Corp and Pelepas, or between Singapore Airlines (SIA) and the low-cost carriers. PSA and SIA have shown we can face the competition and still hold our ground. But we must be prepared to restructure and forge new strategies. In the competition to be the regional medical hub, the key is our ability to produce clinicians head and shoulders above our competitors.
Loss of teachers
FOR this reason, when I returned to the Health Ministry in 2003, I was a bit troubled by what I saw. Several doctors with whom I had worked during my previous term were now in private practice: Abu Rauff, Walter Tan, June Lou, Ng Soon Chye, Krishnamoorthy, Noel Leong. These are doctors who have devoted many years of their lives to public service; good doctors and dedicated teachers. I had expected them to retire in the public sector. Why are they now in private practice?
Within the ministry, there seems to be the view that the 'loss of doctors to the private sector is not a loss, as long as they continue to practise in Singapore'. I do not agree. The loss of good teachers and clinicians from the public sector is a big loss to Singapore.
First, it is a big loss for our subsidised patients who cannot afford treatment in the private hospitals.
Second, it is a big loss for our young doctors who will miss out on the teaching and mentoring by these senior teachers. Forging the right values for public service is critical for our medical service to remain what it is - highly competent and at the cutting edge.
After all, what is the difference to Singapore between the likes of Feng Pao Hsii and Foong Weng Cheong doing private practice in private hospitals or in public hospitals? To their patients, it may be trivial.
But to the young doctors and junior consultants, it is a big difference: the interactions with their teachers and trainers, in the wards, in the doctors' lounge, in the corridor, are an inspiration and a daily reminder of what public medical service is all about. This is how good institutional values are forged and reinforced.
All strong institutions have a critical mass of role models, who coach and mentor the young. They provide the deep roots from which we get the new shoots, branches, flowers and fruit. After a century of medical education, we have sunk some roots, but not quite deep enough.
Look at the Mayo Clinic, it has deep roots and strong branches. You can cut off several branches and the institution will continue to flourish. Against tsunamis, it will not be uprooted. Can our public medical service survive a tsunami?
Third, it is a big loss even for SingaporeMedicine as private practice here tends to be solo or, at most, limited groups. While there are notable exceptions, this model offers few opportunities for medical advancement.
SingaporeMedicine must have deep roots to compete globally. Our regional medical hub can no longer just compete with our neighbours. India has emerged as a competitor and soon it will be China. They have the talent, the ambition and the large base of clinical material for their doctors to sharpen their skills.
Competing globally requires us to continually acquire new capabilities. This means sub-specialisation, research and perfecting new skills. Progress is more likely to be made in teaching hospitals and academic medical centres, with departmental structure and rigorous peer review processes.
As the region and the world raise their medical standards, we must work even harder to remain leader. Solo practice with its attendant limitations will not give us this edge.
A perennial problem
TO BE sure, retention of medical talent is a perennial issue. I have spent many years in the health sector. During this period, public hospitals have always had to grapple with the problem of retaining their share of talent. Some years, like in the 1980s, we bled badly; in recent years, we are coping better. There are now more specialists in the public sector than in the private sector.
But talent retention is a continual challenge. It is not just about money. Medical service in the public sector is a noble career choice, a calling. While we should pay our doctors well, we must not chase the market. Whatever we decide to pay in the public sector sets the floor for the industry. It is fruitless to think we can close the gap.
The right approach is to concentrate on the basics: focus on medical service as a noble profession, build strong institutions and go all out to retain doctors with sound institutional values. The more we have such doctors, the stronger the institutional culture. The more such role models, the greater will be their influence on young doctors. As they interact with the likes of Balachandran, Tan Cheng Lim and K. T. Foo, correct values will be reinforced and a new generation nurtured.
Deepening our roots
I ASKED some young doctors how they saw their career progression. Some were candid: train hard, become a specialist, acquire sub-specialty skills, build reputation, then leave for the private sector in their prime. If this is representative of their generation, then I worry both for the public medical service as well as for SingaporeMedicine.
I worry because, while we take in 300 doctors every year, to sink deep roots, we must have the top 20-25 per cent of each cohort remaining in public institutions until they retire from medical service. At a steady state, these 3,000 doctors, spanning all age cohorts, will form the critical mass of our medical talent pool. If we succeed in this, SingaporeMedicine will be able to compete internationally, while safeguarding the high medical standard all Singaporeans, rich or poor, deserve.
We must try to achieve this. There is no single silver bullet which can solve all the issues.
Some doctors are fed up with administrative duties. They want to focus on their clinical and teaching duties. We should not unduly load them with unproductive paperwork.
Some want better recognition of their contribution. We should find a way to acknowledge their status and their achievements.
Some want to have a better say in the way their hospital is run. We should engage them and give them a productive role to play.
Some are keen on research and enjoy the opportunity to pioneer or train in new procedures. We should try to support them.
More fundamentally, many young consultants who have left told me they would actually like to remain in public hospitals but felt uncertain about their continuing employment in later years. They saw public hospitals not being able to accommodate senior doctors like Foong Weng Cheong and K. L. Tan, despite their having put 30 years of their career in public institutions. Given such uncertainty, they decided they had better start their private practice earlier, while in their prime.
We must remove such uncertainties and reset the career progression of our young doctors. They must see that we have a viable model of allowing dedicated doctors who have invested 25, 30 years of their lives in public service to remain productive in the public hospitals and retire gracefully.
Many such senior doctors, like Y. Y. Ong, Tan Ser Kiat and Low Cheng Hock, are happy to do 40 years of public service and retire in public hospitals. We should assure them there is an important role for them to play in public hospitals. We can vary the nature of their role as they enter different phases of their public service. For example, as they reduce their clinical duties, they can take on more of a teaching and mentoring role.
But some doctors find the independence of private practice and the freedom of being self-employed hard to resist. Perhaps, it is possible for these doctors to have a second career in private practice but within public hospitals, after they have served their years in public service.
Why can't we offer these senior consultants the privilege to migrate, say at age 50, from public service to private practice, without leaving the public hospitals?
They can run their private practice as they would if they were in the private sector, running their own clinics, with admission rights for their patients in our private wards. They would remain as members of our clinical departments with departmental support for their inpatients in return for the continued teaching and coaching of young doctors and trainees.
Private practice in public hospitals is not a new idea. It has been done elsewhere. We have talked about it but have worried about its impact. Will there be abuses? Will public patients be neglected?
If we restrict the privilege to the senior consultants who have put in 25, 30 years of their time in public service, of what is there to be fearful? If we start small and expand gradually as our staffing levels improve, there is no reason why existing public services will be neglected. In time, as we gain experience and confidence, we can extend such privilege to senior consultants from a younger age of 45. But I think we must never go below this age threshold.
Building strong institutions
BUILDING institutions and retaining talent are the responsibilities of hospital managements and their boards of directors. In fact, these are their most important responsibilities.
Let me challenge them to work towards the vision of what our public institutions can become. We should aim to match the best in the world in patient care, teaching and research. In Asia, we should be the best and be recognised as such by our peers, head and shoulders above all the others.
Being the best, however, does not mean tall shining buildings or the most fanciful and expensive pieces of equipment. Being the best means we have the best clinical outcomes, we invent new devices, new techniques and new processes. We do everything better, faster and cheaper than others, and patients from the region want to come here for their treatment.
In short, let us become the Mayo of the East, but without the costly price tag. Not all our clinical specialties can succeed, but hopefully a few will produce dramatic results within a few years, to encourage the rest to keep faith.
Can it be done? Some of our best students take up medicine every year; some of our best brains are in the health sector. Moreover, we are not starting from ground zero. After a century of medical education, we already have some of the assets in place. But we have to be clearer in our goal and bolder in our approach towards this goal.
Building strong institutions is a long-term endeavour, beyond bricks and mortar. It requires leadership, dedication, discipline and patience. Take a long-term view but have a clear road map so progress can be measured and, if need be, refine the strategy.
The ability to retain good teachers and good role models is the key. The ability to enlarge the pool of such medical talent year by year will track our progress.
But this must be done in a sustainable way. First, it must not clog up the medical leadership with limited career opportunities for the upcoming young consultants. Second, it must also be financially viable for the public institutions.
Adapting to the new world
AS WE look back at the last 100 years, we can be nostalgic about the good old days of the old masters like Cohen and Seah Cheng Siang. Their grand rounds were legendary, attended by all staff from housemen to consultants. That period was sacrosanct and everyone enjoyed the teaching and the camaraderie that went with it. The junior doctors who were ill-prepared would tremble in fear as they would have to present their cases to the grand master.
But as Dr June Lou lamented to me: That world is, sadly, gone. These days, when a round is conducted, half the staff are absent. I suppose we now live in a new world and we have to adapt. If we do not, we will be more disappointed, and worse, become ineffective in our mission.
I am optimistic because I still see many in the public institutions with strong institutional values: Satku, Tan Chorh Chuan, John Wong, Tan Ser Kiat, Y. Y. Ong, Chee Yam Cheng, Low Cheng Hock, Soo Khee Chee, K. T. Foo, Rajasoorya, Lim Yean Teng, Philip Eng and so many others. There are enough people around who still believe in the higher calling of public service.
But we need to ensure they have worthy successors in the pipeline. To do so, we must convince our young doctors to reset their career progression. It should be to train hard, become world class, serve the rich and the poor, teach the young, build the next generation of doctors, retire in public institutions.
Not all doctors will share this career path. But for those with good institutional instincts, we must do our best to support them along this career path.
Abridged version
The Straits Times
26 Feb 2005 -
Interesting posts, OM. Thanks for digging those out. Unfortunately in the last 2 or so years since those reports I don't think much has tangibly changed. Working in the public sector is no more fulfilling than before and people are still leaving.
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grass is greener on the other side. frankly there are pros and cons working in the public sector.Originally posted by cherry_garcia:Interesting posts, OM. Thanks for digging those out. Unfortunately in the last 2 or so years since those reports I don't think much has tangibly changed. Working in the public sector is no more fulfilling than before and people are still leaving. -
pros and cons are there for sure...but when your salary can jump by 8k to 10k overnight in the private sector, it is increasingly difficult not to leave for private hospitals.....especially when the workload is less.Originally posted by rane:grass is greener on the other side. frankly there are pros and cons working in the public sector. -
actually, it depends on what the doctors want. In govt hospitals, they gain more in the area of research, and are given more opportunities to explore new technologies, more challenging and so on. In the private sector, they have freedom to do what they wanna do, lesser workload and earning is more, too!!Originally posted by oxford mushroom:pros and cons are there for sure...but when your salary can jump by 8k to 10k overnight in the private sector, it is increasingly difficult not to leave for private hospitals.....especially when the workload is less. -
What research opportunities is there when doctors in public sector are overwhelmed by patients and have to resort to doing locums after hours to supplement their income? Don't forget doctors have a huge study loan to pay after graduation as well.Originally posted by rane:actually, it depends on what the doctors want. In govt hospitals, they gain more in the area of research, and are given more opportunities to explore new technologies, more challenging and so on. In the private sector, they have freedom to do what they wanna do, lesser workload and earning is more, too!!
If Singaporeans want local doctors to remain in public hospitals, they will have to pay more or else lose them to private hospitals.