Holistic approach to ease doctor shortage

'Pay hike alone can't solve doctor shortage' and 'Ex-govt doctor says...'

18 Jul 2011, The Straits Times

Pay hike alone can't solve doctor shortage

I READ with concern Health Minister Gan Kim Yong's announcement that his ministry will review salaries of doctors in an attempt to alleviate attrition of doctors in public hospitals ('MOH to review doctors' pay'; Wednesday).

While it is important to ensure that physicians are paid a fair wage, we must not resort to only remuneration to address the shortage of public sector health-care professionals. In tandem, we must examine the root cause of this shortage and address its constraints.

* First, we should review the working conditions in public health facilities. Work hours and case load are important factors which contribute to the level of job satisfaction and healthy work-life balance. How do doctors in public hospitals fare on these?

* Second, given the serious constraint in supply, what are our plans on expanding student intake in the local medical schools? Each year, many local students fail to secure a place in our medical schools. Of these, those who can afford it go overseas to pursue their ambitions to be a doctor. Others must take alternative career paths.

We should ramp up capacity in local universities to capitalise on the strong interest among our youth to pursue medicine as a vocation.

* Finally, as we mull over the shortage of public sector doctors, have we studied the implications of the growth of medical tourism on our local health-care scene?

As we develop Singapore as a health-care hub for the region and more affluent foreign patients come here for treatment, we must be aware of the squeeze on an already tight labour pool.

Perhaps we should have in place policies to ensure that the needs of our local community are met before we further expand services to others. After all, health care is a core sector for any nation and it is impossible for the average Singaporean to compete with affluent foreigners for scarce services. As Singapore ages and chronic ailments become even more prevalent, we will need to ensure a sufficient pool of committed and compassionate doctors to attend to the needs of the elderly. If we rely solely on compensation to retain talent in public health, we may inadvertently price out good physician care from the reach of ordinary Singaporeans.

Dr Paulin Tay Straughan

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Ex-govt doctor says...

'While revising pay upwards will help keep more within the public umbrella, the main grouse is the difficult working environment.'

DR HO HUA SZE: 'I quit the public sector last year and monetary rewards were not the main reason why I, as well as friends of mine, did so ('MOH to review doctors' pay'; Wednesday). While revising pay upwards will help keep more within the public umbrella, the main grouse is the difficult working environment faced by some. I have seen colleagues who left the public health service after having worked almost daily shifts, including weekends, for more than three months at a stretch; as well as putting in more than a 100-hour week. Couple that with a heavy workload, examples of which include staff nurses managing up to 12 patients each, one would expect the exodus to continue unless changes are made.'

Reply From MOH

DR PAULIN Tay Straughan ('Pay hike alone can't solve doctor shortage'; July 8) highlighted that remuneration alone will not resolve the shortage of doctors in the public health-care sector, and that other measures such as working environment and local medical student intake must also be considered.

Dr Ho Hua Sze ('Ex-govt doctor says...'; July 8) said the difficult working environment must be changed to retain public sector doctors.

These are valid concerns. We agree that a systemic holistic approach must be taken to alleviate doctor shortage in the public sector. To attract and retain talent, the Health Ministry is reviewing the compensation framework for doctors to ensure that it remains market-competitive, and the public sector health-care clusters are studying how to further improve the work-life balance of doctors. We have, over the years, taken active steps to ease the workload of doctors and meet the needs of a growing and ageing population.

The number of public sector doctors has increased by 43 per cent from 3,500 to 5,000 over the past four years. We are also training more future doctors, through increasing the medical intake at the National University of Singapore's Yong Loo Lin School of Medicine and the opening of two new medical schools - the Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine at Nanyang Technological University. Together, the three schools will train 500 doctors a year by 2025, double the current number.

To improve working conditions, public health-care hospitals and institutions have implemented shorter rotating shifts for doctors, protected time for structured learning, enhanced the physical environments and adopted IT innovations to lessen administrative work.

The hospitals and institutions have also recruited and trained more allied health-care professionals, nurses and pharmacists, as well as administrative staff, to better support doctors in the delivery of quality care to patients. Sixty-eight Singaporeans studying medicine in Britain and Australia accepted the pre-employment grant they offered last year. This grant, which partially covers their tuition fees, will help bring home more Singaporean doctors to work here upon graduation.

We assure Dr Straughan that our public hospitals' mission and priority are geared towards local patients. Foreign patients form less than 3 per cent of the total patient load at our public hospitals.

As Deputy Prime Minister Tharman Shanmugaratnam indicated last weekend, the private sector could also play a larger role in meeting the national health-care needs of Singaporeans. The ministry is exploring possibilities in this area further.

Bey Mui Leng (Ms)

Director, Corporate Communications

Ministry of Health