Doctors leaving for private hospitals in Singapore.
Posted in the Singapore Forum
Pay revisions may not stem public-sector doctors’ exodus
The Straits Times, 01 March 2012,
By: POON CHIAN HUI & MELISSA PANG
A PAY revision for health-care professionals in the public sector is on the cards, but will it stem the flow of doctors leaving for the private sector?
On Sunday, Minister of State for Health Amy Khor said the Health Ministry was reviewing the salaries of doctors, nurses and allied health professionals, to attract more people to join the industry.
A ministry spokesman yesterday added that it was also looking to improve work environment, including providing better career paths and work processes.
Doctors and medical community watchers say that more competitive pay, while welcome, is not the only or main reason for the exodus of public health-care doctors to the private sector.
The push factors include heavy workload and dissatisfaction with changes to the health-care system over the years. The pulls are because going private is seen as a “natural career progression”, and because they have been offered a reduced workload and job and organisational stability.
So, how bad is the bleed?
Between 2006 and 2010, the attrition rate for doctors in the public sector was between 6 per cent and 8 per cent.
In 2009, 259 doctors, including 64 specialists, quit. In 2010, 310 doctors, including 103 specialists, left. It was the largest annual exodus of doctors.
Latest available figures showed that in the first half of last year, 150 doctors – 115 non-specialists and 35 specialists – left public hospitals and polyclinics. This made for an attrition rate of 3.2 per cent, a shade off the 4 per cent in the first half of 2010.
These numbers comprise those who quit to join the private sector or voluntary welfare organisations, as well as those who stopped practising.
Singapore Medical Association chief Chong Yeh Woei said that in the last decade, public hospitals have been hit by big changes and crises – the set-up of the National Healthcare Group and SingHealth, the Sars crisis and the debut of a residency programme for doctors in training.
“Each of these events was exhausting in itself. Each time, entire hospitals were thrown into crisis mode and senior doctors often bore the brunt of it,” he said.
Small wonder the feedback from doctors has been that they are “very tired” and in need of more stability, he said.
The Straits Times understands that the pay structure in public hospitals has three components:
The basic salary, which is the same across doctors of the same grade.
An allowance pegged to the medical speciality, with doctors doing surgery getting more.
A fee scheme determined by the type of patients a doctor treats. A doctor who sees non-subsidised patients will earn more under this scheme than one who treats more subsidised patients. A doctor who sees non-subsidised patients who are foreigners earns even more.
When doctors leave, it is no guarantee they will earn as much – at least initially.
A doctor who left for the private sector three years ago said that depending on a doctor’s speciality, it can take a few years to match his last drawn salary in the public sector.
But one thing is clear: For the same amount of money or more, doctors in private practice see only half the number of patients they are typically expected to treat in public hospitals.
On this point, Dr Chong, a general practitioner in private practice, said the high workload in the public sector puts doctors at risk of professional errors and being complained against by patients.
However, it is not as if a review of salaries and other benefits will be of no help.
Firstly, Dr Chong said, doctors’ base pay has been static for the last 15 years.
And although “call” allowances have gone up, trainee doctors are barred from doing more than six calls a month, given that being “on call” entails working shifts that can last more than 12 hours and which can span nights and weekends.
Secondly, a salary review will also help the junior doctor who may start out his career in debt: Tuition fees at the National University of Singapore, for example, have doubled in the last 20 years to $20,000 a year. A trainee doctor’s pay is said to start from about $3,000 a month.
Thirdly, a pay revision will stop the income gap between the public and private sectors from yawning even wider.
Consultant doctors in the public sector get $10,000 to $60,000 monthly, depending on their speciality and seniority. Top private doctors can earn more than a million a year.
Dr Lam Pin Min, an ophthalmologist in public practice, said:“While it’s impossible for the Government to match the salaries of doctors in the private sector, there can be some form of benchmarking so that the difference will not be so stark.”
Dr Lam, a Member of Parliament who heads the Government Parliamentary Committee (GPC) for Health, said that pay may not be a top reason for leaving, but doctors may be nudged to go if it is appreciably more.
Public sector orthopaedic surgeon Chia Shi-Lu, an MP, offered a fourth reason – that it would be a morale booster “for the many of us who work hard and often beyond what is required of us”.
Associate Professor Phua Kai Hong, a health economist at the Lee Kuan Yew School of Public Policy, prefers a longer-term fix to the problem, such as through investments in local facilities like medical schools. A pay increment is a short-term measure which will just attract doctors from neighbouring countries such as Malaysia and the Philippines, he said.
MP Fatimah Lateef, an emergency medicine specialist in a public hospital, said she foresees a pay rise of 5 per cent to 8 per cent.
Reflecting the views of most doctors, private head and neck surgeon Ranjiv Sivanandan said that as much as salaries matter, bumping them up will only temporarily stem the loss of good doctors.
He said:“Clarity of purpose, recognising and valuing the right attributes, investment in a shared common vision and enlightened leadership that embraces diversity of opinion are perhaps factors that will go some way in providing the right milieu and genuine motivation for right-minded individuals to stay.”
Former top civil servant’s candid views on Singapore
by inSing Editor
inSing.com - 2 October 2013 4:30 PM
An outspoken speaker on current affairs, former high-ranking civil servant Ngiam Tong Dow is known for his frank and controversial insights into the policies of the Singapore Government.
In a recent interview with Dr Toh Han Chong for the Singapore Medical Association’s newsletter, he spoke on the challenges Singapore will face in its bid to transform into a medical hub, among other issues related to the country’s socio-political state.
Ngiam was a civil servant for more than 40 years.
He has served as Permanent Secretary in the Prime Minister’s Office, the Ministry of Finance, the Ministry of Trade and Industry, and the Ministry of National Development. His expertise is in developmental economics.
The following are extracts of quotes from the interview:
"When you raise ministers’ salaries to the point that they’re earning millions of dollar, every minister — no matter how much he wants to turn up and tell (Prime Minister Lee) Hsien Loong off or whatever — will hesitate when he thinks of his million-dollar salary. Even if he wants to do it, his wife will stop him. "
"The civil service has definitely become tamer, which is not good because we need a contest of ideas. The difference is that no one wants to make a sacrifice any more. The first generation of PAP (People’s Action Party) was purely grassroots, but the problem today is that PAP is a bit too elitist."
“I think that they don’t feel for the people; overall, there is a lack of empathy.”
"We shouldn’t buy trophies. The best thing is to train our own people and give them the experience. I wrote an article some time ago on how we were spending over $6 billion trying to raise productivity. I found out that we have 30,000 trained workers each year, if we took into account the graduates from all our universities, polytechnics and Institutes of Technical Education!
"Yet, our employers refuse to take them on because they say that while the graduates may have the theories, they may not be able to do the job! As such, I proposed that MOF (Ministry of Finance) using the money set aside, pay for the salaries of new graduates that employers hire and train for the first year. If these employers hire them permanently, the training will be free; if not, half of their total salaries must be returned! I think that’s the best way, as we can reduce a lot of manpower wastage."
"My own hospital stay has really opened my eyes. Other than the radiologist, who was a Singaporean, all the hospital technicians were Chinese, Filipinos or Indians. If we send all of them back, the hospitals may have to close down.
I think a lot of these pseudo-economists and pseudo-politicians say Singaporeans should be employed first, but are Singaporeans fit or willing to do some of these job?"
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