PAY AND INCENTIVES
Second, incentives matter and shape doctors’ choices of post-graduate training. It is encouraging that the authorities have already assured that career paths and compensation will be enhanced and made commensurate with other doctors.
The details will be important. Specialists earn very different incomes depending on specialty and even some sub-specialties have far higher earning potential. Where would the broad-based hospital clinician be pegged?
A 2023 commentary by Alexandra Hospital doctors published in the Annals of the Academy of Medicine Singapore wryly noted that despite Internal Medicine specialist training being the most ideal for general medical coverage of multi-condition patients (probably the closest in today’s context to the hospital clinician), only a smattering of doctors is so accredited. The Singapore Medical Council latest report documents only 326 of Singapore’s 17,326 medical practitioners (on full and conditional registration) were Internal Medicine-accredited.
Morale and job satisfaction challenges are the likely factors here. Anecdotally, my fellow doctors tell me Internal Medicine training is tough and the practice even tougher in part due to tension and inadequate communication with organ-specific specialists.
PUBLIC ENGAGEMENT
Finally, the public is used to the notion of the specialist as the “dua lo kun”. The assumption that the “big doctor” (in Hokkien) knows everything and has the wherewithal to integrate all the different considerations is implicit but sadly unrealistic as Singapore becomes super-aged.
That said, the hospital clinician may be deliberately trained to have the competency but this is contingent on building up public trust in and credibility of the hospital clinician. The public has to be convinced that the hospital clinician model is a superior way to organise inpatient care – not an off-loading measure to save specialists’ time, not a cost-cutting intervention.
It is also critical to avoid, at all costs, the misconception that public healthcare minimises access to specialist care and thus pushes patients to private sector care.
Continue reading...