I just one simple question to ask you in this forum. Please answer it for the benefit of all Singaporeans.
When I was in Singapore two years ago, I found that they was hardly any patients waiting in the doctors' clinics....a far cry from 20 years ago when I just immigrated. Then I was at Dr Koh's dental office and waited for him for an hour for a dental treatment.
Wow his dental clinic was full of people waiting outside and the the 1 hour I waited for him, I could not see a single patient at the clinic which shared a premise with the dentist. My 12 year old son was outside when I was treated by the dentist for another 1/2 hour. My son told me there was no patient at the doctor's clinic for that 1/2 hour.
Is the business of private doctors that poor?
And if yes, why?
I will share what I know about the private GP market in Singapore.
1) Too many GPs. Oversupply.
2) Undercutting business strategy of GPs. You charge cheap I charge cheaper. Good for the patients bad for the profession. Good business decision? I leave that to businessmen to answer.
3) MOH opens polyclinics to "check costs" just like with NTUC and supermarkets. Polyclinic compete with private GPs for same market (they have "premium"/"private" type GP services at the polyclinics where you can see famly physician, pay market consult rates but get drugs at subsidized prices. Tough for private GPs to compete when polyclinic bulk purchase millions of dollars of drugs they get massive discounts.
4) Presence of big GP clinic chains eg RMG, HMG etc. They go for corporate contracts. Offer cheap consult fees to companies for their workers. Market rate goes at about $5 per consult per worker/patient. Cap for total bill is $20 per visit (ie $5 consult, $15 for all of medicine). GP cannot tell worker the cap as it will upset the worker who was promised that all "medical" is free when working for the company. But patient gets upset when gets what they perceive as too little medicine or "inferior" medicine. These GP clinics got lots of patients, but profit per patient is maybe $5 after counting rental costs, manpower costs etc etc. Don't be fooled by "busy" clinics. Some "not so busy" clinics can make more profit.
5) Most of profits in most clinics come from profits from drug sales. Strange phenomenon in Singapore, where patients love getting lots of medicines. The more medicine they get the more "value for money". Advice from doctor is just talk talk only, if no medicine given no need to pay. But get lots of medicine....arr.....good lah. Doctors give more medicine, earn more profits also. In the end it is a err.....win-win situation? Personally I hated this. 99% of patients got flu expects antibiotics. Go see doctor is not to see doctor, is to get antibiotics. Proper management is not to give unless necessary. And 90% of flu is viral, don't need antibiotics. Senior told me off before. When you go buy mee pok, the mee pok man won't say "ai mai hiam?". He says "ai hiam mai?". If you never say, he give you with chili. If you dowan then you tell him and he will say you never say mah. Same goes with antibiotics. Nail in the coffin is when he said "why so stupid? you give patient antibiotic he happy and we make more money! You don't give they not happy and we don't earn so much money!" Yeah but I am proper doctor leh not drug seller leh. Who cares? It's all about customer satisfaction and earning money.
6) MOH is happy with the situation at GP level as it keeps costs low for the consumers. The GPs silly enough to eat each other until nothing left.
7) Singaporeans actually very lucky. Want to see doctor everywhere also got. And spoilt for choice. And open late late at night also.
8) A&E also machiam like GP clinic. P3 cases all seen within 1 hour. Overall fee is flat $90 for everything, drugs, X-ray, blood tests everything....in a way A&E competes with GPs also.
9) In survey on average earnings of GPs in 2008 it was about $10k/month. Figure was the same as in 1998. Over 10 years no change. Factor in inflation, it has dropped a lot over the years. Good for the people.
10) Ironically despite all these benefits, patients still hate doctors. Attack them in the press. Press also attack them. Now SMC got lawyers on the council.
11) Over the long run, doctors will go down the route of how teachers are like in Singapore. Teachers will know what I mean.
12) Influx of foreign doctors. Cheap manpower. They are paid 50% less than local doctors but work the same hours.
12) Next up is specialists. After flooding the GP market, MOH is planning to do the same to specialists. New residency programs where straight from graduation they enter specialist training residency. Every graduate doctor will be a specialist from now on. Good for the people.
I always felt that despite all these measures being very bad for doctors, it is good for the patients/population. It would have been a consolation if at least the patients appreciated doctors more. But instead they don't. Everything threaten to complain. Complain they get what they want. Don't complain you get treated badly. This is how the admin people handle things. Lack of courage and integrity is covered with talk of "patient-centric approach", "customer satisfaction".
No one goes to the hospital or clinic to have a good time. Yet they send the staff for training by SIA and hotel service training groups. Please lah. SIA and hotel always say "see you again" when you leave. In healthcare try saying that to patients and see what you get. It is a different ball game altogether.
Nevertheless, it is still good for patients/people that healthcare costs are kept low. The costs are kept low because doctors and nurses are relatively underpaid. Admin costs however are high and sometimes you wonder why you need so many admin people anyway? How the government chooses to pass the costs to the people is another story and politically charged. So I will stay away from it as I am no politician and have no interest in that whatsoever.
Give another 10 years, few will want to study medicine in Singapore. Study overseas better. Either you stay there and do well, or you come back and the hospitals will proclaim you as some foreign trained genius much better than any local graduate.
