Angry Doctor

Saturday, July 14, 2007

How much is that doctor in the window? 9

angry doc wasn't planning to blog about this topic, but since Prof Lee thinks it's important enough for her to write to the ST Forum (emphasis mine)...

Why single out doctors as being mercenary?

IN THE letter, 'Concern over senior docs going into private practice' (ST, July 12), Ms Annie Koh Seok Kien laments the increasing numbers of doctors leaving restructured hospitals for private practice.

The past two years have seen an increasing number of foreign patients, driving up the income of specialists in private practice, while the remuneration of doctors in the public sector has remained largely unchanged. The income gap between medical specialists in the private and public sectors is now blatantly obvious to the entire medical fraternity.

Students apply to medical school for a variety of reasons. Whatever the initial reasons, when they graduate and subsequently set up families, even those who remain extremely altruistic have to start planning to accumulate wealth as any responsible parent would.

Even if their initial aspirations were to send their children to a local university, as the potential for earning more arises, their aspirations may now be to send their children to top universities overseas.

These are natural instincts which ensured survival of homo sapiens over milleniums. Even politicians and civil servants whose ambition is to serve the nation harbour these same aspirations. Why single out doctors as being mercenary?

Indeed, there are some doctors who are unscrupulous. This is possible in private practice where there is no regulation to prevent overcharging. These are not the doctors we would want to retain in the public sector.

Speaking for the doctors at the National Neuroscience Institute, a restructured hospital, as long as the difference in income is not too great, the working conditions reasonable and fair, and there is a sense that we are providing the best patient care we can, we are happy to stay on in the public sector to serve all patients who need us.

But if the gap gets greater as it is threatening to, I would not hold it against any of my colleagues with families who leave for the private sector. I only hope that in private practice, they will still be guided by their conscience when dealing with patients.

The price of medical care does not follow the rules of supply and demand because the consumer (the patient) can never be fully informed and usually goes to the doctor with total trust, submits to various procedures recommended and seldom questions the fees that are eventually charged. That is the reason why private practice can be so lucrative.

Associate Professor Lee Wei Ling
National Neuroscience Institute

Well, angry doc doesn't think 'why single us out?' is a valid defence, nor that the freedom to overcharge patients is the only or primary reason for doctors joining the private sector.

By the same token, it doesn't mean that all those who leave the public sector are greedy and unscrupulous, or that those who remain are all virtuous and self-sacrificing.

Doctors in the public and private sectors are not opposites of each other, nor is the relationship between the public and private sectors always antagonistic. In fact, as this article by The Hobbit explains, the two may be much more dependent on each other than we sometimes realise, and the existence of an 'attractive' private sector may not always be to the detriment of subsidised patients, as Ms Koh feared.

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  • Angry Doc,

    If I were a doctor and have a choice between making $2M a year or $600K a year...I would choose the former.

    In the past we had a small number of private hospitals and healthcare resources were mostly in the public system. Healthcare resources is limited - blood, doctors, nurses, hospital rooms etc. You can see our system transforming to a medical hub for regional and beyond. Just last year 410,000 medical tourists came to Singapore. Our limited resources strained. At the same time our govt is looking at cutting medical subsidy primarily aim at the upper & middle-class families. Also subsidised care is now rationed - longer waiting times - to encourage more people to seek unsubsidised care.

    At the same time our medical insurance is de-nationalised and put in the hands of "for-profit" insurance companies.

    We are moving away from the No. 1 heathcare system in the world which is France towards an American type system where profits is maximised and resources allocated to whoever can pay more be it local or foreign patients.

    It is not where we are today that scares me, it is where we are heading that terrifies me....

    By Blogger Lucky Tan, At July 17, 2007 1:40 pm  

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