I have been in solo practice as a specialist for almost 15 years. I wish I could say that I devote all my time to the practice of medicine and direct patient care, but in reality, clinic administration duties take up a third of my time.
I am continually learning how to better manage my practice, and I face new challenges every year, especially with the multiple hats I wear.
In addition to seeing patients and performing surgeries, I spend time on other clinical matters such as writing reply letters to referring doctors and submitting applications for insurance companies to pre-approve treatments. When insurance companies first started requiring doctors to submit applications for pre-approval of treatments, I took a long time to complete each application due to the learning curve for each insurer's portal. I was also frustrated by the need to answer supplementary questions to justify treatments.
As HR director, I have to ensure that my staff are adequately remunerated and provided with sufficient leave and health benefits in accordance with Ministry of Manpower guidelines. I was recently faced with the need to implement a policy on how to handle gifts, as my staff and I had received rather large ang pows (red packets) from one of my patients. My concern was to ensure that the gift did not exert undue influence over how the patient would be treated, yet at the same time maintain our respect for customs and traditions.
As information technology (IT) manager, I have to ensure that my hardware is up and running, safely secured against cyberattacks. As data protection officer, I have to implement policies to protect patients' personal information. This is no easy task for someone not formally trained in IT, and with the proposed Health Information Bill, I will have to devote even more time and resources in this area.
As chief marketing officer, I have to keep an eye on my internet marketing campaign and refresh my website content regularly so that it is relevant for patients, at the same time making sure that it complies with the Ministry of Health's (MOH) regulations on advertising.
Finally, as a business owner, I have to secure premises to practice in. It is common knowledge that clinic premises are not cheap to purchase or rent; I count myself fortunate that I got mine 15 years ago.
The non-clinical aspects of a solo practice take up a substantial amount of time and contribute to the running costs of the practice. I do not know the exact number of solo practitioners in Singapore, but it is likely to be substantial. Back in 2010, MOH's primary care survey found that 93% of private GP clinics have less than two full-time equivalent GPs working in their clinic.1 So, I am together in the trenches with the majority of private doctors in Singapore.
I do not regret being in solo practice – the independence is priceless. Practising in a specialist centre, I do not feel isolated as there are many like-minded specialists in the same facility whom I can call upon for advice and help. In a similar vein, I believe that solo GPs can tap on Primary Care Networks to obtain resources and assistance. Still, one of the downsides of solo practices is that there is no economy of scale and costs can rack up. There is no denying the increase in the costs of practice; I have recently observed that it is becoming more common for new private doctors to join group practices, likely due to lower costs.
Notwithstanding this, solo practices have contributed, and will continue to contribute, significantly to the nation's healthcare needs. As time goes by, solo practitioners will have to adapt to policy changes. Likewise, policymakers should also support solo practitioners so that that their practices can continue to be viable.