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Dear Sir,

The manpower question

I read with great concern the numbers of physicians needed in S’pore and how to respond to short term contraction of manpower at the medical officer level and the need for retaining physicians in the public sector. Physicians are not a homogenous population. It is a motley crew with characteristics such as the following:  

  • highly talented (many are computer wizards, accomplished pianists and musicians) 
  • highly idealistic, especially in their early formative years in the public sector. One or two are pastors in time local Christian churches. A few, in their later years, leave the private sector to return to teach 
  • high achievers, whether they are doing medicine or chess politics
  • highly individualistic like the musicians in a orchestra who knows his/her personal worth 
  • they have a high sense of self-esteem and have high expectations commensurate with the many years of arduous and expensive training on the part or their parents and the state.
Hence, it is a difficult group to manage, as any CEO of hospitals, presidents of academies, colleges and medical association will attest. It is difficult to speculate why they leave, and for what pasture. Without the facts of the case (ie. taking a good history), one cannot reach a diagnosis. In good medical practice, without a diagnosis, one cannot reach a rationale plan of management. So, how do we know that raising the number of medical student intake will solve the problem in 5 years’ time? If the conditions of work and reward systems in the hospital and polyclinics remain unchanged, it is likely that no matter how many pints of “E” blood we transfuse to resuscitate the system, the haemorrhage will continue unabated. The usual approach to treating shock is to look for the source of bleeding and arrest the haemorrhage.

The frustration will grow as the new graduates of the class of the year 2002 (no=180) and 2003 (no=2003) find training prospects ,just as bleak and private sector just as saturated, if not more so than in 1997. It will be a recipe for mass emigration of very expensively trained, high IQ, Singaporeans. The five-year bond will mean that if they wish to switch to another profession such as finance and business, they cannot do so until the ripe old age of 30 years old. By that time, they have families to raise, COEs to pay and housing loans to maintain. Only those with rich parents can afford to bail out and do other things.

How does one go about meeting the expectations and needs of venous subsets of this motley crew? It is difficult a task. The answers are not readily available. Suffice to say that good intentions are not good enough. There need to be various outlets for many things that we as physicians want to do. These areas include, the following (not in order of merit):

  • Continuing medical education
  • Research
  • Job satisfaction
  • Volunteer work
  • Teaching undergraduate as well as postgraduate
  • Recognition for efforts put into the above
  • Overseas conferences
  • Time with family 
  • Expression of one’s faith in medical work eg. mission trip abroad
  • Espirit de corps. Ask anyone in solo practice and they will tell you that the isolation can reed fear and insecurity as well as a lack of support when patient care goes wrong. 
  • Earning an income compatible to one’s status. COEs and E-condominiums don’t come within the  easy reach of a civil service MO’s pay 
  • Humane working hours regardless of seniority. Just because the older hospital doctors in the 60’s and 70’s used to work 36 hours at one stretch in those days when Singapore’s population was booming (KKH delivered one baby every minute) does not mean that the young ones these days need to go through the inhumane system that saps not only the physical and mental energy leading to “burnout” but also to an erosion of one’s ideal of altruism.
Is it the Ministry’s job to see that doctors get what they need? Yes, if they see it as part of staff welfare. Otherwise we will be doing the same old thing day in and out – an antithesis to the idea of research which is to elucidate the facts and to propose changes for the better – whether in the search for new cures for medical disorders or a solution to what is essentially a management structural/organisational problem. 
 
DR LAWRENCE NG