Young doctors are increasingly breaking their bonds to move to the private sector due to long hours and low pay, reported TODAY on June 22. 

In truth, the push factors for young doctors to leave public service have been around for decades.

When I graduated in 1994 and became a house officer — a clinical apprentice — my gross salary was less than S$2,000 per month. I received an allowance of S$40 for each overnight call I did. 

My peers in law and banking, who graduated two years before me, were making S$3,000 monthly, with up to six months’ bonus.

Nowadays, the starting salary for a house officer is about S$5,000, and the night duty allowance has increased to S$400 per call. 

But there are many other non-medical professions that pay better than this. Young people seeking a rapid rise in pay scale will be disappointed if they become doctors.

Back in 1996 when I started my traineeship in internal medicine, we rotated through different hospitals and would not know which department in which hospital we’d end up at during the three-year period. 

Trainees often spent these years travelling all over Singapore, from National University Hospital in the west to Changi General Hospital (CGH) in the east.

If a trainee wished to rent or purchase a residential property, it would be tough to decide on location as he would not know where he would be posted next.

After getting married at the age of 25, I bought a resale Housing and Development Board flat at Jurong West. Thankfully, I was never posted to CGH.

Nowadays, residents — trainees for specialities — are confined to one of the three Singapore healthcare clusters (the National University Health System, which runs hospitals and polyclinics in the west; the National Healthcare Group in the central region; and Singapore Health Services in the east). Trainees stay within the hospitals of each cluster, making their posting locations more predictable. 

According to TODAY’s report, one common complaint among junior doctors is the night calls. Yes, these are indeed tough — I did about seven to 10 calls a month during my year as a house officer. 

But night calls are here to stay, as hospitals will always need doctors around at all hours.

Implementing a float system, whereby a separate team of doctors attend to night duties, would help provide better work-life balance for young doctors. 

But such a system would be logistically hard to implement in hospitals where manpower is already short.

THE PULL FACTORS

The pull factors enticing young doctors towards the business-backed private sector are nothing new, either. 

Even when I was a junior doctor, some colleagues broke their five-year bonds to join the private sector as many large medical groups were happy and able to pay back their bonds. 

The major pull force in the private sector today is from aesthetics, which is often backed by wealthy investors and willing to offer starting pay of up to three times what young doctors last drew. And that is only the starting pay for a young doctor with no prior experience in aesthetics medicine. 

Established aesthetics doctors can be expected to make a lot more — to the point where the Government would likely never be able to match what the private sector can offer in full. 

DOWNSIDE OF BREAKING BONDS

To begin with, why is a five-year bond imposed on all medical graduates?

Graduating from medical school is only the beginning; it takes many years of supervised work to fully, safely train a doctor. Five years is just the correct minimum duration. 

Once a doctor enters private practice as a general practitioner (GP) or an aesthetics doctor, he will be on his own, with little to no supervision. Some large medical groups continue to train and groom their young doctors, but not all young doctors would be able to upgrade and self-train. 

Starting locum GP work as a first-year medical officer, as one TODAY interviewee did, would put heavy strain on oneself to self-learn and self-train. Leaving a supervised environment too early risks leaving young doctors with insufficient knowledge and experience.

Breaking bonds is expensive, too. Some young doctors could afford to do so with help from their families, but many would have to rely on support from the private sectors. 

With more cash on hand, private-sector outfits could redeem S$100,000 bonds with ease. But this will not be strings-free. More likely, these private centres would impose another bond or long contract with the young doctors. 

Lastly, niche areas of practice may be attractive when they’re on the uptrend, but present certain risks. 

For example, the remuneration figures offered by the aesthetics sector now may not last forever. In every shopping mall I visit nowadays, I usually spot at least a few aesthetic clinics; they are rapidly expanding into the heartland areas as well. What will happen when the supply of such clinics reaches a point of oversaturation? 

Bear in mind that disciplines such as these, which are based on volatile market demand, tend to require entirely different skill sets that are not typically taught in med schools. I have heard of many doctors returning to mainstream medicine after a taste of aesthetics.

WHAT MORE CAN WE DO FOR YOUNG DOCTORS?

Many new measures have been implemented across all three of Singapore’s healthcare clusters of late, but evidently, more could be done to increase satisfaction, especially among the younger cohorts of medical professionals. 

Could we increase their pay even more? Could we add “hardship compensation” to unpopular duties, such as working on weekends and public holidays and after office hours?

Could we limit the total number of work hours for each individual? For example, if a doctor were to work a 24-hour shift, could they get more days off during the week?

Could we increase the value of medical students’ bonds so it becomes more costly for them to break them later on?

Could we introduce new regulations into the private sector so there are reasonable limits to what they can offer young doctors in terms of remuneration?

Of course, none of these suggestions are perfect. In order to adequately weigh the costs and consider the downsides of these and other ideas, all stakeholders — including the Ministry of Health, the three clusters, and young doctors themselves — will need to come together for an open, candid dialogue.

At the same time, all aspiring medical students should take care to do their due diligence before embarking on medicine as a career.

When all is said and done, Singapore’s medical students are among the best and brightest in our education system. They are a vital national resource, and it would be a waste of their talents if they were to halt their medical careers too early — or worse, abandon them altogether.

ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist at Mount Elizabeth Novena Hospital.