SINGAPORE is facing possibly its largest-ever exodus of specialist doctors from the public to the private sector, as the robust economy gives them the courage to leave secure jobs. In the first half of this year, 68 specialists left the public sector, compared with 63 the whole of last year. Among them were five cancer specialists, seven general surgeons, seven orthopaedic surgeons and seven diagnostic radiologists. If this trend continues for the rest of the year, it will be the biggest outflow of specialists the public sector has ever seen. The previous high was a loss of 87 specialists in 2007. The Health Ministry could not provide more up-to-date figures for this year.
Industry observers say doctors are feeling confident enough to leave their safe jobs for private practice because of the booming economy. A highly successful specialist in private practice can make up to 10 times what he was drawing in the public sector. These top doctors earn more than $1 million a year, with some reputed to rake in more than $5 million. In the public sector, consultants earn between $12,000 and $60,000 a month, based on their seniority and specialty.
Even less successful private sector doctors would make about the same pay they were getting in the public sector, but with a much lighter patient load. Not all who go private set up their own practice. Some find it easier to join an existing group practice, where their pay may not be as high but is regular. Among them are about 20 specialists in seven specialities who have joined the Healthway Medical Group this year. One is colorectal surgeon Adrian Leong, who is in his early 50s. He left the National University Hospital (NUH) in July to take on the role of group medical director. He said the group pays more than the public sector, but “not multiples” of what they were receiving. Some specialists who have left said that pay is not the whole story.
Cardiothoracic surgeon T. Agasthian, 49, said there were many factors behind his decision to leave the National Cancer Centre in October to open his own practice. They included the desire to continue working beyond the retirement age. “You can’t start a practice at 62. It takes time to set up a private practice,” he said. He added that while some very senior people are still around in public hospitals, not everyone is given the option to stay. Dr Agasthian said he would have stayed on if he had been given a teaching post, since teaching the next generation is one of his passions. He added: “To stay on in the public sector, we need to feel useful.”
Professor Leong, who holds an adjunct teaching role at the university, was also planning for his future when he left. He said: “You usually take about five to 10 years to make a significant impact in a particular arena. The time was about right to start on something new before I got too old.” But he added that some of the new specialists at the group moved to private practice “to get a better quality of life”. They now work part-time and choose their own working hours.
The Health Ministry has always maintained that it is the role of public hospitals to train doctors for the country. At the end of last year, Singapore had 3,180 specialists, of whom 1,927 worked in the public sector and 1,253 in the private sector. There were then 42 oncologists in the public sector and 25 in private practice. With at least five moving out of public practice this year, the equation changes significantly.
Cancer is the top killer in Singapore, with more than 9,000 people diagnosed each year. The majority seek treatment at public hospitals. Cancer patient Ananda Pereira has had two of his specialists leave for private practice this year, and is unhappy with the changes. Said the retiree: “Patients often put their trust in their doctors. And when the doctor changes, it can affect their confidence in the treatment.”
Prof Leong said: “I do feel sorry about some patients who wanted to continue to see me, including a very nice old lady who was crying in my NUH clinic when she was told.” But hospitals said they have no problems coping with the losses. The National Cancer Centre said its number of doctors is increasing and “there is also no significant change in the waiting time for patients to see doctors”. Tan Tock Seng Hospital, which lost nine specialists in the first six months, said the “vacancies were quickly filled”.