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Young docs shy away from going solo

  Saturday, 28 l 08 l 2010 Source: The Straits Times   
By: Salma Khalik

More join clinic chains, citing work-life balance, lack of financial worries

MORE young doctors opting for private sector work are joining established health-care groups as salaried professionals rather than going it alone with their own clinics.

They cite work-life balance, lack of financial worries and having senior doctors to turn to as their main reasons for forgoing being their own boss.

More than 900 non-specialist doctors entered the market as general practitioners (GPs) between 2005 and last year, yet the number of single-doctor GP clinics fell from 1,245 to 1,232. This means that older doctors who retire from their solo practices are not being replaced.

The number of GPs in group practices, however, rose from 1,238 to 1,408 over the same four-year period. The rest of the 900 joined hospitals and polyclinics or became locums doing part-time work.

Dr Koh Hau Tek, 36, has been with Singapore’s largest clinic chain, Healthway, for five years.

The foremost reasons for his choosing to join a group practice are access to mentoring by senior doctors and freedom from worry over keeping the practice in the black.

Besides the $150,000 or so he would have needed to start a solo practice, the father of “a very active four-year-old boy” said going it alone would have meant “almost zero family time”.

gp clinic

Most neighbourhood clinics are open at night and on weekends, when residents are back from work and school and likely to consult the doctor. A struggling new GP, probably unable to afford a locum to take on some shifts, would end up working long hours.

In a group practice, however, Dr Koh works sensible hours and gets paid leave and childcare leave.

Dr Felix Tan, who has been with the Parkway Shenton clinics for three years, says going solo “is a very risky business”:

“I was just out of training, with no experience of the private sector. It’s a whole new frontier. I would have had to figure out how to survive.”

Now, he does not need to fret over inventory, or by how much to mark up medicines. The group also gives him continuing medical education, which he needs to retain his right to practice. He got time off – a week a month for six months – to attend a graduate diploma course in occupational medicine, for example.

Had he been on his own, he would have had to pay a locum around $70 an hour to stand in while he hit the books.

Dr Chng Shih Kiat, who as deputy medical director with the Raffles Medical Group recruits doctors for the group, has noticed that younger doctors now put a bigger premium on work-life balance than on fat salaries.

But that said, the medical groups are competitive in pay, he said. A fresh graduate can expect to earn about $10,000 a month, and get a 13th-month bonus.

This is likely more than what they would earn if they had struck out on their own in the early years. To be sure, a highly successful solo practitioner can earn twice that or more, but a less successful one may make $8,000 to $9,000 or less, said Dr Chng.

It does not help that the market is competitive. There is only so much of the pie to go around in a neighbourhood with four or five GP clinics within walking distance of one another.

Another factor which makes survival more certain for GP chains is that they get the bulk of corporate accounts and look after the entire staff of companies. Patients new to an area are also more likely to choose a “brand name” clinic, he said.
Dr Chng noted, however, that some doctors start their own clinics after gaining experience within a group, especially when the economy is booming.

Health Minister Khaw Boon Wan, asked about the trend, said it is fuelled by the bigger role GPs now play in helping people manage their chronic diseases over the long term.

He said this requires a team approach with nurses, physiotherapists and counsellors, which in turn means running a larger clinic; to justify that, a larger clientele is needed to share the overheads.

He added that landlords like the Housing Board should take this trend into account when tendering out clinic space by providing larger units for group practices.

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