"Competing globally requires us to continually acquire new capabilities.  This means sub-specialisation, research and perfecting new skills.  Progress is more likely to be made in teaching hospitals and academic medical centres, with departmental structure and rigorous peer review processes.

"As the region and the world raise their medical standards, we must work even harder to remain as leaders.  Solo practice may not give us this edge.

A Perennial Problem 

"To be sure, retention of medical talent is a perennial issue.  I have spent many years in the health sector.  During this period, public hospitals have always had to grapple with the problem of retaining their share of talent.  Some years, like in the 1980s, we bled badly; in recent years, we were coping better.  There are now more specialists in the public sector than in the private sector.

"But talent retention is a continual challenge.  It is not just about money.  Medical service in the public sector is a noble career choice, a calling.  While we should pay our doctors well, we must not chase the market.   Whatever we decide to pay in the public sector sets the floor for the industry.  It is fruitless to think that we can close the gap. 

"The right approach is to concentrate on the basics: focus on medical service as a noble profession, build strong institutions and go all out to retain doctors with sound institutional values.  The more we have such doctors, the stronger the institutional culture.  The more such role models, the greater will be their influence on the young doctors.  As they interact with the likes of Balachandran, Tan Cheng Lim and KT Foo, correct values get reinforced and a new generation of such doctors gets nurtured.

Deepening Our Roots

"I asked some young doctors how they see their career progression.  Some were candid: train hard, become a specialist, acquire sub-specialty skills, build reputation, then leave for private sector at their prime.  If this is representative of their generation, then I worry both for the public medical service as well as for SingaporeMedicine.

"I worry because while we take in 300 doctors every year, to sink deep roots, we must have the top 20-25% of each cohort remaining in public institutions until they retire from medical service.  At steady state, these 3,000 doctors, spanning all age cohorts will form the critical mass of our medical talent pool.  If we succeed in achieving this, SingaporeMedicine will be able to compete internationally, while safeguarding the high medical standard that all Singaporeans, rich or poor, deserve.

"We must try to achieve this.  There is no single silver bullet which can solve all the issues.  

"Some doctors are fed up with administrative duties.  They just want to focus on their clinical and teaching duties.  We should not unduly load them with unproductive paper work.

"Some want better recognition of their contribution, and we should find a way to acknowledge their status and their achievements.

"Some want to have a better say in the way their hospital is run.  We should engage them and give them a productive role to play.

"Some are keen on research and enjoy the opportunity to pioneer or train in new procedures.  We should try to support them.

"More fundamentally, many young consultants who have left told me that they would actually like to remain in public hospitals but felt uncertain about their continuing employment in later years.  They saw public hospitals not being able to accommodate senior doctors like Foong Weng Cheong, KL Tan despite their having put in 30 years of their career in public institutions.  Given such uncertainty, they decided that they better start their private practice earlier, while they are at their prime.

"We must remove such uncertainties and reset the career progression of our young doctors.  They must see that we have a viable model of allowing dedicated doctors who have invested 25, 30 years of their lives to public service to remain productive in the public hospitals and retire gracefully.

"Many such senior doctors, like YY Ong, Tan Ser Kiat and Low Cheng Hock, are happy to do 40 years of public service and retire in public hospitals.  We should assure them that there is an important role for them to play in public hospitals.  We can vary the nature of their role as they enter different phases of their public service.  For example, as they reduce their clinical duties, they can take on more teaching and mentoring role.

"But some doctors find the independence of private practice and the freedom of being self-employed hard to resist. Perhaps, it is possible for these doctors to have a second career in private practice but within public hospitals, after they have served their years in public service. 

"Why can't we offer these senior consultants the privilege to migrate, say at age 50, from public service to private practice, without leaving the public hospitals?

"They can run their private practice as they would if they were in the private sector, running their own clinics, with admission rights for their patients in our private wards.  They would remain as members of our Clinical Departments with departmental support for their inpatients in return for continuing teaching and coaching of young doctors and trainees. 

"Private practice in public hospitals is not a new idea.  It has been done elsewhere.  We have talked about it but worried about their impact.  Will there be abuses?  Will public patients be neglected?

"If we restrict the privilege to the senior consultants who have put in 25, 30 years of their time in public service, what is there to be fearful of abuses?  If we start small and expand gradually as our staffing level improves, there is no reason why existing public services will get neglected. 

"In time as we gain experience and confidence, we can extend such privilege to senior consultants from a younger age of 45.  But I think we must never go below this age threshold..."

Excerpt of Speech by Minister for Health Mr Khaw Boon Wan during Launch of the Commemorative Book "To Sail Uncharted Seas" in Celebration of the Centenary of Medical Education in Singapore