Tuesday 28 February 2012

MOH reviewing pay of health-care staff

Salary, career pathways being looked into in bid to attract staff
By Royston Sim, The Straits Times, 27 Feb 2012

DOCTORS, nurses and allied health professionals working in the public sector could be looking at a pay rise soon.

The Health Ministry is reviewing the salary structure of health professionals to attract more people to join the industry, said Minister of State for Health Amy Khor yesterday. She added that the ministry will touch on salary reviews during the upcoming Committee of Supply debates in Parliament.

This came after Deputy Prime Minister Tharman Shanmugaratnam said in his Budget speech earlier this month that the Government would engage 'many more health-care professionals' and pay them 'more competitively'.

He added that 1,900 public general hospital beds and 1,800 community hospital beds would be added by 2020.

Dr Khor, speaking on the sidelines of a health-care career fair at *Scape yesterday, said about 6,400 nurses and 1,800 allied health professionals and support staff would be needed for those facilities.

Although pay is a key factor in attracting new staff, other things matter as well, she noted. 'We have to pay a reasonable salary to attract people, but I think we have to look at the whole environment as well as career pathways and career enhancement opportunities.'

One key group that the health industry hopes to attract to join the nursing or allied health professions: young people aged 16 to 20 who are leaving school.

To that end, the National Healthcare Group (NHG) brought in about 50 nurses and allied health professionals to the fair to raise awareness of what they do.

NHG said that, aside from nurses, the sector is facing a shortage in eight allied health professions: medical social workers, dietitians, diagnostic radiographers, physiotherapists, podiatrists, respiratory therapists, occupational therapists and speech therapists.

NHG chief human resource officer Olivia Tay said it is seeking 1,100 allied health professionals this year.

For instance, the Institute of Mental Health (IMH), under the NHG cluster, is looking to hire 10 medical social workers this year. It has 50 such staff now.

The IMH wants more staff like medical social worker Kang Xinyi, 24, who joined it right after graduating from the National University of Singapore last year. She entered the profession as she had friends with self-harming tendencies and family issues during her teenage years but was unable to help them.

Dunman High student Seah Yi Yun, 18, was among the more than 1,100 people who attended the career fair yesterday.

Her interest in pursuing a career as a physiotherapist or occupational therapist was spurred by career days and work experience programmes held at her school.

She said: 'I came to get to know more about the jobs. Over here, you can talk to them and know exactly what they do.'

Pay revisions may not stem public-sector doctors' exodus
By Poon Chian Hui & Melissa Pang, The Straits Times, 1 Mar 2012

A PAY revision for health-care professionals in the public sector is on the cards, but will it stem the flow of doctors leaving for the private sector?

On Sunday, Minister of State for Health Amy Khor said the Health Ministry was reviewing the salaries of doctors, nurses and allied health professionals, to attract more people to join the industry.

A ministry spokesman yesterday added that it was also looking to improve work environment, including providing better career paths and work processes.

Doctors and medical community watchers say that more competitive pay, while welcome, is not the only or main reason for the exodus of public health-care doctors to the private sector.

The push factors include heavy workload and dissatisfaction with changes to the health-care system over the years. The pulls are because going private is seen as a 'natural career progression', and because they have been offered a reduced workload and job and organisational stability.

So, how bad is the bleed?

Between 2006 and 2010, the attrition rate for doctors in the public sector was between 6 per cent and 8 per cent.

In 2009, 259 doctors, including 64 specialists, quit. In 2010, 310 doctors, including 103 specialists, left. It was the largest annual exodus of doctors.

Latest available figures showed that in the first half of last year, 150 doctors - 115 non-specialists and 35 specialists - left public hospitals and polyclinics. This made for an attrition rate of 3.2 per cent, a shade off the 4 per cent in the first half of 2010.

These numbers comprise those who quit to join the private sector or voluntary welfare organisations, as well as those who stopped practising.

Singapore Medical Association chief Chong Yeh Woei said that in the last decade, public hospitals have been hit by big changes and crises - the set-up of the National Healthcare Group and SingHealth, the Sars crisis and the debut of a residency programme for doctors in training.

'Each of these events was exhausting in itself. Each time, entire hospitals were thrown into crisis mode and senior doctors often bore the brunt of it,' he said.

Small wonder the feedback from doctors has been that they are 'very tired' and in need of more stability, he said.

The Straits Times understands that the pay structure in public hospitals has three components:

- The basic salary, which is the same across doctors of the same grade.

- An allowance pegged to the medical speciality, with doctors doing surgery getting more.

- A fee scheme determined by the type of patients a doctor treats. A doctor who sees non-subsidised patients will earn more under this scheme than one who treats more subsidised patients. A doctor who sees non-subsidised patients who are foreigners earns even more.

When doctors leave, it is no guarantee they will earn as much - at least initially.

A doctor who left for the private sector three years ago said that depending on a doctor's speciality, it can take a few years to match his last drawn salary in the public sector.

But one thing is clear: For the same amount of money or more, doctors in private practice see only half the number of patients they are typically expected to treat in public hospitals.

On this point, Dr Chong, a general practitioner in private practice, said the high workload in the public sector puts doctors at risk of professional errors and being complained against by patients.

However, it is not as if a review of salaries and other benefits will be of no help.

Firstly, Dr Chong said, doctors' base pay has been static for the last 15 years.

And although 'call' allowances have gone up, trainee doctors are barred from doing more than six calls a month, given that being 'on call' entails working shifts that can last more than 12 hours and which can span nights and weekends.

Secondly, a salary review will also help the junior doctor who may start out his career in debt: Tuition fees at the National University of Singapore, for example, have doubled in the last 20 years to $20,000 a year. A trainee doctor's pay is said to start from about $3,000 a month.

Thirdly, a pay revision will stop the income gap between the public and private sectors from yawning even wider.

Consultant doctors in the public sector get $10,000 to $60,000 monthly, depending on their speciality and seniority. Top private doctors can earn more than a million a year.

Dr Lam Pin Min, an ophthalmologist in public practice, said: 'While it's impossible for the Government to match the salaries of doctors in the private sector, there can be some form of benchmarking so that the difference will not be so stark.'

Dr Lam, a Member of Parliament who heads the Government Parliamentary Committee (GPC) for Health, said that pay may not be a top reason for leaving, but doctors may be nudged to go if it is appreciably more.

Public sector orthopaedic surgeon Chia Shi-Lu, an MP, offered a fourth reason - that it would be a morale booster 'for the many of us who work hard and often beyond what is required of us'.

Associate Professor Phua Kai Hong, a health economist at the Lee Kuan Yew School of Public Policy, prefers a longer-term fix to the problem, such as through investments in local facilities like medical schools. A pay increment is a short-term measure which will just attract doctors from neighbouring countries such as Malaysia and the Philippines, he said.

MP Fatimah Lateef, an emergency medicine specialist in a public hospital, said she foresees a pay rise of 5 per cent to 8 per cent.

Reflecting the views of most doctors, private head and neck surgeon Ranjiv Sivanandan said that as much as salaries matter, bumping them up will only temporarily stem the loss of good doctors.

He said: 'Clarity of purpose, recognising and valuing the right attributes, investment in a shared common vision and enlightened leadership that embraces diversity of opinion are perhaps factors that will go some way in providing the right milieu and genuine motivation for right-minded individuals to stay.'

What's driving them away?

DOCTORS quit the public sector for a variety of reasons, said MPs and health-care experts.

They range from poor work-life balance to a higher risk of complaints and legal action by dissatisfied patients. Rarely, they say, does salary figure high up.

Factors raised include:
- Additional responsibilities such as teaching medical students and clinical research, which are often required of senior doctors. This means more work to juggle with, on top of seeing patients.
- Organisational instability from events that have occurred in the health-care scene over the last decade or so. These include the introduction of health clusters like National Healthcare Group, SingHealth, and now, regional health clusterings.
- Unhappiness with the Residency Programme. A new training structure for student doctors started in 2010, and this has led to more work for senior doctors who have to teach.
- Too many patients and long hours, causing a poor work-life balance.
- Higher risk of legal problems in the public sector arising from patient complaints, as doctors have far too many patients to handle.
- They prefer to have more autonomy in the way they treat patients.
- Limited employee benefits, including health plans, which are little different from those of other public servants, despite working in the health-care system.
- Better status and recognition by going solo.

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