Forum: Low consultation fees for family physicians may lead to rushed care

The medical community is grateful that Prime Minister Lee Hsien Loong showed his appreciation for the commitment and professionalism of family physicians (Family physicians lauded for commitment, professionalism, Dec 4).

Family physicians play a crucial role in managing common chronic diseases like obesity, diabetes and hypertension.

But in their quest to provide the best care, family physicians run into the hurdle of economic considerations.

Guidelines for managing these chronic illnesses always start with lifestyle modifications such as dieting, regular exercise, weight control and appetite control.

But it takes time for a physician to discover a patient's lifestyle and offer appropriate recommendations.

Many third-party administrators that help corporations take care of their employees' health needs pay family clinics less than $10 per consultation.

Depending on location, some clinics can depend on these third-party administrators for 50 per cent to 90 per cent of their patients.

With rising manpower and rental costs, family clinics would have to schedule many consultations to break even.

Without adequate consultation time, family physicians may opt to prescribe medication to control chronic illnesses, instead of spending time to discover and change a patient's lifestyle.

This is not ideal. Without appropriate lifestyle changes, an overweight diabetic patient may end up taking more and more medications, while his body weight continues to increase. Eventually, he will develop other conditions like hypertension and high cholesterol.

There is currently no fee benchmark for primary care consultations. But polyclinic charges - $30 for consulting a family physician - could be used as a benchmark. This should be set as the minimum fee offered by third-party administrators to family clinics.

Allowing market forces to determine consultation fees would lead to the unintended consequence of rushed care, which is not ideal.

If Singapore wants to have chronic illnesses well under control, we have to compensate family physicians fairly.

Desmond Wai (Dr)

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