The review announced recently of the way doctors are being trained here reflects the critical need to ensure this matches public health requirements. America, for instance, is said to have too many specialists and too few primary care doctors. When too many of the former are involved in a case, the result often is "waste, disorganisation and overload", as an American expert noted. When each specialist focuses on a particular organ, tests might be ordered for specific investigations. But, as Duke University professor emeritus Allen Frances asked, who is considering "the whole patient to organise a global, integrated, safe and effective treatment plan"?
Ageing societies, in particular, must get the right balance of specialists and family doctors. Generalists will be the first line of defence always for seniors grappling with multiple ailments. The Health Ministry is right, therefore, to urge more doctors to work in more general fields. Yet, of course, specialists are necessary because no generalist can hope to acquire mastery over the treatment of the entire spectrum of organs.
The review of the way in which doctors are trained as specialists is also timely as there is a measure of disappointment that some of the outcomes of the American-style residency programme, introduced in 2010 to help speed up training for specialist doctors, have not lived up to expectations. Detailed reasons for the gap between expectations and reality should be made available to promote a full discussion of the issue.
As medicine is associated with prestige and the possibility of higher earnings, one might expect those training to be doctors to be fiercely competitive women and men who wish to prove their worth to their peers and to the world at large. This streak is useful in preventing practitioners from falling back into the mediocrity of doing and learning the minimum to keep themselves employed.
However, the medical profession as a whole must first serve the welfare of patients, both individually and collectively as a healthy society. In this context, specialisation should be seen as another way to contribute to overall public health by ensuring that patient care is properly coordinated, the possibility of unnecessary testing is minimised, and health costs are kept in check. In the United States, for example, about one out of six US dollars spent goes towards healthcare. "If we do not succeed in controlling these costs, they will gradually crowd out other necessary societal expenditures," as a Time magazine commentator observed. Further, higher expenditure does not necessarily lead to better health outcomes. Research there has shown that "higher percentages of primary care physicians are positively associated with better health metrics". These points are worth pondering as the direction of medical training here is reviewed.