Aspiring doctors should pursue family medicine as a career: Director of Medical Services Benjamin Ong

Medical Students (from left) Mr Sundheep Subramani, Mr Ng Guan Yee and Ms Ong Seen Kun.

SINGAPORE - The role of the family physician is set to become more important in Singapore, said Health Ministry's Director of Medical Services Benjamin Ong, as he urged medical students to consider pursuing family medicine as a career.

In contrast, he said a smaller percentage of each cohort will become specialists and narrow-capability specialty practice will be less relevant as "many more doctors will need breadth and depth, and general professional skills and capabilities".

Speaking at the first National Medical Students' Convention on Saturday (Aug 26), Associate Professor Ong told some 210 aspiring doctors that their career aspirations, competency development and maintenance should seek to address the needs of the society.

"We should not be in it for prestige, financial rewards or fame... We should not seek to be a super-specialist when there is limited demand for such capabilities or choose a specialty primarily because it gives us a good work-life balance," he added.

The event at Marina Bay Sands discussed issues that will impact how future doctors practise medicine, and was part of the Singapore Medical Week, hosted by the Singapore Medical Association (SMA).

In his speech, Prof Ong first outlined the need to shift the focus of the healthcare system to meet the changing demands of an ageing population and tighter manpower resources.

He said the development of the healthcare system in Singapore has been largely focused on acute hospitals and specialty centres delivering specialised, episodic care, though the Government had also invested in the set-up and enhancement of polyclinics across the island,

"Even though acute care will continue to be an important part of our healthcare system, the growing heath needs of our ageing population, with a corresponding increase in healthcare costs, makes the current hospital-centric model increasingly unsustainable," he added.

Prof Ong cited how the number of Singaporeans aged 65 and above is projected to double to 900,000 by 2030. This means one in four Singaporeans will be in that age group, up from one in seven today.

An ageing population will spark an increase in chronic disease burden, which will not only be larger, but also more complex to manage, he said, adding that patients are likely to have multiple medical conditions that require a multi-disciplinary approach.

"These 'complex' patients will form an increasing segment of our patient population even as medical standards advance and lifespan increases. The demands on our healthcare system will increase even as we face greater manpower and fiscal constraints in meeting those demands. This makes it even more challenging for us to meet the care needs of our patients," he added.

As a result, Prof Ong said the era of any doctor working in isolation has disappeared and effective care is now team-based, with the doctor as a member of an inter-professional team.

"Many more doctors will need broad and general professional capabilities. This implies that a smaller percentage of each cohort will become specialists and narrow capability specialty practice will be less relevant. Most of you will practise in settings such as GP clinics, polyclinics, and community hospitals," he added.

He said the training of more family physicians is one of the health ministry's key commitments because of the central role they play in community-based care, making them best placed to manage a patient's care needs from cradle to grave.

Family physicians in primary care settings are also at the frontline of defence for public health threats, such as the Zika virus outbreak last year during which some family physicians identified the clues that led to the first reported case of community spread.

For those training to be specialists, Prof Ong said there will also be a shift in emphasis towards developing the more generalist disciplines, as well as those with greater roles in the community, such as internal medicine, geriatric medicine, and rehabilitation medicine.

He said specialists with broader skills are important contributors to healthcare provision in the community, especially for elderly patients and the government will expand the number of specialists trained in these areas to provide for shifting care needs.

"At the same time, it is important for all specialists not to overlook their broader competencies, and to treat their patients holistically instead of focusing solely on the diseases or body part relevant to their discipline," he added.

SMA President Dr Wong Tien Hua, who spoke at the event as well, stressed the importance of "collegiality", as doctors no longer make clinical decisions in isolation, and quality care is "now more dependent on teamwork".

Graduating medical students at the event, which was attended by over 200 people, said they agreed with Assoc Prof Ong's remarks on the role of family physicians.

Mr Sundheep Subramani, 24, a fourth-year student at Nanyang Technological University's Lee Kong Chian School of Medicine, said that while he aspired to be a surgeon when starting medical school, he has since realised that Singapore has shifted towards complex care.

"There's always the thought of generalist care over specialist care, given all the chronic diseases that we have today," he said.

"Patients are no longer going to just one doctor, to see them for one condition... we're most likely going to have to become generalists, all of us."

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