A survey of general practice clinics has found that while the costs of running a clinic went up by 45 per cent between 2006 and 2013, fees charged to patients went up by only 16 per cent.
The GP Fee Survey 2013, published this year in the Singapore Family Physician, a quarterly journal of the College of Family Physicians Singapore, also found that while doctors were working fewer hours, they were seeing more patients.
The survey found that the median opening hours for clinics were 44 hours a week, four hours shorter than in 2006. But the median number of patients seen rose significantly to 1,500 a month, up from 1,000.
Dr Pauline Neow, who has a clinic in Queenstown, agrees that she is now working fewer hours without a drop in patient load. This is partly because of loyal patients who still see her even after they moved out of the area, as well as new patients who get government subsidies as part of the Pioneer Generation Package.
She said: "Old people who would otherwise not have seen a doctor for financial reasons are now presenting much earlier in the course of an illness."
The voluntary survey polled 992 clinics, but only about 12 per cent responded. The last such survey was in 2006. They were solo clinics with one or more doctors providing "traditional" practice, which excludes things like aesthetic medicine, although seven respondents did provide aesthetic treatments.
The majority were clinics in Housing Board estates. Solo clinics provide two-thirds of primary care in the country. On average, patients were charged $40 per visit in 2013, although half paid $35 or less, including the cost of medicine. The consultation fees alone ranged from no charge to $100, with half of the clinics charging $20 or less.
But while the median fee charged went up from $30 to $35, operating costs went up more sharply.
Although the median property cost went up only slightly between 2006 and 2013 from $4,800 to $5,000, total practice cost including salaries went up from $21,400 to $31,000, an increase of 45 per cent.
The article said: "It appears that GPs (general practitioners) have been keeping their prices competitive and affordable for patients despite rising practice costs."
It is harder for younger doctors, said the survey team led by Dr Andrew Tay, which found those aged 46 and below faced economic challenges of higher property cost and higher total operating cost than the older GPs.
Half the doctors paid themselves a monthly salary of $10,000 or more, with the highest taking a salary of $42,000 a month. However, when the profit was calculated by subtracting cost (excluding doctor's salary) from revenue, half the doctors made $15,000 or more, with the highest grosser taking in $95,000 a month.
The study warned that single-clinic practices "do not enjoy economies of scale and work with lean manpower" and are vulnerable to rising operating costs and the need to provide competitive pricing. They might be tempted "to venture into non-traditional areas of GP work, such as aesthetic medicine, to supplement their income and keep the GP practices viable".