Sunday, March 29, 2009

Too few doctors? Yep, most definitely... and the giraffe's neck is too short.

A letter writer in today's ST posed the question "Why didn't we see it earlier?".

I'm afraid we won't readily get an answer, I don't think. But let me tell you a story. A story that is just that, a story. And one that is definitely not based on any insider information.

Once upon a time, doctors were pretty much regarded as the scum of the earth. Temperamental, self serving, greedy prima donnas who were difficult to manage and kinda messing up the pristine pretty health care system, and in the process escalating health care costs. So the response was pretty predictable. Cap the number of doctors. Control the supply of services, and the demand for services will be bottle necked. QED.

This kinda coincided with the sudden flurry of excitement about life sciences and biotech, and the lure of fame and fortune through patents and drug discoveries etc. It was such a waste that talented high achievers were all queuing up to enter medical school. Unpatriotic lot!! No reason at all to produce more doctors.

A little bit down the road the life sciences initiatives morphed into biomedical sciences and a recognition of the need for yet another catch phrase - "translational research". Multiple and repeated visits to US great halls of learning taught us that the great medical research institutes were all populated by clinician researchers. All of a sudden doctors came back into vogue. Plus, the ideas for a biomedical hub and commercialized medicine suddenly began to assume well-definable shapes. How are we going to have a bustling medical service reaping megabucks off the medical tourist industry when we don't have enough doctors? How are we going to get those top-notch clinical scientists if we don't have enough doctors in research? Train them!! But our medical schools are obsolete traditional structures merely teaching students all the unexciting mundane stuff about being good practitioners and concerned health care givers. What a waste! They should all be trained to be translational, clinical researchers. What an unpatriotic lot!

Solution? Increase the intake of medical students! A second medical school - make that a graduate one to train physician scientists! Why stop there ..? Have a third school! Bring in those top tiered research oriented US medical schools to challenge our own home grown one. Dukes, Cleveland...etc...

Nothing wrong with the strategy. Who cares about over-servicing anymore, especially since the more you service the global community the more we can tax, and the more the ancillary services can also make money? How about the escalation of cost of health care? Tricky problem, but our population's pretty docile and we can still manage public expectations pretty well.

Do we need more doctors? can you even ask that question? Of course we do. Meanwhile the giraffe's neck gets longer. Hmmm...on the other hand, perhaps its his legs that are getting shorter.


auntielucia said...

Hi Giga! This piece of writing sure has byte! Coming from a family of three doctors spread over 2 generations and a married-into-the family pharmacist, Im afraid I look on doctors without the awe that most pple do. In fact, I question, question n question every diagnosis. Given our longer life expectation, mayb the 3rd medical should take in mature students who may make better doctors than those who go straight into medical school while still wet behind their ears and perhaps end up like the likes of Allan Ooi, both wasting themselves and time and money of the country?

gigamole said...

heh....yeah, that's been considered. The 2nd school (Duke's-NUS)actually takes in graduates just like the US system. But I hear the students are having problems with the very crammed curriculum.

Personally although I would prefer the students to be more matured, I believe the medical course does mature the student as he/she comes through. But it needs to be done properly. Nowadays, they are rushed through without the same kind of mentorship as in the past, and I think we do miss out on nurturing the students through into their professional lives.

A big loss I think.