After years of working with teams of colleagues in the public hospitals, entering into the private sphere can be a daunting move. However, just because private practitioners may work in silos, they need not be working alone.
Here, we invited A/Prof Cheong Pak Yean and Dr Desmond Wai to share with us how being part of a medical professional body can be helpful and encouraging for private practitioners.
Cheong Pak Yean
Relevance of Professional Medical Bodies to Private Medical Practitioners
Although doctors in Singapore need to be registered only with the Singapore Medical Council (SMC) and have medical indemnity coverage to practise medicine, most doctors voluntarily join one or more of the three professional medical bodies (PBs), namely the SMA, Academy of Medicine, Singapore (AMS) and the College of Family Physicians Singapore (CFPS).
The three PBs play both collaborative and unique roles on issues relevant to the practice of medicine, especially for those in the private sector. These are roles of advocacy, maintaining ethics and professionalism, continuing professional development and fostering collegiality.
Advocacy for doctors, for patients
The PBs engage the Ministry of Health (MOH) and other ministries on important issues of public interest and contribute to the frameworks regulating practice. One example is the concerns on patient confidentiality and privacy of the National Electronic Health Record (NEHR). Another recent example is the disquiet of many doctors over the SMC's complaints and disciplinary process. SMA's slogan "For Doctors, For Patients" is the raison d'être of such advocacy. Doctors can best care for patients only if they are also looked after in a relationship of trust and healing.
Unique issues pertaining to private practice, for example the implementation of the NEHR, also need attention. Doctors in the private sector may not have the institutional support for such implementation.
Ethics and professionalism
The PBs have established structures to promote expertise in the areas of ethics and professionalism. The SMA Centre for Medical Ethics and Professionalism1 is one vehicle working with medical indemnity organisations. AMS has its Faculty of Medical Experts, while its Office of Professional Affairs provides opinions to statutory bodies such as MOH, SMC, the police and the courts. CFPS incorporates training on ethics and professionalism in their Graduate Diploma, Masters and Fellowship training programmes.
In today's challenging medico-legal environment, doctors, especially those in the private sector, need to be trained to navigate the ethical and legal issues they increasingly face in practice.
Continuing professional development and enhancing practice management
The SMA Medical Practice Management conducts training courses for doctors and healthcare assistants. AMS has a Learning Management System through which it provides Self-Learning Modules for each of its specialties and subspecialties. Its Deanery conducts training courses and in-training examinations, and awards diplomas recognised by MOH. The CFPS Institute of Family Medicine conducts Graduate Diploma and Masters training courses that lead to certification by the National University of Singapore. Its Censor Board trains and awards the SMC-recognised degrees of Collegiate Membership and Fellowship. Members are often accorded privileged access.
The three PBs are also tasked by SMC to designate activities for core CME points for different categories of doctors. When SMC mandates maintenance of competencies, the PBs would likely be asked to participate.
Collegiality and publications
Collegiality within the medical profession and among other professionals (eg, lawyers) is fostered through sports and other social events. SMA also supports the Singapore Red Cross and other organisations' medical humanitarian projects in the region. The opportunity to participate in these various activities helps to prevent professional isolation, especially for those in private practice.
Newsletters such as the SMA News and College Mirror update members of the life and times. The Singapore Medical Journal; the Annals, Academy of Medicine Singapore; and Singapore Family Physician are academic publications of the three PBs, respectively.
Why join?
Many doctors in the private sector are members of the SMA and/or CFPS. Those eligible for AMS Fellowship, especially those in the private sector, voluntarily join as well. The number of members in each PB matters. Though voluntary, there is critical mass of support by doctors in the important roles each PB plays.
Desmond Wai
Help from SMA in Private Practice
I have been an SMA Member for more than a decade. While I was still in public service, my impression of the SMA was that it is merely a social club with regular dining and wining. But since entering private practice in 2006, I have found SMA to be more and more relevant to private practitioners.
The SMA can help you...
Find the perfect timing
One should only leave public service when he/she feels that he/she can practise independently without the support of seniors or juniors. I started thinking about leaving public service when I saw my classmates and contemporaries advertising their new private clinics in SMA News. If they were ready, I should be ready too.
Scout for available clinic space
Whenever I receive the monthly copy of SMA News, I usually start reading from the back, especially the section where available clinic spaces are advertised.
Advertise new clinics
The minimum form of advertisement is to let colleagues know the address of my new clinic. SMA News provides an affordable platform for me to inform all SMA Members about the location of my new clinic.
There was no need to tell people how smart I was. I just let the readers know my new clinic location and contact number.
Glean new insights
I remember attending a couple of seminars on starting a private practice before actually doing so. I am grateful for the sound advice and sharing of the speakers during those seminars back in 2005 and 2006. Besides learning many tips with regard to private practice, the speakers opened up my mind to the issues that came along with setting up my own clinic.
I think that the private practice seminars remain the best-attended SMA seminars over the years.
SMA also organises seminars on taxes and budget, usually held after the announcement of the annual budget. These are very important talks as officers from the Inland Revenue Authority of Singapore, accountants and consultants give their takes on new budget and taxation changes.
This is probably the second most-attended SMA seminar.
Provide a portal for feedback
The beauty of SMA is that their Council Members are also doctors working on the ground, seeing real patients. They understand the issues that affect practising doctors. They are always ready to listen and are an important portal to providing feedback to the authorities.
I had the opportunity to be invited by SMA to meet up with the SMC on the issue of informed consent. I was pleasantly surprised to learn that the SMA Council Members do work very hard to hold discussions with the SMC (and even the MOH) on thorny issues. In fact, the MOH committees that look into fee benchmarks and informed consent also include representatives from the SMA.
I believe that the MOH and SMC do view SMA as a reliable partner.
Weigh in on contentious issues
SMA has made public statements on several occasions when controversies arise in clinical practice, such as third-party administrators issues and the revision of the SMC Ethical Code and Ethical Guidelines.
We do have a loud voice when our professionalism is marginalised.
How else can SMA improve its service?
But SMA must never be complacent. It must continue to work hard (and harder) to make itself relevant. In my humble opinion, there are some areas in which SMA can do more and do better.
Advise on commercial contracts
It is common to see new private doctors having disputes with their landlords or private employers. New private doctors may take whatever their housing agents, landlords or private employers say as the standard, only to have issues arise when the commercial contracts are being terminated.
For example, some rental contracts build in an annual rent increase, while others require the landlord and/or tenant to pay for the agent's commission when the rental contract is renewed. Some new private practitioners sign unfair employment contracts that favour the employers.
When I hired my first clinic assistant back in 2012, I had no idea what items and terms I should include in the employment contract. In such situations, SMA could help by having "standard" rental and employment contract templates to help newcomers formulate their own contracts.
Speak louder and speak more often
Over the last two years, several shocks rocked our profession. A paediatrician was suspended for misdiagnosis and an orthopaedic surgeon was fined heftily for not obtaining informed consent.
While SMA has spoken up and acted on some of these issues, many felt that SMA could have been more prompt in their action.
Providing a benchmark voice for the public
Many patients and their family members use social media platforms to voice their frustrations with the quality (or lack thereof) of healthcare they have received and many of such posts go viral.
SMA could help the profession by speaking out against the public's sometimes unrealistic expectations.
Resist commercialism
Since SMA Members are doctors, SMA-organised events are opportunities for many commercial entities, such as accounting firms, clinic management system providers, wealth banking consultants and high-end car dealers, to advertise and gain clients.
While allowing these commercial entities to sponsor events brings in money, SMA must ensure that their speakers are properly qualified and their advice reasonable.
Members attend SMA events to learn something. We do not expect to be shown too much advertisement.
Conclusion
Every crisis brings opportunities. Recent crises in our profession have allowed SMA to show leadership in protecting the integrity and reputation of our profession.
I personally hope that SMA will grow stronger with a louder voice and be more proactive in upholding the reputation of our profession.