In Search Of A Better Life

In the 10 years preceding Covid-19, from 2009 to 2019, MOH Budget tripled from S$3.7B to S$11.7B. In FY2022, MOH Budget peaked at 19.29B, understandably so, due to the demands brought on by fighting the Pandemic. In the current FY2023, the MOH Budget has shrunk a bit to S$16.8B, as we gradually leave the Pandemic behind us. S$16.8B is still 44% more than what was budgeted in the year preceding the Pandemic, in FY2019. That’s still a lot of growth. And if we extrapolate back to 2009, the 2023 MOH budget is 4.5 times larger than what it was in 2009, a mere 14 years ago.

In any other country that this hobbit can think of, if the government pumped so much money so quickly into the system, you would imagine that there would be better morale amongst healthcare workers in the public sector, because ultimately an influx of such magnitude so rapidly would lead to better pay or more staff to share the workload, or both.

However, when this hobbit talks to young doctors, the mood cannot be more different. It is not uncommonly a spirit of resignation and defeat. Many are heading for the exits, or at least seriously contemplating so. And this is very worrisome. Because as this Hobbit grows older, he needs more and more medical care and he would like to treated by doctors who are at the very least satisfied with their professional lives.

There are many reasons given for this unhappiness. Many of these reasons have been discussed in detail before – excessive and unsatisfying paperwork and administrative duties, unreasonable patients and family members who may even abuse them, bosses who are overly demanding, an environment intolerant of mistakes and even underperforming hospital IT systems etc.

As this hobbit approaches the autumn if not winter of his medical life, he has the luxury of looking back. If he had to live his life again, would he have chosen to apply for Medicine in the local university when he turned 19 so long ago? The answer is still a “yes”. I cannot say the same thing for folks turning 19 now in 2023, though. And that’s the difference.

Wanting and choosing a career in medicine involved many things that haven’t changed much since then: it is a calling, hard work, long hours, sacrifice, satisfaction, status etc.

Over the years, there is also another constant that medical school admission interviewees don’t mention much, but many want to be doctors because they were in search of a better life. I’ll be honest here, one of the bigger reasons why this hobbit chose medicine as a career was that he believed this career would lead him to a better life. A career in medicine has largely delivered on this count for me.

In itself, there is nothing wrong with wanting a better life. One can even say it is a human right to want a better life, similar to the pursuit of freedom, happiness and human dignity.

But what is a better life? To answer this question, we must first recognise “better” is a word that has connotations of relativity. Better than what or who?

• Better than your peers who after A levels or junior college went on to choose other careers?
• Better than what your parents managed to provide for you when you were growing up or that you can provide for your children better material comforts than what your parents provided for you?
• Better than what your seniors in the medical profession could achieve?
• Better than what your classmates in medical school could achieve?

Whether we like it or not, most of the time, this “better” involves material possessions and wealth. Of course, there are a few who do not consider measures of material wealth being pertinent at all; these include admirable folks who go on to work in NGOs, become missionaries etc. But these are the exceptions.

Also, a lot of what a better life depends on where is your starting point. If you grew up in a 2-bedroom rental Singapore Improvement Trust flat or a 3-bedroom HDB flat and taking the bus to school, then buying your first executive condominium at 32 or your first small second-hand car at 30 usually means medicine has indeed given you a better life, materially speaking.

But if you grew up in a freehold landed property in Districts 9, 10 or 11 and you were fetched to school by your parents or even chauffeured in a nice big car from Primary 1 to JC2, then ending up in an executive condominium and buying that small second-car car as a medical officer is not a big thing. In fact, you may start to wonder if being a doctor will ever lead you to a “better” life, without parental assistance in the form of paying for the down-payment of the condominium and/or helping you with paying for that $100,000 Category A COE. And then you may even start to doubt if you will ever make it to a Category B COE vehicle in your lifetime, given how things are going.

What constitutes “a better life” is a tough question that each generation of doctors have to face and answer themselves. Because no one can answer these questions for them.

But the facts are not on young doctors side. 30 to 40 years ago, 150 to 200 students were chosen to read medicine locally out of a cohort size of about 60,000. Another maybe 30 to 50 kids were rich enough to go overseas. In other words, about 200 to 250 medical graduates were produced a year from local and overseas medical schools. Today, a total of 700 medical graduates are produced a year (500 local and 200 overseas), out of a cohort size of about 35,000 to 39,000.

Put it another way, when this hobbit entered medical school, there was one doctor to 1000 persons in Singapore. Now there are 2.7 doctors to 1000 persons. This figure is likely to reach 3 in a few years’ time. While an ageing or aged population will create more demand for medical services, it is unlikely to fully offset the effect of a quickly growing medical profession. In other words, there will be less work for each doctor, which will likely translate into less earning power.

You can see it especially in the private specialist sector. 30 to 40 years ago, nobody really worried about not enough work when they went private. 20 years ago people worried a little but in the end, nobody was short of work either. Today, not having enough patients is a real concern.

The public sector is not spared either. Recently, a senior public sector doctor posted in social media that 25% of doctors in public hospitals were senior consultants. Senior consultants used to be a rarity, now no longer. I hear in some top-heavy tertiary hospitals some consultants only have half a day of operating theatre time a week.

Doctoring is no longer an uncommon thing, like in the past.

We always say medicine is a calling. Only those that receive that calling should become a doctor. This hobbit still believes this to be true. But we need also to be honest and admit if we use the old perceptions and definitions of what a better life is, then medicine is unlikely to deliver the goods for many doctors. And young men and women who aspire to be doctors today should know these hard truths before committing to a career in medicine.

They will need to decide for themselves what are the new norms for defining a better life. And that may already be taking place even as we speak. Maybe that’s why young doctors now talk about better work-life balance and quality of life. Because these are the ingredients for a better life that they can still hope for today.