Want to study medicine and be a doctor in Singapore? Here’s what you need to know

A long-term patient of mine, Madam Tam, brought her son along to see me recently.

Alan, 18, has just completed his Integrated Programme and is starting National Service soon.

Mdm Tam asked me: “My son wants to study medicine. Can you give him some advice?”

Alan told me he scored 44 (out of a maximum of 45) in the International Baccalaureate (IB) diploma examination last November.

Through our conversation, I found him smart, sincere, courteous and authentic.

About 170,000 students take the IB diploma examination annually worldwide. In 2021, 238 scored full marks of 45. So Alan’s IB score of 44 would make him among the top students in Singapore and in the world.

I had a long chat with Alan on what he should expect.

Given that medicine is a field of study that has long been sought after and many may not be familiar with what it entails, I thought it would be useful for me to share what I told Alan.

WHAT DOES IT ENTAIL?

The first piece of good news was that it has never been easier to enter medical school in Singapore. 

Back in 1989 when I enrolled into the Faculty of Medicine at the National University of Singapore (NUS), there were 183 first year students.

Today, there are two other medical schools besides the NUS medical school: Lee Kong Chian School of Medicine at Nanyang Technological University, and the graduate-entry Duke-NUS Medical School. There are more than 500 places for first-year medical students each year.

Given that the annual student cohort sizes have not changed much, the chance of getting into a local medical school is almost three times higher than 25 years ago.

Yet Alan must consider various challenges in becoming a doctor.

First, medicine faculties typically enrol top students from all schools. So competition in medical school can be expected to be tougher for Alan, notwithstanding his outstanding IB score.

The examinations are very difficult and I know of many top students failing the first test in their life at medical school.

After four or five years of medical school, graduates are given provisional registration by the Singapore Medical Council (SMC).

They are not fully registered doctors and have to be supervised in their clinical work. They have to do well in their one year of internship, or housemanship, before gaining full registration as a  doctor at SMC.

Housemanship is tough. House officers work almost every day, including Sundays. They also have to perform several night duties per month, during which they can work non-stop for almost 30 hours from 8am till 1pm the following day.

Because of the length of medical studies and housemanship, a houseman’s former schoolmates in other fields would already be working for a couple of years after graduation and earning more than them by the time they finish.

After a year of internship, a houseman will qualify as an SMC-registered medical officer. The pay is better, and there will be fewer night duties to serve.

But the next hurdle would be to compete for traineeship positions.

To become a specialist, a medical officer must be selected to be in a residency programme as a resident. Most programmes take six years to complete.

In the past, about 50 to 60 per cent of medical officers could get into the residency programme. 

There are no figures on the number of resident posts available, though it is believed currently, about 20 to 30 per cent of each graduating medical cohort are accepted as residents.

Life as a specialist trainee, or resident, is tough. Besides the usual daytime work in the hospitals, residents are expected to read and study after work. There are compulsory lectures which are usually held in the early morning before work, or on weekends.

There would be continual assessment as well as end-of-programme assessment. Residents are expected to pass them all to become a qualified specialist.

Taken together, it will take a minimum of eight years after graduation at medical school to become a qualified specialist.

But not all qualified specialists can get a consultant’s job after all these years of hard work.

Some departments in restructured hospitals have no position for new consultants, so some newly qualified specialists would have to wait for a few years before getting a consultant’s post.

Even after a young specialist is hired as a consultant at a restructured hospital, they are usually put on a two- to three-year renewable contract. And the only way for the young specialist to have a secure job is to be good at his or her work as a medical consultant.

Most private hospitals do not allow newly qualified specialists to join as private specialists. 

A minimum of five years’ experience as a qualified specialist is sometimes required. 

Over the last two decades, three general hospitals have been built: Khoo Teck Puat Hospital, Sengkang General Hospital and Ng Teng Fong General Hospital. And one new integrated healthcare facility incorporating an acute care and community hospital, the Woodland Health campus, is to open in phases from next year.

There has been a steady increase in the number of positions for residents and consultants, to fill up these new hospitals.

But after the Woodlands Health campus, it will be a while before another new hospital is built.

As the number of new medical graduates exceeds 500 now, compared to 180 to 200 graduates 20 years ago, there will be greater competition for young medical graduates to get a specialist trainee post.

I have seen cases of senior residents in some specialties not being able to obtain a consultant’s job after accreditation as a qualified specialist. They are employed as service registrars and are only on yearly renewable contracts.

Those who qualify as medical officers but are not accepted into a residency programme can enrol to be general practitioners by obtaining a graduate diploma in family medicine, which typically takes two years.

EFFECTS OF COVID-19 PANDEMIC

The pandemic has also affected the training of young doctors.

To begin with, many doctors spend months being rotated to Covid-19 wards or community facilities during their training.

Secondly, many elective operations and admissions have been postponed.

As a result, some young doctors have had less hands-on experience in their specialities over the last two years.

Singapore used to be a regional medical hub for foreign patients. Most foreign patients seek medical care at private hospitals and clinics.

In the past, it was quite common to see senior doctors in restructured hospitals entering private practice to achieve better earnings. This creates openings for junior specialists to move up the ranks.

With travel restrictions, foreign patients are few and far between now.

Will this make senior doctors in restructured hospitals more hesitant to enter private practice, indirectly resulting in fewer vacant posts for junior specialists?

Going back to Alan, I told him he must be prepared to work hard from the time he enters medical school. 

He must also be prepared that promotion and senior positions are not guaranteed, even if he has worked hard and has passed all examinations and assessments during his eight years of postgraduate training.

With his near perfect score at IB examination, and very pleasant personality, I have no doubt he can enter any discipline (besides medicine) in any university anywhere in the world.

I have met many bright young men and women wanting to become doctors. 

They usually have high hopes and dreams such as saving humanity, doing kind work for the sick and underprivileged. 

I respect and admire their noble aspirations. But I hope they do not enter the profession blindly, and regret their decisions only after they have already spent 10 years in the field.

After the long chat, I asked Alan: “So, what do you think?”

He replied: “Dr Wai, I still want to be a doctor. I will apply for medicine at NUS.”

I smiled at his decision. As his mother’s doctor and friend, I have done my part in giving him a realistic picture of medical training and life as a doctor.
 
ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist and hepatologist in private practice.

CORRECTION:

An earlier version of this commentary said that the Woodland Health campus is to open in phases from 2022. It should be 2023 instead. We are sorry for the error.