500 docs apply to join family register

SINGAPORE - About 500 doctors out of over 2,000 general practitioners (GPs) in Singapore have registered to be included in a list of GPs with relevant qualifications in family medicine.

The register will be established on July 1 and doctors not on it will be barred from including the title 'family physician' to their names, reported The Straits Times.

Their clinic names cannot use the word 'family' either.

Unregistered doctors who break these rules after July 1 will be penalised under the Medical Registration Act.

The paper reported that most doctors generally support the idea of such a register, but some expressed concern over the use of the term 'family physician'.

According to the College of Family Physician's Singapore (CFPS), a family physician is defined as a generalist who is able to treat and manage patients of different age groups and across a spectrum of diseases in different care settings.

CFPS president Lee Kheng Hock told The Straits Times: "A substantial number of doctors feel the definition used is too narrow and incompatible with the broader, more inclusive ones used in many other countries."

In other parts of the world, a doctor is recognised as a family physician if he contributes to the care of patients in a variety of settings.

Because the words are used often, restricting the use of 'family phyisician' or 'family medicine' as a designation or a clinic's name could be problematic, said Associate Professor Lee.

The register was set up by the Ministry of Health (MOH) with the aim of recognising doctors with relevant qualifications, and to 'set the standards of practice for family medicine'.

The idea arose more than five years ago and after two rounds of public consultation in 2005 and 2009, an Act was amended in Parliament in January 2010 to set up the Register of Family Physicians and an accreditation board.

Another round of public consultation was held last June to determine how doctors could qualify - GPs with a graduate diploma in family medicine or a master's in medicine are elgible for admission.

In another 'practice' route, GPs who do not have the qualifications but have five or more years of relevant experience in practising family medicine are eligible. They would have completed two to four modular courses run by CFPS, in areas such as elderly care, child and adolescent care and mental disorders.

Honorary treasurer of the Singapore Medical Association (SMA) and GP, Dr Lee Yik Voon, reckons few GPs here have postgraduate qualifications, so many will opt to take the practice route.

Regardless of the route taken, all doctors are required to have been in family medicine practice for at least 30 hours a month for at least one of the three years preceding application. This is to ensure that doctors are up to date in their skills.

They can also be accredited by fulfilling a minimum of 30 hours of family medicine practice a month over the next year.

Prof Lee said that under these criteria, only doctors in polyclinics or GP clinics are considered family physicians. Those who tend to more complex cases - doctors in public or community hospitals and step-down care facilities - are shut out.

In response, an MOH spokesman said such doctors can qualify if they fulfil practice requirements at their hospitals' outpatient GP clinics or home-care services.

However, this would be difficult in reality, considering the full days already being clocked at work, noted a doctor who works full-time at a community hospital.

Prof Lee said that CFPS has raised these concerns to MOH and that it supports a broader definition of family medicine, one that is 'based on competency rather than on the place of work'.

A spokesman from MOH said consultation with the medical community will be ongoing as the register is new.

Despite the concerns, Prof Lee told The Straits Times that most doctors see the register as a development in the right direction.

They also see it as a recognition of the increasingly important role that family phyisicians play in health care.

klim@sph.com.sg