Singapore faces need to retain general practitioners

Though the number of doctors planning to leave general practice is relatively low as compared with other countries, Singapore nevertheless urgently needs to boost retention among primary healthcare workers, according to a new study. Promoting the recognition for these professionals, as well as providing them with a more robust support system, can help in this regard.

“Our findings do suggest that much needs to be done to improve the engagement of general practitioners (GPs), facilitate expansion, and improve the quality of care,” the researchers said.

More than 300 GPs in private and public institutions were surveyed through an anonymous online questionnaire. Questions touched on career satisfaction, plans in the next 5 years, and thoughts on factors important for retaining doctors in primary care. The survey also included open-ended questions to allow participants to elaborate their ideas regarding retention factors and initiatives.

Participant responses revealed that they were most satisfied with their “current professional role” and being able to build “rapport with patients.” Both criteria earned a mean score of over 7 points in a 10-point satisfaction scale. Inversely, “paperwork” and the “status of general practice and family medicine (GPFM) in society” were the biggest sources of dissatisfaction, each earning a mean score of below 5 points. [BMJ Prim Care 2022;23:168]

In line with the generally high levels of satisfaction among GPs, only 14.4 percent (n=49) of respondents said that that were planning on permanently leaving GPFM practice in the next 5 years. Meanwhile, more than half either indicated plans of retiring (53.0 percent) or wanted to reduce the number of hours they spend in clinical work (51.3 percent). More than 10 percent were planning to take a career break.

Of note, career plans deviated significantly between participants in public vs private settings. Those in the former, for instance, were significantly more likely to say that they were intending to increase teaching (p<0.001), training (p=0.001), or research (p=0.001) responsibilities, while those in the former were much more likely to reduce clinical hours (p=0.001). This difference might also be accounted for by age, with private GPs being significantly older than their counterparts in public institutions (p<0.001).

Among those planning to quit the GPFM field, the top reasons were “time spent on unimportant tasks,” “reduced job satisfaction,” “long working hours,” and “lack of professional support.”

In conjunction, one of the most highly rated factors for the retention of doctors in the GPFM filed is “recognizing GPFM as a specialty,” which may have been directly tied into the GPs’ need for job satisfaction.

Other important reasons, as deemed by the respondents, for retaining doctors in primary care were also related for their desire for greater professional support, and these included “greater commitment to protect professional practice,” “less litigious environment for medical practice,” and “higher remuneration.”

“With one in four people in Singapore expected to be aged 65 years or above by 2030, caring for a population with multiple complex chronic illnesses and with higher expectations will be an unprecedented challenge for primary care doctors,” the researchers said.

“Enabling and supporting this workforce in navigating these challenges is essential for meeting the healthcare needs of an ageing population,” they added.