Ultimate Guide to Practicing Medicine in Singapore

Singapore – a city-state island, floating between Malaysia and Indonesia – boasts a tropical climate, Michelin star street food, and multiculturalism with four official languages. Singapore hosts a large expatriate population and is a very safe place to live. Understandably, many American physicians dream of practicing medicine in Singapore. Here is a general overview of what it is like to practice medicine in Singapore.

For information on medical licensure, finding a job, and immigration see Ultimate Guide to Practicing Medicine in Singapore

Healthcare System

Singapore provides universal health care coverage through several insurance programs.  Medishield Life is the universal public health insurance and is mandatory for citizens and permanent residents. It covers costs arising from hospital care and certain outpatient treatments, though it does not pay for primary care and most outpatient specialty care. Patients will still have significant out-of-pocket costs including premiums, deductibles, co-insurance, and costs above the claim limit. MediSave is a national medical savings scheme funded by personal and employer contributions. It covers out-of-pocket payments for the member or their family. MediFund is a safety net for poor Singaporeans who cannot pay out of pocket expenses.

The majority of physicians working in the public sector are registered as non-specialists which includes both primary care physicians and those still in specialist training, while 40% of physicians are registered as specialists. Most physicians employ a fee-for service model. There are 18 acute care hospitals, 9 of which are public hospitals. The facilities and equipment are on par or even better than that in the US and  Singapore’s public healthcare sector utilizes EPIC as its national electronic health.

Medical Education

Singapore has three medical schools affiliated with public universities and the government heavily subsidizes medical school tuition. Upon graduation, Singapore medical students are required to work in the public health system for 4-5 years and clinical training occurs almost exclusively in public hospitals.

In the late 2000s, Singapore invested in the development of residency and fellowship programs under the purview of ACGME-International. Singapore is enjoying the fruits of this investment, as the supply of Singaporean specialist doctors now exceeds the local demand, creating a surplus of specialists. The demand for foreign doctors has decreased though doctors with a subspecialty niche or with research experience continue to have promising job opportunities. The government closely regulates the pipeline of both local and foreign physicians.

Salary

Singapore consistently ranks as one of the most expensive cities in the world, more expensive than even New York City – though the average physician salary doesn’t necessarily account for this. The gross median monthly income for general practitioners is 13,707 Singapore Dollars (10,006 USD) and for specialists is 20,078–23,705 Singapore Dollars (14,657–17,305 USD). Most specialties working in the public sector earn a salary equivalent to that of an academic specialist in the US. You can make more in private practice, though it will be harder to for a foreigner without established referral networks and intimate knowledge of the local healthcare system.

Work Culture

English is the language of medical communication though a significant portion of patients speak Mandarin or Malay. The rounding culture is similar to that in the US.

Malpractice Insurance

A physician is provided a standard malpractice insurance though Singapore is not litigious – though a malpractice lawsuit involving any physician may make it to the local news. Patients are empowered to voice concerns and the majority of the concerns are handled by the physician directly, though there are Service Quality Departments.

Hierarchy

Hierarchy is an integral part of the work culture. A physician is automatically promoted from Assistant Consultant, to Consultant, to Senior Consultant based on the years of experience. The culture is that your supervisors will have the final say and you must respect that. The emphasis and value placed on hierarchy can be hard to adjust to.

Healthcare Expenditure

Healthcare expenditure is an integral part of each clinical encounter.  Patients frequently question the need for testing and will seek second opinions to ensure that a service is truly necessary – after all, it is their money on the line. Financial counseling is provided prior to any procedure and details out-of-pocket costs. If a patient receives a service and is unable to pay, their family will bear the financial burden. Some patients will forego certain procedures or treatments for financial reasons. For example, a patient may refuse to initiate dialysis due to the financial burden of the treatment.

Trust and Other Cultural Differences

Building trust with a patient who is under financial stress and who frequently questions your management and recommendations is hard.  If you are a Mandarin or Malay speaking doctor, it will be easier to connect and establish trust with the large Chinese/Malay patient population. Eastern cultural values often conflict with western approaches to medicine –  cultural humility and curiosity will go a long way.

Taxes

The US and Singapore do not have a bilateral Tax Treaty to mitigate the burden of double taxation. However, the Foreign Earned Income Exclusion, Foreign Housing Exclusion, and Foreign Tax Credit can still be used to minimize US tax liability. See 5 Tips For Filing Expat Taxes for more information.

Bottom Line

Singapore provides universal health care coverage though patients bear significant out-of-pocket costs. Their investment in their own post-graduate medical education has resulted in a surplus of locally qualified specialists and decreased demand for foreign doctors. There are significant workplace cultural differences that can be hard to navigate for western physicians – humility and curiosity are key.

With a little flexibility, you could be practicing medicine in Singapore and digging into Soya Sauce Chicken Rice – a Michelin star meal, in the middle of a warm tropical island!

For information on medical licensure, finding a job, and immigration see Ultimate Guide to Practicing Medicine in Singapore Part 2

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Dr. Ashwini Bapat is a palliative care physician who attended medical school at Tufts University and completed residency and fellowship training at Yale-New Haven Hospital. She resides in Portugal and provides clinical care through telemedicine.

Many thanks to an Anonymous Member of our community who shared their experiences practicing in Singapore.

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