Some things to think about if youre considering Singapore as a first

option, or higher in the list than other options in Australia

I remember you telling me that you didnt see any evidence of a tough houseman life in
Singapore, contrary to what had been telling you. This little compilation is to give you a bit of
solid writing about what I said previously about working in Singapore, hopefully its not too
biased. You can use the information here and I hope it will help you come to a decision in the
future, given that you already have attachment experience and perhaps second-hand
accounts from interns that you talked to at SGH.
NB: some works are underlined like this and in blue; you can press CMD+Click to open the
website link that is embedded in the word.

Houseman responsibilities
So as you know, this is equivalent to interns in other countries. Responsibilities are usually
things like: ward rounds, update patient list, blood samples for investigations, small
procedures (cannulas, venepunctures), clerk new cases in the patient notes, do on calls
(roughly 6-8 calls a month).
Responsibilities not different from other countries.
Package, from what I have read and heard:
- workload is roughly 60-80 hours;
- at the Medical Officer (MO) rank you get a starting pay of about S$4000 + 10%
income tax, rising to S$5000-6000 if you are a PGY4 MO.
- Foreign graduates get up to ~S$1000 for housing allowance.

Working conditions (based on forum descriptions from 2010-2015)

Various sources call it slavery. What its called doesnt matter as much as an accurate
description of the working conditions, but if Singaporeans, of all people, are calling it
slavery then perhaps that is something to think about too!
The majority of interns in Singaporean hospitals, according to this guy, are Singaporean
graduates from NUS YLL, and other Singaporean medical universities who may or may not
be bonded to the hospital system after their study time of 5 years at NUS. His opinion is that
the bonded students lose freedoms because they are bonded and subject to whatever
conditions are imposed on them. They cannot speak up because they do not want to be
bullied for the next 5 years.
Ok, so thats for SG graduates. Why does it matter for you?

Well, foreign graduates (such as yourself) will have to work under the same
conditions as these bonded students, simply because they are the accepted norm.

He also mentions that the senior doctors generally have a if Ive been through it, you
must too mentality (of course, your experience may vary, as indicated by your 2
week experience in Singapore) that may contribute to these working conditions.

As a foreign graduate you may have less friends and networks within the system and
you may have to overcome these hurdles insider information is quite valuable;
medicine is another industry where its about who you know, not what you know.
 You will be starting over again, despite gaining a lot of networking through your
PRINT work in Australia.

**This is important** - Take with a grain of salt, its just speculation. The Singapore
Medical Council manages registration of foreign graduates, and on the website it
states that foreign graduates are able to apply for said registration after 2 years of
working. The same author of the comment says that there are a lot of people who
are not given their full registration after 2 years despite having consistently graded
good performance, no clinical mistakes, no complaints made against them.
According to him, the SMC will not give you a reason why full registration is rejected
and the assessment reports are not shared with you. His opinion is that it is used to
keep foreign graduates circulating in the hospital system as junior doctors, such as
MOs for as long as possible. So you may only get your registration after being
trapped in stifling working conditions for longer than you expected. Again, take it
with a grain of salt, experiences will vary, and I have to say my cousins cousin did
not face this issue. However, she had a strong network of old friends (her oldest
cousin is a good friend of a very senior surgeon in SGH) so that might have helped.
Also, you may have friends who go back to Singapore to do their internship, and
while they are Singaporeans they are considered foreign graduates, so their
experience might be different too. But usually medical students from Singapore have
a pretty solid network back in Singapore; parents are quite well connected. Anyway
why is full registration important? You cannot work privately if you dont have full
registration. Forget opening your own practice.
This fellow read the above users comment and added his own perspective:
- He says there is no way to get full registration in Singapore, no matter what rank you
held in other countries; the user said he worked as a Resident Physician for over 7
years, and is still not fully registered. Maybe he is referring to a foreign specialist
coming to get registered in Singapore, but a few paragraphs ahead you can see that
it probably applies to foreign graduates too.

- Discrimination against foreign graduates is big; the overriding impression of foreign

graduates is that they are not good enough, and the NUS students are the best. This
is true from my own experience.

- He recommends Singapore if you 1. Intend to stay short term, 2. Are from a country
where the pay is lower than Singapore, among other things. Otherwise, Australia is
the best choice for work life balance.

Other users ask the questions such as most people want to go to the UK or Australia for
medical work and you want to come here? Whats the reason?
This guy sheds some light on the conditional/non-full registration.
- He says he got full registration after 5 years as a conditional registered doctoryou
need only your supervisor to advice the medical council that you are ready. That is 3
extra years compared to the SMC websites stated 2 years. In Australia, you would
get full registration in the 2 years I think? Perhaps it would be less likely for this kind
of thing to happen because Australia has more work unions and fair work systems
set up.
- He earns 200K in a public hospital per year and is taxed 10%.
Another writer talks about the following things being real life stories and not an exaggeration
of the challenges faced by junior doctors in Singapores public hospitals:
- Singaporean medical graduate from Australia quit only after one week in the ward
locked herself in the call room and switched her hospital handphoneHead of
Departmentdidnt take kindly to her AWOLlast I heard of her is that she is now
working in a hospital in Melbourne and has settled down there

- six to eight night calls a monthstart at around 6pm and end at 8amexpected to
work til 1pm before you can knock off

- Fellow house officer who broke down crying after being scolded right in front of a
patients family by consultant was told straight in her face to cut the pretence and
stop being a crybaby.

Ok, so the above are experiences gathered from the internet.

From myself, I didnt personally experience that because I was a medical student at SGH.
But you, like me, probably have met interns at your time in SGH, so you probably got
accounts of experiences and information, and are able to decide for yourself what
information is important to you.
In particular, I remember you mentioned you can communicate with SG doctors more easily.
I dont disagree with that! But my experience with Australian people and their workforce is
that they are quite fair and meritorious, so credit is generally given where it is required. I
think its primarily an initial unease in communication but as you know, after you get to know
them its not so bad. There is ass-kissing but there is a lot less of it than somewhere like
Singapore.
In general, the reasons I would consider Australia as a first option are because:
- You will graduate here so you will have been trained for this system
- If you apply correctly with the right preferences as you said, you can get a spot
- If you get a rural spot you probably can transfer back to the city or swap it with
someone using NSWMSC swap forum. If the worst case scenario is CMI, then you
STILL only spend 1 year rural at worst.
- Good work-life balance
- Yes, everywhere is competitive, Singapore and Australia are both competitive for
certain specialties but if you have a shot at a Western country like Australia Id
definitely go for it.
Anyway youve done your attachment in Singapore so you will have your side of the
experience to add to your decision! Hopefully this extra information helped!

Australia application overview

Just thought Id include Aussie application pathways here! As you already know there are a
few different pathways you can choose, including:
1. Optimised pathway (ballot), list of networks here
2. Direct regional (ballot for a smaller network of hospitals, including places like
Bankstown, Liverpool, etc.) can be seen here
3. RPR
4. CMI (100 spots nationally, divided between NSW, Queensland and WA)
The internship priority list is here, and while reading it I noticed that medical graduates of
NSW universities who are not Aus/NZ citizens or Aus PRs and who hold a visa that allows
them to work applies to you. This is category 4. Category 2 and 3 are medical graduates of
interstate or NZ universities who completed Year 12 studies in NSW and medical
graduates of interstate or NZ universities who completed Year 12 studies outside NSW
respectively.
I figured that maybe there is a chance that graduates from interstate medicine will more
likely elect to stay in their own states, rather than shift to NSW. So actually you are
competing primarily with Category 1 (domestic NSW) rather than with 1, 2 and 3. Still, you
have the few interstate people who do want to shift to NSW, but I guess you could say they
are likely to rescind on their offer.
Twitter for HETi will tweet their offers as they come out, for e.g., on Dec 9 it just announced
NSW made 1 offer today for intern positions via the Direct Regional Allocation pathway to
Category 4. You can use this to track how many offers came out for your Category 4.
AMSA gives some stats on 2015 internship offers; in 2015, 3676 applicants for internships in
total; 3004 domestics, 480 international full fee, 192 other applicants
There is another report giving the figures for the same year, but different numbers! Strange,
but it says Of note is that there were a total of 545 international medical students who were
eligible for internship in 2015 and only 258 of them actually gained internship.

So roughly 47% of international students got an internship in Australia. Anyway the person
who asked the question was asking for a friend who eventually got Coffs Harbour through
the Direct Regional Allocation pathway. So they got a spot.
I hope this information helped; I didnt go so in depth with the Australian application
procedures because they are available on the internet and I guess you would have to do
some reading on that in the future anyway.

Appendix of copied comments and sources

A. Taken from here, if you want to read the whole forum thread.
There is a lot of truth in all that slave of medicine and dempsey said about working
conditions for the junior doctors in Singapore (in the post for salary 2007). Kudos to
them for speaking up. And yes, sleep deprivation has been linked to impaired
concentration, no one can credibly dispute that. Annual leave? Plenty but you can't take
them because someone else is already on leave.

Singapore has been on a recruitment drive to recruit foreign doctors for an extremely
long time, yet they are still very short of doctors, especially doctors they are hoping to
target (who received their medical education from first world countries). When
something is such a hard sell, you have to wonder why. Just like the old adage: When
something is sounds too good to be true, it is too good to be true. You dont see
Cambridge or Oxford going overseas on recruitment drives, do you?

Actually, I think the issue here is not the salary. The overall take home salary (ie, after
taxes) are comparable to what a junior doctor (HO, MO, registrar) with similar
experience would earn in Australia. But, a junior doctor in Australia works much less
hours, and when you break down to hourly pay, the doctors in Singapore earn much
less. Besides, essentials like houses and cars are far cheaper in Australia so your
standard of living is much much better than in Singapore.

I think the issue is about working conditions (likened to slavery by slave of medicine)
and respect. The vast majority of the junior doctors working in Singapore are Singapore
graduates bonded to the system for 5 years(because of their NUS study bond). Like it or
not, they have to stay because most of them cannot afford the very large sum they have
to pay back to break the bond. When one is bonded, they lose bargaining power. Like it
or not, they have to accept whatever conditions get imposed to them. They do not dare
to speak up because they may get bullied for 5 years if they do. And also because of the
fact that they are paid by the month not by the hour, they are forced to put in a lot of
extra hours. I know hospitals which have daily meetings that start at 7am and MOs have
to attend. And for MOs to have to come back alone every Sunday for routine ward
rounds, thats totally uncalled for, I think. I remember a posting I did where I did not get
a single day off for 2 months. Yup, I worked 60days in a row. As someone said, even
maids get a compuslory day off.

And since these are the set working conditions in Singapore, the foreign grads also have
to work under the same conditions. Many many foreign grads have come back to work in
Singapore, then left again when they realised what they really got themselves into. If
someone borrowed money from loansharks and are now subjected to their
harrassments, why should you come along and be subjected to the same harrassment?
Totally unnecessary. But it is a pity that these foreign grads have wasted time & effort
exploring what they think is greener pastures, only to realize that the grass in Singapore
is actually wilted!

I think if the seniors make us feel appreciated and try to acknowledge the hardship that
the juniors go through, it does go a long way. Rather than think Ive been through it so
you must go through it too. It may not actually change the conditions, but it makes us
feel better about it. Many people are not driven by money, but by job satisfaction.

In terms of trainee positions, I cant say there is a bias against foreign grads. However, if
no one knows you, youre less likely to be selected for a job than another doctor who
have worked here and is known to the seniors. Its human nature. Even if you are on the
selection panel, youre more likely to pick someone you know, than someone you dont
know isnt it?
For foreign grads who come back to Singapore, there are also hurdles like the fact that
you have to form new friendship, you dont have anyone to advise you re which postings
not to choose, what to look out for etc, you have no one to confide in about work
worries, because you dont have any close trusted friends. You really have to start over
again in far more aspects of your life than you think.

If you are prepared to work extremely hard and forget totally about work-life balance,
then yes, Singapore can be the place for you. But for many people like me, work-life
balance is very important. Working about 60-80 hours a week does burn you out after
awhile, and sooner than you think! And think about it, if you put in 60-80hrs a week of
hard work where you are right now, your chance of becoming very successful is very
good, maybe even better than Singapore!

There is another issue the SMC. Even though they state on their website that
Singaporeans who are foreign grads can apply for full registration after two years, in
reality there are a lot of people who, for no apparent good reason, are not given their full
registration after two years (MOs whose performance have been consistently graded
good, never made any clinical mistakes, never had complaints made against them!)
and the first indicator of a poor performance was when full registration is rejected after
two years. The best thing is, they dont give you a reason why full registration is
rejected! Your SMC assessment reports are not shared with you. It is likely a ploy to
keep foreign grads trapped in the public system, because the foreign grads have no
study bond. So foreign grad Singaporeans, be very aware! You may want to rethink your
decision to come back if you think you can get full registration after two years! The
actual fact is that youre likely to be trapped in stifling working conditions for longer than
you think!

As for foreign consultants who want to work in Singapore, the reality is that your hands
will be severely tied with the conditional registration which stipulates where you can
work, how many hours you must work etc. You can forget about flexibility or locum
work. You have to start all over again, and if you really think about it, youre probably
better off spending those few years building your career in where you are right now, and
starting over.
The bottom line is, if you graduated from a first world country like UK, Australia, USA,
youre really MUCH better off staying put, because the working conditions and living
conditions, quality of life (for yourself and your family) are far better in these countries,
and spend the time/effort establishing your practice where you are. I cant say the same
for doctors who currently come from the third world countries, because living conditions
are probably better in Singapore compared to those third world countries and they do
stand to gain by coming.

Just my opinion of course, from someone who's worked in Singapore, and overseas!

B. This next one was in reply to the comment in A

Very complete input. Just to add some points for who are still coming to Singapore and
work as Doctor.

1. There is NO WAY you can get full registration in Singapore, be it Specialist or

whatever in UK/USA/Australia. I worked here as Resident Physician for over 7 years, still
not fully registered. That means no hope for those try to settle in Singapore. Those
aiming for short term stay - pay is not bad, around S$ 4000 as basic to start of as
Medical Officer.

2. Work enviroment - Supervisors review are very VERY bias. They thought locally
trained are best but reality is a joke. I have 2 local diplomas while I working here. If you
do better than them - jellous you & attack you like crows (According to my experience
here over 7 years in 4 hospitals).

3. Work Life - over stretched. short of man power at all time. Prepare yourself to work
60 -80 hours a week. Very demanding as well. Night duty/long duty start at today
830am and you only can knock off tomorrow 1230pm if you are lucky, otherwise end up
going back 4-5pm next day. No official off day after long duty.

4. For training - They may say training, but end up with work for all time. No proper
training. Supervising is in your dream but prepare for yourself to be blamed if something
wrong.

5. Language - perpare yourself to be Mandarin/Hokkian efficient. Even among local

docotrs - they perfer to speak in those langauages rather than English, not only patients.
On the top of that you should be able to speak basic Malay and Tamil. That will give you
good start.

6. Living Cost - If you stay in one room rental is about 700S$ (not whole flat)(as of
current marlet rate) - you only will have one small bedroom (10x 12 feet)with common
toilet. If you want to rent a whole flat about 70 sq meter flat - is about S$2000 and
above depends on location. For meals - if you eat cheapest one - cost you about S$5
plus including drink. Most of rental room here not allow to cook your meal. No way of
buying own car here - toyota altis like japanese can cause you around 90-100KS$ which
is only can use for 10years. plus so called ERP (road pricing gantry) are everywhere.

7. Discrimination against foreign trained - whereever you trained before(including

UK/USA), you will get this treatment. If you keen to work in Singapore, prepare yourself
mentally before you come. This is culture here.

Recommendation:
1. Good for doctors from third world countries where pay is lower than Singapore.
2. Good fot those who intended to stay for short term.
3. Good for who can work 60-80 hours a week persistently
4. Good for junior/school leaver to earn some ecperience before settle in
USA/UK/Australia.

My personal opinion - Australia is the best choice as work-life balance

C. This guy gives another perspective as an Aussie grad who

shifted to SG (he is not Singaporean)
I am a consultant in Singapore went thru med school in Australia and completed
specialist training in Singapore. Just thought to shed some light on some issues
discussed.

With regards to registration

Yes all foreign grads are given conditional registration unlike if I go UK or Australia where
I would qualify for full registration. But in reality conditional registration unlike temporary
registration does not require so much hand holding as long as you practice in a local
hospital in a department with a supervisor. Anyway I would be very concerned as a
foreigner if i was taking a job and not aclimatizing to local situations. I turned full
registration after 5 years as a conditional registered doctor and no I am not
Singaporean. You need only your supervisor to advice the medical council that you are
ready.

Pay wise we are very comparable to UK or Australia AFTER tax in our public hospitals .
Tax in Singapore is far lower than UK or Australia. As a young consultant earning above
200k in a pulblichospital I am only taxed 10%. So I keep most of what I earned. Also
medical indemnity insurance here is cheaper.

Cost of living here is comparable to Melbourne or London (I lived in both) as long as you
can adapt to local foods (bowl of noodles is $4 or chicken rice can be $3.50). But yes
housing and a car are the biggest costs here. Housing you prob can rent a decent
apartment for 2000-3000 a month (comparing to central London at 3000 pounds a
month). In terms of getting around our subway is very convenient apart from recent
mess ups... Taxis are cheaper than in UK or Aust for sure

Living in Singapore is safe and secure as long as you do not go looking for trouble at
certain spots. But in general you can jog around at night. There is also a huge expat
community here so you can meet up with countrymen by using online forums at attend
meetups at usual hangings like Clarke quay, siglap, holland village or Jalan kayu.

The main disadvantage here is there is sill laxity in working hours oversight... As a
registrar I used to work close to 60 hours a week.. This went down to 40 hours after I
turned consultant. There is little in union practices here. Also your bonuses are tied in
with performance so if you are coming here be sure you know you can perform well.

Lastly living in Singapore means no more 4 seasons and no natural getaways unless you
fly out of the country. Most of Singapore is a built up island city. But saying that we do
have a good airport

D. This is an article from a now defunct website, but someone

pasted it on a forum before the website got shut down.
The writer just completed his bond with MOH and is celebrating his new found
freedom. He wishes to remain anonymous.

I thanked Ms Yvonne Chew for her letter on the plight of junior doctors. (read
letter here) As a house officer, I had the honor of serving in the respiratory unit
of one of the biggest public hospitals in Singapore. Local medical graduates will
know which hospital I am referring to. It was an experience I will never forget.

A typical day begins with daily ward rounds at 8am. The house officers usually
arrive half a hour earlier to prepare the case notes, familiarize themselves with
the new cases and to trace results from the previous night.

I am not sure about the workload now, but during my time, the average number
of patients under the care of one house officer ranged from twenty to forty.

The ward round which is often intimidating, seldom ends before 11am and
sometimes stretches pass 12 noon if the cases are complicated. Then begins a
days mundane work of drawing blood, doing ECGs (there were no phlebotomists
or ECG technicans in those days), typing discharge summaries, arranging for
urgent CT scans, talking to patients family etc.

If one is lucky to have lunch, it usually means a quick bite at the caferia provided
the nurses are kind enough not to interrupt you during the precious few minutes
when the new admissions will start to come in at the same time.
The house officers are responsible for clerking, examining the admitted patients,
ordering and taking the relevant tests and to present the cases to their MOs or
Registrars during the evening round which can sometimes last till 7pm or later.

We had six to eight night calls a month which start at around 6pm and end at
8am the next day after which you are still expected to work till 1pm before you
can knock off if there is enough manpower.

I still remembered the Head of Department telling us during the orientation that
post-call is privilege, not a right. Very often we dont get to leave early after a
hectic night deprived of sleep or if we do, in the late afternoons around 3 to 4pm.

You have to experience it for yourself to know how it feels like to be without
sleep for 36 to 48 hours. Your mind gets switched off, your eyelids go drooping all
the time and you get irritated very easily. The body craves for sleep and yet you
have to force it to be up and running. There was once I dozed off at the bedside
of a patient while talking to him!

The long working hours, mental fatigue and emotional distress are not helped by
superiors who are not quite empathetic to the problems encountered by doctors
fresh out of medical school.

A fellow house officer who broke down crying after being scolded right in front of
a patients family by a consultant was told straight in her face to cut the
pretence and stop being a crybaby! (I was just besides her) She took two
weeks of emergency leave a week later and was transferred to another
department upon her return.

A Singaporean medical graduate from Australia quitted only after one week in
the ward. On her first night call, she was so overwhelmed that she locked herself
in the call room and switched off her hospital handphone. She was expectedly
haul up the very next day to face the music dished out by the Head of
Department who obviously didnt take kindly to her AWOL . The last I heard of
her is that she is now working in a hospital in Melbourne and has settled down
there.

The above examples are real life stories and not an exaggeration of some of the
challenges or tortures encountered by junior doctors in Singapores public
hospitals.

Why didnt we bring up our grievances to the attention of the senior doctors
then? There is a macho culture pervading the local medical fraternity that
because medicine is a noble profession, all doctors are expected to put up with
sacrifices and hardships which the job entails even at the expense of their own
personal well-being.

More than often, the consultants will brush aside the complaints of the juniors
with a dose of their own anecdotes:

In those days when I was a houseman, I worked longer hours than you with half
your pay and I have never complained even once!
You should be thankful to be serving your housemanship in Singapore instead of
Kuala Lumpur or Kuching!

Nowadays the load is so light compared to the past and you guys (and girls) still
whine so much!

Thats why consultants working in public hospitals are the creme la crop as they
have demonstrated their mettle in surviving and emerging from the system
unscathed.

Please do not get me wrong. I am not writing to lash out at anybody. I still have
utmost respect and admiration for the consultants whom I have worked with.
They are the most dedicated, hardworking and knowledgable clinicians I have
encountered and I am indeed honored to be given the opportunity to learn from
them.

The long hours and poor working conditions faced by junior doctors are perpetual
problems in public hospitals. As long there is a ready supply of cheap labor to
keep the system running, there is little incentive to improve the welfare of the
junior staff as it will lead invariably to higher operating costs.

Under free market conditions, very few local doctors will want to work in public
hospitals unless they are training to be specialists which explains why almost all
will leave for the public sector upon completion of their bonds. At least 10 of my
classmates have broken their bonds during their final years of service.

Recruiting foreign doctors and increasing the number of medical students are
only temporalizing measures which will create a bigger problem in the future if
the crux of the issue remains inadequately addressed.

While the public sector remains chronically short of doctors, the private sector
will be flooded with general practitioners and specialists which will depress the
overall wages of doctors.

MOH should do more to keep doctors within the public healthcare system by
offering them better working conditions and renumerations which are
comparable to that in the private sector.

Keeping more local doctors in the hospitals and polyclinics will obviate the need
to recruit more foreign doctors who will have difficulties communicating with
elderly patients and understanding our unique Singapore culture.