Debated in Parliament on 3 Aug 2021.
Dr Shahira Abdullah asked the Minister for Health (a) what policies and programmes are in place to reduce the burnout rates and poor mental health among junior doctors working in the public healthcare system especially after such an unprecedented public health crisis; and (b) what are the processes that ensue, and what support is provided when a medical practitioner or applicant for a medical licence declares to the Singapore Medical Council that he is receiving or have previously received psychiatric care.
MOH works with the healthcare clusters on various initiatives at the national and cluster levels to improve the well-being of healthcare professionals, including junior doctors.
At the national level, MOH has been working with the Singapore Medical Council ("SMC") to monitor the situation in our public healthcare institutions and to ensure that their guidelines on the total allowable work hours per week are complied with and sufficient rest periods are provided in the work schedules of post-graduate year 1 doctors (PGY1s) to ensure that they have adequate rest. There are similar guidelines in place for all junior doctors.
MOH has been working with key stakeholders to review the night call system and to ensure that junior doctors are distributed across the various departments based on their training needs and the clinical service demands. In addition, MOH has started reviewing the job scope and roles of doctors and optimising the system in which they are working in. This includes changes to the team structure and the implementation of alternative manpower coverage systems, both of which aim to balance the work hours and further improve the well-being of junior doctors. We will progressively engage the hospital clusters when implementation details are ready.
At the cluster and institutional level, junior doctors’ wellness workgroups have been formed, to address specific issues related to junior doctors’ wellness. In addition, there are structures and facilities in place in the public healthcare institutions for the welfare of healthcare staff, which include call rooms, rest areas and staff lounges.
Each institution also has specific measures, platforms and dedicated emotional support programmes, for example, feedback sessions with senior management, helplines, anonymous counselling services, resilience workshops and mindfulness training sessions to help address these concerns. There are also confidential communication channels for staff to provide feedback on disruptive workplace behaviour so that timely interventions can be made, in order to bring about a more conducive work environment that promotes mutual respect amongst healthcare workers and their peers. These measures are communicated to the junior doctors through various means including email, orientation programmes, the institution’s intranet, posters within the institution and regular engagement sessions.
To monitor the effectiveness of the measures, MOH works with the public healthcare institutions to conduct regular focus group discussions (FGDs). In the recent FGD involving PGY1s in late 2020, the reported burnout rate has decreased overall from 50% in 2019 to 39 % in 2020. There were less adverse feedback from PGY1s about working hours. Nonetheless, there are still some areas of concerns which MOH is working with the hospitals and specific departments to address.
SMC is committed to protecting the health and safety of the public by ensuring that registered medical practitioners are fit to practise. If a doctor’s mental health condition is declared or reported to SMC, a medical report from his psychiatrist will be required to allow SMC to better assess the impact of the mental health condition on the doctor’s ability to provide safe and appropriate care for patients. While an important concern is to safeguard the safety and welfare of patients, SMC will also consider whether there is a need for a doctor to take time off clinical practice in order to obtain proper care for a mental health condition.
Doctors who have had mental health conditions and have fully recovered can continue to practise independently. For doctors who are still receiving psychiatric care, SMC considers whether he can continue to practise safely, either independently or under supervision by another senior doctor.
Professional support for the doctor is made possible through these processes by the treatment, counselling and therapy provided by psychiatrists, psychologists and medical colleagues who supervise the doctor’s work.
Doctors who are mentally incapacitated by their conditions and, therefore, pose a danger to their patients if they continue to engage in clinical practice will be referred to a Voluntary Insight Committee, Health Committee or an Interim Orders Committee appointed by SMC. These are for serious or severe conditions which require close supervision or the cessation of practice.
PAPERCUTS