Unlike many other medical specialities, maintaining a substantial number of family physicians proves to be a challenge in the future. A literature review covering studies around the world from 1993 to 2012 found that less than 30% of medical students were interested in pursuing family medicine.
Similarly, Singapore sees a lack of interest among undergraduate medical students for a career in primary-care or family medicine. Understanding the development of family medicine could allow healthcare professionals to recognise the value it.
Additionally, the attitudes of general medical students towards family medicine could help in proposing appropriate methods to increase interest among Singaporean medical students.
Development of family medicine
Modern-day family medicine was introduced as a “counterculture” movement to the huge subspecialisation of medicine, with a potential for fragmentation of healthcare. As such, family medicine serves as a link between patients and specialists.
From 1972 to 1992, MCGP was the family medicine postgraduate examination for diplomate membership into the formerly named College of General Practitioners, now known as College of Family Physicians Singapore (CFPS). During that period, family medicine was recognised in 1987 as a distinct academic discipline, after several efforts from the College members.
Later in 2011, the Ministry of Health Singapore (MOH) introduced the Family Physician Register. This register was established to raise the profile of family medicine and upgrade the skills of existing general physicians, portraying family medicine as a discipline that has a “unique body of skills and knowledge”.
Following the former MCGP examination for family medicine, the year 1993 saw the first Master of Medicine (Family Medicine), or MMed (FM), examination. This programme was later revamped and restructured in 2011, when the Family Physician Register was introduced.
Qualifications to pursue family medicine
To join the Family Physician Register, doctors need to have relevant postgraduate academic qualifications and experience that are specific to family medicine (FM). These include MMed (FM) or the Graduate Diploma in Family Medicine (GDFM), a programme jointly organised by the College of Family Physicians (CFPS) and the Division of Graduate Medical Studies (DGMS).
Medical schools in Singapore place emphasis on family medicine and primary care in the curriculum. For example, in Yong Loo Lin School of Medicine, family medicine is included in the third year curriculum, and is allocated the same amount of time as internal medicine, surgery, paediatrics and orthopaedics.
The GDFM and MMed (FM) programmes both also believe in reducing the fragmentation of healthcare due to medical specialisations. As such, specialists are involved in the teaching for these programmes, ensuring there is a close collaboration between specialists and family physicians.
Lifestyle and experience with role models
Among other positive factors, such as the opportunity for private practice and the ability to have patient societal orientation, a high ‘lifestyle’ component was ranked as a main factor for medical students’ choice in family medicine.
It was found that the exposure to family medicine during medical school, such as a family medicine clinical teacher, could also create a positive or negative influence on students. In fact, one of the seven factors that led medical students to switch careers was discouragement by a physician, a 2007 study found.
Low income and prestige
The repayment of medical school debt posed as an important factor for the career choices of medical students. Medical students were in favour of a career with either a high potential income or shorter residency programme like family medicine.
However, despite the lifestyle component associated with this discipline, low remuneration and prestige were factors against family medicine. Other negative factors against choosing family medicine included the lack of research opportunities and the nature of family medicine, such as the wide breadth of required knowledge, routine-based work, and limitations in managing patients.
The rise of chronic diseases and the increasing fragmentation of healthcare due to medical specialisations would require a strong base of family physicians to upkeep good holistic care for patients. Since the provision and financing of healthcare will affect the future working environment of the medical student, this will also play a part in how students perceive their roles in the local healthcare context, along with their preferred career choices.
In addition, little is known if the perception of family medicine in the healthcare setting prior to medical school is a strong factor for medical students. Students may have set their minds on a particular speciality, or against family medicine even before entering medical school. According to a study published in 2007, only one in five medical students changed their minds in career choices during the preclinical years of medical school. MIMS
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