Training

Type of Training – Master of Medicine (Family Medicine), Fellowship by Assessment [FCFP], private practitioner’s stream (Program B), graduate diploma of Family Medicine (GDFM)

Length of Training – Master of Medicine (Family Medicine) – 3 years, Fellowship by Assessment [FCFP] – 2 years, private practitioner’s stream (Program B) – 2 years, graduate diploma of Family Medicine (GDFM)- 2 years

Year Family Medicine established – 1988 (pilot Family Medicine vocational program for medical officers)

Number of family medicine residents graduating each year – unknown

Number of institutions that offer family medicine – 3 medical schools (Yong Loo Lin School of Medicine in NUS, Duke-NUS Graduate Medical School, and Lee Kong Chian School of Medicine)

practice

Number of family doctors – 8,218 Family Physicians and General Practitioners.

Physician to population ratio – 225 physician per 100,000 individuals.

DALY: 10,542/100,000 individuals (due to all causes).

Life Expectancy:

• Females 2017: 85.2 years

• Males 2017: 80.7 years

Mortality rate 2017:

• Males: 61 per 1,000 male adults.

• Females: 35 per 1,000 female adults.

Infant Immunization-HepB3: % of 1-year-old children received: 96%

College of Family Physicians (Y or N):

• Yes: College of Family Physicians Singapore.

training

In 1970, undergraduate family medicine started as a general practice attachment for one week and was initiated between the College of Family Physicians and the University (Thomas, Santoshlional, 2013). A joint memorandum between the Department of Social Medicine and Public Health of the University and the College in 1987, lead to the declaration that family medicine should be taught as an undergraduate discipline (Thomas, Santoshlional, 2013). The undergraduate family medicine education program provides medical students an understanding of the knowledge, core values, and role of the family physician in the healthcare delivery system (Thomas, Santoshlional, 2013). In 1987, the one-week attachment was increased to 2 weeks, and since 2001 it was increased to 4 weeks, during which students spent some time with family physicians in private practice and in public polyclinics (Thomas, Santoshlional, 2013). There are three medical schools that offer family medicine as an established component of clinical curricula: Yong Loo Lin School of Medicine in NUS, Duke-NUS Graduate Medical School, and Lee Kong Chian School of Medicine (Goh, Lee Gan, and Chooi Peng Ong, 2014).

The College of Family Physicians Singapore was started in 1971, when a group of family physicians came together and wanted to have an institution in place that would enshrine and promote both the ideals and values of family medicine (The Singapore Family Physician).  In 1972, the first college examination was held (Thomas, Santoshlional, 2013).  In 1988, the pilot Family Medicine vocational program for medical officers was created (Thomas, Santoshlional, 2013). In 1991, the University of Singapore created the MMed (FM) program (Thomas, Santoshlional, 2013).  In 1995, a Private practitioner’s stream (Program B) of MMed (FM) was created (Thomas, Santoshlional, 2013).  Between the early 1970s and early 1990s, vocational Family Medicine training was comprised of self-directed learning, lunchtime talks, and examination preparation courses run by hospital specialists. The last vocational examination was conducted in 1992 (Thomas, Santoshlional, 2013).

There are a variety of programs for family medicine on a postgraduate level. In 2000, a two-year graduate diploma of Family Medicine (GDFM) was started (Wonca Europe).  At the same time, the Collegiate Membership by Assessment (MCFP) and the two-year Fellowship by Assessment (FCFP) were developed by the College of Family Physician Singapore (Wonca Europe & Goh, Lee Gan, and Chooi Peng Ong, 2014). This integrated postgraduate training program in family medicine was organized through collaboration between the Ministry of Health, National University of Singapore (NUS), and the College, and it has ever since provided the academic and professional family medicine development at all levels (Wonca Europe).  The College recognizes doctors with GDFM as certified family physicians (FP), the MCFP as Senior family physicians, and the FCFP as consultant family physicians (Wonca Europe).

Vocational training leading to Diplomat membership of the College (MCGP) started in 1971, right when the College was founded (Wonca Europe). The Masters of Family Medicine (MMed (FM)) that was given by the National University of Singapore (NUS) then replaced MCGP in 1993 (Wonca Europe).

The Master of Medicine (Family Medicine) – Program A is a formal 3-year vocational training program that followed the Diploma program (Thomas, Santoshlional, 2013). The program was structured similarly to programs in the UK and Australia, with 3 monthly rotations in hospital departments for the residents (Thomas, Santoshlional, 2013).  The program is comprised of rotating hospital postings, distance learning program, face-to-face workshops, and 2-week advanced Family Medicine course (Thomas, Santoshlional, 2013).  In 1993, the first examination was held (Thomas, Santoshlional, 2013).  The examination contains theory papers, case studies with an oral examination component, and a clinical examination with long and short clinical cases.4

In 1995, the two-year private practitioner’s stream (Program B) was created to support private practitioners on improving themselves vocationally since these practitioners did not attend a vocational training program (Thomas, Santoshlional, 2013).  Family physicians with a minimum of four years experience in private practice or two hospital years could apply (Thomas, Santoshlional, 2013).

In 2000, the Graduate Diploma in Family Medicine (GDFM) was introduced for family physicians interested to practice at an enhanced level (Thomas, Santoshlional, 2013).  This program is comprised of distance learning programs and face-to-face workshops, and is targeted towards family physicians who did not have the time to complete MMed (FM) (Thomas, Santoshlional, 2013).

An important development is the linkage between the Diploma and the Master’s program for those in Program B (Thomas, Santoshlional, 2013). In 2006, GDFM became an entry requirement for Program B (Thomas, Santoshlional, 2013). Those who received the GDFM needed to complete an additional year in order to be awarded the MMed (FM) (Thomas, Santoshlional, 2013).However, the examination entry requirement is six years of general practice experience or equivalent (Thomas, Santoshlional, 2013).

practice

According to the College of Family physicians Singapore, a Family Physician is a registered medical practitioner “who has acquired core competencies in clinical care, person-centered care, comprehensive and continuing care, collaborative and integrated care, community-orientated care, and a commitment to professional care based on ethical principles.” (Thomas, Santoshlional, 2013).

There is a shift in roles of family physician (Wonca Europe). Vocationally trained family physicians have moved from traditional practice to clinical leadership positions in community hospitals, palliative care, and home care (Wonca Europe). The plans for the Family physician Register, the FM Specialist Register, and the Sub-Specialist register for palliative care and sports medicine, where family physicians can register in, all show the growing role of family practice (Wonca Europe).   

Family physicians work in private sector primary care clinics (GP Clinics), public sector primary care clinics (polyclinics), community hospitals, private hospitals, and long-term care facilities (Thomas, Santoshlional, 2013).

Every 2 years, all registered doctors need to renew their practicing certificates and are also required to meet the mandatory CME requirements (Thomas, Santoshlional, 2013). A family physician needs to participate in continuing professional development activities that include continuing medical education, research, quality improvement, teaching the family medicine discipline, and interact with peers through membership (Thomas, Santoshlional, 2013).