More physiotherapists opting to work in private healthcare – can the public sector keep up?
This article focuses on the numbers but I think it misses the reason behind them. As someone who has spent years working in Singapore's public healthcare system, I don't think physiotherapists or Allied Health Professionals at large are simply being "attracted" to private practice. I genuinely believe the vast majority of clinicians don't want to leave. They leave after years of small frustrations accumulating like less competitive pay, heavier workloads, burnout, feeling underappreciated and a growing sense that the system is asking more while giving back way less.
Before I continue, let me make one thing clear. I fully appreciate that public healthcare is a public good. I don't expect public-sector salaries to ever match what successful private practitioners can earn, nor do I think they should. But they do need to remain competitive.
From my experience, public healthcare has gradually become a harder place to build a long-term career. Workloads continue to increase while documentation, administrative work and productivity targets compete with the time we actually want to spend with patients. Many clinicians feel that extraordinary effort has become the expectation rather than something recognised. Frontline staff often feel unheard, while allied health senior leadership (Directors and Group Directors I'm looking at you) can appear more focused on operational KPIs and service targets than on supporting the clinicians delivering the care. Career progression and recognition also do not always reflect the experience, expertise and contributions that clinicians bring to the organisation. Burnout gradually replaces enthusiasm until many eventually ask themselves, can I realistically keep doing this for another 10 or 20 years?
On top of that, I've also seen the system lose excellent clinicians when it didn't have to. I remember a time when many AHPs particularly young mothers returning after maternity leave wanted to continue contributing on a part-time basis. They simply wanted some flexibility during a different stage of life but they were strongly discouraged from doing so. It was obviously not the intent but the message was effectively return full-time or leave. It was bewildering to me that we were willing to lose 100% of an experienced clinician instead of retaining 60% or 80% of one. Thankfully, things have improved over the years but we've already lost many good people because we weren't prepared to be flexible enough.
MOH's plans to increase the PT student intake are welcome but I don't believe we can recruit our way out of a retention problem. Every experienced clinician who leaves takes with them years of clinical judgement, mentorship, institutional knowledge and leadership that cannot simply be replaced by another graduate. I genuinely believe the vast majority of clinicians don't want to leave. Most joined public healthcare because they believed in the mission. They wanted to care for patients, develop their skills, and build meaningful careers and many still believe in that mission today.
It is worrying because if all good AHPs go to private, public paying patients are in trouble. I hope we can have a broader national conversation about how we can build a public healthcare system where experienced clinicians once again see a future worth staying for.