business - internal assesment
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Business and Management
Internal Assessment
Research Question:
Should The Balmoral Clinic hire a full-
time doctor instead of using part-time
locums?
Research proposal word count: 429
Report word count: 1982
Number of pages: 25
Done by: Sarah Lee Shan Yun
School: ACS (International), Singapore
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Contents
1. Executive Summary............................................................................................pg 3
2. Research Proposal...............................................................................................pg 4
3. Introduction.........................................................................................................pg 6
4. Methodology.......................................................................................................pg 7
5. Main results and findings....................................................................................pg 8
6. Analysis and discussion......................................................................................pg 9
7. Conclusion and Recommendation.....................................................................pg 12
8. Limitations of research......................................................................................pg 13
9. Bibliography......................................................................................................pg 14
10. Appendices........................................................................................................pg 15
11. Supporting documents.......................................................................................pg 19
12. Tables and graphs..............................................................................................pg 22
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Acknowledgements
I would like to thank the head of management at The Balmoral Clinic, Andrea Ong,
for taking the time answering questions for my interview, all the participants that
contributed to the survey of customer preferences and my teachers for mentoring and
preparing me for this assignment.
Executive Summary
The Balmoral Clinic was founded in 2000 by Dr Adrian Koh and specializes
in providing medical aesthetic services1. In 2009, The Balmoral Clinic opened a new
branch in Kallang, Singapore with the objective of providing general healthcare
services to families and corporate patients. Currently, the management only recruits
part-time doctors who rotate the use of the clinic daily. The firm is thus considering
hiring a permanent full-time doctor as an alternative.
Using Lewin’s Forcefield analysis as a framework, the driving and restraining
forces in effects of change within the business was explored. A SWOT/PEST analysis
was also drawn to compare and contrast the strengths, weaknesses, opportunities and
threats that the business environment poses. In addition, a breakeven analysis and
cash flow forecast was adopted to anticipate the financial ramifications and rewards
of hiring a full-time doctor. An interview with the head of management at the
Balmoral clinic and a survey amongst potential clientele was performed to gather the
qualitative opinions of a variety of key stakeholders. Moreover, various articles on the
employment patterns of doctors were collected and analyzed in order to examine the
contemporary business environment.
I have concluded that the Balmoral Clinic should hire a full-time doctor.
200 words
1 http://www.balmoralclinic.com.sg/aboutus.php
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Proposal
Research question
Should the Balmoral Clinic hire a full-time doctor instead of using part-time locums?
Rationale
The Balmoral Clinic was founded in 2000 by Dr Adrian Koh and specializes
in providing medical aesthetic services2. In 2009, The Balmoral Clinic opened a new
branch in Kallang, Singapore with the objective of providing general healthcare
services to families and corporate patients. Currently, the management only recruits
part-time doctors who rotate the use of the clinic daily. The firm is thus considering
hiring a permanent full-time doctor as an alternative. In this investigation, a
conclusion on the cost-effectiveness of employing a full-time doctor will be drawn.
Frameworks
Using Lewin’s Forcefield analysis as a framework, I will explore the driving
and restraining forces in effects of change within the business. A SWOT/PEST
analysis will be drawn to compare and contrast the strengths, weaknesses,
opportunities and threats that the business environment poses. In addition, a
breakeven analysis and cash flow forecast will be adopted to anticipate the financial
ramifications and rewards of hiring a full-time doctor.
Methodology
For primary research, I will be conducting an interview with the head of
management at The Balmoral clinic and a survey amongst the residents surrounding
Kallang Leisure Park to gather the qualitative opinions of a variety of key
stakeholders, including the managers and customers. For secondary research, various
articles on the employment patterns of doctors are to be collected and analyzed in
order to examine the contemporary business environment. This includes articles on
the costs of employment benefits, the retirement age of employees in Singapore,
government policies that restrict the education or employment of female or foreign
doctors, and the employment preferences of doctors in Singapore.
2 http://www.balmoralclinic.com.sg/aboutus.php
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Anticipated difficulties
- May not manage to get financial accounts
Solution: Ask about revenue and costs and work out an approximation of the
profit-and-loss account. Find out the selling prices of the firm’s products and
services and the daily running costs to determine the firm’s cash-flow
- Interviews may be hard to schedule
Solution: Call in advance to discuss an available time for meetings
Action plan Date Action Source Modification 31/10/11 Secondary
research Articles on the internet and newspaper
31/10/11 Schedule interviews
Contact through parents
31/10/11 Plan out the interview questions
Self Planning done on the 25/11/11
5/12/11 to 8/12/11 Interview with head of management and doctor staff at the Balmoral Clinic, Collect financial information
Head of management and doctor staff at the Balmoral Clinic
Date scheduled earlier on 29/11/11
8/12/11 to 11/12/11
First draft Self
17/01/12 Meeting with supervisor
Teacher (Ms Pamela Ng)
18/01/12 to 21/01/12
Final draft Self
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Introduction
The Balmoral Clinic was founded in 2000 and its original branch is located in
Balmoral Plaza. It began as a small family practice before the demand for Dr Adrian
Koh’s aesthetic treatments grew in popularity, leading to the specialization of the
branch in laser and medical aesthetics.
In 2009, Dr Adrian Koh and his wife, Mrs Andrea Ong, decided to open a new
branch in Kallang, with the objective of expanding the business. It was aimed at
returning to the provision of general healthcare services to families and private
patients. Since the new branch is relatively new, the management is open to adopting
different strategies with regards to recruitment and marketing.
Currently, the management of the branch in Kallang only recruits part-time
doctors who rotate the use of the clinic daily, all of them of which are female locums.
This was done in attempt to move away from the norms of recruitment practices in the
clinic’s original branch, and rather to experiment with new tactics and strategies of
employment.
The management is, thus, also considering hiring a permanent full-time doctor
in place of the part-time locums as an alternative. Since the part-time recruitment of
the branch has been an ongoing practice for the past 3 years, the management is
receptive to returning to the employment of a permanent full-time doctor.
The effects of change would have to be investigated before making the
decision to hire a full-time doctor in place of the part-time locums. This is especially
since the new branch caters to a very different market, with dissimilar services being
offered. This would have to include anticipation of financial and non-financial costs
and benefits.
This report will look at whether the Balmoral Clinic should hire a full-time doctor instead of using part-time locums.
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Methodology
Primary research
I have conducted an interview with the head of management at the Balmoral clinic,
Mrs Andrea Ong, to obtain insight into the regular practices of recruitment in the
business and to identify some of the driving forces behind her decision-making. A
survey amongst the residents surrounding Kallang Leisure Park was conducted to
predict their response toward the change to a full-time doctor.
Secondary research
Various articles on the employment patterns of doctors were collected and analyzed in
order to examine the contemporary business environment. This includes articles on
the costs of employment benefits, the retirement age of employees in Singapore,
government policies that restrict the education or employment of female doctors, and
the employment preferences of doctors in Singapore. This information would help to
predict the costs and benefits that the external environment presents with hiring a full-
time doctor.
Frameworks
Using Lewin’s Forcefield analysis as a framework, I have explored the driving and
restraining forces in effects of change within the business. A SWOT/PEST analysis
was drawn to compare and contrast the strengths, weaknesses, opportunities and
threats that the business environment poses. In addition, a breakeven analysis and
cash flow forecast was adopted to anticipate the financial ramifications and rewards
of hiring a full-time doctor.
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Main Results and Findings
- Patients prefer to see the same doctor regularly3 4
- Patients prefer to see female doctors5
- There is an increase in demand for general practitioners (doctors working in private clinics) as opposed to polyclinic doctors6
- Part-time doctors’ (locums) wage-rates are higher than full-time doctors’ wage-rates7
- Full-time doctors are given employee benefits such as medical leave, annual leave and health insurance8
- $60 is spent on each job advertisement in SMA magazine9
- Word-of-mouth or referrals are used when the company is hiring personnel.10
- It is very time-consuming for the manager to arrange schedules of part-time doctors (locums)11
- A skill development levy (payroll tax) has to be paid12
- There is a high risk involved in relying on a single full-time doctor13
- There was an increase in the CPF (Central Provident Fund) rate, employee’s retirement savings that the employer has to pay the government14
- Female doctors prefer to work as part-time doctors (locums) because of their personal responsibilities as mothers15.
- The government limits the number of female medical students to one-third of every cohort16
- Doctors prefer to work in larger, more established medical groups because they provide more job stability17
- The retirement age of Singaporean employees is expected to be raised to 65 18
- More doctors prefer to work in private clinics as opposed to public hospitals19
3 See Appendix A, question 12 & 13 4 See Appendix D 5 See Appendix A, question 14 6 See Supporting Document E 7 See Appendix A, question 5 & 6 8 See Appendix A, question 11 9 See Appendix A, question 8 10 See Appendix A, question 8 11 See Appendix A, question 17 12 See Appendix A, question 16 13 See Appendix A, question 12 14 See Supporting Document B 15 See Appendix A, question 15 16 See Supporting Document D 17 See Appendix A, question 9 18 See Supporting Document C 19 See Supporting Document F
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Analysis and discussion
Lewin’s Force Field Analysis20
One of the biggest benefits of hiring a full-time doctor is the appeal of a
regular face to customers. This is an extremely important asset, as it serves to increase
customer loyalty and aid business revenue in the long run. Secondly, the decrease in
the costs of wages by $1000 each month21 will lower average costs and benefit the
business’ profitability. Thirdly, The manager of the clinic would also no longer be
required to arrange the schedules of part-time doctors – a process that seems to be
rather time-consuming22. Mrs Andrea Ong, the manager, would then be able to focus
on more important issues of the company.
There are, however, certain restraining forces involved. Statutory benefits,
such as Medical and annual leave (of up to a total of 28 days23), is payable by the
company to the employee should he or she be absent from work. The costs of which,
however, are not very significant. More importantly, during the doctor’s absenteeism,
the clinic branch has to halt the provision of its services to customers and thus, cannot
generate revenue, affecting the company’s profits, cash flow and brand image.
Besides that, the manager has also indicated that working with a single full-time
doctor poses great risks to the company24, as the business is more reliant on one
employee as opposed to many. According to the manager, the gamble of reliability of
the doctor is not worth the costs of recouping consequential losses of the doctors’
shortcomings. Lastly, the costs of job advertising were also considered, and though
the quantitative costs are not very significant ($60 per month on an SMA magazine
advertisement25), the time and effort spent on searching for a full-time female staff
could result in a large amount of hassle due to the restrictions of government policies
and the lack of flexible working hours available to full-time female doctors26.
20 See Table A 21 See Appendix A, question 5 & 6 22 See Appendix A, question 17 23 See Supporting Document A 24 See Appendix A, question 12 25 See Appendix A, question 8 26 See Appendix A, question 15 & Supporting Document D
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SWOT / PEST Analysis27
There are several strengths that the company would enjoy with hiring a full-
time doctor. Firstly, the appeal of a regular face to customers28 would give the
business an advantage over larger medical groups and polyclinics29 that do not offer
the same one-to-one benefits. Secondly, the decrease in the costs of wages30 would
lower the firm’s average costs, which in turn, allows the business to price its services
slightly lower to attract more customers. Thirdly, since the part-time doctors’
schedules are relatively uncertain, hiring a full-time doctor would mean that there is
more permanence in the availability of timeslots for patients to book or walk-in,
increasing the clinic’s reliability.
In turn, there are certain weaknesses with regards to hiring a full-time doctor.
Firstly, as there is much difficulty in recruiting of a full-time female doctor31, the
company might have to resort to hiring a male doctor instead. This would,
unfortunately, decrease the firm’s appeal to female customers32. Secondly, the
business would also be affected when a full-time doctor is on medical or annual leave.
When the clinic’s services are halted, its overall reliability would decrease.
The business environment also poses several opportunities to the company.
Since, there is more of a demand for the healthcare services in private clinics than
polyclinics33 and doctors prefer the working environment of private clinics to that of
public hospitals34, there is more willingness of doctors to ‘turn private’, and thus a
greater pool of doctors to recruit from. Furthermore, and the retirement age of
Singaporeans is said to rise to 65 by next year35, thus there is a greater sense of
stability with hiring full-time doctors.
Threats in the external environment include the increase in payable CPF
(Central Provident Fund Rate)36, which would increase the cost of hiring long-term
employees. Doctors also prefer to work for larger, more established medical groups37,
which might cause further difficulty with finding and recruiting suitable candidates.
27 See Table B 28 See Appendix A, question 12 & 13; Appendix D 29 See Supporting Document E 30 See Appendix A, question 5 & 6 31 See Appendix A, question 15 & Supporting Document D 32 See Appendix A, question 14 33 See Supporting Document E 34 See Supporting Document F 35 See Supporting Document C 36 See Supporting Document B 37 See Appendix A, question 9
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Break-even analysis38
Since The Balmoral Clinic chose to use part-time doctors (locums), the
predicted break-even point was at $66,000 of sales revenue and the predicted break-
even output was 2,200 units or services sold to patients.
If The Balmoral Clinic had chosen to use a full-time doctor instead, the
predicted break-even point would have been at $55,440 of sales revenue and the
predicted break-even output would have been at 1848 units or services sold to
patients. This means that The Balmoral Clinic would have broken-even and started
earning profits approximately 1 month earlier if they had hired a full-time doctor.
Cash flow forecast39
Although the initial costs of job advertising may slow profits and net cash
flow in the months of December and January, the company will benefit from the
eventual increase in sales revenue, despite having to pay fixed employment benefits
each month. The costs of job advertising are not substantial, and can be easily covered
with existing cash. No negative net cash flow values are seen, meaning the company
would not be at risk of a loss should the job advertising be unsuccessful.
38 See Graph A and Graph B, pg 24 39 See Table E, pg 25
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Conclusions
Firstly, from Lewin’s Forcefield Analysis, we can see that the driving forces
outweigh the restraining forces of hiring a full-time doctor in place of the part-time
locums – 10 to 8. This is due largely to the substantial benefits towards increasing
profitability and greater customer loyalty that the business would enjoy. Furthermore,
although there were many small restraints that the company would face (such as slight
increase in costs of statutory benefits), they do not add up to be sizable in comparison.
The company would also, be able to utilize the full advantages of hiring a full-
time doctor. Such strengths, such as increased appeal to female clientele, would give
the business a considerable upper hand against competitors of the surrounding area.
Weaknesses, however, can be easily overcome with specific strategies discussed in
the recommendations section. Although the threats, essentially, surround the
bureaucracy of hiring female doctors, they can be overcome, again by using
straightforward recruitment strategies.
From the breakeven analysis and cash-flow forecast drawn, we can see that the
company would ultimately benefit from a shorter breakeven period and further
improvements in cash flow. The costs of recruitment would not be significant because
of the company’s relatively small nature, the lack of training and induction costs and
the flexibility of job advertising tactics.
In essence, the costs outweigh the benefits, thus I recommend that the
Balmoral Clinic in Kallang Leisure Park should hire a full-time doctor.
Recommendations
Along with the decision to switch to the use of a full-time doctor, I
recommend that the company use more effective forms of job advertising to target a
younger pool of female doctors. Such advertising would include seminars in
Singapore universities, where emerging graduates would be targeted. In addition,
more focus should be placed on the “more reliable” word-of-mouth40 job advertising.
Also, with regards to the weakness involving the stagnation of the branch’s
operations during the doctor’s absenteeism, I recommend hiring a part-time locum
when the part-time doctor is on leave.
40 See Appendix A, question 8
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Limitations of Research
In this investigation, I have placed more focus on the cost and benefits of the
decision. Further investigation on the effects on recruitment practices and workforce
planning can be taken into account to address future issues (e.g. the motivational
levels of part-time versus full-time doctors in the Balmoral clinic).
Limitations also include the extent of secondary research. In this case, studies
on the employment patterns of doctors in Singapore can prove to be a broad and wide
topic, which can be further studied and investigated.
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Bibliography
Books
- Business and Management by Paul Hoang, IBID press, ISBN-13: 978-1-
876659-63-9
Websites
- http://www.balmoralclinic.com.sg/aboutus.php
- http://www.guidemesingapore.com/incorporation/hr/singapore-employment-
act-guide
- http://mycpf.cpf.gov.sg/NR/rdonlyres/FB06395E-3B17-49C9-B667-
3A5A7D29E392/0/PressRelease_ConRatesChanges2010.pdf
- http://www.onlinewomeninpolitics.org/sing/aware.pdf
- http://www.straitstimes.com/print/BreakingNews/Singapore/Story/STIStory_7
39584.html
- http://www.geraldtan.com/medaffairs/manpower-doctors-
public_sector_doctors_leaving.html
Interviewees
- Head of management at The Balmoral Clinic, Andrea Ong
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Appendices A) Interview with head of management of The Balmoral Clinic, Andrea Ong
Q1. What is the average number of customers seen each day by all doctors? Answer: Probably around 40 per day.
Q2. How do the customers schedule appointments to see doctors? Answer: We encourage them to call, but there will be walk-ins as well.
Q3. Is it possible to meet the demands of the number of customers that call and walk-in each day? Answer: Yes, because at the moment the business is still growing.
Q4. What are the prices of the current healthcare services offered by doctors? Answer: A consultation fee of $30 will be charged to each patient. Of course, in addition, they will be charged for the cost of medicine. The number of customers does not affect the doctors’ earnings.
Q5. How is the wage-rate or payment system like for full-time doctors? Answer: Doctors are paid via packages. They are paid approximately $8,000 per month, depending on their seniority. They get a fixed salary for working 2 shifts a day: in the morning at 9am to 12.30pm, and in the afternoon from 2.30pm to 5.30pm.
Q6. How is the wage-rate or payment system like for part-time doctors? Answer: Around $65++ per hour. If I were to equate the wage-rates of the same hours of a full-time staff to that of a locum (part-time), the locum is often more expensive. They cost around $9,000 in total each month.
Q7. Are there enough offices to accommodate more full-time doctors? Answer: There is only one room, and there is only one staff at one time. If a new full-time doctor would be employed, he or she would work in place of the locums (part-timers) that are currently working there. For now, all my doctors are locums (part-timers).
Q8. How much is spent on average for job advertising of full-time doctors? Answer: It costs around $60 for a 3-line advertisement on SMA (Singapore Medical Association) magazine. Jobs are also advertised through referrals or word-of-mouth, which has no cost and is usually the more reliable method.
Q9. Would you consider the recruitment process of hiring full-time doctors to be
time-consuming? Answer: Yes. From an isolated experience, we tried to put up advertisements but the response was not great. There were only a handful of doctors that came along and most of the time, they were not suitable candidates. It could be because the doctors prefer to work in larger, more established groups like Raffles Medical Group or Shenton Medical, in order to have more job stability.
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Q10. What is the cost of training and inducting full-time doctors? Answer: There are no costs because doctors are already trained.
Q11. Are there any employee benefits offered to full-time doctors? If yes, what are the costs of these benefits? Answer: They are given medical leave, annual leave, personal medication (medicine at cost price), and health insurance should they need it. Because different doctors need different benefits, the costs are not fixed. However, it is not a substantial cost to cover.
Q12. Do you feel a greater sense of security with hiring full-time doctors? Why or why not? Answer: No. From a bad experience, I can say that there is a lot more risk with hiring a full-time doctor, because if he or she does not perform, the business will be substantially affected. Where-as, if one part-time doctor does not perform, the other doctors can still sustain the business. Initially, I hired a full-time doctor for consistency and for patients to have regular face, but in the end, the costs outweighed the benefits.
Q13. Is the clinic always busy? If not, why do you think so? Answer: It depends on the availability of specific doctors. Most customers prefer to see the same doctor regularly, so in a sense there is a loss in revenue when a certain doctor is not available.
Q14. Do you find that there is more of a demand for female doctors? Answer: Yes. Female doctors appeal to female patients. They are perceived to be more gentle and easy to approach. With certain services like Pap smear, female patients prefer to have female doctors conducting the procedures. In fact, I am using all female locums at this moment in time.
Q15. Do you find it more difficult to hire full-time female doctors? Why or why not? Answer: Yes, most female doctors prefer to work part-time as locums, because there is more flexibility with their working hours. They often need to spend time with their families since most of them have children at the stage of their lives.
Q16. Are there any payroll-taxes that the business has to pay for with hiring full-time doctors? Answer: Yes, there is a skill development levy that has to be paid, but the cost is not very significant.
Q17. Is the process of hiring part-time doctors more time-consuming than the process of hiring full-time doctors? Answer: Yes, a lot of time is spent on scheduling the time-slots for each part-time locum, as opposed to having a fixed schedule of a full-time doctor.
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B) Profit and Loss account of The Balmoral Clinic (Kallang) for November 2011 SGD Dollars Total Revenue 28,000 Cost of sales X-rays 2,400 Lab costs for blood tests 2,000 Medicine and drugs 4,000 8,400 Gross profit 19,600 Expenses Rent 6,500 Staff wages (not doctors) 3,000 Doctors’ wages 10,000 Electricity & water 200 19,700 (100) C) Cash flow of The Balmoral Clinic (Kallang) from July 2011 to November 2011 July August September November Opening Balance 146,460 147,360 150,160 152,460 Inflows Revenue 28,000 29,500 30,000 28,000 Total cash inflows 28,000 29,500 30,000 28,000 Outflows X-rays 2,200 2,000 3,000 2,400 Lab costs for blood tests 2,200 1,000 2,500 2,000 Medicine and drugs 4,000 5,000 3,500 4,000 Rent 6,500 6,500 6,500 6,500 Staff wages 3,000 3,000 3,000 3,000 Doctors’ wages 9,000 9,000 9,000 9,000 Electricity & water 200 200 200 200 Total cash outflows 27,100 26,700 27,700 27,100 Net cash flow 900 2,800 2,300 900 Closing balance 147,360 150,160 152,460 153,360
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D) Survey of patient’s preference: seeing the same doctor regularly versus seeing
different doctors on each visit
A survey was conducted on 40 residents living around Kallang Leisure Park. Random
sampling was used.
Questionnaire
Survey of patient’s preference for school research project -- ACS (International)
Name: _________________________________
1. Do you see the same doctor regularly or do you see different doctors on each
visit?
Same doctor □ Different doctor □
2. Do you prefer to see the same doctor regularly or do you prefer to see different
doctors on each visit?
Same doctor □ Different doctor □
Thank you for your time
The results were as follows:
80%
5%
15% 0%
People who see the same doctor regularly and want to continue seeing the
same doctor regularly
People who see different doctors each visit but want to see the same doctor
regularly
People who see a different doctor each visit and what to continue seeing
different doctors each visit
People who see the same doctor regularly and want to see a different doctor
on each visit
want
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Supporting Documents
A) Article: Guide To Singapore Employment Act And Common Benefits by Janus
Corporate Solutions, Singapore41
Medical Leave
If the employee has worked for at least 6 months for the company: The employee is
entitled to 14 days of sick leave per year, and 60 days of hospitalization leave
(inclusive of the 14 days). The employee must produce a medical certificate.
Annual Leave
To qualify for annual leave, you must have served at least 3 months with your
employer. The amount of annual leave you receive is dependent on the contractual
agreement between you and your employer, but is subject to a minimum of seven
days during the first year and one extra day for each additional year of service.
Annual leave taken even on a half-working day is considered one day’s leave, unless
otherwise stated in the employment contract. As a common practice in Singapore, all
employees are given an annual leave around 12-14 days per year, well above the
minimum required under the Singapore Employment Act.
B) Press release: Employer CPF contribution rate to go up by 1% to help workers
build up retirement savings42
Published 1st May 2010, abridged version
At the May Day Rally this morning, Prime Minister Lee Hsien Loong announced that
the Government will raise the employers’ CPF contribution rate by 1 percentage
point. The increase will be done gradually in two steps to moderate the impact on
employers. The first 0.5 percentage point increase will be implemented on 1
September 2010, and be made into the Medisave Account (MA). The remaining 0.5
percentage point increase will be affected 6 months later on 1 March 2011, and will
be made to the Special Account (SA).
41 http://www.guidemesingapore.com/incorporation/hr/singapore-employment-act-guide 42 http://mycpf.cpf.gov.sg/NR/rdonlyres/FB06395E-3B17-49C9-B667-3A5A7D29E392/0/PressRelease_ConRatesChanges2010.pdf
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C) Business Inquirer news article: Singapore to raise retirement age to 65 by 2012
Published 19th August 2007, abridged version
Singapore will raise the retirement age for its citizens to 65 from 62 by 2012 and
eventually to 67 to account for the higher life expectancy of its ageing population, its
prime minister said on Sunday.
D) Article: Quota of Women Entering Medical School in Singapore by Center for
Asia-Pacific Women in Politics (CAPWIP)43
A policy introduced in 1979 limits the number of female medical students to one-
third of every cohort. The quota continues even as Singapore faces a shortage of
doctors. To make up for this anticipated shortfall, the Government is easing entry
requirements to medical school and welcoming foreign trained doctors – while the
quota on women students remains.
Government’s Rationale
The 15 to 20% attrition rate among women doctors is a waste of the money spent
training them. “Equal opportunities, yes, but we shouldn’t get our women into jobs
where they cannot, at the same time, be mothers. You just can’t be doing a full-time,
heavy job like a doctor or engineer and run a home and bring up children,” said then
Prime Minister Lee Kuan Yew in August 1983. Women doctors, because of their
responsibilities to family, only want to “work office hours and watch the clock”, was
the reason given in 1987 by the then Health Minister Toh Chin Chye.
43 http://www.onlinewomeninpolitics.org/sing/aware.pdf
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E) The Straits Times newspaper article: More choosing private general practitioners
over polyclinics44
Published 30th November 2011, By Salma Khalik
“Biggest shift seen among foreigners, after the government subsidy was abolished in
2006”
Patients are increasingly choosing to visit private general practitioners (GPs) instead
of polyclinics, a survey has revealed. The findings come amid competition between
these family doctors, which may have made them more affordable - particularly as
levels of affluence grow. A one-day poll carried out last year by the Ministry of
Health showed 81 per cent of patients chose to see a GP. This is up from 78 per cent
in 2005, the last time the same survey was conducted. The findings reverse the trend
seen in the early 2000s, when increasing numbers of patients were drawn to
polyclinics by their cheaper prices.
F) The Straits Times newspaper article: More specialists leaving public sector45
Published 4th September 2004, abridged version
In the past decade, the only time when more than 50 consultants quit in a year was in
2000, when 61 specialists moved to the private sector. That year, a record of 243
doctors - or more than 20 a month - left the public service. It was paperwork that
drove Dr Tan Chee Eng out of the Singapore General Hospital (SGH). Dr Tan, the
former head of endocrinology, said he was spending half his time on administrative
work, and the needs of running a department curtailed both his patient care and
research. 'That took away my reason for staying in the public sector,' he said. At 44,
he was a senior consultant and both his salary and title had reached a peak. 'Salary
was not the major factor. If it was, I would have left long ago,' he said. Since he set up
his clinic at Gleneagles Medical Centre last month, he not only sees more patients but
is able to spend more time with them.
44http://www.straitstimes.com/print/BreakingNews/Singapore/Story/STIStory_739584.html 45 http://www.geraldtan.com/medaffairs/manpower-doctors-public_sector_doctors_leaving.html
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Tables and graphs
Table A) Lewin’s Force Field Analysis
This is a cost-benefit analysis that includes a comparison of the driving forces
(benefits) and restraining forces (costs) of hiring a full-time doctor as opposed to
hiring part-time doctors (locums). A value is allocated to each of the forces from 1
(weak) to 5 (strong)46 and the total value of benefits and costs are shown at the
bottom of the diagram.
Allocated value
Driving forces (Benefits) Restraining forces (Costs) Allocated value
5 Regular face for customers to visit, increasing customer loyalty due to patients’ repeat visits to the clinic
Increase in costs of employee benefits such as paid medical leave, paid annual leave and health insurance
1
3 Decrease in fixed costs due to decreased wage-rates
Costs of job advertising and recruitment
1
2 Manager saves time as arranging schedules of part-time doctors (locums) are no longer needed
Increase in the skill development levy (payroll tax) to be paid to the government
1
High risk involved in relying on a single full-time doctor
4
Increase in the CPF (Central Provident Fund) rate, employee’s retirement savings that the employer has to pay the government
1
10 Total Total 8
46 Business and Management by Paul Hoang, IBID press, ISBN-13: 978-1-876659-63-9
23
Table B) SWOT / PEST Analysis
This is an analysis of how the employment of a full time doctor will give the business
strengths and weaknesses against competitors and how the external environment
poses opportunities and threats with regards to hiring a full-time doctor.
Strengths Weaknesses - Able to meet customer demand of
seeing the same doctor regularly, increasing customer loyalty
- Lower wage-rates may result in a decrease of prices of the clinic’s services, increasing price competitiveness
- Increase in the availability of doctor, adding chance for patients to book appointments, thus increasing customer satisfaction
- May not be able to hire full-time female doctors, resulting in a lack of appeal to female patients
- Should the doctor be on medical or annual leave, the clinic’s services will be halted, decreasing the business’ reliability
Opportunities Threats - Increase in demand for general
practitioners (doctors in private clinics) over polyclinic doctors
- The retirement age of Singaporean employees is expected to be raised to from 62 to 65 in 2012, increasing the sense of stability with hiring a long-term employee
- Doctors are preferring to work in private clinics as opposed to public hospitals because there is less administrative work to handle, and more time to attend to patients
- Increase in the CPF (Central Provident Fund) rate, employee’s retirement savings that the employer has to pay the government
- Female doctors prefer to work as part-time doctors (locums) because of their personal responsibilities as mothers
- Furthermore, the government has a policy, limiting the number of female medical students to one-third of every cohort
- Doctors prefer to work in larger, more established medical groups like Shenton Medical Group or Raffles Medical Group
24
Table C) Predicted units sold, unit price, variable cost and fixed cost of The Balmoral
Clinic, November 2011
Time Units sold Unit price Variable cost Fixed cost
Month 440 30 19 19,700
Graph A) Break-even chart of The Balmoral Clinic using part-time doctors (locums)
Break-even chart of The Balmoral Clinic
Using part-time doctors (locums)
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
0 1000 2000 3000 4000
Units sold
Sales
Fixed
Total Cost
Table D) Predicted units sold, unit price, variable cost and fixed cost of The Balmoral
Clinic, if full-time doctors were hired instead: assuming an increase of 5% in units
sold47 and a decrease in $1,000 of fixed cost48
Time Units sold Unit price Variable cost Fixed cost
Month 462 30 19 18,700
Graph B) Break-even chart of The Balmoral Clinic using full-time doctors
Break-even chart of The Balmoral Clinic
Using full-time doctors
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
0 1000 2000 3000 4000
Units sold
Sales
Fixed
Total Cost
47 See Appendix D 48 Calculated by subtracting $8,000 from $9,000 – see Appendix A, question 5 & 6
25
Table E) Cash flow Forecast
Cash flow Forecast of The Balmoral Clinic from December 2011 to April 2012
Assuming that it takes 2 months to recruit a full-time doctor, $60 is spent each month
on job advertising49. After a full-time doctor is employed, doctor’s wages will
decrease by $1,00050, sales revenue will increase by 1% each month, and employee
benefits will cost $80 each month51. Assuming all other costs remain the same as
stated in the cash-flow accounts of The Balmoral Clinic November 201152
December January February March April Opening Balance 153,360 154,200 155,040 157,140 159,520 Inflows Revenue 28,000 28,000 28,280 28,560 28,840 Total cash inflows
28,000 28,000 28,280 28,560 28,840
Outflows X-rays 2,400 2,400 2,400 2,400 2,400 Lab costs for blood tests
2,000 2,000 2,000 2,000 2,000
Medicine and drugs
4,000 4,000 4,000 4,000 4,000
Rent 6,500 6,500 6,500 6,500 6,500 Staff wages 3,000 3,000 3,000 3,000 3,000 Doctors’ wages 9,000 9,000 8,000 8,000 8,000 Job advertising 60 60 0 0 0 Employee benefits
0 0 80 80 80
Electricity & water
200 200 200 200 200
Total cash outflows
27,160 27,160 26,180 26,180 26,180
Net cash flow 840 840 2,100 2380 2,660 Closing balance 154,200 155,040 157,140 159,520 162,180
- End -
49 See Appendix A, question 8 50 See Appendix A, question 5 & 6 51 See Supporting Document B 52 See Appendix C