Friends, families and even fellow doctors often ask how they should go about seeing an Ear, Nose & Throat (ENT) Specialist in Singapore.
Many are not even aware that ENT as a surgical specialty even exists! Although I end up seeing them myself most of the time, they often have many questions. These include questions about the costs of seeing an ENT Specialist, or the need for a subspecialist for their condition.
As an ENT Specialist with more than 10 years of experience in this field, I hope this article will shed some light for those in search of an ENT Specialist in Singapore.
What is an ENT Specialist?
ENT Specialists are surgeons trained in the field of Ear, Nose, and Throat. They also have expertise in the Head & Neck region (medically known as Otolaryngology or Otorhinolaryngology).
Other commonly used terms to describe an ENT Specialist include “Otolaryngologist” or “Otorhinolaryngologist”. (Oto = ear, rhino = nose, laryngo = voice box or throat).
The most commonly used medical term to describe an ENT Department in the hospital is “Otolaryngology Head & Neck Surgery” - I know, it's quite a mouthful!
How does one becomes an ENT Specialist in Singapore?
It takes 5 years of medical school in NUS to become a doctor. A newly graduated doctor then works as a Houseman or Intern for 1 year in the public hospital. Thereafter, he or she becomes a medical officer.
As ENT is a highly competitive surgical specialty, most ENT "trainee wannabes” would have spent some time rotating through various ENT Departments in Singapore as non-trainee medical officer.
In Singapore, the ENT residency is a 5 year postgraduate surgical residency program. The ENT resident (also known as “trainee”) has to go through vigorous trainings, assessments and exams throughout the 5 years.
The ENT resident becomes a “Senior Resident” (previously known as “Registrar”) when they fulfill the training requirements. They also need to pass an annual national ENT exam by NUS at the end of the 2nd year.
The ENT resident becomes an ENT Specialist when they fulfill the necessary training requirements. They need to pass the annual “Exit” exam at the end of 5th year of training.
What is the difference between an Associate Consultant, a Consultant and a Senior Consultant?
These are titles that are unique to the public hospitals in Singapore and, I believe, in Hong Kong too.
After fulfiling training requirements and passing the "Exit" exam, ENT residents can be appointed as an "Associate Consultant".
Next, after being an "Associate Consultant" for at least 2 years, they can be promoted to a “Consultant”.
After approximately 5 years of being a “Consultant”, they can be promoted to a “Senior Consultant”.
The promotion depends on factors such as:
- duration of service
- research activity
- administrative roles
- teaching of medical students and ENT residents, and
- work ethic
Associate Consultants, Consultants and Senior Consultants are fully qualified Specialists. Private hospitals do not award such titles.
However, when some Specialists leave for private practice, they retain the titles that were awarded to them while they were in public hospitals. The most commonly used title to describe a Specialist in a private hospital is a Consultant.
Are ENT doctors physicians or surgeons?
Patients are often surprised that an ENT Specialist can perform surgeries too!
For most specialties, there is a “Physician” and a “Surgeon” counterpart. For example, Neurologist (Brain Physician) and Neurosurgeon (Brain Surgeon), Cardiologist (Heart Physician) and Cardiothoracic Surgeon (Heart Surgeon), Nephrologist (Urinary Tract Physician) and Urologist (Urinary Tract Surgeon).
Physicians and surgeons often manage overlapping conditions in each field.
ENT Specialists manage both the medical and surgical aspect of ENT conditions. This is similar to how Eye Specialists manages both medical and surgical conditions of the eye.
The types of ENT surgeries range from minimally invasive endoscope- and microscope-guided surgeries to open head & neck surgeries and robotic surgeries.
How do I see an ENT Specialist as a subsidized patient?
You need to be either a Singaporean or a Permanent Resident of Singapore to be seen as a subsidized patient in public hospitals.
You will also need a referral letter from:
- Polyclinic (Singapore Government Subsidized GP Clinic)
- Accident and Emergency Department (if your ENT condition is serious enough)
- SAF Medical Officer
What is the difference between seeing an ENT Specialist in the public or private hospital?
As for most medical and surgical specialties, the difference between seeing an ENT Specialist in public or private sector are mainly down to:
- Convenience and time
- Overall patient experience
It generally costs more to see an ENT Specialist in the private hospital compared to that in the public hospital.
The table below provides only an estimate of the range of fees charged based on information available on the internet and from a few ENT Departments at public hospitals. (Fees updated as of 2015).
|Public Hospitals||Private Hospitals/Clinics|
|Subsidised Patient||Private Patient|
|First Consultation||SGD 35-60||SGD 100-150||SGD 100-220|
|Follow-up Consultation||SGD 30-50||SGD 70-120||SGD 80-150|
Nasoendoscopy (Scope through the nose):
|Public Hospitals||Private Hospitals/Clinics|
|Subsidised Patient||Private Patient|
|First Scope||SGD 50-125||SGD190-400||SGD 290-500|
|Follow-up Scope||SGD 0-20 (within the first 6 months of the first scope)*||SGD 0-50 (within the first 6 months of the first scope)*||SGD 100-200|
*Subsequent scopes after 6 months of the first scope will be charged as a “first scope”
OR (for those who want the full details, here you go - prices were obtained in Sept 2016
|First scope (Medisave claimable)||Subsequent scope (non-medisave claimable)||First scope (Medisave claimable)||Subsequent scope (non-medisave claimable)|
|NUH||SGD 197||SGD 50 (within 1 year)||SGD 50||SGD 20 (within 1 year)|
|TTSH||SGD 350||SGD 36 (within 6 months)||SGD 128||SGD 17 (within 6 months)|
|KTPH||SGD 370||SGD 20 (within 6 months)||SGD 125||SGD 10 (within 6 months)|
|SGH||SGD 364.87||SGD 5 (for cost of nozzle if used)||SGD 119.35||SGD 5 (for cost of nozzle if used)|
|CGH||SGD 260||Nil (within 6 months)||SGD 90||Nil (within 6 months)|
|Private Hospitals||First scope (Medisave claimable)||Subsequent scope (medisave claimable)|
|First Scope||SGD 290-500||SGD 100-200|
2. Convenience and time:
The waiting time to be seen in a subsidized ENT clinic in the public hospital can be between 2 weeks - 3 months from the point of referral.
A subsidized ENT clinic can have between 80 to more than 100 patients in a session (morning or afternoon). Only a handful of medical officers, Registrars and ENT Specialists see the patients. Hence, the waiting time in the clinic can be long (1 to 2.5 hours).
Private patients can “walk in” to the clinic and make a direct appointment with the ENT Clinic. They may need a referral letter from a GP as required by some insurance companies for medical reimbursements.
The waiting time to see an ENT Specialist as a private patient in a public or private hospital is usually shorter (usually less than less than 2 weeks).
As the number of patients seen per ENT Specialist in a private clinic are fewer than that seen in a subsidized clinic, the waiting time to see an ENT Specialist is also significantly shorter. It is rarely more than 1 hour in most private clinics, especially in private hospitals.
3. Overall patient experience
a. Different doctor vs same doctor
As a subsidized patient, you do not get to choose the doctor who your wish to see. It is also likely for a subsidized patient to see a different doctor each time in their follow up clinic visits.
The ENT medical officers and Registrars do rotate between the different public hospitals in Singapore. All subsidized patients have an overall ENT Specialist in charge.
He or she will usually vet or review the cases seen by the medical officer or Registrar.
In a private ENT clinic, you get to choose the ENT Specialist who you wish to see and your subsequent follow up clinic visits will be with the same ENT Specialist.
Most patients feel that this provides a more “personalized” experience and they do not have to repeat their medical history with a different doctor at each follow up visit.
A better doctor-patient rapport can be established in a private ENT clinic.
b. Less time vs luxury of time
Unfortunately, due to the packed schedule in a subsidized clinic, the luxury of time is often not available for lengthy consultations (except in the case of serious ENT conditions such as cancer or severe infections).
In a private clinic, as the clinic schedule is usually not as busy as that in a subsidized clinic, the ENT Specialist can often afford to spend more time explaining the conditions and treatment plans.
c. Endoscope tower vs no endoscope tower
Private ENT clinics are usually equipped with an endoscope tower. This enables patients to see live videos and pictures of their nasoendoscopy (scope through their nose and throat).
Most nasoendoscopies in subsidized ENT clinics are done without the endoscope tower. Hence, no pictures or videos will be taken.
Some public hospitals do have a common room with an endoscope tower for patients with significant findings on their nasoendoscopy to have their scope pictures or videos recorded.
However, as this is a common or shared facility, the patient may have to wait to get their scope pictures or videos taken.
What conditions are managed by an ENT Specialist?
The answer is not as simple as just ear, nose and throat conditions.
Most ENT specialists manage many other conditions. For example, giddiness and vertigo, snoring and sleep apnoea, head & neck lumps and bumps (including lumps in the mouth, tongue and throat region).
They also look at growths on the salivary glands (e.g. parotid, submandibular, sublingual glands and minor salivary glands) and thyroid nodules.
Are all ENT Specialists the same?
All ENT Specialists. can manage about 80-90% of ENT conditions.
However, as with most other medical and surgical disciplines, there has been significant advancements in medical and surgical knowledge, and technology within the ENT field.
Most ENT Specialists in Singapore do undergo an additional 1-2 years of overseas training in renowned centres (often known as fellowships) to subspecialise in a specific area within ENT. The 7 known ENT Subspecialties are:
1. Otology and Neurotology (Ear Subspecialist)
2. Rhinology and Endoscopic Skull Base Surgery (Nose & Sinus Subspecialist)
3. Laryngology (Voicebox Subspecialist)
4. Head & Neck Surgery (Head & Neck Subspecialist)
5. Pediatric ENT (Children’s ENT Subspecialist)
6. Sleep Medicine (Subspecialist in snoring and obstructive sleep apnoea)
7. Facial Plastic (Subspecialist in plastic surgery of the face, including “nose jobs” aka Rhinoplasty)
Most ENT Specialists can manage the majority of general ENT conditions considered “bread & butter” well.
These ENT conditions include sensitive nose (Rhinitis), sinusitis, tonsillitis (infection of the tonsils), ear infections, snoring and obstructive sleep apnoea. It also includes uncomplicated head & neck lumps (e.g thyroid nodules).
However, relevant ENT Subspecialists may be able to manage more complex conditions better. For example, a patient with a large head & neck cancer should see a Head & Neck Subspecialist.
Likewise, a patient with a complex sinus anatomy, who had failed previous sinus surgery and are considering revision sinus surgery or who has severe nasal polyps should consider seeing a Rhinologist.
Is the cost of your ENT consultation and treatment insurance or medisave claimable?
This depends largely on your type of insurance, the level of coverage provided and whether there are presence of exclusions of certain medical conditions.
In general, if there is a need to undergo a nasoendoscopy (scope through the nose and throat region under local anaesthesia), the cost of the consultation, scope and medications can be medisave claimable (up to SGD 250 in most public hospital and up to SGD550 in some private ENT clinic).
A nasoendoscopy is considered a Day Surgery procedure with a Table Code of 1A.
The cost of consultation, scope, investigations and medical treatments may be insurance claimable when a nasoendoscopy is performed for patients with private medical insurance plan with a rider to cover deductables.
Some private ENT clinics offer direct billing to the insurance companies (ie no payment from the patient – often called “cashless” or “e-filing”) for patients who have undergone a nasoendoscopy in the clinic.
Who is the best ENT Specialist for you?
All ENT Specialists in Singapore have to be accredited by the Singapore Medical Council and the Ministry of Health of Singapore. Of course, there are strict criteria to be met.
Hence, you can be assured of their qualifications. There are some doctors with a Diploma in ENT. This is NOT the same as a specialist qualification which require a much longer training period.
There is no such thing as “the best ENT Specialist in Singapore”. The correct question to ask is who is the right ENT Specialist for you. To help you decide, you may take these factors into consideration:
1. Public vs Private (Pros/cons of each as mentioned earlier)
2. Training and qualifications of the Specialist
3. The relevance or need for a subspecialist for your condition (if you are unsure, just ask your GP or the ENT Specialist himself/herself!)
5. Professionalism and conduct of the doctor
6. Feedback from patients
Finally, you may also send an enquiry to the ENT Specialist whom you wish to consult to clear any concerns that you have before visiting the clinic.
Through his or her response, you can also gauge how comfortable you are with him or her. Most of the time, the only way to determine if the ENT Specialist is the right one for you is after the initial consultation.
You should leave the consultation room with a clear understanding of your condition and be given a treatment plan and options.
You should have ample time to ask questions during the consultation and should never feel shy or intimidated to do so!
Ultimately you have to decide if the Specialist is someone who you are comfortable with, competent and have your interest at heart. Hope this helps and all the best!
Dr Gan Eng Cern is an ENT specialist at Pacific Healthcare Specialist Centre, and is also a Senior Clinical Lecturer at the National University of Singapore. He obtained Subspecialty training in Nose and Sinuses, and has a passion for the treatment of snoring and Obstructive Sleep Apnoea (OSA). Dr Eng Cern enjoys jogging regularly to keep his spare tyres under control.