Surviving Private Practice In Malaysia

Clinic systems in Private Practice

Summary

There are 2 clinic systems in Private Hospitals in Malaysia. The first is that a doctor owns or rents a clinic from the hospital. Here the doctor is in full control of everything that is done in the clinic. The second is that the hospital provides the clinic for the doctor to use. In this podcast I will describe the advantages and disadvantages of both these systems

Transcription

Surviving Private Practice in Malaysia – Clinic systems in Private Hospitals

Hello, welcome to my podcast entitled “Surviving Private Practice in Malaysia”

My name is Dr Selva I am a consultant obstetrician and gynaecologist at Mahkota Medical Centre in Melaka, Malaysia.

This is my 4^th podcast entitled “Clinic Systems in Private Hospitals in Malaysia”

Since the 1990’s private hospitals have mushroomed in Malaysia. In 2018 the total number of private hospitals in Malaysia was reported as 240 as opposed to 144 government hospitals. The biggest groups of hospital are Kumpulan Permodaln Johor KPJ with 27 hospitals, Pantai /Gleneagles group with 15 hospitals and Columbia Asia Group with 13 hospitals.

How we started in Mahkota Medical Centre?

In 1994 I joined a brand new hospital called Mahkota Medical Center in Melaka. It was originally built and owned by the Lion’s Group. Dr. Jack Chiang a Taiwanese hospital builder was employed by the Lion’s Group to build this hospital. It was build based on the Taiwanese concept whereby everything was owned by the hospital. The doctors just walk in and work for a percentage of the procedure fees. This was a new concept in Malaysia All other private hospitals had a system where the doctor’s charge is separate from the hospital charges.

In this new system the doctor gets 1/3 of all procedures charged to the patient. So for a certain operation, if the procedure fees is RM 3000 then the doctor gets RM1000. The hospital will charge extra for any disposables used during the surgery but there is no separate OT usage charge or instrument charges for all reusable items used during the surgery.

This system was very attractive to young doctors like me. It is good because since our fee is directly attached to the hospital fee, the hospital fee will not be increased unilaterally without increasing the total bill. As all of us were young and keen to do more cases even though we get less money per procedure, we had the chance to perform more operations. This was very good for me. Since I was just starting to perform laparoscopic surgeries the time taken to perform laparoscopic surgery was obviously long. The hospital charges were the same whether I took 1 hour or 3 hours to perform the surgery. The only difference was the cost of the extra drugs used during anaesthesia. The anaesthetic fees was also 30 % of the surgeons fees and so all the charges and doctors fees were tied together. We were able to control the patient’s bill and kept it to a minimal thus attracting more patients to this new hospital.

As for outpatient services, we are given codes for consultation fees. The fee was RM 30 for a first visit and RM 20 for a follow-up visit. We get 30% of the total ultrasound charges as the machine belongs to the hospital. As young specialists we were very happy with this arrangement because we need not come out with any capital when we started working in this hospital.

Economic Crisis of 1998

During the economic crisis of 1998, Lion’s group decided to sell off the hospital because it was not doing well. The Ballestier’s group of Singapore headed by Dr. Gan See Khem bought the hospital at a very reasonable price. The new owners thought that the system in the hospital is only benefiting the doctors and not the hospital. They decided to change the system to the Mount Elizabeth hospital, Singapore model, whereby suites were created to sell or rent to the doctors. In this way they could raise cash for the running of the hospital. They created suites ranging from 400 sq feet to 1000 sq feet on the first and second floor of the building.

The doctors were unhappy and revolted. As a result of the unhappiness, 10 doctors decided to move to another hospital called Specialist Medical Centre, Melaka, which was owned by a group of doctors. Later this hospital was sold to the Pantai group and it was renamed Pantai Air Keroh Medical Centre.

I remained in Mahktota Medical Centre. I rented a 920 square feet suite and after 1 year bought it for a premium. My contract with the hospital allows me to dispense drugs and do procedures in the clinic. I am also allowed to collect cash from patients in the clinic. This was a complete change from the way we worked before. At first all of us were very unhappy with this arrangement. However, over time we have learned to recognise that this is a very good system.

Since then, the hospital’s fees structure still remained the same namely we get 1/3 of all surgical fees. Although in the initial agreement, the management was not supposed to charge for the usage of any equipment used during surgery, this has changed over the years. Gradually patients are being charged for usage of special equipments used during surgeries

Clinic systems

There are basically of 2 types of clinic systems in private hospitals in (Malaysia).

The hospital owns everything and the specialist gets their income from consultation fees and doctors’ fees for procedures done in the hospital. Some hospital charges their doctors rental for clinic usage. In some hospitals they my even need to pay the nurses’ salary. The KPJ Group, Pantai Group, Columbia Asia group of hospitals and many other private hospitals use this system.
Consultant owns clinics in the hospital and uses the hospital for their inpatient facilities. Only 4 hospitals I know off have this system namely Gleneagles Hospital Kuala Lumpur, Mahkota Medical Centre, Melaka, Putra Hospital, Melaka and Pantai Air Keroh Melaka. However in both Putra Hospital and Pantai Air Keroh Melaka, this privilege is not extended to all new doctors joining the hospital.

Lets look at some of the advantages and disadvantages of the 2 different systems.

The advantage of owning a clinic in the hospital are:

You can run the clinic the way you want
You can collect cash in the clinic
You can buy your own equipment
You can sell drugs in the clinic and earn from it
You can employ your own nurses
Your clinic value may appreciate over time
You may be able to take assistant doctors
You have your own space to place your personal things

The disadvantages of owning a clinic in a hospital

You have to pay rent or pay a premium to buy the suite
You have to pay maintenance fees
You have the burden of paying your nurses salaries
You will have the burden of paying leasing for all your equipment
Even if you want to get an assistant, the hospital may not give the rights for the assistant to work in your clinic
You may not be allowed to sell the clinic to anyone else except the hospital because the person who want to buy your clinic may not be given practicing rights in the hospital

The advantages of not owning a clinic

You don’t have the burden of paying for rental and nurse
You don’t have to keep stock of drugs, medical supplies etc
You don’t have to manage the clinic and the staff
You don’t have to worry about collection of money and pilfering of drugs or stealing of money by your staff

Disadvantage of not owning a clinic

You may be moved out of your clinic space at any time by the management
Your nurse may be changed by the management as they wish
You have to work with equipment decided and provided by the management
You cannot try out new treatment strategies as everything must go through the management.
You cannot differentiate yourself from your competitors in terms of providing superior service or competitive pricing

In Conclusion,

I foresee that no private hospital is going to have the system of owning your own clinic in the future. Private hospitals have learnt that total control of the hospital is to their advantage. They can dictate to the doctors what they want to do. As a young specialist, this system is good for you. This will allow you to establish yourself and have your own clientele at a low initial cost. However, as you grow older and have more patients, you will prefer to have your own space and clinic so that you have a better control of what you do. Unfortunately, this is not going to happen in any Malaysian private hospitals in the future. As more and more specialists come out to private practice, I predict that a new system will emerge. In the future private hospitals are going to employ doctors so that they will have absolute control of them.

I hope you have leant something from this podcast. Please subscribe to this podcast to receive notification of all my future podcasts. I hope to post a podcast every week on Monday morning. Please also introduce this podcast to your friends.

Bye.

Clinic systems in Private Practice

Summary

Options for Private Practice

Summary

So if you have decided to go into private practice and are looking for a place to go into practice, these are your options.

Join as a pioneer in a new private hospital

Join an established private hospital

Join as an assistant to an established private practitioner

Open your own clinic/centre and do visiting in private hospital

In this podcast I will be discussing the advantages and disadvantages of this 4 options.

When to leave for Private Practice

Summary

In this episode I will discuss the advantages and disadvantages of working in the government hospital and private practice. This will help you decide when you will be ready to move to private practice.

Why am I doing this podcast

Summary

My name is Dr Selva I am a consultant obstetrician and gynaecologist at Mahkota Medical Centre in Melaka, Malaysia. This is my first episode and I am excited to record and share this podcast to all of you. This podcast is entited “Why I started this podcast”.I started a blog entitled “Surviving private practice in Malaysia” last year and I thought that a podcast will be good to reach out to more people. I have been working in private practice in Malaysia for the last 27 years.

Many students who want to become doctors and young doctors working in the government hospitals, do not know how private practice in Malaysia works. This podcast is aimed to educate them about private practice in Malaysia. In this podcasts I will talk about my experiences working in private practice in Malaysia. I will discuss on how private practice works . I will also be speaking to other doctors who are already working in private practice in Malaysia. I am hoping that by listening to this podcast you will have a good idea about how private practice in Malaysia works and hopefully you will be better prepared to face private practice when your time comes to move from the government hospital to private practice.

Surviving Private Practice in Malaysia

Hello, welcome to my podcast entitled “Surviving Private Practice in Malaysia”

My name is Dr Selva I am a consultant obstetrician and gynaecologist at Mahkota Medical Centre in Melaka, Malaysia.

This is my first episode and I am excited to record and share this podcast to all of you. This podcast is entited “Why I started this podcast”.

I started a blog on the same title last year and I thought that a podcast will be good to reach out to more people. I have been working in private practice in Malaysia for the last 27 years.

Each year about 5000 doctors are graduating from medical colleges just in Malaysia alone. Being a doctor in Malaysia is going to be very competitive. This is more so in the private sector. Every one entering a medical school is hoping for a successful carrier as a doctor. However surviving in private practice is not going to be easy.

I come from a poor family. My father was a lorry driver and my mother, a housewife who later had to work as a labourer in a factory to supplement our family income. When I was young, my only determination was to do well in my studies so that I could get a scholarship to go to a local university. At first my father (a Public works Department PWD or Jabatan Kerja Raya JKR lorry driver) obviously wanted me to be a civil engineer. However due some turn of events, I managed to get good grades to enter University Malaya to do Medicine. One needs to get top grades to do Medicine in University Malaya in those days. I also secured a Johor State scholarship.

In the university I was just an average student. After graduating, I did my housemanship at the Kuala Lumpur General Hospital. I was then transferred to Johor Bahru and later served as a medical officer at my hometown, Mersing. Undecided as to whether to do Medicine or Obstetrics and Gynaecology, I studied for the Part 1 of both while enjoying the peace and tranquillity of the small town. I secured the post of Registrar in the Department of Obstetrics and Gynaecology at the Hospital Sultanah Aminah, Johor Bahru in 1988. I went to the United Kingdom to work for a year and passed the Part 2 in 1991. On returning to Malaysia. I was a clinical specialist at Hospital Sultanah Aminah, Johor Bahru and later for a short while, as a consultant at the Batu Pahat District Hospital.

In 1994, after seeing that I do not have much future in the public sector, I decided to move to private practice. I applied to several hospitals in Johor Bahru but all my applications were rejected.

The reasons given were:

I was too young,

a male gynaecologist

and the wrong race.

Mahkota Medical Centre, Melaka a brand new 600 bedded hospital offered me a job. Mahkota Medical Centre was build by the Lion’s group and its CEO invited all the local doctors in Melaka to join them. Most of the Melaka specialists rejected the offer. So the CEO decided to offer jobs to young doctors from other states. I was offered a job perhaps because he could not attract anyone else. Despite never having been to Melaka before, I took the offer.

There were several reasons why I accepted the offer. Firstly this was the only good offer I had and I did not have much choice. Secondly I liked the mere size and beauty of the hospital. Thirdly, they also offered me a 2 months training in laparoscopic surgery at the Chang Gung Memorial hospital, Taiwan. I had always been intrigued by keyhole or laparoscopic surgery and this offer is one I could not refuse. After undergoing training in Taiwan, I came back to practice at Mahkota Medical Centre. As an incentive, the hospital offered all of us a small guarantee income for 1 year. The amount was RM 7600, which was twice my government salary at that time, and all of us were very happy with that guaranteed income.

Working in a brand new hospital was a real experience.

A colleague once told me

“you are the wrong age (young)

wrong sex (male gynaecologist),

wrong colour (Indian)

and in the wrong town (don’t know anybody in Melaka)”.

How am I going to survive? It was not easy. The first few years were tough, as I was sitting in my clinic waiting for patients to walk in. I had to do things differently in order to distinguish myself from all the other obstetricians and gynaecologists in town who are more senior and experienced than I am. I delved in my passion, which is laparoscopic surgery and aimed to excel in it. I also persuaded the hospital to start an invitrofertilization or IVF centre. I went to train in IVF at King’s College London and started the Mahkota IVF centre in 1997. It was the first IVF centre south of Kuala Lumpur at that time. I spend 3 years doing a Masters in Reproductive Medicine. Earlier, after returning from the United Kingdom and working as a specialist in Johor Bahru, I joined a night class to learn how to speak Mandarin. Even though I had all the disadvantages namely being young, male, Indian and in working in a town where I didn’t know anyone, I over came all these difficulties with the things that I can do, namely learn to speak Mandarin so that my Chinese patients can communicate with me, able to do laparoscopic surgery and IVF, skills not mastered by other gynaecologists in Melaka and going out to meet General Practitioners and the public to tell them I exist and I am a worthy alternative to my esteemed colleagues. With hard work, perseverance and always thinking about my practice in the long run I managed to survive private practice.

Many junior doctors who come to train under me ask me for advice as to how to survive in private practice. I tell them my experience working through all these difficulties I had faced. I thought that collecting my thoughts and writing it down in blog posts and now with this podcast would benefit young doctors and potential doctors in Malaysia.

Even though much of what will be in the podcasts will be my experiences in private practice, I will be also speaking to other doctors both in the government hospital and private practice. I am hoping to write about their experiences or do an interview with them, which I will post as a podcast.

My wish is that you listeners can have an inside about what private practice is like in Malaysia so that you can plan your future and succeed. My best wishes to all of you on your carrier. Please do subscribe to this podcast and help me spread the word about this podcast to your friends. I hope to post a podcast every week on Monday morning.

Bye for now and till we meet again in the next podcast next Monday.