Surviving Private Practice in Malaysia – Choosing your private practice

When I decided to go into private practice in 1994 I looked at all my options. Being an Obstetrician and Gynaecologist I had several choices. I had the option of joining an established hospital. This was tempting at that time. Firstly, an established hospital will be equipped with all the facilities for me to practice in comfort. Secondly most of the consultants in an established hospital will have many patients. I was hopeful that there will be some spill over of patients from the busy senior consultants to me. I applied to 2 such hospitals in Johor Bahru but my application was turned down. 

I had 2 offers. A well established Obstetrician and Gynaecologist offered me to join him and I had another option of buying an established maternity home. I spoke to my boss and he advised me against buying the maternity home because it will be difficult for me to progress in my speciality if I am tied down by a maternity home. I listened to him and turned that offer down. I decided not to join the senior Obstetrician and Gynaecologist because I was not sure I could get along with him. 

I was ambitious and I wanted to do more than just be a general Obstetrician and Gynaecologist. When I decided to join Mahkota Medical Centre, it was a calculated risk. Fortunately, I grew with the hospital and managed to do so many new things, which I would have not done if I had chosen differently. This might have been my good luck or my sheer determination or both. I am grateful that the management supported me in all my new ideas even though I had to fight very hard to get them.

 So when you are looking for a place to practice the following are your options:

  1. Join as a pioneer in a new private hospital
  2. Join an established private hospital
  3. Join as an assistant to an established private practitioner
  4. Open your own clinic/ centre and do visiting in private hospitals

1. Join as a pioneer in a new private hospital

Advantage

  1. Being in a brand new hospital, you will have a pioneer status in the hospital
  2. You may be able to help in the setting up of the various services in the hospital
  3. You may be consulted in the way the hospital and the doctor charge patients.
  4. You are not answerable to any senior colleagues
  5. The hospital will help promote you

Disadvantages

  1. Since it is a new hospital, it may take some time for the hospital to become busy. You will need to be patient.
  2. You will need to work hard. You need to go out and talk to the public to help bring in patients into your practice and the hospital
  3. The hospital might fail
  4. The hospital may have cash flow problem and you may not be paid for your service
  5. You work hard to help establish yourself and the hospital and just when you think you are comfortable, the hospital will take another specialist in your speciality without even asking or telling you
  6. Since it is a new hospital, some facilities may not available yet
  7. Your income may not be secured
  8. The management may not allow you to work in other hospitals
  9. You may have restrictions as to what you can do and cannot do in the clinic and hospital.
  10. You will have to follow the managements’ policies whether you like it or not.

2. Join an established private hospital

You can choose to join an established hospital as a second, third etc specialist in your field.

Advantage

  1. Since it is an established hospital, there will be many potential patients. You need to try to make them (patients) see you instead of your other colleagues
  2. There will be spill over of patients from other established specialist who are already busy.
  3. All the facilities will already be available for you to use them immediately.
  4. Cash flow may not be a problem since it is an established hospital.
  5. You will be riding on all the hard work done by the pioneers who have build the business of the hospital.
  6. There is a better chance of a more secured income.

Disadvantage

  1. You will be a junior specialist and you may have to answer to your senior colleagues
  2. You will need to follow all the existing rules and regulations of the hospital even if you do not like them
  3. The hospital may not help promote you.
  4. The management may not allow you to work in other hospitals
  5. You may have restrictions as to what you can do and cannot do in the clinic and hospital.
  6. You will have to follow the management’s policies whether you like it or not.

3. Join as an assistant to an established private practitioner

Advantage

  1. There will not be shortage of patients since it is an established practice
  2. You are assured of a secure income
  3. You can take time off since there are more of you in the practice

Disadvantage

  1. You are always in the shadow of the senior doctor
  2. You may not be able to practice medicine the way you want
  3. You may have a misunderstanding with your boss and may be out of a job
  4. You are not establishing your name and your own practice.
  5. If you leave the practice, the patient records are not yours
  6. Your boss may take advantage of you

 

4. Open your own clinic and do visiting in private hospitals

Advantage

  1. You will be free to do what you like in your clinic
  2. You can pick and choose which hospital you want to admit your patients.
  3. Your clinic will have a value when your retire or decide to sell it
  4. You keep all your goodwill with you in the clinic

 

Disadvantage

  1. It will be more costly for you to set up your own clinic
  2. You will need to market yourself so that you get patients
  3. You will have to do administrative work
  4. It may be difficult to get visiting rights in hospitals
  5. You may not get support from seniors and other colleagues
  6. You may feel lonely
  7. You may not get panel or insurance patients

Conclusion

Choosing the type of private practice can be a daunting task. Sometimes your options may be limited and you may have to take whatever that is available to you at that particular time. Obviously you can change to another option anytime if you are dissatisfied with your first move. I have seen specialist starting his or her own private practice and later move to a private hospital and vice versa. Staying in one practice for your entire life is not common. The most difficult step is to make that big decision of leaving the government service. It is unfortunate that in Malaysia, once you leave the government hospital for private practice, the “cord is cut” and there is no way you can get back to serve the government again. This will be even more difficult in the future as more doctors are graduating and more specialists will come into service. 

Selva
Sevellaraja Supermaniam
3/4/2020

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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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