“Marketing is a battle of perception”
When I first decided to move to private practice, I applied to a well-known private hospital in Johor Bahru. My application was turned down, as I was considered “not marketable”. This has nothing to do with my skills or ability to work very hard. The decision was just based on my physical characteristics, namely I am a male, Indian gynaecologist. I had to do more to attract the patients away from my female Chinese or Malay colleagues who will be the first choice for a woman requiring the service of an obstetrician and gynaecologist. In this blog I will examine all these physical factors that may play a role in attracting patients to your practice.
We live in a multiracial country. About 65 % of the population are Malays, another 25% Chinese, 8% Indians and the remaining others. When I started practice in 1994, there were very few private hospitals. Patients had limited choices. Patients of all races consulted me. However as more and more private hospitals were established, more doctors were employed in these hospitals. Now, patients have more choices. I also believe that the political environment and the education system had made the new generation of Malaysians, to be more polarised. In private practice, more and more people are choosing doctors of their own race.
One of my friends, who work in a group practice with doctors of all races, told me his observation. Most patients choose to see doctors of their own race! This is not surprising. For a patient to cross-racial boundaries, either they have had a good recommendation or they are brought up in a broad-minded family.
We all agree that the purchasing power of the Chinese is high in this country. A high percentage of Chinese work in the private sector and patronises the private health care system. As for the Malays, more and more are willing to pay for private practice. As the percentage of Malays in the country is large, this constitutes a large number as well. More ever, many Malays work in government-linked corporations (GLCs) which have been privatised (eg. Tenaga and Telekom). These organizations buy insurance for their employees. So Malay doctors in private practice have a substantial number of patients to see.
As for Indians in this country, a large majority are still poor, without insurance cover and cannot afford private practice. Since the Indian population in this country is small and only a small percentage of them can afford private practice, for an Indian doctor to depend solely on Indian patients is suicidal. In order to compete to gain patients of other races, Indian doctors have to innovate. Some like me, learn a Chinese language. Others may market themselves as “cheaper” then their colleagues by reducing their fees. Yet others acquire special skills to stand out in their field.
Malaysia is also a multireligious country. Islam is the official religion while there are a large number of Christians and Buddhist among the Chinese. Even though the majority of Indians are Hindus, there are also Muslims, Sikhs and Christians.
Does religion matter in the choice of doctors in private practice.? All Malays are Muslims. As such there is no confusion about a Malay choosing a Malay doctor as to whether the choice is because of race or religion. As for the non- Muslim public, religion may appear to be not very important in their choice of a doctor. For example an Indian doctor may be a Hindu, Christian, Sikh or Muslim and his religion may not be a factor for choosing the doctor.
However in certain circumstances religion may play a role. I have a friend who is a staunch Christian and most of his Church members see him instead of his other colleagues. Only when there is a strong recommendation to see a doctor outside their Christian group will the patient choose a non-Christian doctor.
I think language is a very important factor in patients’ choosing their doctors. This is especially so among Chinese and Indian patients. The ability to express their symptoms in the language they are comfortable with is very important. A tamil-speaking patient who is not very good with Malay or English will seek out a Tamil speaking doctor. Similarly, Chinese patients are more comfortable to see Chinese doctors because of the language. I myself have benefitted from the ability to speak some Mandarin as my Chinese patients are able to communicate with me and I am able to explain their condition in the language they are comfortable with. As most doctors in Malaysia speak reasonably good Malay, Malay patients do not have this problem. However, Indonesian patients are very happy to be seen in Malaysia because of our ability to communicate with them in their own language.
When I first stated practice in Melaka, I remember a very senior gynaecologist telling me “ You are so handsome and young, how can I compete with you”. This struck me as I was a brand new doctor in town and he was the most senior gynaecologist in town. I have always wondered whether “looks” play an important part in the choice for doctors.
Do good-looking doctors get more patients? It has been shown clearly in numerous studies that good looking people get better jobs and more salary compared to their not so good looking counterparts. Does this apply to doctors in private practice?
I presume that if you are an obese unattractive doctor doing aesthetic medicine it will probably not work. (Despite this I know of a large obese plastic surgeon who is doing very well). Again if you are an obese doctor treating obese diabetics this will not work either. Patients have to look up to their doctors to follow their advice and so the doctor must have the looks to complement their practice.
It is said that “you need to old enough to have the experience and young enough to be energetic” for patients to choose you as your doctor. What is this magical age? Some say it is between 45 and 55 years of age? Less than 45 you are considered too young and inexperienced and more that 55 you are too old and not energetic. This may be too much of a generalization. Some patients want to be treated by the oldest, most decorated and experienced doctor while others prefer younger doctors who are probably more energetic and more current in their management. When I was a young specialist, I wanted to look older so that my patients will trust me. Now that I am older, I want to look young so that the same patient will still trust me. Life is a cycle!
There is not a single profession in medicine that gender is important as in obstetrics and gynaecology. Most women prefer their obstetrician and gynaecologist to be another woman. (My advise to all male doctors is never do gynaecology. If you still want to do it, marry a female gynaecologist so that she can feed you patients.)
As Malaysia and the world becomes more and more conservative, the number of male gynaecologist all over the world is dwindling. Why do males want to do gynaecology in the first place? I chose it because it is a happy profession. It is the one profession that the final outcome is mostly a happy one, the patient going home with a baby.
What about other speciality? Female breast surgeons do better than male ones for yet another obvious reason. Most urologist are male as well. Women doctors all over the world complain that need to work harder and they suffer more during their training in the male dominated medical profession. Once they have become a specialist, is there discrimination in the private sector? Will a female orthopaedic surgeon or general surgeon do as well as a male? Does the public trust a male more than a female surgeon? A long time ago, one of my female gynaecologist colleagues told me “ the public do not trust young women gynaecologist to operate on them”. I wonder whether that is true in the 21st century. Perhaps not.
The dictionary defines Personality as “the combination of characteristics or qualities that form an individual’s distinctive character”. Different types of personality have been described. One description is the personality types namely Type A (The director – goal orientated, risk taking and good under stress), Type B (The Socializer – relationship-orientated, outgoing, enthusiastic), Type C (The thinker – detail oriented, logical prepared) and Type D (The supporter – task orientated, stabilizing cautious). I am sure each one of these personalities can succeed as a doctor in private practice. Are patients attracted to a particular personality? I think so.
A colleague of mine told me that she liked a certain male gynaecologist because he was quiet, professional and does not talk much. Another colleague chose a female gynaecologist because she is friendly and talks a lot. I guess it is impossible to please everyone. It is difficult to change one’s personality to suite different patients. You will be found out to be a fake.
On the other hand, you can choose a speciality based on your personality. Some one once said “You don’t choose your profession, the profession chooses you”
There may be some truth in this. I find most neurosurgeons to be risk takers as that profession has a high morbidity and you need a certain kind of personality to be able to take those risks. Physicians usually have a more sedate personality than surgeons who are more adventurous. Yet, most of us doctors learn to adapt our personalities to the profession we choose.
Factors that are beyond our control affects how we succeed in private practice. These are inherent factors that cannot be changed. We have to live with them. However when choosing a speciality you have a choice to see whether the factors you posses will benefit or be detrimental to the speciality of your choice. For example in certain speciality such as pathology and radiology your gender, personality, religion etc is not very important. The only important factor here is your skills. In other profession as I have shown above even if you are very skilful at your work, other factors play a major role in acquiring patients to your practice. You need to think carefully about these issues when you choose a speciality to pursue.
I would like to thank Dr. Gunasegaran P.T. Rajan for proof reading this article.
Thank you to Amita Sevellaraja for all the illustrations
Thank you to Sarojini Sevellaraja for editing the manuscript.