I left government service for Mahkota Medical Centre, Melaka in 1994 at the age of 34.
I was a young specialist at that time. Most of the pioneer doctors were off about the same age. Being in a brand new hospital, we worked very hard to build it. As time passes, more doctors joined the hospital. In 2019 we celebrated our 25th anniversary. I am now considered a senior Consultant Obstetrician and Gynaecologist (although I still feel very young) in this hospital. Like most private hospitals in Malaysia, all specialists work as solo practitioners because most of the time we work alone with little involvement of our colleagues.
In order to survive in this kind of environment, I had to learn how to interact with all the resident specialists as well as the management of the hospital. Over the years I have gained much experience on how to build relationship with the various stakeholders of this hospital. Some of my experiences were good while others were not so pleasant. Somehow, even though these experiences are talked about casually among doctors, I think no one has actually written them down. So I decided to write down what I feel is important for a young specialist to know before joining a private hospital.
- Introduce yourself to everyone in the hospital. One of the problems I faced in Mahkota Medical Centre, is that I only get to know who has joined the hospital after they have started work. The management do not consult the resident doctors before signing a contract with a new doctor. This may not be the same practice in other private hospitals. The reason given is that some time ago, a resident specialist had dissuaded a new doctor from joining the hospital and so they are afraid that this may occur again. You are keen to join a hospital. You are offered the job. Even if the management advised you not to speak to the resident doctors, it is in your best interest to meet them especially those in your own specialty because you are the one who will be interacting with them in the future. My advise is to make a courtesy call to all the resident doctors especially those in your own specialty to inform them that you are joining the hospital and ask them for their advice and blessing. It will make the senior doctors happy and not feel antagonistic towards you. You many feel a sense of animosity towards you during that courtesy call because you are going to be his/her adversary but a courtesy call will obviously soften your landing in the hospital. In time, they will accept you as their colleague.
- Stay humble When you are in the government hospital, you have climbed the ladder to reach a position of power. You have also gained sufficient skills and knowledge in your specialty, which you feel, will be sufficient for you to survive in private practice. When you walk into a private hospital, you start at the bottom of the ladder again. Your senior colleagues have been working in the hospital for some time. Even though you may feel that you are up-to-date with your knowledge in your specialty thus feeling superior to the dinosaurs in the hospital, my advise to you is to stay humble. Your senior colleagues may not be knowledgeable on the latest advances in your field but they have years of experience in the field especially in private practice.
- Do not antagonize anyone. Even if you feel that you don’t like a colleague in your specialty, do not antagonize him. You will not know when you will need his help. There is more for you to loose by antagonizing your senior colleague. Your senior colleague has been in that hospital for many years and he has adapted to the environment. He does not need you as much as you need him. Stay polite even if you don’t like him.
- Don’t talk bad about your colleague. There are times when a patient who has seen your colleague and not satisfied with them comes to see you and complain about him. Do not agree with them. Tell them that all doctors have their own opinion and your colleague is correct in giving his decision. Don’t add fuel into fire. This will one day backfire. One day your colleague will do the same to you. Stay away from bad mouthing your colleagues.
- Be patient – It is extremely frustrating sitting in your clinic and waiting for patients. You are a well-trained specialist and had been very busy working in a government hospital. However now you are sitting around doing nothing. Private practice is not the same as a government hospital. All of us sat around for a long time before patients knew about us and started trusting us. So be patient.
- Don’t feel dejected if a patient who saw you finally end up with your more senior colleague. I have had this experience on numerous occasions when I was younger and still experience this now. However well you have discussed the options with your patients, they will make up their own mind and decide who will ultimately manage them. You may feel dejected and upset that you have lost the patient to your colleague but if you have been honest in your opinion and did not bad mouth your colleagues, I assure you that ultimately you will have sufficient work and will be successful.
- Be honest with your patients – When you first start in a private practice, there are a lot of temptation to do procedures on patients that may not be warranted. I had this experience as well during my early days in private practice. Sometimes the line between being conservative and aggressive in managing a patient can be very thin. You may be tempted to be more aggressive because you want to earn more from the patient. My advice is to refrain from doing this. You have to think long term and build a good reputation for yourself and not look at the short-term immediate gain. My advice is to be honest to your patients and you will be rewarded for your honesty in the future. Sometimes it may be a good idea to ask your patients to get a second opinion. You may be worried that you will loose your patient to your colleague but you will appear honest to your patient.
- Get new skills – If you are the 8th or 10th specialist of your specialty in the hospital, there must be a reason for a patient to want to see you instead of the other specialists in the same field. Having special skills helps. With this special skill you may be able to attract patients away from your colleagues. Again don’t be arrogant because you have these skills. In my experience your colleagues who do not have your skills will either downplay your skills or send them away to a doctor in another town for treatment. Their reason is that if the patient gets the treatment in another town, the chances are, when they come back they will still return to see them. If they send the case to you, they will possibly loose the patient to you. Only patience and by being humble, can you win them over so that they will refer their patients to you for your special skills. After doing what you have to do, it is nice to send the patient back to the doctor for future follow-up. I will give you an example. I started doing IVF in 1997. I was the first to do IVF in my town. However I find that my colleagues do not send their patient to me to do IVF but send them away to Kuala Lumpur. It took me years to convince them to send their patients to me to do IVF. After a successful IVF cycle, I always send them back to the referring doctor for the pregnancy checkup and delivery.
- Avoid forming cliques One of the method used in private hospitals is to form alliances with counterparts in other specialty. For example a gynaecologist will form a clique with a general surgeon, a urologist, a physician, an orthopaedic surgeon, an ophthalmologist, an ENT etc. By forming such a clique they refer their cases to each other. This is not uncommon in a private hospital. There are advantages and disadvantages of forming this kind of cliques. The advantage is that you have a chance to get cases from doctors in your clique. The disadvantage is that you are obliged to refer a case to the doctors in the group even though you might think that another doctor is better qualified to handle your patient. My advice is, it is better not to form such alliances. Leave it to the spineless politicians to create alliances. As doctors, we are more ethical.
- Don’t feel bad about colleagues not referring cases to you. You are the new doctor in the block. The other doctors in all the other specialties have their own referring habits. It is difficult to break that habit. Some will refer to you and you must be grateful to them for helping you. However, it is not their obligation to refer their cases to you. You have to be patient and engage with all the other doctors in the hospital. You have to prove to them that you are a good and a well trained doctor so that they will send their cases to you.
- Don’t be upset if your colleague or a close friend consults your colleague and not you. This has happened to me on numerous occasions. When this occurs I usually feel dejected and I ask myself why am I not good enough for them. You and I must realize that deciding on who will be their doctor is the sole prerogative of that patient even if they are your good friend. There may be many reasons to their decision. Their reason may be other than that you are not good enough for them. Just think that it is their loss and move on. There is no point sulking over it.
- Engage more with your nurses, paramedical staff and Marketing and PR staff. They are part of your team. In a private hospital you rarely work with another doctor especially of your own specialty but you work with nurses and paramedics all the time. They assist you in all your work. Have a good relationship with them and treat them with respect. Besides nurses and paramedical staff, the marketing and PR staff are also important to you. They help inform the general practitioners and patients about you and promote you on their road shows.
- Continue to teach. You learn the most when you teach. Teaching can be in the form of lectures to your nurses and paramedics, to other specialists in other discipline in your hospital or in a local or national body. By teaching you will be seen as an authority in a particular subject and that will propel your career Some people may think that teaching means giving away your skills to others but on the contrary, teaching will make your students look up to you and they will always have something nice to say about you in the future. Personally, I have continued teaching what I know whether be it to medical students, young doctors or specialists, my entire medical career even in a private hospital.
- Don’t believe everything the management tells you – The management of a hospital will tell you all the good things about a hospital before you join them. Every hospital has its good and bad points. The most important thing is the working environment, which involves you working with others in the hospital. You need to talk to the doctors in the hospital to understand the DNA of the working environment in the hospital.
- Don’t be dejected if after some time the management brings in another specialist of your specialty before you can become established – This is not uncommon. Management has its own key performance Index (KPI). One of it is to bring in as many specialists as possible because the more doctors there are in a hospital the higher the chances of their success. They don’t owe you anything. It is up to you to attract patients to your practice.
- Engage with the management – The management of the hospital wants doctors to sit in different committees. These are voluntary committees required by the private health care act. Some of the committees are the MDAC (Medical and Dental Advisory Committee), Ethical Committee, Operating Theatre committee, your specialty committee etc. Many senior doctors are too busy to participate in these committees. Since you are new and have more time, engage the management by offering your services. By engaging with them you have more exposure to the workings of the hospital. The management have limited budget for advertisement and promotion. If you are close to them, they may chose to promote you in their advertising campaign.
As more and more specialists are looking for opportunities in the private practice, owners of hospitals are having a good time handpicking the doctors they want to work with. It is a very competitive environment out there and you have to plan your career when you chose to work in a private hospital.