Is Moving Your Practice From One Hospital To Another, good for Private Practice?

Is Moving Your Practice From One Hospital To Another, good for Private Practice?

I recently met a doctor who moved his private practice from one city to another because his daughter started studying at there.  Then, rcently he moved to work from one hospital to another. This was because the newer hospital had better facilities hence, enabling him to  learn a new skill and improve his existing skills with cutting edge equipment. These are valid reasons to move.

Another specialist in Melaka moved from one hospital to the hospital I am working in now,  about 20 years ago.  Eight years ago, he  moved again  to another  hospital and is very happy working in his current hospital.

Unlike both these doctors, I have stayed in the same town and the same hospital for the last 28 years. I am not sure whether I am lucky or just complacent, working in the same hospital for such a long time. I must say the single most important reason why I continued in this hospital is that I have been able to continuously improve my skills over the last 28 years. I am not sure whether the credit should be given to myself or the hospital. It is perhaps both, as I have always been interested in improving myself and the hospital has supported most of my endeavours, although on many occasions, I have  had to fight very hard for it.

Is staying in one hospital considered being loyal? Do  private hospitals value your loyalty? These are some of the questions I often ask myself.

Private hospitals are created as a business entity. Doctors work in these hospitals to earn a living. Hospitals should create an environment whereby doctors working there,  have a sense of belonging. They should be proud of where they work. How can hospitals do this? Most doctors working in a private hospital do not have anything that belongs to them in the hospital. This is how hospitals are created, at least in the current environment. They are created as a place for a doctor to work. Everything in the hospital belongs to the hospital. In this way any doctor is replaceable. In this scenario, a doctor is just given a space to do his work. It could be a temporary place and could change everyday or after some time. The space that he sits in and sees his patient does not belong to him and he does not have a sense of ownership to it. It is just a temporary space. Some doctors do not even have an office dedicated to them. An example is an anesthesiologist. He works in the operating theatre or intensive care unit. He is not given an office. In this kind of scenario, do you think a doctor will have a sense of belonging to the hospital? Most definitely not. He will be the first person to leave the hospital when a better offer comes by.

What about others who are given a semi permanent office to work in? Would  they have a sense of belonging? At the hospital I currently work in,   a doctor is allowed to rent or buy a  suite. The doctors who buy suites will have some form of ownership in the hospital because they have invested in the hospital. The chances that they will leave the hospital is lesser than those who are renting.

How does a hospital invest in a doctor?  When a doctor joins a hospital, the hospital spends money marketing that doctor. This is an investment made by the hosptial on the doctor. The more popular the doctor becomes and the more patients he sees, the more lucrative it will be for the hospital. It is easy for hospitals to market their building, facilities or even their services but nothing beats the marketing of an individual: a doctor. Stories about an individual gets better attention from the public than an innate object such as a building or  a machine. That is the reason why hospitals spend money on advertising their doctors. So, after spending so much time and money on a doctor and he becomes famous, how does the hospital feel when he is enticed to move to another hospital? If the hospital is owned by a person or a family, they will feel the loss. However, since now most hospitals are corporate bodies, no one feels anything anymore. Life just goes on.

Now lets look at the doctor’s perspective. He is promoted by the hospital but he also works hard and spends his own money to improve himself. He spends his time doing his own marketing especially  in social media. He becomes a popular doctor in the new town he had moved to. Patients from near and far look for his services. He wants more expensive instruments and the hospital cannot afford to buy  them for him. He is lured to another hospital which promises everything he asks for. He decides to move to the new hospital. Is he being unloyal? He is just taking care of himself and his own interest. Loyalty does not count here and I think he is right to choose what he wants.

How does a hospital reward your loyalty?  One way is to give you a voucher or a gift during an annual function when you have worked for a long time in the hospital. This could be 10 years,15 years or 25 years. I have received all of them and probably will receive the 30 and even 50 years loyalty gift, god willing if I am still alive and healthy. However, just giving a gift during an annual function is probably not enough. Hospitals should look at other avenues to thank their long service doctors. They may be there not because of loyalty, but because they are probably in their comfort zone and do not want to shift to a new hospital l or town at the late stage of their life. They are not expecting monetory rewards from the hospital, only some form of recognition for their grit to stay and work in one hospital. People in the management of a hospital change. A new CEO is not interested or even bothered about the history of a hospital.. He couldn’t care less if a doctor has worked there for 25 years or 5, as long as he is bringing patients and money to the hospital.

What are the advantages of staying in one hospital for a long time? The first is that there is a sense of continuity of work. If you work in one place for a long time, you will know your patients’ history. I have delivered the babies of women I have delivered themselves before. There is also the opportunity for continuous improvement through the collection of data. You are   familiar with the culture of the hospital and so  you will be in your comfort zone. There is also no disruption to the service provided. Patients know where to find you if you are in one place all the time.

What are the disadvantages? The management of the hospital will take you for granted and will not support you after some time. You are on your own to market yourself to get your patients. Since you have been there for a long time and they feel that you will not leave,  they will not give you what you want. They will ask you to just use the existing facilities to manage your patients. Investing in new things will mean more cost to the hospital l and less profit for them. It will be a “take it or leave it situation” and since you will not leave you just have to take it.

What are the advantages of moving to another hospital? Newer hospital are always keen on investing in new technologies. New hospitals aim  to outdo existing hospitals in terms of  “looks” and facilties. This will be a benefit to established doctors. You move to a newer hosptials with better facilities. Since patients move with doctors you need not worry. Your patients will follow you. By moving to a newer hospital l l you can also press the “refresh” button and change your bad habits that you developed in the old hospital. You can create newer and better habits in the new hospital l. There is also an opportunity to meet new people in the new hospital l.

What are the disadvantages of moving? There is always this worry that your patients may not follow you to the new hospital. This is especially so if  you move to a new town. You may have to start all over again and this can be tiring especially when you are already middle aged. The new hospital l may not be better than the old one as after some time things will appear to be the same, so why bother with  the hassle of moving?. You will need to adapt to the new environment and culture of the new hospital. This can  sometimes be challenging , especially if you are one of those who are dogmatic in what you do.

So what advise can I give young doctors moving to private practice?

  1. The first private hospital that you are offered a job in may not be your first choice hospital. So work the best you can in that hospital to get as much publicity as possible for the work you are doing. Giving your best will bring out the best in you. However, at the back of your mind always do things that will enable you to move if a better offer comes by.
  2. In private practice there is no such thing as loyalty.This is especially so in corporate  hospitals. The owners of the hospitals have no idea of who you are and what you are doing for the hospital.  Do what is good for you and move if you find better opportunities
  3. If you like the  place you are working and would like to remain there for a long time, claim some ownership in that hospital. This could be buying a suite, or investing in the hospital or even buying equipment used in the hospital. A sense of ownership will make you proud of the hosptial you are working in.
  4. Always believe in yourself and your ability. Do things to improve your skills and your image. The image of the hospital is the duty of the management. Your image is the one that will carry you when you decide to move to a different hospital or even a different town. It is easier now with social media than it was  15 or 20 years ago. Be that man or woman with skills searched for by everyone, near and far.
  5. Don’t be complacent even if you are doing well. Things can change very fast in this fast moving world. A new hospital may open up in your neighbourhood or a new doctor in your field may join the hospital and take away all your patients. Be vigilant and move if you find a better opportunity. You must always be prepared for it.
  6. Make yourself so valuable that the hospital you work in wants to keep you and other hospitals are dying to entice you to work for them. Keep looking for a better deal all the time. Just like hospitals keep you on your toes by bringing in other doctors anytime they want, keep them on their toes but letting them know that they can loose you anytime. Not many doctors can achieve such status.
  7. The end game is about providing good and efficient care for your patients and accomplishing it in a safe environment. The move should justify this objective.

Dr. Selva

16/9/22

I would like to thank

My wife P. Sarojini for editing this article

Dr. Gunasegaran for reading through the article and giving good suggestions.

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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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