So you have decided to move to Private Practice. How are you going to persuade the public to consult you in preference to your colleagues?
At medical school, you were never taught about the economics of medicine or marketing for patients. In fact talking about money in the medical field is abhorred.
“You do medicine because you want to help people, not to make money stupid” – that is the expectation of the public of doctors.
After graduating from medical school, you will first work as a houseman for 2 years. Then you will have to decide on a speciality and train for an average of 4 to 6 years to become a specialist. After that, some of you will go on to train as subspecialists for several more years. By the time you feel competent to move to private practice, most of you are in your late 30’s.
Having concentrated on working hard to gain your skills, you have never thought of how to survive in private practice. You are unaware of how you are going to market yourself when you move to private practice. When working in the public service, you work in a cocoon where there is always an overflow of patients. In private practice, you will have to compete for your patients. This is a topic often discussed by doctors but rarely penned down. Having worked in the private sector for 25 years, I will try to outline my thoughts on this topic.
Medical Act 1971 (Act 50)
In the “Code of Professional Conduct 2019” adopted by the Malaysian Medical Council (MMC), Item 4 states, “ The medical profession in this country has long accepted the convention that doctors should refrain from self- advertisement. In the Council’s opinion self- advertisement is not only incompatible with the principles, which should govern relations between members of a profession but could be a source of danger to the public. A practitioner successful at achieving publicity may not be the most appropriate doctor for a patient to consult. In extreme cases advertising may raise illusory hopes of a cure”. The document then goes on differentiating between “advertising and canvassing” which is obviously not allowed and “dissemination of information” which is allowed under strict conditions.
My experience with this law
The law is somewhat archaic and draconian. I know it well because I had to face the Medical Council in 2005 for an offence of advertising. Let me elaborate.
Mahkota Medical Centre started its IVF services in 1997. In the year 1999, the management decided to invite all the patients who were successful in undergoing IVF treatment at the centre to bring their children for a birthday party. During the party, I, as the head of the IVF centre was asked to give brief opening remark. An article came out in the Sun newspaper on that event (see the picture above). In the paper my face appeared. Someone complained to the Malaysian Medical Association and the MMA took up the case against me with the MMC. I had to defend myself. As I did not speak to the writer and he wrote the article by himself, the writer was my witness. After 5 years of personal torture and stress the case was heard by the MMC. I was acquitted of any wrongdoing. It was a great relief. However, it taught me a big lesson on the draconian laws of the country.
After that, for many years I have avoided places where there are reporters fearing that the same incident may recur.
How does private hospitals work?
Currently, there are more private hospitals than government hospitals in Malaysia and more are mushrooming. Private hospitals are competing with each other for patients. For a private hospital to succeed, it first must have the necessary facilities to entice patients. These include an elegant building, clean wards, good equipment for diagnostics etc. They also need competent doctors to work in the hospital. Currently, in Malaysia, most specialists are not employed by private hospitals. They are consultants to the hospital and earn from their consultation fees and procedure/ surgical fees. This has an advantage to both the hospital and the consultants. The hospital is not burdened by the wages of the consultants and the consultants earn based on how hard they are willing to work.
During one of the meetings with the management, the newly employed CEO of a private hospital told a group of doctors that the most important part of hospital business is the hospital facilities. The doctors jumped in disagreement. Doctors feel that they are the most important part of a hospital. Thus, there is a constant tussle between doctors and the hospital management as to who is more important in attracting patients.
When you decide to join a private hospital, the management will give you the reassurance that they will help to promote you. The management might have given you a guaranteed income and so it will be in their best interest to find and send patients to you to ensure that they are not loosing money having promised you the guaranteed income. However, when terms of your guaranteed income are over, they will bring in another specialist in your own field or sometimes even earlier. Sometimes they will not even inform you of this employment. It is now time to promote the new specialist. You are left to fend for yourself. You will need to think how to market yourself so that you can continue having a decent practice. This is the reality of life in the private practice.
How do the public choose their doctors
A vast majority of patients in this country see a doctor in the public/government hospital. Here they receive good and almost free service. However they do not have the option of choosing their doctors (unless they have ‘connections’). Private practice survives because of personal relationship between the doctor and the patient. However, the patient has to pay, out of their pocket for outpatient consultation and treatment. If they have medical insurance, then their inpatient charges are covered by the medical insurance.
I have always been intrigued to know how the public decide on who to seek treatment for their ailment. Do race, religion, age, gender, looks and personality play a role in their choice?
I have always adopted a very professional personality at work. Being a gynaecologist and dealing with women all the time, I thought this is what I should portray. Some people have called me uptight and unfriendly. I have always envied my colleague who has a friendlier personality. Unfortunately, I am not able change myself. However skilful you are in your speciality all the factors I have listed above will play a part in getting patients to your consultation suite. ( I will discuss these factors in another blog)
How to market yourself in the current climate
I always felt that the law in the country favours businessman who owns hospital. Although hospitals have their own guidelines on advertisement, the laws towards them are more relaxed compared to medical practitioners. If a hospital breaks the law, they just get fined. If a medical practitioner breaks the law, he may get a suspension or his name may be struck of the MMC register.
If you want to buy a car, you Google to get information about cars, prices, quality etc. You read blogs on other peoples’ opinions about cars and then you make a decision as to which car to buy based on your budget.
If you have an illness and you want to find the best doctor to deal with your condition, what do you do? You ask your neighbour, friends, relatives or your friendly general practitioner and then you decide who will be treating you. This is called “word of mouth”. Does this sound correct? How can you as a young specialist get the word out about your skills and your personality? It will take a long time for this to work for you. What are your choices in getting the word out about yourself? Some of the time-tested methods are:
- 1. Visiting General practitioners (GP) in your area and informing them about your skills so that they will refer their cases to you
- 2. Giving talks to GPs to show case your expertise
- 3. Giving talks to the public through associations and NGO’s informing them about your skills and expertise
- 4. Joining groups and associations and be active so that people know who you are.
What are the newer methods used now.
- 1. Webinars – Since the COVID-19 pandemic, webinars are a common practice. The reach is far and deep. It is easy to do and cheap. Many doctors have got into this bandwagon and give talks in webinars.
- 2. Facebook live – Some doctors have their own sessions on face book live where they talk on certain topics giving the public information and hopefully the impression that they are the expert in that particular field.
- 3. Youtube videos – Many doctors have their own youtube channels where they post videos on their speciality. The public will hopefully see these videos and reach out to them.
- 4. Other social media – Instagram, Twitter, Linked-in etc. With an active social media platform, doctors hope to reach out to the public.
- 5. A friend of mine joined BNI (Business Networking International) where professionals come together to help each other grow their business. They meet every week and each discuss their business and help in improving network to assist each other in cross referrals. Since only one member per profession is allowed in a chapter, there will not be any competition. This I thought was an innovative method of marketing without the worry of being caught for advertising.
- 6. Write a book- You could write a book on your area of speciality and this can portray you as an expert in your field
- 7. Publish papers in journals – I am unsure whether the Malaysian public is sophisticated enough to recognise someone as an expert by looking at their publications in academic journals. In fact most private practitioners never publish anything and are still busy working.
Is marketing in social media legal?
One is unsure whether having an active social media is considered a violation of the Medical Act. I was told that strictly, any form of social media is a violation. However the only good news is that if no one complains than you can get away with it. The only issue is how effective is social media marketing. Your competitor is also doing the same and probably pays Google to attract traffic. The public will still have to decide who is the best doctor for their illness.
There are so many medical schools in Malaysia now and hundreds of doctors are graduating every year. The government is unsure how to deal with all these doctors. Most of the young doctors are going to be given contracts. They will be asked to pay for their own speciality training. The young doctors are going to find it very difficult to find a hospital to train as specialists. Moreover, since there are less patients to train on, there are going to take a longer time to be well trained in their specialities. We are going to see poorly trained specialists looking for jobs in the private sector in the future. Private hospitals are going to employ these specialists and pay them a small amount perhaps salaries that are even lower than the salaries in government hospitals. In this way they will be able to control them. Employed doctors are usually not so committed or hardworking compared to fee-per-patient consultants. They will stop their clinics at the stated time and not come to see patients when they are not on call etc. The environment in the private sector will change completely. There will be no necessity to market yourself, it is the duty of the hospital to bring in the patients to you. Hospitals will only employ the number of specialist that is sufficient to run their business as opposed to now: the more consultants the merrier because they are not paying their wages. The ultimate losers are the public. They will not know who is the best doctor to treat them. This is the future of private health care in Malaysia. Businessman controlled, good facilities but poorly qualified, inexperienced and uncommitted specialists. So if you are contemplating doing medicine, switch to hospital management. You can rule the doctors, have a good night sleep and still make a lot of money.