One of the most difficult decisions I had to make in my life was to leave government service for Private Practice. Having worked in the public sector for 9 years I found myself not being able to improve myself in the areas of my interest namely Minimally Invasive Surgery (laparoscopy) and Assisted Reproductive Techniques (IVF). Mahkota Medical Centre offered me a job and training in Minimally Invasive Surgery. I took that offer.
The timing to leave for Private Practice is different for different specialities and at different times. My seniors told me that if you want to leave for Private Practice, leave early. You will have more time to establish yourself in private practice. I took that advice and left at the age of 34. I could do so in 1994 because I thought that I had enough skills to survive in Private Practice. I thought that my training in Obstetrics and Gynaecology in Hospital Sultanah Aminah, Hospital Kuala Lumpur and in the United Kingdom, was sufficient to start Private Practice. My training in laparoscopic surgery in Taiwan was an additional skill, not possessed by any gynaecologist in Melaka at that time. This I hoped will distinguish me from others in town. Another incentive is that Mahkota Medical Centre gave me a guaranteed income for the first year. It was twice that of my government income at that time which was RM 3500.
At present, remuneration at Public Hospitals is far better than in 1994. Many public hospitals also allow limited private practice. Senior specialists in the Ministry of Health are given a day off from work per week to do locum at private hospitals. In the university sitting, private practice is more sessional. However, it is difficult for junior specialist to compete for patients with the Professors who are already established and have good reputation.
Before making a decision to leave for private practice, there are several issues I want to discuss:
Table of Contents
1. What are advantages of government service/academic institutions
- You have an assured pay check every month
- You have junior doctors doing all the menial work.
- You can take leave anytime you want without the worry of losing patients or even the need to look for coverage. There will always be someone working and taking over from you when you punch out.
- You have seniors to get advice from and easy referral to tertiary centreYou have continuous medical education
- You can do research
- You can go for conferences
- You can interact and learn from other doctors in the other government hospitals
2. What are the disadvantages of government service/academic institutions?
- You have to abide by the rules of the Ministry of Health or your Head of Department which may not be in accordance to the latest guidelines
- Continuity of patient follow up is more of a choice, however due to the large number of patients, it may be difficult/selective
- You may not get to do what you want.
- Your Head of Department or even your colleagues may not like you.
- On call schedule may not be at your convenience of liking.
- You may be called back for your services at any time despite being on leave.
- Leaves can be frozen for example in this current pandemic.
- You may not be happy with the working environment
- You may not get the promotions that you deserve
- You may be discriminated
- Your juniors may supersede you in promotion.
- There is no transparency in promotions
3. Why specialists leave for private practice.
- To make more money.
This is the commonest reason for leaving the government service. If you leave at an early age when your income is not that high, your expectation will not be high as well. However if you leave at a later age, when your income in the government service is higher, you will have much more to loose. Many will try to get an optional retirement if they are in the pensionable scheme. Others will just have to wait until retirement before moving to private practice.
Previously, a promotion indicates transfer to another city/state. Many specialists do not like to be transferred frequently and so leave the government service. However, transfers are not common nowadays although there may be transfers to smaller/ district hospitals when promotion is given. When subspecialist training is offered, it is written in the contract that you will need to agree to work in a designated hospital after completion of the training.
- Work dissatisfaction
Some specialists may not be satisfied with the work that they are doing and so leave government service. There may be more opportunities for self-improvement in the private practice.
- Freedom to do what you want
In Private Practice, most of the time you are the boss. You can decide how you want to work. You can practice medicine the way you want and not be told what to do.
- Continuity of patient follow-up
It is nice to be able to see a patient throughout his/her life. The continuity of patient follow-up may not be possible in the government service as one is too busy tying up all the loose ends of all your junior doctors.
4. What is the reality of Private Practice?
- You are at the mercy of your patients
As a Private Specialist in a hospital, you are a solo practitioner. You are on your own most of the time. Firstly you must find a way to bring patients into your clinic. Next you have to please them and comply with all their whims and fancies so that you can keep them in your practice. When you start Private Practice, all the patients you see are new patients and it is your job to convert them to repeat patients.
- Don’t Expect your Government patients to follow you
You may have been a very popular doctor in the government service but don’t expect your patients to follow you to private practice. Most of them will ask you to refer them to another government doctor when you leave.
- You cannot take leave
In order to establish yourself and not loose your patients to your competitors, you cannot afford to take leave especially in the early part of your Private Practice. I did not take any leave for almost 3 years so that I could establish my practice.
- Insufficient work
As a new specialist in private practice, work it is going to be slow. It will be demoralising. You may feel that you are a good specialist/surgeon and patients should come to see you but that is not the reality in private practice. You may feel depressed and useless as you are not utilizing your skills. You will miss the busyness of government service.
- Market yourself
You will need to market yourself. When I first started in 1994, I felt really awkward visiting general practitioners. I will give the receptionist my calling card and wait to be called in, to introduce myself to the GP. I felt like being a drug representative. Doctors are never trained to do this. In our line of work, we sit and wait for patients to come and see us and not visa versa.
You cannot afford to fall sick. Even if you are unwell, you will need to pull your self up to get to work so that you can continue seeing your patients and not loose them to your competitors.
When you first start working in a private hospital, the hospital will try their best to promote you. Just when you think that you are comfortable with the volume of your work, the hospital without informing you will bring in another specialist in your own field. You have to be on your toes all the time to ensure that your rice bowl is protected.
- Your Colleagues
When you are in the government service, all the private practitioners in your city are your friends. When you move to the private sector, your colleagues will see you as their competitors.
5. What factors determine your success in the private sector?
When we started working at Mahkota Medical Centre in 1994, most of us who joined the hospital were young specialist from outside Melaka. Very few of the established private specialists in town joined the hospital. The CEO at that time decided that in order to attract patients to this new hospital, we should charge less. We did charge less. Some may call it undercutting but this is legal in the medical practice. We worked very hard for very little money to promote the hospital to the local community and the surrounding districts.
I have always asked myself this question. Why should a patient come to see me instead of my colleagues/competitors? Being an Indian male OBGYN, I will be the last option to consult for a lady who is pregnant or having a gynaecological problem. I must have something that distinguishes me from others. What could that be?
Am I more friendly? Do I smile more often? Do I listen to my patients better? Do I give a better-unbiased opinion? Do I look more presentable?
Do I have special skills not provided for by my competitors? Will these skills draw patients away from my colleagues/competitors to me?
Am I more honest in giving advice?
Do I come to see my patients anytime they want me to see them? Am I prepared to be called at anytime of the day? Do I give my personal mobile number to all my patients?
Am I cheaper than my colleagues/competitors? Are my fees lesser?
Before leaving for private practice you need to decide what is your unique selling proposition (USP) that makes a patient choose you over your competitors. In the book Blue Ocean Strategy, the authors Chan Kim & Renée Mauborgne suggested that you should open up uncontested market space thereby making competition irrelevant. So, very early in my carrier, in order to survive in private practice, and acknowledging my physical deficiencies, I decided to adopt this strategy. I learnt to speak Mandarin, focussed on being the best in Minimally Invasive Surgery (laparoscopy and hysteroscopy) and be the first to start IVF services south of Kuala Lumpur. I am still looking for opportunities to distinguish my self in my speciality.
When to leave for private practice?
Now that you have all the information, you have to decide whether you are ready to leave government service for private practice. There are a thousand reasons you can give yourself why you think you are not ready. A colleague of mine once told me “ Everyday I wake up and ask myself, “am I ready to leave for Private Practice”? The answer is always “not yet”. So I stayed on in the government service”. Unfortunately he passed away while in the government service. Another professor once asked me “ How sure are you that you will never fall sick during the entire time you are in private practice?” He stayed on in the university till retirement.
Someone once told me – “Make that jump to private practice and you will find your way – there is an ocean of opportunities awaiting you”. Are you prepared to take that jump? I took the jump in 1994. The only problem is that no one told me that in that same ocean there are also ferocious sharks waiting to sink me.
Well, only you can make that decision as to when you are ready to leave for private practice. At present, continuing to work for the government is going to be more enticing. The reason being, young doctors are all on contract and are not assured a permanent job. So if you already have a permanent job, it will be more difficult to leave. Always remember that when you leave, only few will have an easy path to success. For the most of us, it will be a slow and ardours journey, grinding through hard work to achieve success.
I would like to thank Dr. Andrea Angeline Dass for her contribution in improving this document