Deciding if and when to go into private practice

Crossing over from government service into the private sector is a big decision and shhould be carefully considered. — AMITA SEVELLARAJA

One of the most difficult decisions I had to make in my life was to leave government service.

Having worked in the public sector for nine years, I was not able to improve myself in the areas of my interest, namely minimally-invasive surgery (specifically, laparoscopy) and assisted reproductive techniques (specifically, in vitro fertilisation or IVF).

When a private hospital in Melaka offered me a job with training in laparoscopy, I readily accepted.

The right time to leave for private practice is different for every medical speciality.

My own seniors in obstetrics and gynaecology told me: “if you want to leave, leave early, you will have more time to establish yourself.”

I took their advice and left at the age of 34.

I did so in 1994 because I thought that I had enough skills to survive in private practice.

My training in laparoscopic surgery in Taiwan was an additional skill.

The private hospital also gave me a guaranteed income for the first year, which was twice my government income of RM3,500.

At present, remuneration at public hospitals is far better than in 1994.

Many public hospitals also allow limited private practice, whereby a day off is given from work per week to conduct such practice.

In the university hospitals, private practice is sessional.

However, it is difficult for junior specialists to compete for patients with their more established and reputable professors.

So, before making a decision to leave for private practice, do consider the below points.

Pros and cons of public service

In government service, you have a team of colleagues who can cover for you when you go on leave or fall ill; however, you may also not get along well with them, making your working environment unpleasant. — AP

Firstly, let’s take a look at the advantages of being in government service.

These include a guaranteed salary and pension for your retirement.

You also have junior doctors to do all the menial work, as well as seniors around to advise you and to whom you can easily refer difficult cases to.

You can also interact with and learn from doctors in the other government hospitals.

You can take leave at any time, without worrying about losing your patients.

There is also no need to look for someone to cover for you; there will always be someone to take over your cases once you punch out.

In addition, you will be able to more easily attend continuous medical education sessions, perform research and attend conferences.

On the other hand, the disadvantages of government service include having to abide by the rules of the Health Ministry or your department head, which may not always be in accordance to the latest clinical guidelines due to a lag time in implementation.

Continuity of patient follow-up is more of a choice, and it may be difficult or limited in scope.

The oncall schedule may not be to your convenience or liking.

Similarly, you may be called back to work at any time despite being on leave, and indeed, leave can be frozen if the hospital deems it necessary.

You may not be able to explore your areas of clinical interest.

And your career advancement and promotions depend on your superiors, which may sometimes mean seeing your juniors advancing ahead of you.

Pros of private practice

So, why do specialists leave for private practice?

The most common reason is to make more money.

It is easier to leave when you are younger as your income is not yet high and private practice will seem more lucrative.

However, if you leave at a later age when your income is higher, you will have much more to lose.

Those in the pensionable scheme would have to try to get optional retirement in order to not lose their pension, while some may indeed wait until retirement before moving to private practice.

Another reason is to ensure a stable home, especially for those with families.

Previously, a promotion in government service usually meant a transfer to another city or state.

Many specialists do not like to be transferred frequently, and therefore, leave the service.

However, transfers are not as common nowadays, although there may be transfers to smaller/district hospitals when a promotion is given.

When subspecialist training is offered in government service, it is usually written in the contract that you will need to agree to work at a designated hospital upon completion of the training.

Some specialists may also not be satisfied with the work that they are doing and leave government service to do what they really want.

In private practice, you have more freedom, as most of the time, you are your own boss.

You can practise medicine the way you want and not be told what to do.

In addition, there may be more opportunities for self-improvement in the private sector.

Another aspect is that of patient care.

It is nice to be able to see a patient throughout his or 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 the junior doctors under you.

Cons of private practice

But private practice is not all rosy.

You are now at the mercy of your patients.

As a private specialist is a solo practitioner, you are on your own most of the time.

First, you must find a way to bring patients into your clinic.

This is especially so when you first start out in private practice as all your patients will be new ones.

Next, you have to please them and comply to their whims and fancies so that you can convert them to repeat patients and keep them in your practice.

You may have been very popular in government service, but don’t expect your patients to follow you to private practice.

Most of them will more likely ask you to refer them to another government doctor when you leave.

And in order to establish yourself and not lose your patients to your competitors, you cannot afford to take leave, especially during the early years of your practice.

I did not take any leave for my first three years as a private specialist in order to establish my practice.

You also cannot afford to fall sick.

Even if you are unwell, you will need to pull yourself up to continue seeing patients and not lose them to your competitors.

As a new private specialist, work is going to be slow.

It will be demoralising; you may feel depressed and useless as you are not utilising your skills.

You will miss the hectic schedule of government service.

You will also need to market yourself.

When I first started in 1994, I felt awkward visiting general practitioners (GPs).

I would give the receptionist my calling card and wait to be called in to introduce myself to the GP – I felt like a drug representative.

Doctors are not trained to do this. In our line of work, we usually sit and wait for patients to come and see us, not vice versa.

Also, when you first start working in a private hospital, the hospital will try its best to promote you.

Just when you think that you are comfortable, the hospital will bring in another specialist in your field.

So you have to constantly be on your toes to ensure that your rice bowl is protected.

Similarly, when you are in government service, all the private practitioners in your city are your friends.

When you move to the private sector, they will see you as their competitor instead.

Making more money is the main reason most doctors leave for private practice; however, as a new private doctor, you might have to actively market yourself in order to get patients. — Filepic

What’s your USP?

Before leaving for private practice, you need to decide what is your unique selling proposition (USP) is; what are the special factors that will makes a patient choose you over your competitors?

In the book Blue Ocean Strategy, authors W. Chan Kim and Renée Mauborgne suggest that you open up uncontested market space, thereby making competition irrelevant.

So, very early in my career, I decided to adopt this strategy in order to survive in private practice and overcome my shortcomings.

I learnt to speak Mandarin, focused on being the best in laparoscopy and hysteroscopy, and was the first to start IVF services south of Kuala Lumpur.

I am still looking for opportunities to distinguish myself in my speciality.

When to leave

Now that you have all the above information, you have to decide whether or not you are ready to leave government service.

There are a thousand reasons you can tell yourself as to why you think you are not ready.

A colleague once told me: “Every day I wake up and ask myself, am I ready to leave for private practice?

“The answer was always ‘not yet’, so I stayed on in government service.”

Unfortunately, he passed away while still in government service.

Another professor asked me: “How sure are you that you will never fall sick during the entire time you are in private practice?”

He stayed on at his university until retirement.

Someone else 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 did in 1994.

The only problem was that no one told me that in that same ocean, there were also ferocious sharks waiting to eat me.

Only you can decide when you are ready to leave for private practice.

At present, continuing to work for the government as a specialist is going to be more attractive.

The reason is that after being a young doctor on contract and not assured of a permanent job, getting that permanent position will make it more difficult to leave.

Always remember that when you do leave, it will not be an easy path to success.

It will be a slow and arduous journey with grinding hard work to achieve your dreams.

Dr S. Selva is an obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the second article in a weekly series about surviving private practice in Malaysia. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.