Practice options when a doctor decides to go private


Going into private practice also means having to choose which type of practice you want to work in. — AMITA SEVELLARAJA

When I decided to go into private practice in 1994, I looked at all my options.

Being an obstetrician and gynaecologist, I had several choices.

One option I had was to join an established hospital.

This was tempting at that time for two reasons.

Firstly, an established hospital would be equipped with all the appropriate facilities in order for me to practice my speciality in comfort.

Secondly, most of the consultants in an established hospital would likely have a big patient load, which I hoped would spill over to me if they had insufficient time to manage them all.

I applied to two such hospitals in Johor Baru where I was based at the time, but my application was turned down.

I also had two other offers.

A well-established obstetrician and gynaecologist had offered me an opportunity to join him in his practice, and I also had the option of taking over an established maternity home.

I spoke to my boss and he advised me against buying the maternity home as it would be difficult for me to progress in my speciality if I were tied down by a maternity home.

I took his advice and turned that offer down.

I also decided not to join the senior obstetrician and gynaecologist as I was not sure I could get along with him.

I was ambitious and I wanted to be more than just a general obstetrician and gynaecologist.

When I finally decided to join the private hospital I am with now, it was a calculated risk.

Fortunately, I grew with the hospital and managed to do so many things that I would have not done had I chosen differently.

This might have been my good luck or my sheer determination, or both.

I am grateful that the hospital management has supported me in all my new endeavours, even though I had to fight very hard to get them to do so.

So, if you have decided to go into private practice and are looking for a place to go into practice, these are your options:

> Join as a pioneer

This means joining a brand new private hospital that is just about to open or has just opened very recently.

The advantage to this is that you will obtain “pioneer” status.

You may be able to help in the setting-up of the various services in the hospital, as well as be consulted in the way the hospital and doctors charge the patients.

You will not be answerable to any senior colleague, and will indeed be deemed the senior colleague to doctors who join the hospital later.

The hospital will also help to promote you as part of their efforts to publicise the hospital’s services and facilities.

Of course, as a new hospital, it may take some time to attract patients and to become busy – you will have to be patient.

Your income may not be secured, especially during the early days.

It is a real possibility that the hospital might fail altogether, or that it may have cash flow problems, resulting in you not being paid for your services.

You will also have to work doubly hard as you will need to go out and talk to the public in order to help bring patients into your practice and the hospital.

And once you work hard to establish yourself and the hospital, the hospital is likely to take in another specialist in your area without consulting, or even telling you, giving you direct competition.

A new hospital also means that some facilities relevant to your practice may not available.

And you will have to follow the management’s policies whether you like them or not, including possible restrictions as to what you can and cannot do in your clinic and the hospital, and not being allowed to work in other hospitals.

> Join an established hospital

Joining an established private hospital usually means that facilities such as imaging equipment, are available for you to use. — Photos: FilepicJoining an established private hospital usually means that facilities such as imaging equipment, are available for you to use. — Photos: Filepic

You can choose to join an established hospital as the second or third (or so on) specialist in your field.

As it is already established, there will be many potential patients, although you will need to attract these patients to choose you, rather than your colleagues.

There is likely to be a spillover of patients from the other established specialists in your field who are already busy.

Cash flow is also unlikely to be a problem in an established hospital.

These factors mean that you have a better chance of a more secured income.

In addition, all the facilities you need should already be available for you to use.

The disadvantage of joining an established hospital is that you will considered the junior specialist and may have to answer to your more senior colleagues.

The hospital may not help to promote you.

An established hospital also means established rules and regulations that you have to follow, even if you might not like them.

Similar to joining a new hospital, you will have to follow the management’s policies, which may include restrictions as to what procedures you can and cannot do, and not being allowed to work in other hospitals.

> Join as an assistant

This means that you become an assistant to an established colleague in his or her private practice.

The advantage of this is that there will not be a shortage of patients as it is an established practice.

You will be assured of a steady income and you can more easily take time off as your colleague can cover for you.

Conversely, your boss may take advantage of you and it might be hard to say no to him or her.

You will always be in the shadow of the senior doctor.

As it is their practice, you may not be able to practice medicine the way you want.

In fact, if you have a misunderstanding with him or her, you may wind up being out of a job!

And if you leave the practice, the patients’ records are not yours, even if you are the one who attended to them exclusively.

You will also not be establishing your own name or your own practice.

> Open your own clinic

Opening your own clinic gives you the freedom to call the shots, but also means coming up with the capital to invest in infrastructure, equipment and personnel.Opening your own clinic gives you the freedom to call the shots, but also means coming up with the capital to invest in infrastructure, equipment and personnel.

You can open your own clinic and also have the freedom to practise as a visiting consultant in private hospitals.

As the boss, you will be free to do what you like in your clinic and practise medicine your own way.

All the goodwill and rapport you build with patients and colleagues will be yours exclusively.

You can also pick and choose which hospital you want to admit your patients to.

In addition, your clinic is an asset that can be sold upon your retirement or whenever you decide to do so.

The disadvantage of this type of practice is that you have to come up with the capital to set up the clinic and its facilities.

You will not only have to market yourself to get patients to come consult you, but you will also have to do your own administrative work.

You might also not be able to secure a position as a panel clinic for companies, including insurance, resulting in a smaller pool of available patients.

It may be difficult to get visiting rights in hospitals.

And you may not get support from seniors or other colleagues, and may feel lonely.

You can change

Choosing the type of private practice you want to go into can be a daunting task.

Sometimes, your options may be limited and you may have to take whatever is available to you at that particular time.

Obviously, you can change to another option at any time if you are dissatisfied with your first move.

I have seen specialists starting their own private practices, then later moving to a private hospital, and vice versa.

Staying in one practice for your entire life is not common.

The most difficult step is to make that big decision to leave government service.

It is unfortunate that in Malaysia, once you leave the government service for private practice, the cord is cut and there is no way you can go back to serve the government again.

This will be even more difficult in the future as more doctors are graduating and more specialists will come into service.

Dr S. Selva is an obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the third article in a weekly series about surviving private practice in Malaysia. For more information, email starhealth@thestar.com.my. 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.

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