Eight tips for the specialist moving into private practice


Be honest with your patients, and avoid the temptation of doing procedures that are not completely justified. — AMITA SEVELLARAJA

I left government service to practice in a new private hospital in Melaka in 1994 at the age of 34.

I was a young specialist at that time, and most of my fellow pioneer doctors at this hospital were also about the same age.

We worked very hard to build up the hospital.

As the years passed, more doctors joined us, and we celebrated the hospital’s 25th anniversary in 2019.

I am now a senior consultant obstetrician and gynaecologist.

Like most private hospitals in Malaysia, all us specialists work as solo practitioners, with little interaction with our colleagues most of the time.

However, as part of the pioneering team in a new hospital, as well as due to a change in ownership, I had to learn how to interact with all the resident specialists, as well as the management of the hospital.

Over the years, I have gained much experience on how to build good relationships with the various stakeholders of this hospital.

Some of my experiences were good, while others were not so pleasant.

Somehow, although these experiences are often talked about casually among doctors, I think no one has actually written about them.

That is why I decided to write down what I feel is important for a young specialist to know before joining a private hospital.

1. Introduce yourself to everyone

One of the problems I faced in my private hospital was that I only got to know new doctors after they were employed.

The management does not consult its resident doctors before signing a contract with a new doctor. (Do note that this may not be the same in all private hospitals.)

The reason given for this was that a resident specialist had once dissuaded a new doctor from joining the hospital and they were afraid this might occur again.

If offered a job at a private hospital, it is in your best interest to meet with the resident doctors, especially those in your own speciality, even if the management advises you not to, as you are the one who will be interacting with them in the future.

My advice is to make a courtesy call to all the resident doctors, especially those in your own speciality, to inform them that you are joining the hospital and ask them for their advice and blessing.

It will make the senior doctors happy and less antagonistic towards you.

You may feel a sense of animosity towards you during that meeting as you are going to be his or her competitor, but this courtesy call will “soften” your landing in the hospital.

In time, they will accept you as their colleague.

Do introduce yourself to your new colleagues when you first join the hospital as a matter of courtesy. — Photos: FilepicDo introduce yourself to your new colleagues when you first join the hospital as a matter of courtesy. — Photos: Filepic

2. Stay humble

In government service, you have to climb the ladder to reach a position of power.

You work to gain sufficient skills and knowledge in your speciality, which you feel will be sufficient for you to survive in private practice.

But when you walk into a private hospital, you start at the bottom of the ladder again.

Your senior colleagues have been working in the hospital for some time.

Even though you may feel that you are the most up-to-date with the knowledge in your speciality, thus feeling superior to the “dinosaurs” in the hospital, my advice to you is to stay humble.

Your senior colleagues may not be knowledgeable about the latest advances in your field, but they have years of practical experience, especially in private practice.

3. Do not antagonise anyone

Even if you do not like a colleague, do not antagonise this person.

You never know when you may need their help.

There is especially more for you to lose by antagonising a senior colleague who has been in the hospital for awhile and has adapted to the environment.

He does not need you as much as you need him.

Be polite, even if you don’t like him.

4. Don’t talk bad about colleagues

There will be times when a patient who has seen your colleague and is not satisfied with her, will come to see you and complain about her.

Do not agree with them.

Tell them that all doctors have their own opinion and your colleague is correct in giving her diagnosis.

Don’t add fuel to the fire; this will backfire one day as your colleague might do the same to you.

So refrain from bad-mouthing your colleagues.

5. Be patient

It is extremely frustrating to be sitting in your clinic waiting for patients.Learn new skills so that you can differentiate yourself from your fellow specialists.Learn new skills so that you can differentiate yourself from your fellow specialists.

You are a well-trained specialist who was very busy working in a government hospital prior to this.

Now, you are sitting around doing nothing.

Private practice is not the same as a government hospital.

All of us sat around for a long time before patients got to know about us and started trusting us, so be patient.

6. Don’t feel dejected

Try not to feel bad if a patient who consulted you finally ends up with your more senior colleague.

I have had this experience on numerous occasions when I was younger, and still experience this even now.

However well you may have discussed the options with your patients, they will make up their own mind and decide who will ultimately manage them.

You may feel dejected and upset that you have lost the patient to your colleague, but if you have been honest in your opinion and did not bad-mouth your colleagues,

I assure you that ultimately, you will have sufficient work and will be successful.

7. Be honest with your patients

When you first start in a private practice, you will be tempted to do procedures on patients that may not be warranted.

I had this experience as well during my early days in private practice.

Sometimes, the line between being conservative and being aggressive in managing a patient can be very thin.

You may be tempted to be more aggressive because you want to earn more from the patient.

My advice is to refrain from doing this.

You have to think in the long term and build a good reputation for yourself, not just look at the immediate short-term gain.

Be honest with your patients and you will be rewarded for it in the future.

Sometimes, it may be a good idea to ask your patients to get a second opinion.

You may be worried that you will lose your patient to your colleague, but your patient will find you honest.

8. Get new skills

If you are the eighth or 10th doctor in your speciality at the hospital, there must be a reason for a patient to want to see you instead of the other specialists.

Having special skills will help. With these special skills, you may be able to attract patients away from your colleagues.

Again, don’t be arrogant just because you have these skills.

In my experience, colleagues who do not have your skills will either downplay those skills, or even send their patients away to a doctor in another town for treatment.

The reason is that if the patient gets the treatment in another town, the chances are when they come back, they will still return to see them.

If they send the case to you, they will possibly lose the patient to you.

Being patient and humble can help win them over, so that they will refer their patients to you for your special skills.

After doing what you have to do, it would be nice to send the patient back to the original doctor for future follow-up.

I will give you an example.

I started doing IVF (in-vitro fertilisation) in 1997. I was the first to do IVF in my town.

However, I found that my colleagues did not send their patients to me to do IVF, but instead, sent them away to Kuala Lumpur.

It took me years to convince them to send their patients to me for IVF.

After a successful IVF cycle, I always send them back to the referring doctor for the pregnancy checkup and delivery.

Dr S. Selva is a consultant obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the fifth 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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