Surviving Private Practice In Malaysia

In this episode I will discuss the importance of learning the Art of Asking when working in Private Practice. I will discuss the book of the same title by Amanda Palmar and how it can be applied in Private Practice.

Overthinking is the tendency to ponder all possible outcomes when an event occurs. It's something that happens to all of us, but learning to manage it is crucial, especially for doctors in private practice. In the book entitled "Soundtracks: The Surprising Solution to Overthinking" , Jon Acuff. delves into the concept of overthinking and offers practical steps to conquer it. He introduces the notion of "soundtracks" – those repetitive thought patterns or scripts that influence our actions and decisions. Overthinking isn't a personality trait; it's the sneakiest form of fear, robbing us of time, creativity, and goals. It's an epidemic. He gives 13 steps to overcoming overthinking.

In the medical profession, a difficult case refers to a patient with a complex or challenging medical condition that is difficult to diagnose, manage or treat. I have always wondered whether it is worthwhile doing difficult cases in Private Practice. In this episode I will discuss the advantages and disadvantages of doing difficult cases in Private Practice and give some advice to young specialists in Private Practice.

In this episode I will look at different group practices among specialists in Private Practice and discuss its advantages and disadvantages.

In this episode I will compare the airline industry with the healthcare industry. By learning from mistakes the airline industry has improved their safety record. This is not so in the health care industry. I will discuss why this is so and attempt to give some suggestions as to how doctors can learn from mistakes.

I have always wondered what are the reasons for moving your practice from one hospital to another. Is staying in one hospital for a long time considered loyal. Do hospitals appreciate long staying doctors? In this episode I will contemplate these questions and discuss the advantages and disadvatages of staying in one hospital or moving your practice to another hospital.

I learned very early in my career about the importance of keeping data to improve myself as a doctor. In this podcast I will describe the  challenges I went through over the last 28 years as a private practitioner to keep good data which helped me to learn from my patients. I will also give some tips to young doctors going into private practice how to organize yourselves and keep good data.

In this episode I will try to discuss about dealing with your colleagues in private practie. This will include touching on a sensitive topic of jealousy in private practice and how to avoid and deal with it. 

The operating theater, to me, is the actual “engine” of a hospital.

It is the place where the most revenue (per unit time spent) is made by the hospital and the surgeons. Optimal running of the operating theatre is vital for the success of any private hospital. Every private hospital has its own system for booking cases for surgery. It is very important to have a proper system because the employment and engagement of  staff is vital for the  successful and profitable running of an operation theatre. I will describe what I have experienced at the hospital I work in and then present some suggestions as to how to optimize your work flow to fit into the system.

When working in private practice, one of the difficulties is to get good assistants in performing your work. In this episode I will be discussing my experience in training nurses to assist me and the frustration I faced when trained nurses leave. This led me to employing my own personal nurse. I will discuss the advantages and disadvantages of having your own personal nurse in Private Practice. 

In this episode, I will be discussing about Mark-ups of drugs and medical devices in Private Practice. Mark-up of Drugs and medical supply plays an important part in generating revenue for a hospital. In this podcast I will be answering several questions regarding mark-ups : 1. Why are mark-ups necessary? 2. How is mark-up done 3. Should hospitals inform doctors of their mark-up policy?, Who monitors these mark-ups? and Why is the government not regulating mark-ups?.

The Private Healthcare Facilities and Services Act 1998 (Act 586) and Regulations 2006 (PHFA) on the medical practice in the corporate private hospitals (for profit) in Malaysia was implemented on the 1st May 2006. The whole of the doctors fee schedule is included in this Act.  In this podcast I will discuss the many flaws in this Act that is actually stifling medical progress in Malaysia especially in the Private Sector. 

Our brains can probably hold 5 or 6 items at one time.  Beyond that, we will miss things.A checklist is a type of job aid used to reduce failure by compensating for the  potential limits of human memory and attention. It helps to ensure consistency and completeness in carrying out a task. In this episode I will discuss how I use checklist during my surgeries as well as how I use checklist in my daily life.

The general view among doctors is that it is better to be a specialist in your field than a generalist in your field. In this podcast I will discuss the benefits of being a generalist or better still being a specialist but also have a good idea of being a generalist. I will also give some of my thoughts on how you should prepare yourself when training to be a specialist or subspecialist.

Malaysia is now experiencing a glut of doctors. Many young doctors will be moving to General Practice. Mr Allan Fernandez has 22 years of experience in the health care industry. He runs the Asia Group Practice in JB. He will give his views of what is expected of doctors joining General Practice and the future of General Practice in Malaysia.

Walk-in patients are not uncommon in private practice in Malaysia. In this episode I will discuss the pros and cons of having an appointment system in your clinic and give some tips as to how to deal with walk-in patients. 

Datuk Dr. Tamil Selvam is a consultant Cardiologist at CVS KL. Having worked in a corporate hospital before, he will explain the difference between working in a corporate hospital and working in a hospital that he partially owns. 

Writing Medical Reports is one of job that I despise. In this episode I will explain why I hate writing medical reports as well as give some tips as to how to make writing medical reports easier. 

A grandfather clause is a provision whereby an old rule continues to apply to some existing situations while a new rule applies to all future cases. In this episode I will describe how "the grandfather clause" affects medical practitioners in Malaysia

What is a kickback? The dictionary describes it as an illicit payment made to someone in return for facilitating a transaction or appointment. Fee splitting is the practice of sharing fees with professional colleagues, such as physicians or lawyers, in return for referrals.In this episode I will discuss how kick back and fee splitting has infiltrated Private Practice in Malaysia

Maternity hospitals were popular in the 80's and 90's. Before joining Mahkota Medical Centre, I actually toyed with the idea of opening my own maternity centre. In this episode I will be talking to Dr. Jaspal Singh, Consultant Obstetrician and Gynaecologist at Park City Medical Centre who was running a maternity centre for many years before joining a private hospital. He will give his experience working in 2 compeletely different types of medical facilities. 

Credentialing and Privileging  is a process that every private hospital have to undertake for all physicians practicing in that hospital. It is important for doctors to understand this process and to be prepared for it. In this podcast I will discuss my experience with Credentialing and Privileging  and I will give some advice to doctors planning to move to private practice. 

Disposable instruments are commonly used by surgeons especially during lapararoscopic surgery.  Disposable instruments are expensive. Can we reuse them instead of throwing them away after single use. Is it ethical to reuse disposable instruments? In this podcast I will discuss my experience using disposable instruments and give some advice to young doctors venturing into private practice. 

Medic Foot prints Malaysia is an organisation by doctors for doctors, with  doctors' wellbeing at the centre of their focus. With Industry 5.0 already  on the horizons they believe that doctors should not be boxed into just one field - i.e. clinical. Healthcare is such a vast and wide ocean that  needs more input from doctors. Medic Footprints Malaysia aims to support doctors in all  stages of their careers, from medical graduates to consultants, who want  to make the transition out of clinical medicine and also doctors who  chose to remain in clinical medicine.  
Medic Foot prints  understands how scary and lonely it can be going on this journey and they are here to support doctors so that they will not  have to walk this journey all alone. In this interview I will be talking to Dr. Selina Chew, founder of Medic Footprints Malaysia about her organisation. 

The common thinking is that self- improvement should be the domain of those in the universities or public hospitals and that a private practitioner’s duty is only to provide service. I beg to differ. In his book entitled “ The Anatomy of Success’ the late Dr. Rakesh Sinha said that there are 2 types of people in the world: the learners and the non learners. The best doctors are the ones who want to constantly improve themselves: the learners. By doing so they are providing the best treatment to their patients. In this podcast I will give 15 tips on how to be progressive in Private Practice.

Providing a guaranteed income is a common method used by private hospitals to entice doctors to join them. It provides a sense of security to the doctors who are leaving government hospitals to go to  private practice. In this episode I will be talking about my experience with a guaranteed income and what does guaranteed income mean in Private Practice.

There are many private hospitals in Malaysia. Most of them are owned by government linked organizations or by business man. Very few are actually owned by doctors. Today we are fortunate to have Mr. Timothy Chang who works for a private equity firm, TPG capital and they have set up hospitals where doctors become part owners of these hospitals. This is a very interesting concept and we will learn more about this from him.

In this episode I will try to explain what is a difficult patient and how I deal with them.

Taking a consent for surgery in private practice can be tricky. In this episode I will discuss what factors to consider when taking a consent for surgery in private practice.

We only have 168 hours in a week.How we utilize this time will determine how successful we can be in private practice. I will first give you my experience managing my time as an obstetrician and gynaecologist and then give you some advice as to how you could maximize your time to achieve your goals in life.

A junior specialist recently asked me “How do you deal with complications: the shame, the gossip, the emotional discouragement and the potential litigation?” This is a topic that we   doctors often do not talk about because it exposes our weaknesses and makes us vulnerable in the eyes of the public and our colleagues. In this podcast I will be talking about how to cope with all the emotional problems that may occur when a complication occurs during surgery. 

In this interview Dr. Muruga Vadivale will share his experience working for the Pharma Industry for 25 years. He will give advise to doctors thinking of moving to work for Pharmaceutical companies. 

In this interview I will be asking Prof Lokman Saim, Dean of the KPJ Healthcare University College the challenges he faced in starting a Masters Programme in the Private Hospitals in Malaysia as well of the future of such programmes in other private hospitals in Malaysia. 

Most of us working in private practice will know that the whole private practice will not work without medical insurance. Today I am fortunate to speak to Dr. Prema Sundaralingam, a medical doctor who works for the insurance industry. She will not only answer how is it to work for an insurance company but also how the medical insurance industry works and how it supports Private Practice in Malaysia. 

Medical insurance is an important and integral part of private practice in Malaysia. Almost all patients seen in the private sector have medical insurance. In this podcast I will explore the advantages as well as the challenges faced by doctors and the public when the use medical insurance to get treatment in private hospitals

In this episode I will be speaking to Dr Naveen Rajadurai, Consultant Radiologist and subspecialist in Musculoskeletal Radiology at Damansara Specialist Hospital. The KPJ university also runs a Masters in Radiology programme and Dr Naveen is a teacher and trainer of Master Students in Radiology

This is part 2 of the interview with Dr Ho Hon Lian Consultant ENT specialist at Ampang Puteri Hospital in Kuala Lumpur. In this second part, I will be asking him what happens after he has passed his Masters exam and how he obtained his NSR and became a consultant ENT specialist at Ampang Puteri Specialist Hospital.

We know that many junior contract doctors will be out of job soon. Many of them who want to become specialist have to find alternative ways to get training. I believe that the private sector can also take on this challenge of training specialist in private hospitals.

In this Podcas, I will be talking to Dr. Ho Hon Lin Consultant ENT at Ampang Puteri Hospital in Kuala Lumpur. Dr Ho was trained to be an ENT specialist in private hospitals owned by the KPJ group. This podcast is divided into 2 parts. In this part 1, I will be asking Dr. Ho about his training to become a specialist in private hospitals. In the second part I will be asking him what happens after he has passed his Masters exam and how he became a consultant.

Dr. HM Goh started his career as a medical doctor. Then he transitioned to an informatics expert. Later he moved to health care management and now he is a health care investor working with a private equity. In part 1 he described how he transitioned from a medical doctor to his current job as a health care investor. In this part he will be giving advise to young doctors who want to pursue an alternative path to health care management. He will also talk about the future of private practice in Malaysia.

In this podcast I will be interviewing Dr. HM Goh. Dr. HM Goh started his career as a medical doctor. Then he transitioned to an informatics expert. Later he moved to health care management and now he is a health care investor working with a private equity. This podcast is divided into 2 parts. In this part 1 he will describe how he transitioned from a medical doctor to his current job as a health care investor. In Part 2 of this interview Dr HM Goh will be giving advise to young doctors who want to pursue an alternative path of health care management. He will also be giving his view on the future of private practice in Malaysia.

There is an unseen bond between pharmaceutical companies and doctors. Pharmaceutical companies need the doctors to promote their products and doctors need the financial assistance and marketing capabilities of pharmaceutical companies. The Malaysian Medical Council has a specific guideline entitled “Relationship between doctors and the Pharmaceutical industry” (MMC guideline 007/2006), which aims to ensure, that doctors be as ethical as possible when dealing with pharmaceutical companies. In this podcast, I will describe my experience with the pharmaceutical companies and I will give some advice to young specialist moving to private practice.

There are many situations in which you will need assistance from your colleagues or a specialist from another specialty. When and how to get assistance can be tricky. There will be situations where a colleague will ask you for assistance. You will have to decide whether you want to provide that assistance and the consequences that follow. I will discuss my experience in this area.

You are a government doctor and you want to move to the private sector. In the government service you get a fixed salary. You do not charge for your work that you do. In the private sector, you earn a living by charging a fee for your service. One decision you will have to make is when are you going to waive your fees or give a discount. Are you going to charge your colleagues, other doctors and the staff at your hospital? This issue is rarely discussed among doctors in Malaysia. In this podcast I will explain my experience having worked in a private hospital for more than 25 years. This I hope, will give you some insight on the decisions you will need to make when you move to the private practice.

As a practicing private practitioner, I will divide specialists in private practice into 2 categories and I will call them frontline specialists and supportive specialists. Let me explain further.

A frontline specialist is a specialist who has direct contact with patients. These are the specialists whom patients look for to seek treatment. Examples of these specialities are: Medicine and its subspecialities (general medicine, cardiologist, endocrinologists, rheumatologists etc), Paediatrics, Surgery and its subspecialties, Orthopaedic surgery, Obstetrics and Gynaecology. ENT specialists, Ophthalmologists etc.

Supportive specialists are those who support the frontline specialists. Patients don't seek them out. Examples of these specialities are Anaesthesiologists, Pathologist and Radiologist.

In this podcast I will discuss the advantages and disadvantages of these two different categories.

When I first decided to move to private practice, I applied to a well-known private hospital in Johor Bahru. My application was turned down, as I was considered “not marketable”. This had nothing to do with my skills or ability to work very hard. The decision was just based on my physical characteristics, namely being a male, Indian gynaecologist. I had to do more to attract the patients away from my female Chinese or Malay colleagues who will be the first choice for a woman requiring the service of an obstetrician and gynaecologist.  In this podcast I will examine all these physical factors namely race, religion, language, looks, age, gender and personality that may play a role in attracting patients to your practice.

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. Having concentrated on working hard to become a specialist, 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.

One clause in that contract that has always bothered me is that I am not allowed to practice anywhere else unless I get prior approval from the management. I have always wondered about the unfairness of this clause. We are not allowed to practice elsewhere but the management can bring in anyone into the hospital without even informing us! Bringing in another specialist in my field would definitely eat into my patient load and thus lessen my earnings but I am not allowed to go out to practice elsewhere to supplement my income? This, I have always felt was unfair. In this podcast I will discuss this issue.

I left government service for Mahkota Medical Centre, Melaka in 1994 at the age of 34.

I was a young specialist at that time. Most of the pioneer doctors were off about the same age. Being in a brand new hospital, we worked very hard to build it. As time passes, more doctors joined the hospital. In 2019 we celebrated our 25th anniversary. I am now considered a senior Consultant Obstetrician and Gynaecologist (although I still feel very young) in this hospital. Like most private hospitals in Malaysia, all specialists work as solo practitioners because most of the time we work alone with little involvement of our colleagues.

In order to survive in this kind of environment, 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 relationship with the various stakeholders of this hospital. Some of my experiences were good while others were not so pleasant. Somehow, even though these experiences are talked about casually among doctors, I think no one has actually written them down. So I decided to write down what I feel is important for a young specialist to know before joining a private hospital.