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Again, it has been 3 months since I wrote Part 3 of this series of topics. I had discussed the public health care system, the general practitioners and now finally, I will discuss the private hospitals. I am sure many junior doctors will be very much interested in what I am going to write as many still “falsely” believe that they are going to make tonnes of money by joining these hospitals in the future!

I am going to write about this topic in various sections of interest. Private hospitals began to appear in this country way back in 1980s. Some of the first few private hospitals appeared in PJ and Penang. Many people rushed to these hospitals for better service and faster specialist treatment compared to government hospitals. Of course, it came with a price and many had to pay cash those days as there was no such thing as a medical card. 

What is a Private Hospital ?

Private hospitals are run by businessman for a profit. There are very few private hospitals which are run by medical doctors, mainly small centres in smaller towns. Saying that, it is still a business entity and the whole idea is to make profit. They are not here to do charity work and every single thing that they use on a patient is chargeable.

Some of the smaller private hospitals are slowly being bought over by bigger corporate giants. Currently, there are 3 big corporate giants who own almost all the private hospitals in the country; Johor Corp runs the KPJ hospitals throughout the country, Parkway (Khazanah owned) runs Pantai and Gleneagles hospitals and lastly Columbia Asia Hospitals (30% owned by EPF). Singapore owned HMI runs the Mahkota Medical Centre and Regency Specialist Hospital. There are still some independently managed hospitals like Assunta, Fatimah Hospital, Arunamari etc etc.

How do the private hospital system work in Malaysia?

Private Hospitals DO NOT pay the consultant a salary. You are NOT employed by the private hospitals. This is a general misconception by many junior and budding doctors. Many still think that the private hospitals are paying all the consultants a fixed salary totalling more than RM 50K/month etc etc. In fact, many of my friends and patients also feel the same.

Private hospitals only hire consultants to run the clinics. Medical officers are employed to manage the emergency department. However, the consultants are considered self-employed. You are actually renting a room in the hospital to provide services to your patients. Your room rental can range from RM 3K to 8K per month. Your income comes from your consultation and surgical fees that you charge the patients. This is regulated by the Private Healthcare and Facilities Act 1998 which was implemented from 2006. Prior to that, we used the MMA schedule of fees. So, if you don’t charge the patient, you got no income. If you don’t have enough number of patients for a particular month, you may even earn less than what you may earn in the government sector. It all depends on your luck and marketing. This is when unethical practises will appear, especially when the competition gets tougher. I will elaborate this later.

On top of the monthly clinic rental (RM3-8K), the hospital will also take 10-20% of your consultation fee as their administrative fee. So, basically you are working like a dog to give easy money to the hospital. The hospitals don’t care how much you earn per month as long as they get the profit in total. Also don’t forget the higher tax that you have to pay in private sector compared to government sector.

Patients who visit private hospital either have to pay cash or paid by insurance cards. There is no national healthcare financing system in Malaysia to subsidise the patients. Our private and public health cares are 2 different systems with no integration.

The Consultants

Until about 5 years ago; many of the big private hospitals only take consultants of at least 5 years of postgraduate experience. Only smaller hospitals use to take consultants who just passed out etc. However, due to stiff competition and mushrooming of private hospitals everywhere, specialists of less than 3 years are being accepted nowadays.

In a private hospital, the consultant is all by himself. There are NO housemen, medical officers or senior consultants to help or supervise you. If you get stuck halfway during a surgery, there is no one to help you unless another surgeon in the same hospital is willing to help if he is free. So, the risk is all yours unlike in government hospital where there are many helping hands. You must be absolutely confident enough to manage cases on your own if you are planning to go to private practise.

Every patient of yours in your responsibility including during the weekend, except when you are on leave and another consultant/locum has agreed to take over your patients. You do rounds everyday including weekends. Many busy consultants will work from 7am to about 11pm daily. They start their round at 7.30am and then go down to start their clinic at around 9.30-10am. After finishing their clinic around 5-6pm, they go back to do rounds till about 8-10pm. Of course, your clinic can also get interrupted if there is an emergency in ER or ward. If anything happens to your patient at night, you still need to go back to the hospital to see the patient. Medical officers from the emergency department may sometimes be able to help out for minor problems or before you reach the hospital. So, for some people who think that private doctors are enjoying themselves, please check out how they work every day. They hardly take leave and most of the days they spend the whole day in the hospital. Every leave they take means loss of income. That’s why I said that housemen should stop complaining of being overworked etc etc. If you don’t want to work, then medicine is not for you.

Mushrooming of private hospitals and competition

Private hospitals began to appear in 1980s but the mushrooming of private medical centres actually started in 1990s and 2000s. These private hospitals started to recruit many senior consultants from the government sector, including the university hospitals. I still remember when I was about to graduate from UM, many of my senior lecturers, associate professors and professors began to resign to joint these private hospitals, namely Subang Medical Centre, Pantai hospitals and Gleneagles KL.

These caused massive brain drain from the government sector. At that time, the salaries of government specialists were pathetic and promotions were very-very slow. Majority of the specialist were only earning about RM 3000 -5000/month. Most of these specialists who jumped to the private sector were earning a big amount of money due to small number of private hospitals at that time.

However, the situation is changing rapidly. I am sure many still think that you can earn as much as these “old” consultants are earning. I am sorry, you are wrong. With the mushrooming of medical centres, the competition is getting very tough. The income of every specialist is going down gradually. Imagine another private hospital appearing just 5 km away fighting for the same pool of patients? This is what that is happening recently, especially in Klang Valley, Penang and other major towns. Furthermore, the cost of private healthcare has increased considerably, so much so, only 10-20% of the patients who visit private hospitals are cash paying patients. The rests are using insurance/medical cards. So, don’t expect your patients from the government sector to follow you to the private hospital. That does not happen! An appendicectomy in the year 2000 would cost RM 3000 but now, it will cost RM 5-6000. But the surgeon’s fee Has NOT changed since 1998. It is the hospital’s fee that has gone up. Consultant’s fees are regulated by the government but NOT hospital’s fee.

I will give you 2 examples of cases which will tell you what is happening in private sector nowadays:

1)      An O&G specialist resigns from government sector and joined a private hospital as the 3^rd O&G consultant last year. The hospital offered him a minimum guaranteed income of RM 20 000/month for 6 months after which he goes on his own. He took up the offer and thought he is going to make tonnes of money since this is an established hospital. He even bought a new car and a new house nearby the hospital. After 6 months, his monthly income has not even crossed RM 6 000! Finally he resigned and left to another hospital. Hopefully he will do better in this new hospital but his debt remains.

2)      A physician resigned from government sector and joined a newly opened private hospital in Klang Valley. He was offered RM 20K/month for 6 months. After 1 year, his income has not crossed RM 15K/month. He too is contemplating to move to another hospital.

These are just 2 examples of what is happening currently. I got lot more examples that I can give but I am sure you can get my point. Every consultant is fighting for patients nowadays including within and outside the hospital. There are even consultants who don’t talk to each other in the same hospital due to competition. There are some who even pay the front desk receptionist to direct patients to him/her.

This leads to another important issue: unethical practises, cheating of patients and medico legal issues…….. which I will discuss next ……………….