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 3rd 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 ……………….
Pagalavan's Avatar 
Dr Paga thank you for brilliantly putting it down to words. I have known what you have said for the past few years and generally has allowed me to make some crucial career decisions due to the above knowledge. What you have written has just reinforced to me that healthcare management is where I want to gravitate towards, not clinical specialties.
Any “Cybertroopers” who is planning to attack this article just don’t. Go visit your kiddy blogs and websites.
I really hope that some senior and wise ppl out there can give some constructive criticism and input on the Malaysian private hospital hospital conundrum as stated by dr Paga.
Malaysian private hospitals are monopolized by BN cronies. Thats a fact.
Now, they want to profit from health tourism as a NKRA-led industry to achieve our ‘vision’ of a developed country.
Tell me how a national healthcare financing scheme is going to ethically co-exist with the above scenario?
It’s going to be a humongous Godzilla-like mess.
It’s going to be a humongous Godzilla-like mess.
Hei, relak lah brudder! So long as we BN-cronies can make our marney, who cares man!
Does this situation apply to the whole of Malaysia? Or just major cities mentioned above in your articles such as Penang and Selangor? How about smaller cities and towns? Is the competition that stiff as well?
Mainly in major towns but in smaller towns the patient pool is also smaller. The 1st case scenario that I mentioned (about the O&G specialist) was in a smaller town. If you are the only private hospital in a small town then you may do well but soon another new hospital will appear nearby.
The competition is stiff in major cities. General surgeon or physician can’t survive without subspecializing in certain field. In smaller towns, there are usually 1 or 2 private hospitals, therefore the competition is not so bad. However, remember that the number of patients are also less in smaller town. Anyway, I predict more patients will seek treatment at private hospitals due to gluts of unqualified housemen now. Horror stories of government hospital will start spending to public soon!
If you take the expenses a private consultant will need to bear, irrespective of work load, and take it away from income, and then compare with what Jusa C specialists are getting in the Gov service, you will realise in many cases, it’s better to stay on in service. And that is the reason that recently, quite a lot of Gov doctors have stayed on, instead of jumping of the private practice band wagon.
When your income is woeful, the temptation to do unnecessary procedures and tests and treatments is strong, and unethical behaviours will arise. We will wait for the next episode! 🙂
I am not sure about your statement that many gov dr choose to stay as reader s83 mentioned that he and his friends are having high tendency to leave and very unsatisfied with the working environment.
So to stay under the big umbrella (KKM) or to go to the jungle (private) to survive? I dun know the trend now but for sure more outsiders / foreigners are coming to share the cake soon.
However, I wish Dr Paga not to leave out private medical screening center in discussion. Their top marketer can easily earn 100k/mth.
In the end, whether you will do well at private hospital, very much depends on yourself. I have seen specialists who are really poor in communication with patients. And some still carries their “government hospital mindset” when they join private for e.g. refusing to come to see patients. Any wonders they do badly at private hospital?
Dear Dr Pagal
As a specialist working in this country for more than 20 yrs in the private sector, I would like to suggest:
As there are CMEs for doctors to keep up with their knowledge, specialists both in Govt and Pvt sectors need to meet and discuss before being swallowed by the sharks of Pvt Hospitals, who are not just money minded but treat doctors like commodities. We should read our agreements and digest each and every line with a lawyer rather than blindly sign forms as most doctors are busy and do not know what there are in for
Companies like Columbia do undercut doctors by signing with MCOs/Insurance companies slashing doctors professional fees besides 10-20& of their service fees and rental that they collect
Any idea how much they pay their MO in emergency in private ?
I think u mentioned it somewhere but I can’t get back to the link/post
The salary is different in different hospital. Generally with all the extra perks , you will get about RM 10-11K. The basic is usually about RM 7-8K.
Hi Dr Paga… may I know what is the difference between a consultant and a specialist? Thank u
Anyone who had completed a postgraduate education is known as a specialist. Usually, it will take about 8 years before you can be called as a consultant. However, currently once you complete your subspeciality training, you can be considered as a consultant. Unfortunately, any specialist who goes to private sector will automatically be called a consultant. So, there is no real law/rule to determine who is a consultant.
Thank u dr
Hi doc,
Hope everything is well with you. Very interesting article indeed. Eventhough I’m not in the medical line, I’ve learnt a lot from your posts and expanded my knowledge.
I know you have repeated yourself many times with regards to this doc, but I just have to ask you this question again. Had a conversation with my MO friends recently and they were saying about how specialists in private are receiving a base salary of about rm50-80k, and also earn their fees on top of that. Naturally since I have been following your blog, I decided to educate them with regards to this.
I told them that in the private sector you don’t earn a salary. However they were very sure there is a salary. And then they also showed me a statement made by our former deputy healthy minister that the reason specialists are leaving the public hospitals for the private sector is due to these specialists being offered up to 10 times their salary in public sector. So in the end I ended up being confused after reading that article.
Thus would like to ask you again doc, do private sector pay specialists a salary? There are many people outside there who still believe so, and thought of clearing this doubt. Not sure if the former deputy health minister is misquoted or misinformed, or of private hospital policies has changed. Looking forward to your reply doc. And sorry for asking this question again. Just needed a final clarity with regards to this so the others are aware too.
Many thanks doc!
You are absolutely correct! Private specialist do not earn a salary and are NOT employees of the hospital. We are independent contractors who earn what we charge the patients (limited by law) minus the hospitl admin fee and room rental. The deputy minister is obviously misquoted or do not know what is going on. However, some new hospitals do offer a minimum guaranteed income for a limited period of time to attract doctors to join them. Sometimes it would be something like RM30K per month for 6 months etc.
Thank you doc for the clarification! Even the newer hospitals are giving a time limited income, so that is hardly a fixed salary. I still have friends who are thinking they are gonna get a salary of rm60-80k a month in the private sector.
Many young doctors don’t realise this. I wonder why no other doctors have shared this information with them. Keep on writing informative blogs dr paga! I’m sure it greatly helps others.
Yes, Many do not know or understand this. Also they don’t understand the amount of taxes that you are going to pay in private sector compared to public sector (which gets a lot of exemptions). This is one of the reason why some of the younger ones end up doing unethical practices to get money that they ‘thought’ they will be getting in private sector.
Yes doc completely agree. I’ve been hearing more and more stories of how patients are being convinced by specialists to do all sorts of unnecessary procedures, hence these unethical practices. Maybe like u said, to cover the higher taxes haha. That said, not all private sector doctors are the same. There are still genuine doctors who does their work honestly.
As you have rightly pointed out doc, many of these young doctors are choosing a path that will earn them the most money instead of being driven by the passion to serve. They have this idea of earning big bucks the moment they leave the public sector. Probably you should share more of the reality examples you have came across doc.
All I hope for is for the healthcare industry to not be driven by profits only. I know that doctors need to earn too, but not at the expense of the patients welfare. Thank you dr paga for guiding future doctors and hopefully we will have more doctors like yourself in the future, who is doing medicine for the right reasons 🙂
Hi D Krishnan,
Most of the things written by the doctor is correct. However, just a bit of correction on the direction of the article and ur question.
Yes, doctor is private facilities is being treated as independent contractor instead of employees, but most of them received medical benefits etc that is even greater than the employees of the hospital (some of them are unlimited!). This is because private hospital treat consultant as a partner of the business. It is mutual relationship.
And their salary can definitely go up to 30k to 100k per month. And some even earn an income of up to 200k.This is in 2021 we are talking about. But i do know some consultant did have lower income and the lowest I have seen is around 8k.
It will depends on the number of patients they attended and it correlates with the specialization they choose in. For example, surgeon, pediatric neurologist and nephrologist normally earns more due to the nature of the service they provided is being needed by many or due to scarce of service and competition. And of course, nowadays people are generally more educated with financial literacy and mostly opt to get medically insured. Hence, more people go to private hospital to be compared previously.
In addition, consultants who gives good services normally will get a recurring patients. So the quality of hospital and service provided will also play important part in attracting patients to the hospital.
I do agree that there are still a lot to improve such the revision of consultant fees. But if with the non-revised consultant fees, consultant are able to get around average 50k per month (this can be a normal working person’s salary for six-seven months), I can understand the delay in the revision.
I didnt touch on the deductible part out of the income such as taxes. The above are gross salary after deduct the “administration fees” by the hospital. Most of them still earn good money, better than the rest of normal civilian but understandably of the years and years of hardwork and expertise before coming to where they are.
So even without the ‘fixed salary’, most (if not all) of consultant still making a good money.
Tht is as far of my knowledge. Business is about both getting profit and giving the best services they could. This is due to nature principles of economics supply and demand. The profits drives business to give the best they can and have competitive edge than the other competitions to ensure on-going of the business. Consultants also always up-to-date to various method to gives themselves competitive edge.
However so, government hospital also has the best and top consultant and give good services. I am unsure about the amount of salary but they do get fixed salary (in addition to allowances and incentives). But the whole system is just lacking of the incentives to improve which causing them to have more delayed process etc. Definitely has a lot of rooms for improvements.
In conclusion there are pros and cons being in either private or government hospital. Couldnt say one is better than the other because it will depends on your risk appetite. U can definitely earn more in private but u need to work harder for it, and if you are more of a risk-averse and comfortable in getting a stable income, then government hospital sounds good.
p/s: theres a lot of others factors not discussed in this reply (eg: facilities, reputation of hospital etc)
p/s/s: Thank you for writing this article! I stumbled upon this by accident and look forward to read more articles on the blog:)
Hi JJ,
I think I need to correct some of your statements above. Consultants are not partners of the hospitals and they do not receive any medical benefits. Some do get certain amount of discount when admitted with a maximum amount limited per year. For example, consultants in KPJ get a discount for their admission with a maximum coverage cap of 5K/year, which is peanuts. Same goes to my hospital where I use to work. I believe you are referring to the earlier private consultants in 1980s to 1990s where the consultants were considered as share holders. That era is gone. Nowadays(since late 1990s), we need to have our own medical insurance.
As for income, I think I have discussed this extensively in my blog over many years. There are many articles that I have written. Income can be high if you are willing to work 24 hrs daily especially if you are a procedural guy. Also not to forget the unethical nature of the income which I had elaborated many times in my blog. I would not go through these issues again in this reply. Not to forget that this is a one man business show!