I spoke to some GPs recently and I can say that most are worried with what is happening to the medical field in this country and how their income is going down gradually. The drop in income for GPs is unavoidable, as with the income of specialists in private hospitals. Many specialists in private hospitals are not earning as much as how their seniors were earning 5-10 years ago. The same goes to the GPs.
Many newly opened GP clinics in major towns are struggling to survive. I just heard a GP who opened a new clinic near my hospital for the last 8 months. Till today, he does not even see more then 10 patients a day. His rental for the clinic is RM 3000/month! And don’t forget the maintenance cost for the clinic. I know many GPs who have closed shop. Some have ventured into unethical practices and complementary medicine as I have written here. I know some who have become health product agents. I had a patient who attended a close door discussion on a health product that was conducted by a doctor. The doctor even claims that the product can cure immune related diseases like SLE etc. I just saw a patient today (exacerbation of bronchial asthma) who told me that the GP refuse to refer him to a private hospital despite having employer insurance. It is a group practice clinic and it seems the doctor said that his boss do not allow referral to a private hospital. Only referral to government hospital is allowed!! And this is not the first time I have heard this. Many GPs would rather refer to the government hospital or a private hospital further away. If they refer to the nearby private hospital, the patient may not come back to them!! That is the idea. It has nothing to do with the quality of care! They rather keep the patient then loosing them to a nearby private hospital.
Why are GPs struggling? It is competition. They not only need to compete with their own colleagues in the same area but also with Klinik Kesihatans, District Hospitals, Klinik 1Malaysia, Pharmacies, Traditional Medicine Practitioners, Labs and Private Hospitals. Whenever a Klinik Kesihatan or Klinik 1Malaysia opens nearby their clinic, their income drops further, some as much as 10-20%.
This is a comment from a GP in one of the Primary Care Group at Facebook:
Quote from MPCN Group at Facebook:
“My view is that whether solo or group practice GP, the business is not as good as 10-20 years ago. With more 1M clinics (with MOs), Klinik Desa being upgraded to full scale Klinik Kesihatan (with FMS) and extended hours of Klinik Kesihatan till 10pm, I can only foresee more and more GP’s find it hard to survive.
Relying on panels like ING, PMCare, Compumed etc is not a truly long term solution too, as these MCO/TPA will keep cut throat the GPs. And we can see in previous posts in other section, some lamented that new GPs are willing to take only RM5 as consultation fees! Appalling!!
Most of my GP’s are venturing into either aesthtic practice or some “alternatives” (eg. PRP, Live Blood Analysis, Ozone treatment etc) in order to make more money! Some even start becoming MLM (Amway or Usana) agents to coax patients into buying some of those products! Sad.
Patients with freedom in seeing specialists in our country also contributes to the “demise” of GPs. A little nose bleed, they go to ENT; a little bloody diarrhea, they go to Gastro; Headache, they see Neurologist; and sprain ankle, they head straight to an orthopedic surgeon. And how many times nowadays, parents bring in their children to see GPs? Most if not all, are at the nearby Paediatrician clinic, even with trivial URTI or for any form of vaccinations.
Seeing cough and cold, and issuing MCs will be the norm for GPs nowadays. Hypertension patients are half taken away by the cardiologists, and DM patients, the endocrinologists.
BP lab, Pathlab etc will be giving out free annual vouchers for doing blood tests, and they hire in house doctors to give consultation and result interpretation.
Our friendly neighbourhood pharmacists will be selling drugs like nobody’s business. Some without prescription, but just need to write down your name, phone no and address in the ruled line exercise book, and that’s it. You will get whatever antibiotics you want over the counter.
So what’s left for GPs? I reallydunno”
The above statement basically sums up what is happening to the GPs nowadays. GPs were once a highly respected profession. Even when I was small, my father use to take me to see a GP for simple cough, fever and flu. These GPs were considered equivalent to a specialist. In fact, a family rather trusts the GP then a specialist in a government hospital. Those days are gone!
To add salt to the wound, I am sorry to say that more nightmares are coming for the GPs. Budget 2013 will be delivered this Friday 28/09/2012. There may be further shocks in this budget, which will reduce GPs income even further. With the overflow of doctors in government sector, it is only going to get worst. Our Minister’s statement here and here is a clear indication of what is coming (attached below). There will be another 175 1Malaysia clinics throughout the country. Previously GPs were still not very much worried about the 1Malaysia clinics as only Medical Assistants (MA) manned it. Unfortunately, the situation is changing. With some Klinik Kesihatans having more doctors then the number of rooms, doctors are being sent to these 1Malaysia clinics. It has already started in states like Selangor, N.Sembilan and Malacca.
Soon, as mentioned in the newspaper article, these 1Malaysia clinics will start antenatal and child health care services. These clinics are open till 10pm daily! Doctors at Klinik Kesihatans on the other hand are now being asked to work on 2 shifts in order to open the clinics till 10pm every night. This has started as a pilot project in some Klinik Kesihatan as I have mentioned here. It was also mentioned in the newspaper article as “Shorter queues and extended hours at rural public clinics”.
Many GPs survived those days because the government clinics close at 5pm and only the hospital emergency services were open. The “Q” were extremely long in these emergency departments as they entertain emergency cases first. So, the GPs were able to get the “after office hours” market as the patients had no choice if they want faster treatment. Now, that advantage is going or gone!
If you walk into any GP clinic nowadays, you need atleast RM 50. Compare this to RM 1 in Klinik 1Mlaaysia and Klinik Kesihatan? Free for senior citizens! You may end up getting the same medicine from both sides as GPs are also surviving on generic medications to cut cost and to make higher profit.
In another 2-3 years, probably by 2014, the 1Care system will be implemented. This will appoint GPs as one of the primary care providers to the public. I have mentioned about this over here and here. There is a high possibility that dispensing rights of GPs will be taken away and given to community pharmacist. The pharmacist association has been pushing for this for a very long time. As most GPs make money from medications, this change will further reduce their income and they have to survive on consultation fee alone which is regulated by law (PHFS Act).
As you can see by now, life is going to be tough for GPs in another few years time. The days of good money and life are gone. You may still be able to earn a decent income for a decent living just like any other profession but don’t expect to make tons of money! And for this, you have to work from 9am till 10pm daily for 7 days a week and 30 days a month. That’s the reason why many doctors rather join a franchise GP practice rather then opening a solo clinic nowadays. Some GPs have even agreed for a RM 5 consultation fee with insurance and panels to survive. That’s how desperate these doctors have become. It is a matter of survival! The same goes to specialist as well.
My advise for younger doctors whose intention is to open their own clinic is to think carefully. It would be better to open a clinic in rural and semirural areas where people still have high regards for doctors. Find a place where there are no nearby government clinics. However, you can’t charge high rates in these places but you may have better load of patients with lower cost of living.
With the upcoming glut, many doctors who could not get a government job after housemanship may end up opening a clinic to survive. This will only make the situation worst. They may even accept RM1 for consultation from panels and insurance companies. The good old days are gone……………… 40 000 graduates are unemployed according to the government which I think is still underestimated. Will the doctors join the list soon? Only time will tell.
Happy listening to Budget 2013, an election budget for sure with a lot of goodies and good news to the public and civil servants.
Liow: Health Ministry to focus on people-friendly measures in Budget
By YUEN MEIKENG
Minister Datuk Seri Liow Tiong Lai said the ministry will continue to have people-friendly measures in the Budget.
“We are looking to extending the opening hours at Klinik 1Malaysia branches in rural areas,” he told reporters after presenting Kad Diskaun Siswa 1Malaysia to Universiti Kebangsaan Malaysia students here.
He hoped the Finance Ministry would allocate a bigger budget to upgrade medical equipment in hospitals to be on par with developing technologies.
Liow: 175 1Malaysia clinics by year-end
By FLORENCE A.SAMY
KUALA LUMPUR: The Health Ministry plans to set up 175 1Malaysia clinics by year-end due to high demand from patients, said Minister Datuk Seri Liow Tiong Lai.
“The clinics have benefitted some five million patients so far. The response has been very encouraging.
“There are currently 119 1Malaysia clinics in operation nationwide while 56 more are in various stages of implementation,” he said at the launching of the 1Malaysia clinic at the Danau Kota flats here Saturday.
Liow said they planned to expand the clinics’ services to include healthcare for mothers and their children beginning next year.
The 1Malaysia clinics, he said, would make it easier for patients to seek treatment as they were open until night and located near residences.
Pagalavan's Avatar 
In urban India, a mere MBBS holder is ‘nothing’ unless he proceeds with Post graduate course – either an MD/MS or DNB…
Ordinary GPs in urban India just can’t compete with the numerous specialists in multispecialty private hospitals….
…people will just go straight to see the specialists rather than seeing a GP.
The irony is – rural India has a severe shortage of doctors…. the problem is even a GP doesn’t want to work Rural India …
Will our local GPs be willing to set up private practice in rural Malaysia?
The time will come when they will be forced to open clinic in rural areas
i am wondering as rheumatologist, what else can you do apart from giving painkiller? Sound like unpopular field compare to cardiology? what make u dont serve underprivileged patient in gov hosp?
Before asking this question, you should do your research on what rheumatologist do!! FYI, we just don’t give painkillers. We deal with disease that can affect the whole body, each and every organ in the body and NOT just joints!! Please read more. It is unpopular because we see a person as a whole unlike cardiologist who only sees the heart. It is unpopular because there is NO money in it unlike cardiologist!
I served the government for 10 years in 4 different hospitals. Many who leave government service do so because of frustration and NOT money!! Again, please read more and talk to more people
Dear Aaron…Don’t be a prejudice..Don’t personally attack Dr Pagalavan..It is our choice where to serve..i see that your statement is irrelevant..
Even the rural areas are saturated with GPs. My parents are GPs in a relatively small-average size town. When they opened their clinic in 1981 there were 8 practices. Now there are about 30, with no increase in the population. They are at the end of the career so the massive decrease in patient numbers is not too big a deal for them but it would definitely impact someone at the beginning of their GP career.
When I talk about a small town, KFC was the only fast food joint until 2010, when McDonalds opened. There are no cinemas. Only 4 secondary schools until about 6 years ago, when a 5th opened. Even the smaller towns outside this town have seen a proliferation of GPs. This is on the west coast of the peninsula and it may be different elsewhere but I doubt it.
I think from the rakyat’s point of view, the mushrooming of 1Malaysia clinis and their extended clinic hours is a GOOD measure for the benefit of rakyat! We should not blame the gov for this. This is also the result of pressure from the political foe, competition in politic will result in beneficial measures to gain rakyat support. The doctor who wish to venture into private sector have to continuously improve themselves in their knowledge, clinical skill and communication skill. If you are good, patients will still come to you no matter where you set up your clinic and advertise your clinic by word of mouth. People will still pay higher amount just to see that good doctor. But if you just want to set up a GP clinic and offer service quality comparable to a general busy public clinic or 1malaysia clinic, then the smart patient will see no point of visiting your clinic.
so true…..!!!!!
Yes, the government will obviously do anything to satisfy the people as they need to remain in power. That’s why we need 2 party system to keep the government on their toes.
However, how do people know that you are a good doctor? This is where problems arise. I know many good doctors who are struggling and many unethical sweat talkers who are doing well. Our public is not educated enough to look for 2nd opinion etc etc. As I have said before, good doctors are bad doctors in the eyes of public. If you tell a patient that he does not need antibiotics since it is a viral infection, you will be known as a bad doctor!
As far as I am concerned, in the eyes of the public, a good doctor is a doctor who can talk well! Not a doctor who makes a diagnosis.
Have you ever been to 1malaysia clinic?…there is inadequate stuff and medicine there…It got his medicine supply from nearest klinik kesihatan and under authority of FMS nearby clinic which not agree with it’s foundation..Sometimes there is not enough medicine eg. no antibiotics, cannot continue DM/HPT medicine…sometime you cannot done T/s..1malaysia clinic for me is just a name..retoric and polemic..JUST GO THERE..i know because i am ex MHO currently resigned…
Actually the initial intention of 1Malaysia clinic is to treat URTI, do dressing and see common aches and pains. Thus the clinic was given to MAs to run and only limited medications were available. They are not suppose to treat DM/HPT or any chronic diseases. They are also not suppose to give MC.
However, as usual, our Malaysian public who wants everything free decided to go there for chronic conditions. To entertain this, our politicians thought of expanding the services and to start sending MOs there. Soon, it will become another mini KK.
call me shan at 0193602233 many struggling doctors have succeded in making the income they need..no mlm or biz is required upon them..for further info do call..salvage the moment before it salvages u….
Ad?
I think Dr Paga has left out something in GP clinic. That is the quality of the 1 Malaysia clinic doctor. Some of my patients did complain about their quality. They just simply see patient ‘cincai’ and no advice is given. I am not too worry about 1 Malaysia Klinik.
If there is a good GP, it is cost saving because he/she will settle your problem with lesser cost in long run. It is better than just refer to specialist and be ‘slaughtered’ by the private hospital.
In this world there are three things in service business
1. Fast
2. Cheap
3. Good
You can’t get 3 things together. Only any 2 at one time. E.g.
1. Fast & Cheap = No Good (Substandard GP / 1 Klinik Malaysia )
2. Fast & Good = No Cheap (Some good specialists)
3. Cheap & Good = No Fast (Some good GP)
There is no such thing is Fast & Good & Cheap at the same time.
Yes! I have a lot of friends and relatives complain about the quality of 1 malaysia clinics! They say the quality of medicine given there is terrible! As they always say – you get what you pay for.
Dr. Paga there is no doubt that the future of doctors in Malaysia as a whole is at stake. But there is a severe shortage of good doctors in Malaysia. As you have already mentioned in your earlier posts – a lot of young doctors that make up the bulk are not passionate about medicine at all! According to friends, most doctors they see nowadays do not care to talk and explain anything to the patient, and treat patients like second class know nothings.
I think a time will come when the public will reconnect the dots and choose quality over cheapo useless consultations, even if it means paying more. A clinic relies on word of mouth advertising. I think a good GP will still be able to do fairly well in Malaysia, more so in rural areas where people are not poor and ignorant anymore. Good doctors will still be wanted for here – at least for now.
Yes, you are right BUT how do you define a good doctor? Our public assumes a good doctor is a doctor who have good public appearance and can talk well. Even if this doctor bullshits them , they will believe. I see this on a daily basis! That’s why I use to say that unethical doctors are laughing to the bank where as good ethical doctors will remain poor.
I have written about the quality of the frontline doctors in MOH many times before and thus I did not want to repeat. 1Malaysia clinic is meant for simple URTI cases as well as for dressing, detection of common chronic diseases like hypertension and Diabetes. It is not meant to treat complicated disease. Unfortunately, these are also the cases commonly seen as bread and butter cases by GPs. So, if the patient can get it for RM1 , why bother paying RM 50?
With the current economic situation, saving RM 40 is a lot for many middle income people. If they don’t get better then they will go to see a GP or specialist.
I would have to disagree with Dr Paga “life is going to be tough for GPs in a few years time”
The demise of the GP has been speculated for a long time. Let me state that a doctor who owns a clinic or sits in a clinic does not automatically qualify him to be a GP in the public’s eye.
On the contrary, the court of public opinion can make or break the reputation of a GP. In Malaysia, unless quality of healthcare can be standardized across the board, patients will still recognize and pay for good medicine.
Can the quality of healthcare be standardized across the board? How can it be? The training of a doctor is SO fragmented that you have all sorts of shapes, size and quality coming out as GPs or Specialists.
The other factor is the payment consideration. Again, a 1Care mechanism has been speculated for a long time and is yet to come. How can 1Care be implemented when the big businessmen owned private hospitals stand to lose profits if the government becomes the main buyer of healthcare in the country?
Some people say this will be nullified because government hospitals will be corporatised and all hospitals will be on a level playing field. Well, its not so easy because once hospitals start playing by corporate rules all wastages will need to be accounted for and you know for that to happen the government will stand to lose alot of rural support.
Technology is moving rapidly. Within a few years, complicated diseases will be reduced to simpler treatments. GPs will take over the management of these diseases. While I agree some diseases will remain complicated and difficult to treat, they will remain the domain of specialists and will carry its own risks as well.
Patients who get sick and are exposed to the potential of death will need to see an individual who is free from bias and is knowledgable and skilled at giving advice on how to navigate the complex health system. The internet is terrible at this and patients will eventually realise that specialists also have a profit-interest in treatment and management. There will be demand for the GPs as long as GPs keep themselves up-to date and true to the cause.
Btw, I’m a doctor, and I still see my own family GP when I get sick. I need the human touch.
Yup, agreed BUT this statement “as long as GPs keep themselves up-to date and true to the cause” is unfortunately not happening! When I attend CME talks in JB, I see the same faces all the time. There will be less then 30 Gps who attend these talks and it will always be the same faces!
The public on the other hand does not know how to evaluate a GP, most depend on the way the doctor talks and give medications as what they want. Good doctors will always appear as bad doctors for them. I see this daily on how some GPs bullshits the patients and the patient believes everything he says.The same goes to some specialist as well.
I cannot agree more on what you mentioned. GP’s who “convinced” their patients to do “Live Blood Analysis” will easily pocket in RM500 with the high tech screen in front of them; while counseling and health promotion talked till the mouth is dry, will only get RM10 consultation fees.
Yup, how do the public know who is a good doctor? The person who shows fancy stuffs on their computer may look good! Just like how a TCM guy can charged RM200 for just feeling the pulse and telling the patient that he has gout!!
err…I am not a Doctor, but I do read up on my health conditions, facts check the medications prescribed and asks pertinent questions to confirm my understanding. Doctors who gives frank and well reasoned explanations will have my business and trust.
I feel like all these things happen when Datuk Liow is the minister…
Anyway increasing in the number of clinic to rakyat is good, but the they they did is too fast in increasing the numbers. Production of the new doctors per year quickly fill up the posts to saturation, and from there onwards the system keep producing new doctors in surplus, on top of previous years’ surplus. The number will be rising exponentially every year……
I totally agree with Dr Paga, someday in few years time, MD/MBBS graduates will not always have their job as doctors, as the engineering graduates nowadays, it’s just merely a paper that one has graduated from university at degree level…how sad
hahahaha…..
padan muKa those GP….
I am one of your loyal followers in this blog. And thanks for “quoting” my summary in MPCN. It’s indeed how sad the situation for most new and young GPs nowadays. Obviously there are many GP’s out there who are still doing well, especially those who have started their clinics more than 7-8 years ago. I am more concerned about those who have gone into operation recently. As a FMS and an academician, I have much sympathy for these unfortunate groups of GPs.
I am one of your loyal followers in this blog. And thanks for “quoting” my summary in MPCN. It’s indeed how sad the situation is for most new and young GPs nowadays. Obviously there are many GP’s out there who claim they are still doing well, especially those who have started their clinics more than 7-8 years ago. I am more concerned about those who have gone into operation recently. However, doing well is very subjective. And most if not all of my friends out there are “supplementing” their business with aesthetic packages, because this is the only “untapped” field!
Many GPs are still “underestimating” (or choose to be in denial of) what the 1M clinics can do in near future; and that many are still in “denial” that the 1Care will soon roll out. In most KK nowadays, there are 1 FMS, and at least 10-14 MOs serving the public for free or RM1!! And in near future (if you know where to get the reliable source like I do), the FMS will be increased to at least 3 per KK to serve the rakyat better. In the eyes of the poor rakyat out there, this is one piece of good news, whether we like it or not. And most DM and HPT will be handled by the senior MO (will be introduced as “Registrar” post later on) in the KK, together with the FMS (to ease the congestion at MOPD at hospital). FMS going for subspecialty fellowship training in chronic diseases will take over this step by step, and thus decentralize the workload currently held by the MOPD people.
If that’s not enough, the MOs are currently (already started!!) rotating to the 1M clinics; every MO to go for 2 weeks, and rotate to the next MO from each KK. This is “in line” with the national healthcare transformation plan. So one after another, is surfacing, and what Dr Paga mentioned all these while in his blog are true!
Obviously there are many more issues which cannot be disclosed here. But just to remind the rakyat – you all will have to pay less for seeing better doctors very sooon; and to remind the GPs – please don’t be in denial anymore.
As I have said many times before, There is No money in medicine anymore; There is also no guaranteed job in medicine anymore. Many are still in denial mode.
spinosum… thanks for the heads up… whats the best thing for young gps who are in private to do to ensure they dont get swallowed up by the transformation changes?
The only way for GPs to make money now is to be a panel doctor for large private corporations (e.g. Telecom, tenaga, the banks, etc). Almost all panel appointments are now given to bumiputra doctors or bumiputra companies that run the GP clinics (may have a non-bumi GP working for them). This is a guaranteed source of income for the bumi GP or non-bumi GP who has a bumi partner (and there are quite a few out there).
I am excluding GPs who try and sell you nonsense like magnet therapy or homeopathy, but I’m sure their numbers are increasing.
Spinosum.. you seem to have a bone to pick with private gps?
The problem with nationalised healthcare services is the loss of competition-driven quality. With no clear competition, there is no incentive to perform.
How is performance going to be measured with these new clinics? How do we know patients are satisfied? Patient satisfaction with the system is crucial.
One of the most important things with patient satisfaction is seeing the same doctor (the family GP) regardless of how small or big the system. With this ‘brilliant’ 1care system, the patient loses this privelege.
Between 3 FMS who barely knows me beyond my name and health particulars, and 13 rotating MO’s of all shapes and sizes, this system reeks of socialism to the core. Where is the patient/consumer choice????
We are moving towards the era of personalized care where patients choose their health and prevention options. We cant force things down their throat just because they cant afford it.
Let the patient choose their primary care provider.
Unfortunately, economically, majority of the patients don’t care who they see as long as they get medications for free!! That’s why 80% of the population go to government clinics!
10-14 MOs = 10-14 ways of management
Chances of a patient see back the same doctor is 90%
Patient only save RM40 but need to take high risk
Is the risk worth it?
Typo error: Chance of a patient see back the same doctor is <10%
For Malaysians, probably it is worth it! Only when problems arise, they seek treatment elsewhere for short term. That is what I see since I started my private practise.
@Chillax: Chill bro… I have not even touched on 1Care (because I do not want any hoo haa in the comments anymore). Let the reality take its toll. I know what it is up to by now. For you all out there, just hang on there till the news roll out.
And btw, I am not picking on the GPs, as I am on their side. I don’t know why you conclude your perception on me that way. I also have joint ventures with private GPs out there. I am just sad to see the truth is what Dr Paga has mentioned. From excess medical schools churning out excessive young doctors, to the point where the healthcare is basically controlled by certain groups of people up there. I am just here to share my thoughts, just like Dr Paga. Not everyone will agree on what I said or voiced out, but I am just keeping options and my mind opened. I have not been commenting in such issues for a long time, but because I came across Dr Paga quoting my comments elsewhere, I thought of dropping by to say “hello” to Dr Paga! 😉
You’re welcome
Frankly, one more thing, Chillax, please enlighten me on this issue:
If the majority rakyat wants personalized care and good service, theoretically all the KK and MOPD should be goyang kaki all the time… how come it is always packed like sardine?
thanks Spinosum. No worries, your comments are much appreciated. Just maybe a ‘ventilating thought’ on my side 🙂
as to your question: i know ur right. im stumped as well. the same reason why busses are still the major transportation options for the rakyat. The sheer number of people who cant afford ‘choice’ dwarves those who can.
One option for medical graduates is to into lecturing. I mean non clinical subjects ie anatomy, physiology, biochem etc. Not much candidates compared to clinical masters students. More and more medic school is being build in Malaysia and most of the lecturers in these subjects are from abroad.
Yeah not very well paid, but you’ll have time and benefits and perks from the univ.
And hey, if what Dr. Paga says is true about dwindling patients to GPs, then locum is a nice way to pass time….. and getting paid at the same time. Maybe there’ll be locum in KK1M to in the future?
Just highlighting the non clinical subjects here as an option.
Yeop Pelior
Even to be a non-clinical lecturer, you need a postgraduate degree in anatomy, physiology or biochemistry. You can’t become a lecturer in these subjects with just MBBS.
Once all the post in KKs and KK1M is full, there would not be any more locum available.
Hey Dr. Will you recommend IMU-local or Monash Malaysia for students with budget problems? I am aware of the situation of doctors now in Malaysia thanks to reading your blog! I’ll just go with it anyways because it’s what I want to study. I’ll be ok even if I’ll end up as a broke GP.
Trust me, it is very easy to say now that it’s OK even if you end up as a broke GP. This is because you are living with your parent’s money and do not understand that being a doctor is a job to earn a living. I know many who said this before but ended up regretting in doing medicine. Remember, the 5 years undergraduate and 2 years horsemanship? By this time your friends will be making more money then you.
From what I know that Monash has recognition in Australia but you mentioned somewhere that this recognition might be revoked? Also what does it mean by “recognized in Australia” per se, does it mean that if I want to work there/study for postgraduate I can search for a job straightaway without taking the AMC test? People told me that IMU students are more competitive and they give better training in the clinical years, is that true? If I do want to work overseas will Monash Malaysia give me a better standing than IMU?
There will be a surplus of graduates in Australia next year (2013), and that excess will increase as the increased intakes and new Medical Schools produce more doctors. About 250 International students in Oz final year this year will miss out on Internship places. Therefore, it is unlike Monash Sunway graduates will be able to get jobs. Without the Internship year, you cannot get full registration, which is required for further work. It is VERY competitive to get into specialist training in Australia.
If you read one of my recent article on Internship crisis in Australia , you will realise that it very unlikely you will get an internship post in Australia after graduating from Monash Malaysia. Without internship in Australia, you can’t get full registration and thus would not be able to do postgraduate in Australia.
Thus, whether you do in IMU or Monash, may not make a difference now.
Alice, from what i heard, there were only 2 Malaysia Monash students who got the internship post in Australia this year (and they tried very hard to get it!). The rest are heading back to Malaysia as there are no more internship post available for them.
Alice. Take my advice. I wish someone gave me this advice before. Do economics… both bachelor and masters. Major is health economics. Then do your PhD in Health Economics. You will be a true champion in Malaysia one day.
Dear Dr,
I am not a doctor but worked in a group practice, part of the management team. Just to show with you some of my observation. I always wonder if there are surplus of houseman now, why still so much complaints of “overwork” houseman ? Also surplus of doctors seems not to be true. We can hardly find locum doctors, at the rate of RM40-RM50 per hour. When i advertise for full time doctors in Star newspaper, I sometimes do not even get 1 single response. Currently we are paying about 9K to 11K for GP for 48 hrs week. I was told once by a doctor calling up, telling me that as a MO in hospital he is already getting around 8-9K, with nearly 1 month annual leave, so it is not worthy for him to leave and join a private practice. After reading your previous article, I now suspect his words.
Looking at all these, I think it is not bad to be a doctor, in private or public sector.
That is because the tsunami has not arrived at your level. The surplus only just started 2 years ago. That wave is just finishing Housemanship. There is still the 2 years compulsory service, so it will hit you in 2 years time. But it will be good for you, as you will have lots of choices, and that will drive down wages.
I think you are totally mistaken in your assumptions. These complains about “overworked housemen” is coming from people who are not interested in becoming a doctor in the first place. They want easy life and do not want to work, You can go to any hospital and I can tell you that there is no such thing as “overworked housemen” they are doing shift duties now. These overworked housemen are pampered kids, protected by parents! You can ask any consultants in public hospital.
The surplus will hit us by 2016. At the moment, there are still enough post in government sector to support about 4000 graduates this year. The reason why you can’t find locum doctors nowadays is because of new rules and regulations. Housemen who are caught doing locum will be automatically be deregistered. MOs who do locum must inform the HOD and the name of clinic must be mentioned in his APC. Thus, many are reluctant to do locum. Furthermore, most MOs are getting about RM 4500/month salary. They are not desperate for money unless they got huge debts.
The reason why they don’t like to join franchise clinics is because of job security and not very much about salary. In government , you hardly pay any income tax. Only less then 50% of your income is taxable compared to private sector where 100% of the income is taxable. So, even if he earns RM 9k at your clinic, after tax, his actual income will only be around RM7000? Worth it? I don’t think so. You get much more benefit in being government doctor with 25 days annual leave, 1 week paternity leave, 2 weeks unrecorded leave etc etc.That’s the reason why many private clinics and hospitals finding it difficult to get doctors. In government service, your commitment is less as you know you will get paid at the end of the month no matter what happens or whether you work or not. You can also take emergency leave anytime! In some smaller government clinics, you hardly got any work to do!
Many hospitals are also finding it difficult to get specialist due to same reasons. The salary in governemnt is about RNM 10-12k almost tax free whereas in private you are self employed! with 100% tax.
The income of doctors will begin to drop when the market gets saturated by 2016. When the government can’t provide any more job, then they will come looking for you. That’s when you can even get them for RM3000/month! Trust me, the time is coming same like how some GPs are willing to accept RM 5 per consultation.
According to GTI media (the world’s largest graduate careers research firm),
the top jobs in demand in Malaysia in the near future will be :
http://gtimedia.asia/news-clippings/the-sun-28-june-2011-top-10-careers-in-malaysia/
1. Network Engineer
2. Sales/Marketing Executive
3. Accountant
4. Electrical Engineer/Electronics Engineer
5. HR executive
6. Software Engineer
7. IT consultant
8. Corporate Banker
9. Petroleum Engineer
None of these are healthcare related.
You might be surprised nowadays, sales and marketing professionals are in demand, and HR executives as organizations are looking into talent management nowadays, whether is in acquisition of talents or training their employees.
Another research by Karl Fisch, revealed that the top 10 jobs in demand globally in 2010, didn’t even exist in 2004!
Question comes – Isn’t it true that our teachers/education system in Malaysia is preparing our children/younger generation for jobs that may not be in demand or not needed in the future?
Our world is changing way too fast and no one should be in denial.
oops wrong link
hmm, can’t seems to get the right link,
well manually “”http://www.youtube.com/watch?v=YmwwrGV_aiE&list=UU1pASZIGxk6_brexy_sCg8A&index=4&feature=plcp””
No offence. I had bad experience with group practice. Group practice normally overcharged patient. More profit orientated and very few opportunities to improve. I got many patients complained of group practice. UPT charged RM60, Nebilization charged RM120, Chelation therapy for HPT RM150 and etc. 2 URTI at least RM50. Single bee sting gave 5 medicines. 10k/mth after few years, some my friends resigned and joined medical center because nothing can learn.
Well, everything is profit driven in private sector. If not none will survive
this is a systemic problem. the way the national health system is structured, clinics are profit-orientated to ensure their survival. you dont blame the ‘tiger for eating the cow’ in National Geographic programs, can you?
There is a basic misunderstanding of the role of profit and competition in any industry. What is wrong with a clinic that is interested in profit??
Blasphemous! I just said something unacceptable in the medical world. Yet, deep down, many practitioners are also trying to keep a family alive and pay off debts. How do they do it? By being profit motivated.
The key is to ensure that the profit-motivation is driving quality up instead of down. IF this cant be done, then the alternative is to dismantle profit orientated private health system alltogether.
Then, naturally, salaries and income will drop down since medicine is socialized.
Doctors, you cant have the cake (independence) and the pudding (income). One thing has to be sacrified for the other.
The cake is getting smaller!
On another note, it is very dissapointing that many discussions end up on a “how much money can i make” notion although not explicitly mentioned. Look, I’m not suggesting that money is not important. All Im saying is i want to bring up my kids in a country where happiness, achievement and financial security is important; in that particular order.
Why are we sacrificing happiness and achievement for more money?
Lets talk about happiness and job satisfaction. Medicine still retains one of the highest job satisfaction rates in the industry. And Im sure many people will trash me for saying what i just said. But lets not kid ourselves. Once the passion of healing truly hits you when you are in your thirties and fourties, and you have a family to take care off as well ( which means you automatically give the best healthcare advice and knowledge to your loved ones), not many other jobs can top medicine.
You doctors take it for granted what you have. The dwindling income faced by medical practitioners is symptomatic of an ever shrinking and competitive world. Not just medicine, but every other profession is under siege these days by globalization and technology.
But take a step back and look at the real world. Sure accountants and network engineers may be the top job in years to come. Are they happy? They cant wait to leave their job and go back to their homes. But they cant. Their ‘connected devices’ follow them back.
Can doctors bring your patients back home? You can.. but thats a different situation alltogether [if you catch my drift]
So. Start thinking of a job as a doctor as more than just the money. Its about achieving something and being happy. Not bitter and money driven.
Frankly, many people do medicine for money! Just because they spend RM500K, they expect good returns in terms of money which is obviously flawed.
If you do medicine for what it is, then you will not regret BUT if you do medicine for good money, life and future, then you will curse yourself at one point.
Actually, doctors do bring the ‘patients’ back home if you really care for the patient. Sometimes, I can’t sleep well if I have an ill patient in the ward. It might be different for GP but for specialist, it is the same as any other profession. You do bring your work home!
agree with your last statement Dr.Paga. Esp for a surgeon!
My group practice charged RM15 for UPT and RM20 for nebuliser. No Chelation as we think this is not a recognised treatment and panel companies will not acept it. So some group practice might be lucky to get away with high charges. I sometimes wonder if there is any fee splitting involved as the charges are quite out of the norm.
My view is that if BN wins, the 1Care will roll out; if PR wins, more money will be pumped in to healthcare, and thus maintaining a very affordable healthcare services for the rakyat. Either way, the Klinik Kesihatan will continue to be better, and more MOs will be placed at KK’s to reduce waiting time. 1M clinics (or whatever the PR calls them later on) will become the satellite clinics in urban and rural areas to see cough and cold for RM1, including giving out MC’s as well! Then tougher cases will be channeled to nearby KK’s with FMS and Senior Registrars to manage. Complicated and emergency cases will be sent to hospitals to see specialists or subspecialists.
And with this, I can foresee private GP clinics will even be harder to survive or go on, unless of course they are giving services not offered by the ministry’s facilities, such as aesthetic medicine or some other quack therapies. Just like what Dr Paga mentioned, with so many doctors churned out by 2016, the private clinics can definitely hire young doctors at RM3000 salary; but the problem is, will there still be many more rakyat who will visit the GP clinics for cough and cold, and paying RM40-50? They could have gone to see the same batch of graduates or young doctors of the same cohort, at the KK for RM1!
By then, if 1Care rolls out, phase by phase, the GP’s need further certification training or postgraduate degrees like DFM or Master in Family Medicine in order to practice in primary care. And for sure, the “appointed” bodies will raise the fees of the DFM training program because the demand will be there! Even if you all complain by that time, you will just be told off the face “take it or leave it” – as there are many other young GPs who will be willing to take up the postgrad training in order to survive.
And with specialists’ income getting less, because more and more young doctors getting their MRCP and whats not… the competition gets tougher. Until someday, specialists will start their primary care service, seeing cough and cold as well – a heads on competition with the GPs. And of coz if it is paying out of pocket, as a rakyat, I would see a specialist for my cough and cold if the fee difference is not much; anything more expensive I will go back to that RM1 KK or 1M clinic!
So what’s left with GP’s with just MBBS degree in the next 5 years? I really dunno…
Yup, eventually specialist will start running GP clinics. It has already started.
So true about who will get the big panel. Also many big companies are using middleman now. Many GPs have no choice but join the TPA. Is it due to easy management for HR department or some money politics involved ? who knows ? Quite sad, doctors dictated by middleman.
And don’t forget that KK’s are now equipped with state of the art physiotherapy and rehabilitation facilities; as well as laboratory which could get your usual FBC/RP/FBS/LFT/Lipid/UFEME done fast and at only RM1!! I already have many friends and relatives moving away from GP’s who charge RM120 for the same test, using private lab facilities. Also those needing long term dietetic advice and followup, the service is available too! Some even have digital retina fundus camera, to screen for DM retinopathy. How cheap can a private GP offer for all those mentioned above?
From rakyat’s point of view, this is a good and welcomed measures. The gov should keep investing this kind of money in these facilities.
In fact they are. Just probably not up to our high expectation – we think more money should be pumped in. And one of the KK’s I know, is plannig for more roadshows and campaigns to create awareness amongst the rakyat, so that they are aware of the services provided at KK; and only RM1! For those above 60 years old, everything is free!
KKs which are well run will definitely take away the patients from GP. It is a well known fact.
Well… like anything else.. theres no such thing as ‘free’. It comes with a cost. The taxpayers money and government revenue. So many things is subsidized by petroleum money anyway.
Lets not forget the population is expanding very rapidly. THe country is expected to double its population by 2025 (up to 40 million, we are currently at 24M).
If the government can continue to provide RM1 primary healthcare to 40 million people at 2025, then either we are very competitive/rich as a nation OR the quality of care has dropped and people dont really care about the type of medication recieved.
I would all boil down to the health seeking behaviour of Malaysians. If they truly want quality, personalized and individualized health care, then private GPs will be very competitive. If the people are allright with mass market, factory-style primary care, then the private GPs are gone.
There is a caveat to this all. IF the people want the former, the countrys going to the right direction. If the people are going for the later, the countrys going downhill.
Budget being rolled out now. Enjoy.
@Chillax: I can be quite sure that you have either never or a very long time not visited to the KK. Just like me years ago. Not until recently that I am doing my NSR gazettement at KK, I realise the “threat” those KK are contributing to private GP’s rice bowls! Maybe some day, I should take you to a KK, and give you an in depth tour! Indeed it is no longer like what you say “mass market, factory-style primary care”.
funny because that contradicts my real world experience of having patients tell me that they feel rushed through by KK docs and privacy seems to be sacrified regularly.
Look I agree the GP rice boal is under threat (its been under threat for ‘decades’). Im looking at this from both sides of the coin as well.
I have been to and worked in KKs quite recently and I would say that you probably have not visited ALL KKs in Malaysia. There are those that attract upto 1000 patients per day, 10 doctors working hard, averaging out at 5 minute consults.
The point im trying to make is rather simple. If socialised healthcare is to succeed in a fragmented society like ours, than public-private partnership is still the way to go. Public provides volume, private provides customization.
Free RM1 healthcare has its limitations despite being backed by the entire economy. If people cant see through this, than the country is just not ready to progress.
Now wheres Jon J
Budget 2013 just out. Check under Health section:
– RM100 million to improve 350 government clinics
– 70 more Klinik 1Malaysia to be established, increasing total number to 240.
As I have written above!
“thumbs up!” 😉
@Chillax: I fully agree that you have got a point there. But similarly, in private clinics, there are also some which forever are using expat locums when people need “reliable” doctors the most. This is just one of the many points to prove that either in public or private, they are just the same when the clinic is just too busy; or when the leader of the clinic is not leading by good example or not taking full responsibilites of their subordinates. In KK, if you get a strict and responsible FMS or Registrar, the MO’s all work diligently and comfortably, because they have someone to reply on. It is when the FMS or senior doctors in the KK who slack or tak apa attitude, the MO’s down there all become the same! Some FMS stay back even during lunch hours to help the MOs finish up the cases; and at times the MOs have gone but the FMS remain there, solving all the difficult cases which were referred by their MOs.
(@Chillax: I’m still lurking even when not posting! And your knowledge of health economics remains sharp as ever)
I work in one of the finest socialised heathcare systems in the world – the UK NHS. And for all the faults and problems highlighted in the media, it remains an excellent service. The fact that problems are highlighted to such a degree in the media is a reflection of the transparency, accountability and quality assurance policies practised in the UK.
Somehow I can’t quite see quality socialised healthcare ever materialise in Bolehland. Too many closed door cloak-and-dagger administrative policies. And always the focus on quantity (makes for easy sensationalist headlines to appease the sheep) and very little focus on quality (harder to quantify; and if any figures that exist do not fit in with the master-race agenda, they will never see the light of day).
Even in the UK where quality standards of healthcare are relatively even across the board (eg: doesn’t matter which GP you see, advice and management is going to be the same 95% of the time), the public-private partnership remains alive and well. In part, this is due to the needs-wants nature inherent in any free market economy. Everyone needs good quality healthcare, but not everyone wants to sit in a bland NHS waiting room with 30 others waiting to see a doctor who is over an hour behind on his appointment times. So those who can afford it will pay for the 5-star experience of a posh waiting room with soothing music, coffee machine, aromatherapy candles and appointments that actually run to allotted times.
I have always maintained that there will never be an excess of excellent doctors in any healthcare system. 70% of medical graduates are in the bottom 70% of their class after all. So an excellent GP should in theory survive by means of Adam Smith’s invisible hand. The main problem with this argument is as highlighted by Dr Pagal – most people in Bolehland have no idea what a good doctor actually is! An excellent diagnostician who does not administer a battery of tests, investigations and freeflow medicines tends to be seen as a “lousy doctor-lah”. On the other hand, the “empty tong” who… well, you get the point. That said, as society gets better educated (ha-ha!), one would hope they become more discerning and able to recognise the physicians of quality.
Society in Malaysia is becoming increasingly fragmented in terms of wealth inequality. And never underestimate the extent of elitist snobbery inherent in the nature of Malaysians. As Chill-dude said, “public provides volume, private provides customization”. So no, I do not think private GP’s are done for (ppl have been saying this for years). But I think that a successful private GP in future needs to be more niche market, understand his potential clientele and market himself appropriately.
If everyone wanted the RM1 experience, there would be no 5* hotels in existence.
As I have always been saying, GPs can still survive but not going to be. Rich era is gone. You may still earn a decent living as any other job out there.
Was there ever a “rich era” for GPs? I think “comfortable era” maybe. The rich ones were usually from the following groups:
1) traditional solo practice, very long hours (eg: shoplot GP who lives above his consulting rooms on the ground floor)
2) had business savvy and opened up a chain of clinics
3) panel GP for companies (usually boomi or have a boomi-partner)
4) successfully integrated other areas into their primary healthcare service (eg: quasi-aesthetics, minor dermatology, anti-ageing black-magic, pseudo-allergy scaremongering etc)
Aren’t I a cynic!
Haha, you are almost right.But generally most GPs those days, till about 5 years ago, were doing quite well and earning even up to RM100K/month! Now, even to reach RM20K, many are struggling.
Incidentally, there has been much discussion about the glut of doctors and potential unemployment of medical graduates in the near future. And I can understand how someone about to enter medical school might be filled with consternation with all the messages of doom and gloom contained in Dr Pagal’s blog.
But I wonder if anyone has noticed that many of these discussions are rather physician centric. Perhaps it is because there are few surgeons who post to the blog discussions. Or maybe it’s because most graduates tend to end up in primary care (ie: General Practice).
The problem with General Practice is that it is the lowest common denominator in medicine. And as is typical when it comes to the lowest common denominator, the populace tends to gravitate towards the cheapest option. The question of quality is rarely considered since the presumption is that every GP should be equally competent given the perceived basic nature of primary healthcare (how wrong they are, but that’s another story).
The ballgame changes when specialist surgery is required for eg. in the treatment of cancer. The focus shifts sharply to considerations of quality and outcome. And a surgeon’s outcomes are relatively easy to quantify especially when it comes to complication and survival rates.
Even within a socialised healthcare system, an excellent surgeon in private practice will always be in demand. And the beauty of surgery is that for most of us who do it, we do it out of true passion for the craft. There will never be an excess of excellent doctors, and this is particularly the case in sub-specialist surgical disciplines.
So if any medical student is feeling disheartened over the tsunami of excess graduates, consider a career in surgery. The training period and working hours (even as a consultant) are interminably long, stress levels are high and the pursuit for a training post can crush one’s spirit with the prospect of huge numbers competing for a handful of positions.
Surgery is not for everyone, but those who succeed in getting to the end rarely ever feel that the journey was not worth the blood, sweat and tears.
With the avalanche of new doctors but there is only so many training post in any specialist training post inclusive of surgical based discipline. For surgery, the chance to be in the training program is even slimmer than internal medicine as there is no external exam that they can take in Malaysia like MRCP for internal medicine.
“Surgery is not for everyone, but those who succeed in getting to the end rarely ever feel that the journey was not worth the blood, sweat and tears.”
excellent summary and advice for any surgeon to be.
Jon.. great replies.. !
[…] Comments « For Future Doctors: The Hurricane is coming ………… Part 3 […]
is it still valid or its getting better? http://efenem.wordpress.com/2008/01/20/life-as-a-doctor-in-malaysia-part-1/
Yes, it is still valid except for the 36 hours work which has been changed to shift system for housemen since september 2011. However, the 36 hours work still applies for MOs.
efenem is a MO now. Congratulation to him!!
[…] September 2012, I wrote THIS article about the future of GPs in this country. I mentioned about the impending expansion of […]
Malaysia doesn’t need any doctor. Not a country which respect professional.
Don’t be a doctor, it’s a disgrace , whereby your hardworks are worth nothing / just worth rm 1.
Disgrace to be a doctor!
https://polldaddy.com/js/rating/rating.js