One of the common questions I get asked via email and this blog from SPM/STPM leavers is as above. Just recently I had an SPM leaver asking me how much do a heart surgeon earn? From the random survey that I have done looking at these questions, I can only say one thing: majority are only interested in medicine for “good money, good future and good life”, a general misconception. And the reason why many want to become Neurosurgeons and Cardiothoracic Surgeons is also for the same reason: they feel that these are the highest earners in medical field!! Despite explaining many times in this blog, I still get these questions asked to me on a daily basis.
Thus, I thought of writing a separate “thesis” on this topic. Someone asked me a few days ago, how much do I earn as a Rheumatologist? Frankly if I were to practice only as a Rheumatologist, my income per-month would not even cross RM 7K! My major bulk of income comes from Internal Medicine practice, which I am also gazetted for. How much am I going to earn per-month depends on many factors such as, how many hours I work, how many calls I do, how many patients I see in the ward and clinic, how many holidays I take etc etc. As I have said many times in this blog, private consultants are NOT paid a salary by private hospitals. You earn what you receive from your patients as consultation and surgical fees, minus 10-15% administrative fee by the hospital. These consultation and surgical fees are regulated by the government via the Private Healthcare Services and Facility Act 1998 (PHSFA), gazetted 2006. So, you are not allowed to charge anything more than what is stipulated in the act. Your license to practice can be withdrawn if you are found guilty of charging more. FYI, these rates have not been reviewed since 1998!! Everything has increased except doctor’s fee……….. The Hospital charges, on the other hand have increased by leaps and bounds since the last 20 years. An appendicectomy that cost about 2-4K in 1998 is RM 7-10K now with the same surgeon fee!!
Thus, I know some consultants in private sector who are earning barely 15-20K/month and I also know some who are earning up to 100K/month. Now, before everyone gets excited, please let me explain how these consultants work! Many people out there only look at the figures but not what is hidden behind these figures. Firstly, for you to become a consultant, you would have spent almost 10-15 years of trainings/exams after MBBS. If you include the MBBS, it will be 15-20 years of education/practical training. I had written enough about pathways to become a specialist in this blog (many still think that they can become a specialist by just doing another full-time master course!). These means, you will be around 40 years old when you decide to open up your own practice in a private hospital. At this age, you are going to a private hospital where you are the housemen, MO and specialist. You have to run your clinic everyday from 9-5pm, do surgeries in OT and do rounds in the ward. If you don’t do it, no one else is going to do it for you. It is you and ONLY you. Sometimes your “good” colleague can help you but generally all consultants in that particular hospital are fighting for the same pool of patients. So, who is going to share their patients? Loosing a patient means loosing money. It is a business. You work 24hours a day, 7 days a week, whether you are on-call or not, as all your in-patients are your responsibility
I also know a few consultants who earn RM 100K per-month and their home is the HOSPITAL!! They hardly see their children and do not even take any holidays to be with their family. Either they are obsessed with money or too much passion with their job till they forget their family. For me, family comes first. It is the most important thing in your life and seeing your children grow in front of your eyes is really amazing. How can someone not see this and spend their entire life in the hospital? You can talk about dedication etc but whatever said, family comes first! Secondly, do not think that all those who are earning as such, are angels! Many of them do unethical practices to make up that amount of money. Thirdly, this private practice is a ONE MAN show. If anything happens to you, like you are involved in an accident or acquire serious illnesses, your income will be ZERO!! This is not a business where you can hire someone else to run the show as patients come to see you and not anyone else. Whenever I hire a locum to cover me when I go on-leave, I will always be at a loss! Frankly, it is a very RISKY business model. I know one ophthalmologist who told me that he has stopped doing any work to fix anything in his house by himself because he is worried that a small injury to his hand may close down his business!! Also, don’t forget the higher tax that you will have to pay in private sector. Generally, even with all the tax planning, you will end up paying 1 month of your income to Income Tax department! So, work hard to pay the government ………….
As for government sector, everyone is paid the same depending on your grade. It does not matter whether you are a cardiothoracic surgeon, cardiologist, neurosurgeons, a dead wood etc etc, you will still be paid the same amount. Even if you don’t do any surgery, you will still be paid the same! In fact, recently many at grade JUSA C and above have to take a pay cut due to government’s financial situation. Even though government doctor’s salary has improved tremendously over the last 15 years, so does the cost of living and cost of going to a medical school. I was talking to a father who wanted his son to do medicine. His son refused and jumped to accountancy after 1 year of medical course. Well, if the son is not interested, he should not force him. Unfortunately, despite being a businessman (have few construction companies), the father still insists that his son should pursue medicine. What surprises me was the reason why he is asking his son to do medicine! It seems that his son has started “internship” in accountancy and working almost 24hrs a day with a salary of only about RM 2K+. BUT his niece is doing housemanship with salary of RM 4K+. He does not seem to mind working 24hrs a day as long as the salary is higher! So, basically, he wants his son to do medicine for good money and life, based on his perception!! This brings me to another important discussion.
There was an interesting article by a doctor from US ( A Deceptive Income of Physicians)who has written on how pathetic the income of doctors compared to the time, money and hard work spent in becoming a specialist in US. To quote : Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher. It is the truth anywhere else as well. Please read the article, which is very interesting with facts and figures. There was also another interesting survey in US regarding Physician’s job satisfaction and burnt out rate at different career stages. To quote:
- Physicians in middle career worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and their work-life balance, and had the highest rates of emotional exhaustion and burnout.
- Middle career physicians were most likely to plan to leave the practice of medicine for reasons other than retirement in the next 24 months.
Now, coming back to the starting salary of a doctor, no doubt it looks good on paper (minus the work that you have to do). Many will argue that there is no other job in “Malaysia” that will give you that amount of starting salary. BUT there are many issues that people forget. Firstly, all other professions start their working career almost 2-3 years before you start your housemanship. I know many engineers and even pharmacist who earns more by the time you start your working life as a houseman. My hospital was willing to offer a Pharmacist of 4 years working experience (equivalent to 1st year MO) RM 7K/month salary! Secondly, you can find a job in another country with any other profession unlike medicine. I know many engineers who graduated from UTM working in Singapore. Their starting salary is almost RM 6-7000/month with car and petrol allowance provided! Can you do that with medicine? Only UM and UKM degrees are recognized in Singapore. The rest just have to remain in Malaysia unless you pass any Singapore recognized college exams. Thirdly, how fast does your salary increase after that? My wife has been in service for 17 years. She is now in U54 grade with a net salary of RM 8K +(without EPF deduction as she is under pension scheme). If you are a specialist, you will be at U54 at 10 years of service with a salary of about RM 10-11K, after which your salary will only jump if you get JUSA C promotion. So, don’t get excited looking at the starting figure! It is very slow thereafter despite the introduction of time-based promotion in 2010.
When I first entered medical school after STPM, I do not even know how much doctor’s earn. I just did what I felt that I would be good at. Of course, as I have said many times before, no matter how much passion you have, there will come a time where money does matter., especially once you have a family of your own. A person who wants to dedicate their life to mankind by doing medicine would not even be bothered to leave government service. Frankly, government service is where you can serve the people. Unfortunately, there are also many doctors who leave government service due to frustrations with the system. Some of these frustrations have slowly disappeared when the time-based promotion was introduced. These coupled with increasing competitiveness and declining income of private doctors, have reduced the number of doctors leaving civil service over the past 2-3 years. 15 years ago, a private specialist could easily earn about 30-50K/month but now, reaching RM 30K is considered doing VERY well!! And to earn this much you will be working single-handedly, 24hrs a day 7 days a week after 15 years of postgraduate training and after spending almost RM 700K or more (undergraduate and post-graduate, if you are not sponsored by government)…………………..
With the glut of doctors coming soon, GPs life is also getting very tough for those who intend to open up a clinic. Many may become jobless. I hope one day, we don’t land up as what the cartoon below portrays………
My advise is always, never to do medicine for wrong reasons !! You will regret it later. If making money is your intention, there are many other jobs and careers you can choose from (much cheaper to do) which can make you a director of a company etc by the time you reach 40. Many of my friends who did other courses have already migrated to other country with good job, salary and life. Some have become managers of their own company flying all over the world. And here I am working day and night treating patients with minimal holidays per year………………………..and worrying everyday as to what will happen to my family if I drop death today!