Just a week ago, I wrote on the same topic quoting an article written by a philanthropist, Mr Koon on why he refuse to provide scholarship to those who wants to do medicine. Unfortunately, similar to what I had experienced before, multiple nasty comments were made against him in various blogs and newsportal where his article was posted. Readers can check for themselves. People still do not understand what we are trying to say. It is not about passion we are talking about but the economics. If you are doing medicine purely for economic reasons, than medicine is not the field you should choose at the moment, worst still by taking huge loans. I saw comments like ” there are no such thing as jobless doctors“, ” doctors never get retrenched” , ” doctors will always earn money no matter what the economic situation is ” etc
Today, there were 2 articles that caught my attention. The first was a letter in The Star written by a GP (see below). I have been talking about how opening a GP clinic is not as easy as it used to be. I know quite a number who had closed shop and gone back to work as employee of franchise clinics. Most GPs survive on panels. The letter today clearly illustrates how companies and panels demand what they want from the doctors. Either you take it or leave it. If you don’t want to take, someone else will! That is their motto and since many doctors are also struggling in their business, they do not mind taking the offer. It is interesting that the institution had requested the doctors to pay a fee for the contract renewal and further limit the consultation fee. I know some insurance companies which even controls what medicines that can be given etc. I had written about these issues before. The letter again tells people the actual income of GPs nowadays and not to assume that all GPs are rich with big cars! He quoted 1-2% of GPs of being succesfull which is lower than 10% of doctors that I quoted in my last article.
Another interesting article was published in Malaysian Insider on the issue of patient load in private clinics and hospitals. As I had written before, private healthcare is almost 70-80% supported by insurance and corporate panels. Thus, it is not right for anyone to say that doctors will earn no matter what’s the economic situation is. No doubt you may be able to earn to survive but to say that you will still earn handsomely is not right. The general public still do not understand the economics. The private healthcare cost is simply too high for any middle-income group. Once economic slow down occurs, people will tighten their pockets which in turn reduces the visits to private healthcare. Some will treat themselves with medications bought from pharmacy or cheap medication sold by traditional healers which suppose to cure everything under the sun. Some will default their insurance payment which makes their medical card invalid. Majority will turn to public hospitals and clinics. That is the reality. Income of many doctors especially GPs will decline considerably. Even hospitals can close shop due to high overhead maintenance cost. Insurance companies have already started to control what we do and what we are not supposed to do. They simply refuse to pay if they don’t agree what you had done. And the patient will also not pay! BTW, please read the comments in Malaysian Insider. Just see how many give sarcastic remarks about private doctors!
A GP friend of mine had refuse to sign with most panels due to their unfavourable contracts. He only has one insurance panel. He got this to say “I’m lucky that people around here earns S$… Otherwise I’d be full time Uber driver.. …. ”
So, please listen to Mr Koon! He is a businessman and he knows what he is talking about.
To make matters worst, it is reported that the government has SUSPENDED JPA and MOE bursary scholarship with immediate effect ( see below)!!
Panel doctors feeling the squeeze
I AM writing to highlight the underhand methods which some corporations are using to squeeze doctors and general practitioners (GPs) in this country.
Recently, an established and well-known institution of higher learning sent an official communication to all of its existing panel GP clinics, informing them that they were being offered an extension of their panel status with the said institution.
After decades of providing quality primary healthcare services to the institution, these GPs now have to renew their commitments. This is a common exercise, as times are changing and the terms of the contract will need to be reviewed from time to time.
However, what is shocking is the manner it is being done and a new condition which has been introduced. This institution has now decreed that, in order to continue providing services to the institution, the GP clinics would need to pay a processing fee of RM2,500 for the two-year contract period. This means each GP clinic has to pay RM2,500 in order to be eligible to provide services to their employees.
To us, in the medical profession, we feel this is an attack on the integrity of doctors. Through the Hippocratic Oath, we are bound to provide our services to any and all, regardless of race or religion.
Now we have an institution of higher learning, which incidentally also has a medical faculty, that has single-handedly turned this most noble of oaths completely on its head. They are sending a message to the world that doctors now have to pay before they can render medical help to mankind!
They will argue that there is a cost to manage and process the clinics and doctors who provide this care to their employees. They will say that the costs to manage and administer this is rising due to many factors.
But yet, they have the gall to fix consultation rates at RM15 per visit, as opposed to the prescribed rates of between RM35 and RM50 by the Malaysian Medical Association (MMA) through the Fee Schedule.
They have also the nerve to fix medications at unfair rates. For example, upper respiratory tract infection has been fixed at RM21. One pays more for a cup of coffee at certain places these days!
Does this institution, which is also a breeding ground for new doctors, realise that the healthcare industry has also not been spared the increasing costs of doing business?
GPs are subject to increasing costs through higher rentals, utility charges, consumable and disposable charges, equipment costs, etc. This is mainly due to the introduction of the GST, which healthcare has been exempt and therefore cannot transfer the costs to patients. To these people I ask: Who is looking at the welfare of doctors?
The public may have the perception that doctors are wealthy and live the high life. I implore those who have this perception to stand outside any GP clinic and observe what car these GPs drive.
I agree that just like any profession, there would be the top 1% to 2% who have made it. But just because there are high-flying GPs who jet-set across the world, it doesn’t mean all GPs have the same life.
The average income of GPs these days is between RM7,000 and RM10,000 per month, and this is after 15 years of working. Most other professions provide better and greater opportunities to earn much more than that.
In the end, it is the poor GP who suffers. More and more organisations are taking advantage of the market forces to push doctors into a small, pitiful corner.
Additionally, I would like to highlight one important fact. This institution has now also introduced a kickback system into the market. Pay them in order to be allowed to eke some living out of their employees. Pay them before being eligible to provide services and send bills to them. Doctors now need to pay before being allowed to have patients.
What message are they sending to the medical students in their own faculty. This is against the Private Healthcare and Services Act 1998, which outlaws such practices of kickbacks.
Doctors have stood by and just allowed this entire thing to get to this stage. But as a member of this profession, I cannot just stand by and watch anymore.
I am imploring, even begging, for the Health Ministry and the Government to tackle this issue with utmost urgency and importance. Please, help the GPs.
A CORNERED GP
Private healthcare patients feel pain of weak ringgit, higher cost of living
BY MELATI A. JALIL AND DEBORAH LOH
Published: 20 January 2016 7:00 AM
Private healthcare, the preferred option for those who can afford it, is reportedly seeing a drop in patients with practitioners attributing the trend to the effects of increased cost of living and the ringgit’s depreciation against the US dollar which has made certain treatments more expensive.
Tan Sri Dr Ridzwan Bakar, consultant cardiologist at a private hospital in Kuala Lumpur, said some of his patients have transferred to public hospitals.
He noticed a 10% drop in number of admissions to private hospitals since April last year, when the goods and services tax (GST) was first implemented.
“I think this is the general finding of almost all doctors working at private hospitals in the Klang Valley,” the cardiologist with more than 30 years of experience in private healthcare told The Malaysian Insider.
“The drop has remained persistent towards the end of last year,” added the former president of Association of Private Hospitals.
“People have less disposable income,” said another industry professional, Malaysian Medical Association (MMA) president Dr Ashok Philip.
“We have GST, the economy is not so buoyant, the ringgit has depreciated, and times are uncertain.”
Correspondingly, the number of people seeking treatment at public hospitals appears to have risen. Public healthcare in Malaysia is almost free or certain treatments are heavily subsidised although patients have to endure a longer waiting period for procedures compared with private healthcare.
“My colleagues at public hospitals have noticed a 25% rise in the number of admission in public hospitals, maybe there has been a drifting of patients from the private sector to the public sector,” Dr Ridzwan said.
Dr Ashok concurred.
“Anecdotally, the outpatient load in private clinics and hospitals has declined. This is because the outpatient treatment at government clinics is almost free,” he said.
It’s a sign of the times when even cancer patients are opting to cut back on essential chemotherapy at private facilities in order to trim expenses.
Dr Ridzwan said oncology was a good example of one area in private healthcare affected by the exchange rate because of the nature of the treatment.
“The drugs can easily run into five figures per month and there is no replacement. (Patients) have to be given those drugs.”
Private hospitals which have more patients with insurance might not be as badly affected, but given that about a quarter of patients at most facilities pay out of their own pockets, the impact on the hospitals’ bottom line is of concern.
“Between 30% and 40% of patients at private hospitals are self-funded. We can safely assume that many of them have to tighten their expenses, they have to go to public hospitals,” Dr Ridzwan said.
The weak ringgit has impacted on medical fields requiring expensive chronic therapy, a pharmaceutical industry player said.
“Healthcare involving babies, children and pregnant mothers is less affected,” said the sales representative of a drug firm, who declined to be named.
“The drop in patients also varies greatly between different therapeutic areas.”
Some private clinics are seeing a drop of more than 50% while others seem to have smaller decline of 15% to 20%.
“A large private hospital closed one of its wards due to the lack of patients,” he said, adding that he expected 2016 to be a difficult year for private healthcare, especially those requiring costly and chronic therapies.
“The use of generic medication may increase while health supplements may be affected negatively,” he said.
The Association of Private Hospitals Malaysia did not respond to The Malaysian Insider’s queries on these matters.
Expanding public healthcare
Director-general of the Health Ministry Datuk Dr Noor Hisham Abdullah in a reply to The Malaysian Insider said government facilities have seen a steady increase in demand for services but he did not have data from the private sector to compare with.
“The current economic situation has caused a surge in the demand for our services but with the current strategies we have implemented, we are well prepared to face this surge.”
Figures from the ministry show an increase in total admissions at government hospitals by 13.9%, from 2.16 million patients in 2013 to 2.46 million last year.
The number of hospital outpatients also increased by 2.7 million or 5% from 54.2 million in 2013 to 56.9 million in 2014.
To cope with the numbers, Dr Noor Hisham said the ministry has increased the number of public healthcare facilities, especially Klinik 1Malaysia (K1M), employed more staff by an average of 9% annually and expanded the scope of primary healthcare services.
“For example, in our K1M, from the original treatment of minor ailments, the services have extended to include maternal and child health services, doctor services as well as treatment of chronic diseases.”
Operating hours have also been extended, as well as moves to increase the number of beds throughout the country by building new hospitals, upgrading facilities and using day care services to reduce inpatient demand. – January 20, 2016.
– See more at: http://www.themalaysianinsider.com/malaysia/article/private-healthcare-patients-feel-pain-of-weak-ringgit-higher-cost-of-living#sthash.RqlSI7N3.dpuf
Putrajaya suspends JPA scholarships amid falling revenue
Published Today 9:13 pm Updated Today 9:25 pm
Putrajaya has suspended the Public Service Department (JPA) Scholarships for degree courses and the Education Ministry’s bursary for pre-university programmes amid falling national revenue.
According to Sin Chew Daily, this was confirmed by Minister in the Prime Minister’s Department Wee Ka Siong who raised the issue at the cabinet meeting today following several complaints from high-achieving students.
Wee said he had asked the Prime Minister Najib Abdul Razak to rethink and reinstate the scholarship.
“The prime minister understands that the economy is not good at the moment and the people are facing heavy burden so he has instructed the chief secretary to the government and JPA to come up with a new solution.
“I can’t say for certain if there will be a change of decision but we (MCA) have tried our best to appeal the matter because we don’t know how the economic situation will develop,” Wee was quoted as saying by the Chinese language daily.
The suspension applies to both overseas and local scholarships and affects some 700 placements this year.
Wee urged for an urgent resolution to the matter as some university commence their intake as early as Feb 1.
He added that Najib had asked the chief secretary and JPA to submit a report to the cabinet next week with their proposal.
The Sin Chew report also pointed out that some students have questioned why the JPA scholarships were suspended, but not Mara scholarships.
However, Wee declined to respond to this claims, citing that he had not heard them personally.
Asked if the suspension of the JPA scholarships was linked to the planned budget revision on Jan 28, Wee said he did not know.
A check with JPA’s website found the “bursary e-filing system” link which is used by students to apply for the scholarships, have also been removed.
Putrajaya is struggling with shrinking revenue as the Brent crude oil price has fallen to a 12-year low, settling at US$27.78 per barrel.
This is in contrast to a high of US$114.81 per barrel in 2014.
Najib has announced that the 2016 budget will be revised to adust for falling revenue and will see government expenditures optimised.
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