First, do no harm: Why doctors leave government service for private practice

by dr h. krishna, thestar.com.my
December 14

IMG_0345.JPGThere are various push and pull factors that cause doctors to resign from public service.

Our public healthcare system has been rated by overseas agencies as the third best in the world.

It is a proud international stamp of approval that the general population should appreciate.

This is especially as the cost of this healthcare is one of the lowest and most cost-effective in the world.

But this will not last forever. The cost of living and the increased cost of healthcare will make this system unsustainable.

There is an urgent need to restructure the system, while ensuring that the vulnerable groups in our population are protected. The Government has tried it five times before, but failed.

We do note that the Government is trying to improve the public sector.

They have increased infrastructure by creating 1Malaysia clinics, as well as increasing and improving the primary and secondary healthcare facilities. They have also increased the budget for consumables and drugs.

However, the most important aspect of the workforce has not been given enough emphasis.

We have TalentCorp bringing in Malaysians from abroad and treating them well. But what about the world-class professionals that are in the public sector, who have grown and sacrificed for the rakyat through the public healthcare system?

There was a trend of specialists leaving the public sector in the late 1990s and the beginning of this century.

It stopped for a little while when the work conditions and remuneration in the public sector improved.

However, the trend has restarted with a bigger impact.

In any situation, there are the pull and push factors.

Push factors

The biggest reason for specialists leaving the service is being transferred from their area. This is caused by their family ties, their comfort zone and ease in continuity.

To uproot the family and move creates a lot of family disharmony with difficulties and problems to be overcome. This creates unhappiness, and the resignations follow.

There has been a dearth of promotions in the last two years, with many senior specialists sitting in their maximum pay scale for several years.

This appears to shrink their purchasing capacity over the years, and also increases the frustration of these senior doctors.

Bureaucracy also creates a lot of impediments for the practice of medicine.

The way medicine is practiced changes rapidly with the times. What was the gold standard a decade ago, is frowned upon in present times.

However, the machinery is unable to cope with these changing trends.

Those trained in new modalities and methods face difficulties in introducing them due to this reason.

Administration is another area doctors are uncomfortable with.

Managing a department with several categories of staff is no laughing matter.

This is especially so when you have to look after house officers and the various issues related to their training.

Attending numerous meetings also burdens clinicians by taking away the precious time they require to see patients, train junior doctors and provide their expertise.

However, if they do not attend these meetings, their departments will be handicapped by the lack of funding and necessities that come with the service.

The Limited Private Practice was introduced by Tun Dr Mahathir Mohamad when he was the Prime Minister to allow doctors the opportunity for private practice within the public healthcare system.

It was a pilot project that was limited to two hospitals.

Only now is the Government starting to implement this in other hospitals.

However, they are only introducing this in six hospitals, instead of the more than 30 that are eligible.

This creates a disparity within the public healthcare system.

Pull factors

There is no doubt that the biggest pull factor is renumeration.

The renumeration in the private sector can be about four to five times higher than in the public sector. This alone appears to pull a lot of the specialists to this sector.

Stability is the next factor.

Everyone wants to put their roots down and settle in one place with the family.

This can only be done with stability of the work place.

Only if you are assured that you will be in a certain place for the rest of your career, will doctors actually buy houses and establish it as their permanent home.

The family is also reassured that they do not have to be constantly uprooted.

The children’s education then becomes the next major factor.

Previously, senior doctors’ children were given government scholarships to pursue their education.

This privilege no longer exists.

Doctors feel that they have to provide equal or better opportunities for their children, which drives them to the private sector.

Time is another factor.

In the government sector, your time is not appreciated. When asked to work beyond office hours, the remuneration is pathetic.

Only house officers have the privilege of having shift duty and the luxury of having compulsory off-days.

Many senior doctors cannot even finish their annual leave due to their various work responsibilities and limitations.

In the private sector, you are compensated for the work you do.

If you want to earn more, you can work longer hours.

If you value your time with the family, then you can engineer your working time to suit family time.

You are also allowed to dictate what kind of procedures you would like to do. If the patient wants it, the hospitals will be able to decide independently in providing such services with minimal delay.

Flexibility needed

The Government is trying very hard to improve the service terms of doctors.

However, the civil service is not flexible enough. They are tied down to other civil service packages that hinder a flexible system.

Changes that are proposed take a long time to process.

The idea of separating doctors into a separate commission was suggested more than a decade ago to overcome this problem.

The Government needs to continue giving emphasis on this area before the attrition rate creates vacuums in the service that affect the rakyat.

We want to continue providing a secure and stable public healthcare service for the rakyat. This will ensure the health of the general public and the nation for the future.

Dr H. Krishna Kumar is president of the Malaysian Medical Association (MMA). For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

Editorial

These factors were known for a long time now. However, there is a dearth of concrete action and much of it was only limited to rhetorical arguments. This article highlighted the problems but what the medical profession needs is solutions to the problem. Enough talk as it is.