Sunday, December 5, 2010

GPs: Some are making only RM10,000 a month.... New Sunday Times

Some are making only RM10,000 a month

New Sunday Times, 5 Dec 2010

OPERATING your own medical clinic is not as attractive a career option as it was some 10 years ago, as about 80 per cent of general practitioners in the country are now merely "eking out" a living. 

"From the feedback we have received, it is estimated that some 10 to 15 per cent of the 8,000 GPs in the country are doing poorly.

"The bulk are eking out a living, earning less than RM10,000 a month, which is not much when one considers the years they have put in in medical school and the cost of medical education," says Malaysian Medical Association (MMA) president Dr David Quek.

A recent primary care research study undertaken by the MMA revealed that the solo GP is now faring the worst, with take-home earnings of sometimes less than a few thousand ringgit a month after taxes, clinic rentals, expenses and other payroll.

"Those who only work as locums fare even worse, sometimes earning less than RM5,000 per month from long hours and plenty of night calls."

He says the average income of the GP has been steadily declining, "although one can find the odd very successful GP".

The problem is largely because many GPs choose to set up practice in an already concentrated urban area.

"Sometimes there are three to four clinics in a single row of shoplots. The rising cost of rentals and in hiring clinic assistants and workers has also contributed to higher overheads.

"And because it is so competitive, many do not charge their professional fees to keep the cost to the patients low in the hope of attracting more patients," he adds.

The problem is also attributed to the stringent requirements of the Private Healthcare Facilities and Services Act 1998.

"The regulations have made the practices harder because of more inspections and compliance issues which GPs sometimes find hard to fulfil."

Added to this, he says, is the competition from unscrupulous community pharmacies and certain pathology laboratories, which dish out medications without prescriptions, or offer simplistic point of care.

"All these bite into the shrunken cake."

Dr Quek believes the fate of existing GPs will be further threatened with the Ministry of Health's expectation of having some 85,000 doctors by 2020, to meet the 1:400 doctor-patient ratio.

"We agree that it would be ideal to achieve this doctor-patient ratio in the future, but to forcibly push this at such an unprecedented rate is foolhardy. We believe this rate is too fast, too soon."

He says it is unrealistic for the ministry to expect to retain some 50,000 doctors in the public sector as even with expanded facilities and positions, it would not stop these doctors from leaving the public sector for the more independent private sector.

What is more regrettable, Dr Quek adds, is that there is a tendency for the ministry officials to suspect that the GPs and private sector doctors are not offering good enough care.

"There is this prevalent feeling that GPs are not good enough and have done too little to improve the standards of their practice, although there is no data to prove this. This is highly contentious and probably way off the mark."

He says it's ironic that the ministry should feel this way considering that all GPs in the country "graduated" from the public system through at least three years of compulsory service.

"Perhaps this speaks volumes for the 'failed' approach in 'training' or utilising our medical officers that they should still be considered inadequate after five to six years of medical school, three to four years of supervised housemanship and even mandatory medical officership."

The National Health and Morbidity Survey 2006 showed that 62 per cent of all outpatients sought care from the private sector and this was testimony to the quality of care that GPs provide.

"Thus, our GPs must be doing something right. They offer about the most cost-effective quality and moderately priced healthcare available in the region," he says, stressing that most GPs look after generations of families.

There is also a growing fear among the GPs that they will be marginalised with the implementation of the "1Care for 1Malaysia" health reform and integration of the public-private sector which will see the family medicine specialist serving as hands-on first providers as well as gatekeepers in the revamped primary-care led referral system.

The MMA says this would put GPs at a severe disadvantage or even discriminated against as not many would be able to realistically upgrade themselves into "family medicine specialists".

Dr Quek says GPs need to engage in continuing professional development to keep up with new knowledge and skills.

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