Health and Medical Professional Issues in Malaysia
Wednesday, August 8, 2012
A Balanced View on Doctors' Fees.... by Dr Sng Kim Hock
A Balanced View on Doctors' Fees by Dr Sng Kim Hock The STAR Opinion Column
Before any party joins in the debate on the proposed doctors' fee rise, and lash out with knee-jerk responses, please pause to hear a balanced view from an unbiased doctor.
No one welcomes fee increases for sure! And, everyone hates inflation, including the doctor. Hence, the natural knee-jerk response to this matter, raised by the Minister of Health himself, is to object, reject or protest against it. Consumer groups, public opinion, letters on this column, will automatically speak against any such move, giving enough reason for the Minister of Health to retract his statement and tell the doctors: "Sorry, we are not able to approve of any fee raise for the moment!" , even though the moment was ten years ago!
Though I am a specialist (not a surgeon), I would like to speak up for the family practitioner or general practitioner. Fifty years ago, just after Merdeka, I recall that my visits to my family doctor, as a child would cost my parents between RM 10-15 per visit, depending on whether I was given antibiotics or whether an injection was administered. My cousin working for the same doctor revealed that our dear doctor was seeing about 200 patients a day. Simple arithmetics will show that he was `minting money', being able to buy a bungalow or a Mercedes every month! A Mercedes Benz 280s then, cost RM 36,000, and so too was the bungalow in many towns.
This may come as a shocking revelation for some in this generation, but the doctor in private practice were few in numbers and rich (There were only four in my home town). I hear that Che Det and wife, in Alor Setar were doing very well too, as most husband-wife combinations would.
No one really noticed the wealth of the private doctor then, as everyone else was `poor' and `happy', using bicycles or trishaws and buses for transport. Only a few members of upper segments of society owned cars, mainly professionals like the doctor, dentist and lawyer, while the rich businessmen were equally few in numbers.
At that time, RM 15 could buy oneself a pair of shoes, or a pair of trousers (tailor-made), or a pair of spectacles. Fifty years on, with progress and development, the `poor' doctor has arrived - struggling to make a living. He can now charge RM 20 to RM 30 for a simple consultation, with medications, while he competes with dozens, if not hundreds of clinics around the neighbourhood, hoping to see perhaps twenty or thirty patients for the day. Meanwhile, that pair of shoes has gone up to RM 250, and pair of pants (tailor-made) also around RM 250, while a pair of good multifocal lenses and designer frames, between RM 1000-3000.
Let us not forget that his plate of chicken rice has risen from 50 sen to four ringgit, while the rental could have shot up from RM200 to RM 5,000 or more, if he did not buy over the shoplot. His dentist counterpart, who used to charge RM 10-15 for an extraction now charges ten-fold of the preMerdeka days.
Time has caught up with the family practitioner, and many have lost the battle and quit. For that reason, among others, the solo-practitioner has become a dying breed.
What about the lawyer, and the accountant? They know their worth, and any contact with either means very much more by the hour.
It is true that doctors somehow seem to survive, and still remain up there as the upper-ranked wage-earner. Just google "top salaries in USA" or worldwide, and the doctor is among the top ten all the time. In fact, when they list them in their own specialties, the specialists take 8 to 9 of the top ten slots!
So, why are doctors (family practitioners) a frustrated and angry lot? Their fee is capped, by law at a mere RM18 ringgit, any fee raise has to be approved by the Minister of Health, like the `slaughtered chicken' in the market, and he would not do so, if repercussions from the public are drastic. Rumour is that with a national health care funding, this fee is likely to be reduced back to RM 15, back to Merdeka days!!! That will be the day when the plumber and electrician overtakes the doctor!
Considering that it cost me less than RM 15,000 to be trained as a doctor then, and a good RM300,000 to RM1,000,000 these days in a private medical school, and several thousands of doctors flooding the `market', the days of the `Happy GP' are numbered if not doomed! Like bank staff, GPs need to wear a button: "Support your Doctor!"
Specialists, who may complacently think that they are still `king' and `queens' in their earning capacity, must realise too, that their days may also be numbered, with capping and control still in force.
This is one view-point from a government pensioner, now in private practice.