Everyone entering medical school is hoping for a successful career as a doctor. However, with about 5,000 doctors graduating from medical colleges in Malaysia alone each year, this means that it is soon going to be very competitive to earn a good living as a doctor here, more so in the private sector. Therefore, if one chooses to leave government service for the more independent private practice, it is not going to be easy. This series of articles is written to assist doctors who are thinking of going into private practice to help plan their future. Humble beginnings I come from a poor family. My father was a lorry driver and my mother, a housewife who later had to work as a labourer in a factory to supplement our family income. When I was young, I was determined to do well in my studies so that I could get a scholarship to enter a local university. At first, my father (a Public Works Department employee) wanted me to be a civil engineer. However, I managed to get good enough grades to enter Universiti Malaya to study medicine. I also managed to secure a Johor state scholarship. In university, I was just an average student. After graduating, I did my housemanship at Hospital Kuala Lumpur. I was then transferred to Johor Bahru, and later served as a medical officer in my hometown, Mersing. Undecided as to whether to specialise in medicine or obstetrics and gynaecology, I studied for the Part 1 Masters examinations of both graduate courses, while enjoying the peace and tranquillity of my small hometown. In 1988, I secured the position of registrar in the Department of Obstetrics and Gynaecology at Hospital Sultanah Aminah, Johor Bahru. I subsequently went to the United Kingdom to work for a year and passed Part 2 of the obstetrics and gynaecology Masters course in 1991. On returning to Malaysia, I was given the post of clinical specialist at Hospital Sultanah Aminah, and later, for a short while, consultant at the Batu Pahat district hospital. In 1994, after seeing that I did not have much future in the public sector, I decided to move to private practice. From Johor to Melaka I applied to several private hospitals in Johor Bahru, but all my applications were rejected. The reasons given were: I was too young, I was a male gynaecologist and I was of the wrong race. However, I was offered a job at a brand new 600-bed private hospital in Melaka. The chief executive officer (CEO) of the hospital had invited all the local doctors in Melaka to join them, but most of the specialists rejected the offer. So the CEO decided to offer the positions to young doctors from other states. I was offered a job perhaps because he could not attract anyone else. Despite never having been to Melaka before, I accepted the offer. There were several reasons why I did this. Firstly, this was the only good offer I had, leaving me with not much choice. Secondly, I liked the size and beauty of the hospital. Thirdly, they also offered me a two-month training course in laparoscopic surgery at the Chang Gung Memorial Hospital in Taiwan. I had always been intrigued by keyhole or laparoscopic surgery, and this offer was one I could not refuse. As an added incentive, the hospital offered all of us a guaranteed monthly income for one year. The amount was RM7,000, which was twice my government salary at that time, and all of us were very happy with that guaranteed income. Cultivating skills Working in a brand new hospital was a real experience. A colleague once told me, “You are the wrong age (young), wrong sex (male for a gynaecologist), wrong ‘colour’ (Indian), and in the wrong town (didn’t know anybody in Melaka).” How was I going to survive? It was not easy. The first few years were tough, as I was sitting in my clinic waiting for patients to walk in. I realised that I had to do things differently in order to distinguish myself from all the other obstetricians and gynaecologists in town who were more senior and experienced than I was. I delved into my passion, which was laparoscopic surgery, and aimed to excel in it. I also persuaded the hospital to start an in vitro fertilisation (IVF) centre. I went to train in IVF at King’s College London in the UK and started the hospital’s IVF centre in 1997. It was the first IVF centre south of Kuala Lumpur at that time. I then spend three years doing a Masters degree in reproductive medicine. Earlier, while working as a specialist in Johor Bahru, I had joined night classes to learn how to speak Mandarin. So, even though I had all the disadvantages – namely, being young, male, Indian and in a town where I didn’t know anyone – I overcame them with the things that I could do, such speaking Mandarin so that my Chinese patients could communicate with me, and practising laparoscopic surgery and IVF – skills not yet mastered then by other gynaecologists in Melaka. I then went out to meet general practitioners and the public to inform them that I existed and was a worthy alternative to my esteemed colleagues. With hard work, perseverance and always thinking about my practice in the long run, I managed to survive private practice. The benefit of experience Many junior doctors who come to train under me ask for advice on how to survive private practice. I share with them my experience of having faced all these difficulties. It was then that I thought sharing my experience and thoughts might be of benefit to young doctors in Malaysia. Even though much of what will be written in the upcoming articles of this series will be from my own experience, I also hope to share the experiences of many of my colleagues in private practice as well. My wish is for you, dear reader, to have an insider’s guide on what private practice is like in Malaysia, so that you can plan your own future and succeed. My best wishes to all of you in your careers. Dr S. Selva is an obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the first article in a weekly series about surviving private practice in Malaysia. Source
