KUALA LUMPUR, Dec 9 — Malaysia’s private general practitioner (GP) sector, long a pillar of affordable health care, is under threat due to a series of regulatory changes that doctors say could lead to its demise.
Dr Steven Chow, president of Addiction Medicine Association of Malaysia (AMAM) and former president of the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM), warned that the rising number of regulations, combined with external market forces, is pushing the system to its breaking point.
“Our GP system is on the verge of being killed,” Dr Chow told CodeBlue in an interview with a group of senior doctors last month. Private GPs have long prided themselves on their efficiency: a single doctor with minimal staff can care for thousands of patients, handling everything from patient registration, diagnoses, treatment, discharges, and follow-ups, all without the need for an appointment.
Despite the system’s cost-effectiveness and relatively low consultation fees, which have risen modestly from RM35 to about RM50 to RM60 over the years, Dr Chow said GPs are increasingly blamed for the rising costs of health care in the country.
The tipping point, according to Dr Chow, is a slew of new regulations that have made it increasingly difficult for GPs to operate. “The practice of medicine is over-regulated,” he said, citing the absurdity of rules dictating everything from the placement of medical equipment in a doctor’s office to growing pressures on GPs to conform to government policies like e-dispensing and extended hours at public clinics.
“There are too many regulations. They are killing the practice of medicine,” Dr Chow said.
Meanwhile, he argued that the business side of medicine remains inadequately controlled, allowing an influx of middlemen like third-party administrators (TPAs) into the industry, who, he argues, are motivated by profit rather than patient welfare.
Dr Chow also claims that foreign companies, despite restrictions on ownership of local GP clinics, have quietly begun to acquire chains of private clinics, gradually consolidating the market into the hands of a few large players. “When we kill this system, we kill ourselves,” he says, warning that the rise of an oligopoly in the private GP sector will leave little room for independent practitioners.
To keep businesses afloat, Dr Chow says the next generation of doctors is increasingly uninterested in the traditional role of a GP, opting instead for more lucrative and less demanding specialties like cosmetic treatments.
“Many young GPs are more interested in Botox and fillers than in treating coughs, colds, or diabetes,” he said. This trend could result in a future where the concept of a GP no longer exists, or is relegated to large health care corporations, forcing patients to wait weeks for appointments.
No Smoking Signs, Corridor Sizes: GPs Question Regulatory Priorities
Dr Shanmuganathan Ganeson, current president of the FPMPAM, described the private GP sector as a “sunset industry”, saying many practitioners feel “strangled” by the mounting regulatory burdens they face.
“As a doctor, my mind is on finding out what the patient’s complaint is – examining, diagnosing, and planning the management. I’m not going to sit down and think about whether the drug enforcement officer is coming to check the labels, whether I’ve got so many things inside, and whether my label is correct,” he said.
“It makes life miserable for me. You’re taking my attention away from the patient to focus on things that are not as important to me.
“We are changing the GP profession from doctor-patient relationship to commercialising it, to an extent, where we are worried about other things,” Dr Shanmuganathan said.
“We now have to worry about clinical waste, drug enforcement officers inspecting inventory, and even making sure that our clinic corridors meet specific size requirements,” Dr Shanmuganathan added. “They can always come and pick on any doctors they want. So, in that sense, we feel threatened.”
An example of a micro-regulation is the requirement to display a “no smoking” sign inside the clinic, with non-compliance resulting in a fine. Dr Shanmuganathan said, in his years of practice, no one has ever lit a cigarette in the clinic. “So, why is there a need to put up this sign in the clinic?” he asked.
GP Clinics Not ‘Kedai Runcit’, Price Transparency Should Fall On Manufacturers
Health Minister Dzulkefly Ahmad last month announced that private health care facilities will be required to display medicine prices beginning next year under the Price Control and Anti-Profiteering Act 2011.
In private hospitals, patients are already informed about the prices of their medications – along with their use of equipment, imaging, lab investigations, medical or surgical supplies, procedures, doctor charges, and room and board, among others – in itemised hospital bills after discharge.
But GP clinics do not usually provide patients itemised bills with a breakdown of doctors’ consultation fees, drug prices, or use of equipment, among others.
GP doctors argue that it is impractical to “display” all medicine prices physically due to the extensive inventory they manage.
While the health minister’s office has said that the regulation allows for displaying prices through mediums like websites or digital devices at the counter, GP clinic doctors claim that the National Pharmaceutical Regulatory Agency (NPRA) interprets the rule as requiring physical price displays for medications in clinics.
Dr Milton Lum, ex-president of the Malaysian Medical Association (MMA) and FPMPAM, and former elected member of the Malaysian Medical Council (MMC), questioned whether patients would actually be able to decide what they need, even if a price list were displayed.
“Even if the price list is displayed, would the patient be in a position to decide what they actually need?” Dr Lum asked.
Dr Lim Kuan Joo, former Kuala Lumpur Hospital (HKL) director and now public health consultant and advisor for FPMPAM, argued that price display mechanisms at clinics are not comparable to those in supermarkets.
“The clinic is not a supermarket or a kedai runcit (convenience store). When you’re shopping for groceries, you can walk around and compare prices – onions, for example, might cost RM5 per kilo in one store and RM6 in another. That’s how shopping works.
“But when you go to the clinic, do you first look at the prices or see the doctor about your problem? You don’t walk around checking prices like, ‘This Panadol is RM5.’ You go to see the doctor first,” Dr Lim said.
Dr Pearl Leong Yuet Mae, honorary secretary of the FPMPAM, further questioned the practicality of explaining the clinic’s drug choices to patients in a short consultation time.
“The main goal is to manage and provide the best for my patients,” Dr Leong said. “But how can I explain in just 15 minutes why I’m choosing drugs A, B, and C over D, E, and F, which might be cheaper? There are principles behind why I choose one drug or company over another, but I can’t possibly explain all that in such a short time.”
She added, “Patients also often want to leave quickly and aren’t interested in the details of every drug choice.” Dr Leong suggested that drug manufacturers, rather than private clinics and hospitals, should be responsible for displaying their drug prices.
Dr Kek Chee Yen, a young GP at Klinik Welcare Shah Alam, said the landscape for GP clinics has changed significantly over the past few decades.
“I think 20 or 30 years ago, GP clinics faced a different scene compared to now. Back then, I would diagnose and give the treatment, and that was it. The market would see and drive demand — ‘This doctor is good,’ and they would come. If you charged too much, then people wouldn’t come.
“But nowadays, there’s another hand coming through with so much regulation,” Dr Kek said. “Those things are actually not giving us better health care, I would say. It’s not helpful, not just for us as GPs, but for the patients.”
GP Fees Stagnate Amid Rising Influence Of TPAs And MCOs
Dr Lum, a prominent figure in drafting the Private Healthcare Facilities and Services Act (PHFSA) of 1998, highlighted the stagnation of GP consultation fees, which have remained unchanged for over two decades.
Dr Lum said he had warned against linking the fee schedule to legislation, cautioning that it would create additional bureaucratic hurdles, making future revisions difficult and potentially stifling competition.
“If you put the MMA fee schedule into the regulations, you’ll have to ask the government later to amend it. It’s a long process,” he explained.
Citing Singapore’s experience, Dr Lum pointed to the country’s decision to withdraw its own fee schedule due to anti-competition laws, underscoring the risks of a fixed fee structure that could limit flexibility in the health care sector.
Dr Lum also criticised the increasing influence of Third Party Administrators (TPAs) and Managed Care Organisations (MCOs) in the health care system, which he described as the “middlemen” in private GP operations.
These organisations, which gained prominence in the 1990s and early 2000s, market themselves as cost reducers and managers of companies’ HR functions related to health care benefits. However, Dr Lum argued that their involvement prioritises profit over patient care by imposing extra pressures on GPs.
He claimed that these pressures have led some young GPs to resort to practices like aesthetic treatments or selling dubious health products. “Today, you see a lot of young GPs doing things that an ordinary GP would not do,” he said.
Dr Lum also voiced frustration over the inaction of health ministers in tackling these growing challenges. “The natural tendency for any minister is to kick it down the road to the next minister,” he said, as costs for rent, salaries, and drugs continue to rise.
