It is a simple straightforward question of survival for the private medical practitioner.
The doctor, as a medical professional, depends mainly on his expertise, knowledge and skills to provide a professional consultation for a fee. While all salaried workers depend on the monthly paycheck, the medical professional, and other professionals have long been considered different from businesses and trade, and hence a business licence is unnecessary for the doctor.
He or she is governed and supervised under the Medical Act that ensures that he or she is qualified to practise as a doctor, and specialist if there are further qualifications. Thus, in private medical practice, the medical professional is mainly dependent on his consultation fees for his survival as a practice.
When a doctor prescribes and dispenses medications or does investigations, he derives an additional source of income if in his own clinic. When a doctor does procedures, minor or major, he is able to charge an additional procedural fee.
It goes without saying that the doctor depends on the volume of patients as well as the type of procedures that he is performing. Over the years, the private medical doctor is generally able to earn an income above his government counterpart and other professionals through additional incomes apart from consultation fees.
However, in recent decades, the decline in patient numbers continues as more private doctors come on board. The volume of daily patients dropped from a high 100 to 200 in the sixties to much fewer now for Family Practitioners. Just take a stroll along many city clinics and you will not see crowds waiting, which was a common sight in the sixties and seventies.
Tragically, sadly and to the serious detriment to private medical practitioners, the Private Healthcare Facilities and Services Act 1998 (Act 586) came into law. Tied to it were two schedules of fees, one for the private hospital setting and the other for the family practitioner.
This capping, strapping and now trapping of the private medical practitioner began a slow crushing of the private practice landscape, with the solo medical practitioner in the first round of victims. Hundreds and even thousands shut down as it became impossible to sustain a practice, let alone earn a decent income. Many may not recall that a doctor went to prison for failing to comply with Act 586 that required a new licence or registration.
At that time, the family practitioner could charge only RM15 per consultation. Thus, even if he or she saw 30 patients a day, the gross monthly income of a daily dedicated doctor, by simple maths, was only RM13,500, barely enough to pay for rental and staff, and small loose change for the doctor. This is not a joke, but is a joke!
The meek, gentle, caring, compassionate, helpful, dedicated, ethical, sincere and honest doctor still trudged on, surviving on past income and finally closes “shop”.
Fast forward to 2025. With consultation fees capped at RM35 for the general practitioner (GP) and RM235 for the private consultant – who may only see 30 and five new cases respectively (follow-up charges are much less, possibly RM15 and RM105 respectively) – this brings a gross monthly income of RM30,000, or nett of RM10,000, after overheads are deducted.
This means that the private doctor cannot survive on current consultation fees and has to depend on additional sources of income i.e. medication dispensation, minor procedures for the GP, and procedures for the specialist.
Capping a professional’s fees to a token minimum and not reviewing the fees for 10 to 20 years is absurd, unbelievable and should not be tolerated.
It is in doctors’ DNA and ingrained in us to be meek, gentle, compassionate and kind. But that has also made us “stupid fools” to be capped, strapped and trapped in this dilemma. Indeed, we are now a laughing stock to our fellow professionals from legal, engineering, accounting, architecture and other fields for allowing ourselves to be “capped” in our professional fees.
The consumer lobby is strong. The pharma industry connections and influence is huge. The insurance bodies and third party administrators are multi-billion ringgit corporations. The private hospital players are government-linked corporations (GLCs) and big conglomerates.
The Ministry of Health (MOH) is caught in between the big players, but hopefully will see the real dire situation of doctors and assist to remove the suffocating fee schedules. Without the fee schedules, the consultation fees for both GPs and private specialists would have gradually adjusted with inflation over the years and would been accepted by patients.
The doctor, once “god and king” all over the world, has become a mere “servant or slave”, or worse still, “a call boy or girl”, responding to the smallest phone call for a token fee (24-hour clinics and 24-hour calls), besides facing demanding customers and clients who are often rude and threaten to sue for the slightest mishap.
The capping of medical professional fees must be abolished. If slavery, the death sentence, and the Internal Security Act (ISA) can all be thrown out, we seek the understanding and assistance of parliamentarians to throw out the fee schedules from Act 586.
The first Pakatan Harapan (PH) government, when Dzulkefly Ahmad was also health minister, made a Cabinet decision in 2019 to deregulate doctors’ professional consultation fees. But the Cabinet decision was not implemented.
Everyone will support the price control and capping of necessities like eggs, sugar, flour, chicken eggs, and even petrol. Medical care is an important social responsibility of the government, which is provided by the public sector.
But introducing law after law to make private health care “affordable” is ridiculous and absurd when consultation fees have not been reviewed for decades, while medical indemnity fees have reached six figures annually for some disciplines.
The capping of a professional’s fee is unfair, unjust and has dealt a “cruel and crushing” blow to the morale and survival of the medical practitioner. First to the family practitioner, and before long the private medical specialist. We are seeing our professional expertise drop lower than the hairstylist, masseuse, plumber and electrician, with due respect to these necessary occupations.
The fee schedules for private medical professionals must be removed from Act 586. Otherwise, there must be an annual review of 5 to 10 per cent per annum for inflation and to match with all other professions per hour.
Dr Sng Kim Hock believes that this personal opinion of his is felt by all medical professionals.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
