IN 2010, general practitioners (GPs) in Malaysia came together for a summit called “GPs at the Crossroads”. Their objective was to discuss the myriad of issues facing their profession, offer possible solutions and present these to the Government in a united voice. That summit generated a 177-page document which was published and duly presented to the Government. Another summit was held in 2015 which resulted in a memorandum submitted to the Prime Minister.
Today, GPs in Malaysia are facing even more immense pressures to stay afloat. The two summits they held are cries of desperation as they are squeezed, regulated, threatened and attacked from all directions.
One of their biggest problems is the micro regulation of the practice after the implementation of the Private Healthcare and Facilities Services Act in 2006. This Act regulates everything, from the size of the door of their clinics to whether they are allowed to do certain procedures such as intravenous treatments, and many feel it is unfair because it only targets the private sector.
Third party administrators (TPAs) are adding to the woes of GPs, who are subjected to such low consultation fees and charges that are way below the recommended rates. In addition, many are being slapped with administration fees, terminal fees, and etc. As a result, GPs receive a mere pittance, and they only manage to survive by working extremely long hours.
Regulation after regulation are being plied upon GPs, each coming at a cost to the clinics.
A typical GP clinic is subjected to doctor’s annual practicing certificate, signboard licence, pest control certificate, clinical waste disposal contract, regulation and inspection by the Medical Practice Division, Pharmacy Enforcement division, the Environment Department, local authorities, Fire Department and numerous teams from the Health Ministry on certain requirements or issues.
The latest requirements are the Personal Data Protection Act and the premises licence enforced by certain local authorities.
Other regulations in the works are the requirements for continuing medical education points and professional malpractice liability for renewal of the annual practicing certificate, Internet regulations for GP services advertisements, and the control of medicine prices. Many GPs, especially the solo ones, are finding it difficult to survive, and more than 500 clinics are estimated to have closed over the past 10 years.
GPs play a central role in the delivery of healthcare for an extremely affordable and cost effective way. Often, the GP is the first point of contact for any health problems and is the person who knows the patient’s history like the back of his or her hand.
Many families see the same GP for generations as he or she is always there, consistently providing high quality and holistic service.
Many near fatalities and hospitals admissions have been averted by GPs due to the consistent preventive medicine they practise as well as their experience.
This central role is fully recognised by the Health Ministry, with their Healthcare Transformation plan prioritising the enhancement of primary care.
The more than 7000 GP clinics that are currently operational nationwide were all set up with private funds, and the doctors attend to thousands of patients every day who otherwise would go to government clinics or hospital emergency departments, incurring costs to the Government.
GP clinics employ between 30,000 and 50,000 employees nationwide. They are also a significant source of tax revenue, contributing to the RM127bil target set by the Inland Revenue Board for 2017.
Many GPs go beyond the call of duty, donating their time and resources to charities and NGOs, again reducing costs that the Government would otherwise shoulder.
It has been clearly shown that prevention is more cost effective than treatments, and investing in primary care is the most effective means of reducing healthcare expenditure. In addition, investing in primary care promotes better outcomes with lower costs and higher patient satisfaction.
From an economic viewpoint, one of the most cost-effective ways for healthcare is to invest in infrastructure that are already existing. Indeed, the Government has done this on multiple occasions by buying over existing private hospitals at significant savings. The returns can be tremendous with every ringgit invested yielding significant healthcare cost savings for the Government.
The Government should also:
1) Enhance GPs’ skill sets by subsiding and creating alternative pathways for postgraduate training;
2) Purchase services from GPs at a negotiated cost;
3) Invest in IT technology in GP clinics, increasing efficiency in patient management and better private-public collaboration;
4) Subsidise training courses for nurses working in GP clinics to increase their knowledge and patient management skills; and
5) Cut the red tape and micro regulations for GPs.
Isn’t it time for the Government to invest in the 7,000 private clinics and enhance this cornerstone of the nation’s healthcare? Let’s make GPs great again!
DR JOHN TEO
Consultant Obstetrician & Gynaecologist