It’s been about 6 months since I permanently joined the private healthcare sector as a medical officer (a.k.a doctor) in Sri Lanka. I worked as a locum doctor prior to permanently joining, doing shifts here and there, but learnt that there is a vast difference between locum and private doctors.

I’ve been asked so many questions from fellow Sri Lankan junior doctors/medical students who are curious but cautious about the world of private practice. So taking all this into account, I decided to write a little abit about my experience in the private sector.

Working in the government vs private healthcare sector

Literally two very different worlds.

The government healthcare set up in Sri Lanka is amazing in the sense that you get the most experienced doctors and the most expensive investigations FOR FREE. Yes, there a queues. Yes, you don’t get the welcome drink. And yes, it’s not the most bright and sparkly place, but damn. You will get the best of the best care and if it is an emergency, you will get it within a matter of seconds. I have the utmost respect for the work that is done in the government sector after working in it for 2 years and will always direct anyone there.

In the private sector you do get the expertise, the welcome drink and the bright sparkly place, but at a cost. The cost is not as exorbitant as travelling to Singapore or India that have become professionals in the medical tourism trade, but still is a cost. (I still do not understand why on earth Sri Lankans travel to these countries for procedures and consultations that are so widely available in Sri Lanka, not to mention we have some of the best of the best in these fields – but more on that another time).

• What are my working hours like?

As a doctor, my roles have changed drastically. In the government sector, I used to work 24-36 hours often, and used to do 3-4 night shifts in a row in an intensive care unit like a nut job. The hours were long and intense, and I do desperately wish that working hours are brought into effect because it is insane and unsafe to have such long working hours. Yes, you will get more experience, but at what cost? I know this is not the same in all units as some SHOs/MOs have oncall nights only every couple of days and have to be present only 6 hours a day – but this does not happen in units with no intern doctors.

At the hospital I work at now in the private sector, time constraints are much stricter. Only allowing doctors to work a maximum of 18 hours at a stretch (very very rarely are 24 hours allowed). I tend to work 12 hour shifts so that I still have time in my day to destress after a shift. Unfortunately, I make the medical officer rosters for my unit and am involved in administration work (protocols, functioning of the units) so my phone never stops ringing. But it is a welcome change to have some downtime.

• What is my day at work like?

In the government sector my unit shift started at 7 am – ward medical officers however start at 8 am. This has not changed in the private sector as shifts are divided into & am to 1 pm, 1pm to 7pm and the night shift is 7pm to 7am.

Once I get to work there is a hand over from the previous doctor – in the government sector NICU it was only one medical officer on duty (unlike the wards which have 2-3 medical officers/SHOs on duty). In the private sector wards you don’t get as many beds so there is only one doctor on duty for the each ward (atleast it is in the hospital I work in now). The hand over should last about 20 minutes and then I have to do ward rounds to see all the patients.

In the government sector each ward has mostly 1 or 2 consultants, in the private sector however, each ward has MULTIPLE consultants in charge and you have to go for ward rounds with each consultant. This means that my morning ward round gets interrupted atleast 6 times to my annoyance. Because of this, my ward round takes FOREVER. I love all my consultants, but it is HECTIC to get my rounds done in time for each ones arrival. I have to also make sure that the nurses are kept in the loop of any problems I have concerning all the patients so that in case two consultants come at one time, I can send one of the nurses with one consultant.

Ward rounds in the morning always takes forever so if I’m doing a morning shift I’m always so busy. In my mornings I also have to update any consultants over the phone for further management as not all consultants allow the medical officers to do what they want. Most of my consultants allow me a free hand to do whatever I want without bothering them all the time, but some are more strict about management and want all the control. If any investigations ordered are bad such as a blood culture being positive, consultants must be informed because management will then have to change accordingly. In the meantime I also have to type up all my discharges and finish clerking any new admissions (they must be clerked within 15 minutes of arrival to the ward) so it is very hectic. Not to mention that I have about 5 nurses shouting the word “doctor” in every direction every couple of minutes. Remember you’re on your own – there aren’t any other doctors to help you out and the nurses in the private sector have to confirm everything twice with the doctor before doing anything. The risks are much higher in the private sector.

Also unlike in the government sector where it is an open ward and you don’t get to see all your patients very easily as they are in their own private rooms. This makes ward rounds take longer and monitoring more challenging. Never the less, I never take a chance and always knock on and visit my patients as often as I feel is necessary. At the end of the day, a patient comes to hospital to be taken care of, not for the need of a hotel stay so don’t let the luxury part of the private sector affect your patient care. A wise consultant of mine always tells the dengue patients to keep passing urine 2 hourly and if you want to sleep, then you might as well have stayed home. So I tell them the same with absolutely no guilt.

Some wards have a preintern to type up discharges – but I currently do not have one. So my mornings are very hectic and I am constantly on the run. Afternoon rounds must be done in the private sector as well, but are usually calmer than the morning shifts unless you’re in a surgical ward because the consultants all operate at night. Meaning the patients get admitted the morning of and then DT forms have to be sent, pre-op investigations must be traced and informed, and consent has to be taken. It can get insane!

Night shifts are usually much much calmer, unless again you work in a surgical ward where you’re constantly up checking on post-op patients and sending up the pre-op patients.

In the government sector, I would definitely have an intern to do all the discharges. A medical officer in the government sector also does not need to keep informing the consultants as often (and the consultants are around more often). The forms and pre-op investigations are also mostly ordered and seen by the intern doctor (unless interns are not available).

Working in Colombo, transfers are not hours on end and at maximum take half an hour to the destination. This is different in the government sector where mostly interns are sent on transfers to very far locations.

• What kind of cases do I get to see?

In most private sector hospitals, you don’t get to see as much variety as the government sector hospitals, but I’m very lucky to work in a private hospital with so many OG consultants that bring in complicated cases – so I have learnt loads. I also work under tons of consultants in different specialities – Physicians, Nephrologists, Pulmonologists, Haematologists, Surgeons and so many more specialities. This has lead me to learning so many more fields that I wouldn’t have otherwise had the opportunity to learn in before.

• What if I need help on the job?

In the government sector, there is a hierachy to call for help – interns call the medical officers/senior house officers who then will call the registrar who will intern call the senior registrar. If there are no registrars or senior registrar, then the consultant is called directly.

In the government sector I always had my consultant and seniors for back up and someone would be present in about 10 minutes maximum to help me. In the private sector however it isn’t as easy to get a consultant to show up, which means a call for help is a call to the ICU doctor.

• What about specializing/post graduate?

This was the only factor pushing me to remain in the government sector. It is so so very difficult to specialize in the private sector. It is downright ridiculous the amount of extra work that has to be done to get into a postgraduate programme as a private sector candidate. Training posts are almost always given to government sector candidates even though as a private candidate you pay more to even sit for the selection exams and you have to pay fees for the training if you can get into the programme. They only take a very very limited number of private sector (also called non-state sector) candidates and this is determined every year by the board of studies. Therefore do try and stay in the government sector as much as possible if you want to get through PG exams as soon as possible.

Working as a locum vs permanent doctor in the private sector

Many doctors work in the government sector as a permanent doctor and then do shifts in the private sector as a locum doctor during their time off. A locum doctor just comes, does the shift and goes – you might get a weekly slot or get called in whenever a private hospital doesn’t have a doctor for a shift. It’s a way of getting in an additional income for most. I did not work as a locum doctor whilst I was working in the government sector, but did do some locum shifts after leaving the government sector.

Conclusion

I know so many people think moving to the private sector is a sell out and that is something I genuinely do not understand. I still commit 100% to my patients and actually have even more time to chat to my patients and build a doctor-patient relationship unlike in the government sector where we have to see more than 50 patients in 4 hours in clinics – that is less than 5 minutes per patient.

It definitely was not an easy decision to make, but in hindsight I am much happier. I live in the same city as my husband and my family (no more travelling up and down 3 hours and being apart for half the month). I get to spend more time being active in things I love such as medical education, sex education and women’s health. I’m still super busy and am constantly running around, but am glad I don’t have to be far away (6-8 hours away) from my family. I will always have the utmost respect and love for the government sector, they do the best and most incredible work. If ever there is an emergency (especially if trauma), GO TO THE STATE HOSPITALS. I miss working in the state sector so very much, but am happy with the decision I made (despite the many questions I get).

Do what is right for you – you’re an adult, you can make an informed decision!