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Well, I just returned from my holidays down under. During my holiday, I read a lot of news regarding housemanship situation back home. In fact, before I left to Australia, I did receive few emails and phone calls regarding latest development in housemanship postings. However, I did not have the time to write anything till today.

In my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among housemen. I would not elaborate further on these 2 matters. Before I left for my holidays I received at least 3 emails/blog comments regarding new developments in housemanship employment. We all know that Malaysia do not provide housemanship for foreigners. I had received many queries from foreigners in India, Pakistan etc enquiring about this. However, foreigners who are married to Malaysian can be given housemanship post under contract if your degree is recognised in Malaysia. Unfortunately, the situation seem to be changing rapidly.

About 2 months ago, I received information that a Malaysian PR was told that she will not be given a job by KKM. She is a Singaporean who grew up in Malaysia right from kindergarten days. She graduated from one of the private college here. Following that, I received 2 emails from foreigners ( one from India and another from Indonesia) who are married to locals. Both had degrees which were not recognised by MMC. Thus, they spend almost RM25K going for attachment and sitting for MQE exams. They passed. Unfortunately, when they applied for housemanship, KKM told them that a new rule will be implemented . They will need to sit and pass/get credit for SPM BM paper!! It is very clear that KKM do not have enough post to provide housemanship for foreigners or PR holders. Thus, they are creating “so-called” new rules as an excuse. As I have said many times before, passing MQE do not guarantee you a job. This applies to any country in this world. Every country will give priority to their citizens followed by PR. BTW, even Malaysians who do not have BM credits may not get a job soon!!

Many at times, when graduating students ask me whether they should start their housemanship while planning to sit for USMLE or AMC exams, I had always advised them to do so. This is because, passing AMC or USMLE or PLAB DO NOT mean you will get a job in those countries. Unfortunately, there are students who felt otherwise. They felt that if they start housemanship, they will not have enough time to prepare for these foreign exams. Well, they may be right but life in medicine only gets tougher and never gets easier. As I had mentioned since 2012, Australia is also facing internship crisis. The situation will only get worst from next year, as mentioned over HERE. So, if even their own medical school graduates may not be able to get internship post, what more foreigners, who are sitting for AMC exams. So far, I heard only 5 Monash Malaysia graduates manage to get internship post in Australia for 2015.

I received an email from a local university graduate who wanted to migrate to Australia. She declined housemanship posting in Malaysia mid of this year and decided to sit for AMC exams. She had passed her Part 1 and planning to sit for her Part 2 soon. Then came the bad news. Her senior of 1 year who had already passed her AMC exams is returning to Malaysia to apply for housemanship as she could not get an internship post in Australia. It is the same for USMLE as well. I know many who never manage to get residency of their choice. Thus, I will say this again : NEVER do medicine if your intention is to migrate!!

Over the last few weeks there have been multiple letters to newspapers regarding the working condition of house officers. While I had written many times about these issues before, what interested me most was the letter written to Prime Minister’s office. I received a copy of this letter which I would not publish over here, presumably written by a group of housemen from Klang Valley. The letter states 2 main  issues: one on bullying and another on long working hours(supposedly 17-18 hours). Few days after I received the letter, I also saw the letter from PM’s office instructing the state health department to investigate the truth of the matter. It also appeared in the Star. Let me elaborate on both.

2 days before I left to Australia, I received a phone call from a mother whose daughter is doing housemanship for the last 3 months. She informed me that her daughter is very depressed and wants to quit housemanship. She claim that she is being bullied and she is unable to handle it any further. Surprisingly, according to her, the biggest bullies are NOT specialist or even MOs. It is the senior house officers!! Firstly, we need to define what is bullying and what is scolding. Medicine deals with patient’s life and thus certain mistakes have serious repercussions. You go to medical school to learn the basics of medicine and housemanship is to apply those basics in real world clinical medicine. The problem now is the fact that the quality of house officers has deteriorated tremendously to the extend that the senior doctors just throw their tantrum all over the place. Who will not get angry when you do not know how many chambers does a heart has? They should not have graduated in the first place! While I agree that scolding your juniors in front of patients and public should not happen but sometimes, the hectic work life of specialist or MOs just shoots them off the roof.

Bullying on the other hand has nothing to do with scolding for making mistakes.Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Unfortunately, this seem to be an Asian culture. I had said it many times in this blog that the very same person who is complaining about bullying, will become a bully when he becomes a senior. I had personally seen this right in front of my eyes. AND that is exactly what is happening in the case above. The biggest bullies for her daughter were Senior HOs!! As long as these happens, bullying will not end. While KKM do have protocols to make complains on bullying, the line that demarcate bullying and scolding is blurry. The deteriorating quality and the surge in the number of housemen will only make bullying worst.

The second issue was ” working hours”. I had also written about this before over HERE in 2011. While I don’t agree working 32 hours continuously  as what we did when we were housemen, being a doctor means we have to work long hours! That is a fact that most students should know before doing medicine. We cannot just let go of our responsibility to the patient before going home. WE must make sure we have done what we need to do. There is NO such thing as office hour job for doctors. In the court of law, patient safety is the most important consideration. These housemen think that they are the only one working 17-18 hours a day. Most doctors do and even people in other profession work long hours. The only difference is in other profession, you can bring your work back home where as in medicine, your work is done in the hospital. Even after 18 years of service, I am still working 24hours a day, 7 days a week. I can be called anytime of the day, even on weekends. Life in medicine will never get any easier. You must learn to work long hours. If you can’t, then leave.

Our DG has given a good reply to those who complain about working hours over HERE(see below). Another reply from a Paediatrician is also worth reading for those who complain about working hours (see below). Interestingly, a recent study in US showed that work hour limit for trainee doctors do not improve patient safety!! I know many who complains about working hours but will be sitting in a clinic doing locum when they are free!.

You chose this path and you need to adapt to what medicine wants you to be. Life’s are at stake and medicine is a life long learning. Even now, I am still learning. The most important teachers are your patients! The more time you spend with your patients, the more you will learn. I may be harsh but my advise to those who complain of long working hours is : please leave if you can’t handle it.

Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
Posted on December 10, 2014 by DG of Health
I refer to the article published in The Star entitled ‘Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.

The Ministry of Health (MOH) appreciates all feedbacks which have been provided on the housemanship training. Housemanship programme emphasises on training rather than merely employment, whereas the medical officers’ main role is to provide medical service, hence their roles are different. The 2-year housemanship has started since 2008. It encompasses training in 6 disciplines namely General Medicine, Paediatrics, Surgery, Orthopedics, Obstetics and Gynaecology, and alternative postings (either Emergency medicine, Psychiatry, Anaesthesia or Primary Care) for a period of 4 months each.

The housemen flexy working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexy system is among the continuing efforts by the government to maximise the houseman’s learning process which aims to further improve their working conditions. It provides a chance for them to gain experience and take advantage of the learning opportunities to be competent and safe doctors.The flexy system requires the housemen to work an average of 65-75 hours per week. Housemen are entitled to a one day off per week but it is not necessary for it to fall on weekends. Housemen are doctors under training and they must fully utilise the opportunity given to them to improve their competency. MOH is monitoring closely the housemanship training in government hospitals to ensure the flexy system is successfully implemented.
Feedback pertaining to Housemanship Training need to be chanelled to the Housemanship Training Committee at the hospital and State Health Department. It is worth mentioning here that the doctors’ utmost responsibility and inherent value is providing safe and quality care to the patients. The nature of doctors’ working hours is different than other civil servants because patient care requires continuous services of 24 hours a day or 7 days a week.
In appreciating our doctors’ commitment, the Government has given various incentives such as the critical allowance of RM 750 per month and a special allowance for housemen of RM 600 per month. It is hoped that with all the efforts made by the Government, the aspiration to produce quality and competent doctors for the nation will be achieved.

DATUK DR NOOR HISHAM BIN ABDULLAH
Director-General of Health Malaysia.

HOs must stop griping and learn the job
I REFER to the letter “Trauma faced by some housemen in hospitals” (The Star, Dec 8) on the trauma faced by House Officers (HO) at the hands of seemingly sadistic Medical Officers (MO).

I would like to offer a different view of the matter lest the public gets the wrong impression of how medical supervision is practised here and worldwide.

No MO will willingly traumatise a HO unless the former is extremely overworked or the HO is so hopelessly trained that the MO is so exasperated by the inadequacy of medical knowledge and lack of responsibility.

With the current standard of medical graduates coming back, some of whom with dubious medical training in institutions that have been approved through political means, it is not surprising that the MOs are stressed by these incoming HOs.

The extension of a HO after the stipulated period is the decision of the supervising specialist, and he or she has to justify appropriate reasons for extension.

If the performance is still below par after the extension, the HO’s name will be forwarded to the Health Ministry’s director-general to send him to another specialist for supervision.

Nobody likes to extend a HO because of the paperwork that is involved but due to the maintenance of a respectable standard and the future safety of patients whom the HO will be entrusted with, these MOs and specialists have to maintain these standards of care.

The writer has to understand that getting a paper with MBBS or MD is just the beginning of a lifelong journey of training and retraining.

The initial degree should have taught a basic foundation in medical knowledge, ethics and basic practice to allow the HO to function with further supervision for another one to two years and be trained to be a specialist of his or her choice after that.

Without any further training, the MO can become a general practitioner in this country.

If the HO’s performance and knowledge is below par compared to his peers, it will not be fair to let him “loose” to the general public.

This training of HOs occurs all over the world and it is one way of ensuring that the public will be given safe young doctors to treat them in the future.

Ask any supervising specialist in the profession and one hears of the deteriorating standard and responsibility of new incoming HOs.

There are good ones who perform and never write in the newspapers and there are bad ones who complain about working 32 hours at a stretch. They just have to get used to it!

That’s what they signed up when they chose medicine where the patient is paramount to our sleep, food or toilet habits.

I think the writer exaggerated about the predicament of HOs. There is not a trained specialist who has not slept in the operating theatre, patient’s bed, at the table or in the toilet in his lifetime.

A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.

These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.

The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.

PAEDIATRICIAN Z

Kuala Lumpur

My last blog post received almost 27, 000 views in a single day on 5/11/2014. Numerous comments were made. My comment was very simple, a once well-respected and trusted profession to whom the community looked up upon, has gone to a stage where the authorities have to ask sisters/nurses of the ward to monitor their discipline. Some commented that there are only a few bad apples in our profession BUT let me tell you, for those who are not in the system will not know that it is NO MORE a few bad apples. The fact that the Minister has to instruct and give extra job to the sisters to monitor the discipline of house officers is enough to explain the gravity of the situation. BTW, the topic discussed had nothing to do with insulting the nursing profession. It was all about the deteriorating attitude of OUR profession! We brought it to ourselves.

The same situation seems to be happening in smaller district hospitals and Klinik Kesihatans. I am beginning to hear stories that taking MCs, EL and coming late to work is becoming very common nowadays, despite having more MOs. Sometimes I wonder whether it is better to keep less number of doctors than having more as it is easier to monitor. I always believed in quality than quantity. Recently I heard that 4 MOs did not turn up to work in a KK on the first day of the week! 2 decided to take MC, 1 took EL and another claim stuck in traffic jam! Some MOs were found to be taking frequent MCs (must be immunocompromised I guess!), given to each other by themselves! What will MOH do about this ? I am sure sooner or later, another similar circular will be issued to KK sisters to monitor the situation. Few years ago, there was already a circular stating that MOs can only be given MC by a specialist but no one seem to be following this anymore. What impression does the other staffs of the clinic will have on us? An unreliable bunch of ………..?

Every now and then, I hear that HOs and MOs do not turn up to work because they are busy doing locum in 24hr clinics. Some has been caught before. Let me remind those HOs that doing locum before full registration(aka completing housemanship) is ILLEGAL! MOs are allowed to do locum with permission from the Hospital Pengarah. However, the place where you are doing locum must be written in your APC. As a doctor, you can only practise at the places mentioned in your APC. Practise at any other place can be deemed illegal.

All these years, even after locum was legalised in 2006, MOs/Specialists locum incomes are never properly declared to LHDN(IRB). While the clinic may declare the locum fees paid as an expense, I am not sure how many doctors who do locum ever declare their income generated from locum. Remember, every income that you receive are taxable. We all know that the government is running out of money! The last Budget 2015 and the impending GST are clear indications. The drop in oil and oil palm prices in international market will further reduce our country’s income. So, the government has to fall back upon the people to get the money back! Thanks to the 47% who voted in the last election. The toll prices are going up next year, electricity tariffs may go up in June 2015 and petrol/diesel subsidies are being removed effective 1/12/2014. While doctors who are running clinics cannot charge GST to patients (GST exempt), they have to pay and absorb all the GST charged by their vendors on supplying equipment, drugs and clinic rentals. Thus, the overhead cost will definitely increase which in turn reduces your net income further. ON the other hand, an increase in your consultation fee is limited by the government and the patient’s ability to pay! Patient’s cost of living will also increase after GST implementation.

While GST comes under Customs department and follows a completely different set of protocols, income tax comes under LHDN. Doctors in private hospitals who are generally self-employed are still confused about GST. Negotiation and discussions are still going on, between MMA, APHM, Hospital Managements and Customs.

LHDN on the other hand is going around blocking all the loopholes they have, to generate more income for the government. Coming back to the locum incomes mentioned above, LHDN is sending circulars to clinics making it compulsory to declare who their locums are!! The circular (see below) clearly says that, it is needed for LHDN to collect more MONEY! So, for those who thought can do locum and escape without paying tax, please beware. LHDN may come knocking at your doors one of these days. The penalty can be an additional 20% of the tax not paid! Furthermore, you can be barred from leaving the country!

As I wrote in my Part 1 and 1b of the above topic, life is not going to get any easier for doctors. So many rules and regulations are changing nowadays. If the separation of dispensing rights happens in April 2015, income of doctors will further decline. The medico-legal cases and seeking compensation from doctors are also increasing day by day!

Well, it’s time to take another holiday to clear my mind and release my stress. I will be away and may not be able to answer the comments in this blog from 26/11/2014 till 7/12/2014. It’s time for me to go for another round of thrill rides down under!

Good Day mate!

 

LHDN 2

 

For years I have been writing about deteriorating quality of medical graduates. For years I talked about the poor knowledge of housemen and their inability to handle stress. I had also written in this blog the “tidak-apa” attitude of the junior doctors nowadays. We can still tolerate some lack of knowledge as it can be learned but the feedbacks that I get from my friends is the attitudes of the current generation of doctors. Many go missing in action (MIA), SMS their colleagues and even MOs that they are not turning up for work, giving stupid excuses such as car breaking down (can happen even 3 times/month!) etc etc. With the load of housemen in some hospitals and the introduction of shift system, the MOs and Specialist has given up monitoring the housemen. NO one bothers about them anymore. Only the good, hard working ones catches the eyes of the specialist and MOs. The same generations are becoming MOs and the cycle is repeating itself! Unfortunately, the system can’t do anything to kick them out!

Our profession use to be a well-respected profession. People use to look up to us and the staffs in the hospital respected us for whatever we did and said. Most doctor,s up to 10 years ago, use to be the cream of the country. They were the top students and to become a doctor , you need to have a brilliant mind with a lot of hard work. You need not be a ALL A star student but still need certain level of intelligence. We worked tirelessly with only the patient’s safety and life in our minds. Unfortunately, the situation is changing rapidly. Now, anyone can become a doctor as long as you have the money. Everyone who enters a medical school seem to be able to pass after 5 years. No one seem to care for the patient. Many are only interested in the status and salary. Everyone is only thinking on how they can earn money as fast as they can. Everyone is being calculative on the amount of time they are working. Many are becoming “bodoh-sombong”, don’t know anything but don’t bother to find out and give stupid advises to patients! I can go on ranting about it here but the situation will only get worst. Until the entire healthcare structure changes to kick out the “non-functioning” doctors, we are heading for self-destruction.

Doctors had always monitored doctors (apprenticeship). No one interferes. Unfortunately the system seem to be falling apart as specialist are unable to monitor the situation anymore. Thus, MOH has developed a NEW monitoring system for Housemen! Below, I attach a letter from Lembaga Jururawat Malaysia (mind you, NOT MMC!) informing that the Minister has instructed all Sisters of the ward and Matrons to monitor ALL the housemen in the hospital. A “tracking mechanism” is being developed. It will be on trial till December 2015 for feedback.

Well, we brought this upon ourselves. We have come to a stage where nurses aka sisters aka nursing body are being asked to monitor the attitudes and disciplines of housemen aka doctors!. We had lost all the respect that we once had. Soon, they may ask MAs and KK sisters to monitor MOs!!

It is a sad day for medicine………………..

Never do medicine for wrong reasons!

 

 

KKM NUrse 1

Well, my worst fear is yet again proven correct. When I received few emails from AUCMS students that they were accepted en-bloc to CUCMS without the need to repeat any semester, I repeatedly asked them whether this has been approved by MMC. I also wrote in my earlier blog post on 12/10/2014 that CUCMS did get into trouble 3 years ago for taking in more students than what was allowed by MMC. They were derecognised temporarily till they transferred all the extra students to another university. I heard most of the MARA students were absorbed by Newcastle University in 2011. Subsequently, their recognition was extended from 12/2011 for 3 years only, which means it will expire this December 2014. Please read the MMC 2011/2012 report over HERE (Appendix IX)

2 days ago, while I was enjoying my Deepavali holidays with my parents, I read the news below in The Star. Yet again, MMC has issued warning to CUCMS not to take students beyond what they were allowed. I wonder what happened to UKM when they took in all the AUCMS UKM students. Did they also overshoot their quota? Whatever it is, UKM definitely have bigger facility and bigger number of academics. According to MMC, UKM is allowed 200 students per year intake as what was mentioned HERE.

Another news that was recently published in Berita Harian was rather sad. As I mentioned in my earlier post, 3 of the twinning universities withdrew their alliance with AUCMS early this year. Their first medical program was a twinning program with Universiti Sumatra Utara (USU) in 2004. Their first graduate , if I am not mistaken was in 2009. According to the news I received, students who graduated in 2013, who are already doing their housemanship, are in trouble with MMC registration as their degree from USU is being withheld due to non-payment of fees!! Please see the photo below. I wonder what happened to the CEO? I heard, he is in UK.

While I don’t support PERKASA, it will be interesting to read THIS information from their website.

I hope ,this will be my last post regarding this college.

 

AUCMS students in limbo again due to quota ruling

BY REBECCA GRACE RAJAENDRAM
CYBERJAYA: Parents of students affected by the Allianze University College of Medical Sciences (AUCMS) financial crisis are appealing to the relevant authorities to relax the regulations for the medical course at certain private higher education institutions.

Following instructions from the Education Ministry last week, AUCMS students had enrolled in other institutes to continue their studies while the university college sorts out its financial situation.

However, after registering and paying the fees, these students were informed that their chosen institutes would exceed the lecturer-to-student ratio set by the Malaysian Medical Council (MMC) and they would have to be placed in other institutions.

A representative of the parents, Azman Taher, has appealed to the MMC and the Education Ministry to relax the quota ruling so that these students could continue their studies after being in limbo for six months.

“Let the students stay in the university of their choice,” he told the media yesterday after a briefing for students and parents by AUCMS officials at Cyberjaya University College of Medical Sciences (CUCMS).

He added that about 230 AUCMS students, including his daughter, had registered in CUCMS.

Another parent, who did not want to be identified, questioned why AUCMS and the ministry did not inform them of the quota during the briefing on alternative institutions last month.

“Our children have chosen CUCMS because its syllabus is about 85% similar to AUCMS’,” he said, adding that it was the same scenario at AIMST University and Universiti Kuala Lumpur Royal College of Medicine Perak.

During yesterday’s briefing, AUCMS registrar Datuk Basir Elon said the affected students could now choose to enrol in six other institutions – Melaka-Manipal Medical College, UCSI University, MAHSA University, Management and Science University (Bangalore, India campus), SEGi University and Lincoln University College – to continue their studies.

A memo by AUCMS dated Oct 20 said the students would be informed of their new institution by Monday.

 

CDOnNnU

Well,  one medical college may finally be closed down. A college up north which use to promote itself as the only medical college in the world with 5 medical programs may finally close it’s doors for students. Over the last few months, news appeared in mainstream newspapers that many of their staff has left due to non-payment of salaries. The latest appeared on 9/09/2014. I had written several times about this college which was facing huge financial difficulties, over HERE, HERE and HERE.  It started with the withdrawal of the twinning partners, which automatically removed 3 of its medical programs. It was left with 2 medical programs, one of its own and a UKM degree. As I wrote in August, UKM absorbed all the MD UKM students from this college.

Thus, students from their own program and the remaining USU twinning students were left in the limbo. I received many emails from students and parents asking me what to do. Most students were already planning to do credit transfer to other medical schools but majority of them may need to repeat a year or so. I had a tough time giving them a solution. The best solution I could give the students is to get out of the college. They were not getting any training either. It is better to move on rather than waiting for the college’s decision. As for the parents, I asked them to get together and lodge a complain to MMC, MOE etc. I think the parents did do something about it.

ON 29/09/2014, a meeting was held between the students, MOE, MMC and representatives from other colleges. The students were given a choice to transfer to some of the other colleges namely CUCMS, UCSI, MAHSA etc. They were given just 1-2 days to decide! Interestingly, CUCMS has agreed to take ALL students into their campus without the need to do any repeat semester! I am not sure whether this has been approved by MMC.  I am sure you are aware that CUCMS was derecognised by MMC in 2011 as they took in more students than what was allowed by MMC. Based on the current MMC list, it is rather confusing whether CUCMS is still recognised or not.

While I pity the students and at the same time feel happy that at least they got a solution at hand, I believe that all these could have been avoided if our society had done some research before putting their foot into something big. I know many had financial issues but still interested to do medicine. Thus, the generous “scholarship” that was given by this college attracted many middle-income families. I am sure many will be left with HUGE amount of loans! It may take a lifetime to settle their loans and will forever be in debt! I remember giving warnings to many students who seeked my advise to enter this college. However, students being students, they will never listen to advise given by a doctor who supposedly discourages people from doing medicine! They rather listen to the marketing guy from the college! I never discouraged anyone. I am merely stating the facts and the only advise I had always given is, not to do medicine for wrong reasons. Whatever I had said all this while is becoming a reality one after another!

If only they had listened to my advise, they could have avoided all these mess. Interestingly, after all this fiasco involving this college, I still had emails from students who have been offered a place to do medicine for September intake, asking me what they should do? I do not know whether to laugh or cry! Sometimes I am just dumbfounded with the type of questions I get from the current generation of students. Why walk into a sinking ship? Sometimes, I feel that many parents and students just want the degree MD or MBBS at the back of their name. They don’t care whether they are going to receive any training or not. They may very well walk out with a “license to kill”!

Both their own MD program and MD UKM program is still being listed in their website . But if you notice the comment section, the last comment was dated 30/08/2014! Probably, no one is running their website after the date.

This could be a blessing in disguise. With MOH struggling to give housemanship to graduates, the closure of some of the medical schools may very well be a good blessing. The waiting time is now getting close to 6 months! UNIMAS graduates in June will be only starting their housemanship in December 2014. I heard graduates from Russia who came back in June and attended interview in mid August are yet to get any date of employment! AND for those who listened to our latest 2015 Budget last friday, it is very clear that our government is running out of money! NO new hospitals were mentioned, no salary revision for civil servants and ministers. Basically, there were nothing much in that budget. There were some mention about increasing 1Malaysia clinic (which are shop lots BTW) and few new KKs will be built. I also heard that MOs will be sent to all 1Malaysia clinics as ALL the KKs are congested with MOs.

May GOD bless this country……………, BTW, looking at direction the country is taking, it does not look good!

 

 

 

 

IN my last Post, I mentioned a little about the increasing waiting period for Housemanship. Over the last week, I received few more information regarding this “waiting” period. I was informed that the UKM, IMU graduates had to wait for 4 months to get their postings, UCSI took 5 months and PMC graduates are still waiting for their posting since June 2014. I was told that some will get their posting in October and some may need to wait even longer. So, guys, it is time to start the waiting game for your housemanship…………..

Today, a JPA scholar wrote to the Star regarding this issue. Surprisingly, being a JPA scholar does not seem to have any advantage when it comes to housemanship posting. However, the only guarantee that they may have is that the government MUST provide them with a job since they are bonded. From the letter, we can see that he has been given a job in civil service but it is the posting that is being delayed. The posting is done by Ministry of Health. Unfortunately, the situation seem to be getting rather critical in MOH.

MOH just released their Health facts 2014, which summarises the health situation of the country for 2013. I use to write this under ” The Writing is on the wall” series over the last 2 years. One thing is for sure, we are 3 years ahead of our target. The initial plan for our “quantity” government is to achieve a doctor:population ratio of 1: 600 in 2016 and 1: 400 by 2020. Unfortunately due to our generous medical school licensing “program”, with close to 33 medical schools and thousands more returning from overseas, we have already achieved a ratio of 1: 633 last year!! BRAVO !Based on MMC report, we had 4472 new doctors doing housemanship for the year 2013. The numbers will continue to increase as 50% of the 33 medical schools are starting to produce graduates from this year onwards till 2016. As I predicted almost 5 years ago, the number will hit 6-7000 by 2017. I wonder how MOH going to deal with this number, by then.

As of 31st December 2013, we have 46 916 doctors with 75% (35 219) in government service. ONLY 25% are in private sector! This is total opposite to what it use to be 10 years ago. WE only have 141 government hospitals in this country, not all of them are housemanship training hospitals. So, where are these graduates going to be dumped to do their housemanship? That’s the reason why the waiting list is being created.  Until the government introduces a common entry exam, they have to provide Housemanship training for all. The waiting time will only get longer from now onwards.

There is another problem coming soon. The MO post are also getting saturated. What will happen then? I was informed that soon, Housemanship may only be given on contract basis. Upon completion of your housemanship, you need to reapply for a permanent MO post in civil service. There is no guarantee that you will get a job. Compulsory service may be removed. You can be sent anywhere where the post in available. You can’t be choosy anymore. This in turn will reduce the issue of maldistribution of doctors in this country.

AS what the Minister said last month, we are heading for a complete restructuring of our healthcare system. Once our hospitals are corporatised, every graduate have to apply for a job to the respective corporate hospital. It is no more a civil service employment. It is also no more a permanent and guaranteed job. Many countries practices the same system. IT is also a way to get rid of the “non functioning” doctors in the system. Only those who are genuinely interested to work as a doctor and competent enough should be given a job.

Back to the letter below, since you are bonded, unlikely you will be released. That’s the reason why JPA has stopped sponsoring students for medicine. It is interesting to note that she gave the answers to her own query!

So, the waiting game continues………………………..

 

Give JPA scholars postings or free them
MY nephew is a Public Service Department (JPA) medical scholar. He came back in the middle of July.

He attended the JPA interview in early August and was given a job offer letter but until now he is still waiting for his posting. He and his friends called JPA to ask when will they get their postings and the answer they got is to wait till December 2014, if not early 2015 – another two months or later!

I am wondering why the Government spent hundreds of thousands of ringgit sending them to study overseas and yet keep them waiting doing nothing for months.

These scholars came back to Malaysia to honour their contracts to serve the Government.

There are two reasons I can think of why the Government cannot post them as soon as possible:

1) All the Government hospitals are loaded with doctors.

2) The Government cannot afford to pay them.

If either of the above is correct, then the Government should release them from their contract so that they can get to practise their profession in other countries where they will be grabbed.

I hope the authority will look into this matter seriously.

LOH GEOK SUAN

Alor Setar

Over the last 5 years, I had written many times regarding degree recognition, quality of medical educations and pathways to specialisation. Unfortunately, I get asked these questions again and again from budding doctors as well as parents. Sometimes, I wonder whether our society even reads or does any research before asking these questions. Sometimes I do get irritated and thus some sarcastic remarks had to be made! I felt I should write these issues once again for the last time!

As I have said many times before, medicine is rather unique in the sense that just because you have a MBBS/MD degree, it does NOT mean you can work anywhere in this world. Every country has their own way of recognising medical degrees. IF your degree is NOT recognised by the medical council of the respective country, you will NOT be able to work in that particular country, as a doctor. You need to sit and pass their entrance exam conducted by their medical council in order to be eligible to be registered. However, eligibility of registration is NOT equal to getting an employment. Also please do not forget that these entrance exams are NOT cheap and not easy either. Despite spending huge amount of money, you may end up going nowhere. That’s the reason I keep saying that if you intend to migrate, never do medicine!

UK has the PLAB exams for those who graduate from any university outside UK, Australia has AMC exams and US has USMLE exams (which all their graduates need to sit). Unfortunately, to get a job in UK is becoming almost impossible due to their immigration laws where their citizens and EU citizens are given priority. You will be at the bottom of the list. Even if you do your degree in Newcastle Malaysia, the same rule applies except the fact you do not need to sit for PLAB exams. If you do not get internship in UK, you will not get GMC registration. FYI, UK is having the same problem as Australia in the number of internship post. Both these countries are only able to provide internship to those who graduated from their own local universities. I know quite a number of Malaysians who had passed AMC exams but yet to get a placement in Australia. In US, the situation does not look that rosy either. A recent report suggest that for the first time, there are more applicants than post for residency training.  Thus, even their own graduates are unable to get residency post of their choice and need to wait for next year’s intake. Your chances may be better if you choose the non-popular residency post. Meanwhile, Ireland Medical Council has now recognised housemanship training in Malaysia. You are eligible for general registration after housemanship completion in Malaysia without the need to sit for PRES examination. However, I am not sure whether your undergraduate degree have any role to play. Unfortunately, Ireland is not the best place to work currently due to their economic situation. As for Malaysian degrees, only UM/UKM is recognised in Singapore and Monash in Australia/NZ.

The situation in Malaysia is not that great either. I first started to write about possible over-supply of doctors almost 10 years ago when they started to approve too many medical schools (33 in total with 36 medical programs at least). Many were in denial including our politicians, MOH and MMA. I was labelled with all kind of nasty name calling. Fortunately, as I predicted the problem has now surfaced publicly. In 2011, after much denial, the government issued a moratorium for new medical schools. At the same time, MMC came up with the Minimum Entry Criteria. While I disagree that SPM should be used as the main criteria, MMC had no choice as in the name of education hub, we have just too many Pre-U courses conducted by various colleges.  I still feel that MMC should only allow medical school entry based on well established Pre-U courses like STPM, Matriculation, A -level, IB etc. I strongly do not agree that Foundation courses should be used as the Pre-U entry course. It is not a standardised exam as it is conducted and marked by the respective colleges. I have heard enough stories!

MMC has also made it very clear that those who go to unrecognised medical colleges overseas without minimum entry qualifications will NOT be able to sit for MQE exams. So, for those who are doing medicine in unrecognised universities without minimum qualifications, please look at other options. Please be also warned that MQA accreditation is NOT the same as MMC accreditation. For medicine, only MMC accreditation matters. 2 years ago, I remember of  students being offered scholarship to do medicine in CUBA. This is despite the fact that none of the degree from Cuba is recognised by MMC but many were not aware. Recently, it appeared in the news.  Students who had graduated and returned to the country last month are now required to sit and pass the MQE examinations. IN response, MMC said that they are reviewing ALL recognised medical schools and may reduce the numbers further (see below). 

With the mushrooming of medical schools (the highest per capita population in the world), quality became an issue. Recently, MMA president claimed that close to 20% of medical graduates do not have enough qualifications to do medicine. He was referring to many graduates from overseas universities especially from Russia, Indonesia, Egypt etc. I had written about this before especially over HERE. However, local university graduates are not that great either. Many of the medical schools do not have enough academics and dependent on foreigners from Myanmar, India etc. I am not saying that they are not good but the health care system in those countries are different from ours. The very fact that we are dependent on foreign academics tells us that we are NOT ready to have so many medical schools, in the first place. Despite low number of academics, the medical school need to take at least 100-150 students to make profit and get their return of investment. That was the reason why MMC came up with the criteria, as many of them were taking students with low quality by using their own foundation programs. The quality of training after graduation is another issue all together which I had written many times before. The shift system with poor supervision has made it go from bad to worst! We are going to be seeing a lot of THIS type of stories soon!

With the introduction of the minimum criteria, many private medical colleges started to find it difficult to recruit enough students since 2011. This is causing financial problems for some medical colleges. JPA has also stopped sponsoring students for medicine over the last 2 years. First they stopped sponsoring students overseas except for the top 50 students or so. Recently, I heard, JPA has also stopped sending students for medicine to some if not all the private medical schools. Even for public universities, JPA is no more a guaranteed scholarship. I was informed that as of last year, there are NO MORE JPA sponsored students in PMC. This has reduced their intake for this year to only 65 students! This has also prompted the university to reduce their entry requirement (ATAR 80 for 6 years program), including taking UEC students and recruiting foreign students from middle east countries. If not, they will not be able to survive. Ironically, MARA is still sponsoring students for medical studies both locally and overseas! So far, I have not heard of any instruction from MOE to reduce the intake of medical students into private medical schools. However, I feel some of these schools may undergo a slow death like what is happening to THIS college.  I heard this college is working out some agreement with CUCMS. However, I find it interesting that based on the latest MMC LIST, CUCMS only recognised till 12/2012? .  It is rather confusing.

MOH is also finding it difficult to accommodate housemanship posting for graduates. I heard local public university graduates had to wait close to 3 months for appointments (use to be only 1 month). Private universities seem to be taking longer. I heard some PMC students who graduated in May 2014 with interview conducted in the university itself , are yet to be posted for housemanship. Some are getting the posting for October intake and some may still need to wait longer. So, the waiting list is getting longer. I heard some MARA sponsored students have applied for housemanship in Ireland and manage to get it.  Remember, 50% of the 33 medical schools will only start to produce their graduates starting from this year till 2016. So, what the situation will be like, by 2016?

I have a feeling that MMC/MOH may not have any choice but to introduce some sort of entry or exit exams. Even the MO post are becoming full and many are being posted to East Malaysia. Klinik Kesihatans are being filled to the brink with some small KKs in a rural districts have close to 9-10 MOs now!

Finally, if your degree is NOT recognised in another country, you will not be able to do your postgraduate degree/specialist training overseas. This is because, you will not be able to get a job. Specialist training in medicine is FULL TIME working and PART TIME studying. I get asked this question repeatedly! However, you can go for a short attachment on temporary registration,  for training purposes. Generally, no salary will be paid for such attachments. If you have MRCP/MRCS/MRCOG etc, you may be able to get a job in Singapore as a MO/registra.

 

MMC to review all foreign medical schools
Posted on 17 September 2014 – 09:32pm

Karen Arukesamy
newsdesk@thesundaily.com

PETALING JAYA: The Malaysian Medical Council (MMC) is reviewing the accreditation of all foreign medical schools with a view to reducing the number of such recognised overseas institutions.

Director-General of Health Datuk Dr Noor Hisham Abdullah, who is also MMC chairman, said the council is not recognising more foreign medical schools.

“We are cutting the number of recognised universities abroad,” he said when asked to comment on theSun’s page one report today highlighting the plight of medical graduates from a Cuban scholarship programme whose degrees have not been recognised.

“Many universities, including from Australia, have applied for recognition but we are not considering at the moment,” he told theSun today.

According to the MMC website, aside from 29 Malaysian medical schools which are accredited, MMC has recognised medical degrees from 375 overseas medical schools in 34 countries, including Myanmar, Czech Republic, Sri Lanka, Iraq, Russia and Ukraine.

While he declined comment as to why MMC had yet to respond to Cuba’s application for recognition for its medical programmes since 2007, Noor Hisham said medical graduates from Cuba will have to sit for the Medical Qualifying Examination (MQE).

Four students from the first batch of Malaysians sent there in 2007 under a Cuban scholarship programme who returned here on Sept 4, have been told to enrol for a six-month course which costs RM25,000 in a local universities, prior to sitting for the MQE.

However, there is no guarantee that the local universities will accept these students for the programme, without which they cannot sit for MQE.

Meanwhile, Health Minister Datuk Dr S. Subramaniam said the ministry has also frozen all new applications to set up private medical colleges in the country as there are many recognised medical colleges for Malaysians.

An MMC source said it had stopped accepting new applications for medical universities since the beginning of 2013.

As to the recognition of Cuban medical degrees in Malaysia, Subramaniam said if there is an update, the ministry would notify the Cuban embassy.

 

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