Over the past few months, there has been interesting developments and debates going on in UK, especially in England. Back in March 2015, newly re-elected UK Prime Minister David Cameroon announced that he will introduce a “truly 7 days a week” NHS system by 2020. This resulted in huge outcry by the medical community in UK, resulting in Facebook post etc. In July , we saw this interesting Facebook post by Dr Janis Burns who challenged the government to proof that the mortality was higher in the weekends and also to proof that NHS service is not running over the weekends. She also mentioned about her life story!

Politicians are politicians wherever they are. Their interest is only to get public support to win elections. However, we can’t say that whatever he said are all lies. Every system has it’s flaws similar to Malaysian healthcare system. I can’t say much about the UK system as I am not working there at the moment but I can say that the situation in Malaysia is almost the same. IN Malaysia, during weekends, only the on-call doctors work, including MOs and Consultants. Usually, only 1 Consultant is “on-call” over weekend (each for Saturday & Sunday) with 1 or 2 MOs. This is definitely not the same as the working days where everyone is around. Obviously, the standard of care will not be similar.  Of course, priority is given to emergency cases over the weekend. I presume the situation is the same in UK based on the Facebook post by Dr Janis. The Health Secretary has clearly told BMA to get “real”!

The issue in UK has become more intense over the last 2 months. In August The Guardian reported that thousands of UK doctors have applied for ” Certificate of Good standing” from GMC which basically means they are applying to work overseas. The numbers applying increased tremendously after the new contract announcement. The new contract which is being planned to be implemented in England (Scotland and Wales has not agreed to it yet) has redefined working hours which included Saturdays, removed overtime allowances between 7-10pm but increased hourly allowance for newly defined “overtime” and increased their basic pay. However, the doctors in UK claim (see below) it will result close to 30-40% pay cut as they will earn less on overtime allowances. The GP trainees are also affected as their pay supplements will be terminated.

It is very interesting to note that eventually it boiled down to money and survival. Remember, what I said few months ago in my post ” Passion vs Debt” and  “Passion vs Debt vs Reality” , passion is one thing but living a life is another! That’s exactly what this doctors in UK are feeling. While they have the passion to serve, living a life with debts to pay and can’t even afford to buy a property in London and major towns brings them to reality of survival. I keep saying this to youngsters who do not know the reality of life before venturing into any course. At the end, it is just a profession to earn a living. Bankruptcy rates among Malaysians are at a worrying trend due to huge debts!

On 28th September 2015, doctors marched to Downing street in protest of the new contract. Whether this will change anything remained to be seen as the government is planning to implement the new changes as soon as possible, latest by April 2017 if I am not mistaken.Whatever said, you chose the profession and you need to live with what is given. If the politicians can prove that the weekend standard of care is lower than weekdays, then doctors will not be able to defend themselves. This is why I keep telling the junior doctors, you chose this profession willingly, thus do not complain about long working hours etc. It is the same elsewhere. I had said enough before. Our government can also ask doctors to take a pay cut once they have enough doctors as getting  a job will become a privilege. You go where the vacancy is and can’t demand anything. Worst still, our degrees are mostly not recognised elsewhere! You can’t run anywhere!

Where do you think these UK doctors will go? Most will land up in Australia or New Zealand as their training in UK is recognised in these countries. This in turn will reduce the number of available post for others. Malaysians whose intention is to migrate to Australia will need to think about the effect of this UK policy on us. Those who are planning to move to Australia by sitting for AMC exams will be worst affected. As I had always said, never do medicine if your intention is to migrate. It is the most difficult profession to migrate.

Please read all the links given.


‘I can’t sacrifice my family for the NHS’: the junior doctors forced out of jobs they love
Young doctors are seething with anger over new contracts threatening lower pay, longer hours and increased stress. But do they really have it that bad? Here junior medics on the verge of quitting describe salaries that barely cover the bills – and a workload that means they could end up earning as little as £10 an hour
Junior doctor David Watkin: ‘We feel very under-appreciated by the government and the Department of Health.’

Amelia Gentleman
Monday 28 September 2015 17.12 BST Last modified on Tuesday 29 September 2015 09.06 BST
At what point does a dedicated doctor, with a lifelong commitment to the NHS, decide it is time to quit? For Dr Singh, 34, a junior doctor in general medicine, the moment will come when he is no longer able to pay his mortgage and childcare bills, a situation he expects to find himself facing sometime next year.

Dr Singh has worked in hospitals, with regular A&E shifts, for 10 years since qualifying, loves his job and describes himself as “the kind of doctor you’d want to see to your gran”. But, having done an online calculation assessing how the Department of Health’s new junior doctor contract will affect his household income, he believes he and his paediatrician wife face a 25% cut to their joint take-home pay, making life in London unaffordable. He plans to move into the pharmaceutical industry.
New junior doctors’ contract changes everything I signed up for

Several of Dr Singh’s friends have already left the medical profession to work as bankers and consultants in the City; others are considering emigrating to work as doctors in Australia or New Zealand. Most of them are dispirited by the proposed contract, but are more fed up with the daily stress of their work, annoyed that the long hours and considerable financial and personal sacrifices they make during their training are not appreciated, and they worry about the impact that dwindling morale could have on the NHS and its patients.

“I am not looking for parity of pay with my friends in the City. But if you can’t afford to pay your mortgage or your child’s nursery bills and you can’t look after your child yourself in the evening or [at] the weekend because the government is proposing you should work those hours on a normal basis, you can’t continue with that kind of life,” he says, asking for his full name not to be published to avoid annoying his employers. “I am a very valuable resource to the NHS. I do work incredibly hard, I really enjoy looking after my patients and I get immense satisfaction from it. I have an absolute commitment to the NHS but I can’t sacrifice my entire family for that. I have to put a roof over my son’s head.”

Junior doctors will be balloted to decide whether to strike over a radical new contract imposed on them by the Department of Health, which redefines their normal working week to include Saturday and removes overtime rates for work between 7pm and 10pm every day except Sunday. The government says the changes will come with a rise in basic salary, higher hourly rates for antisocial hours and will be “cost neutral” – but doctors believe this change could reduce salaries in some areas of medicine by up to 30%. The British Medical Association (BMA) argues that it is “unacceptable that working 9pm on a Saturday is viewed the same as working 9am on a Tuesday”.

It is unusual to hear doctors getting angry and this swell of rage is disconcerting. A social media campaign means their voices have begun to be widely heard over the past week. If the effects of the government’s austerity drive on care workers, for example, have gone largely unnoticed, the seething protest from this powerful group looks set to be harder to ignore.

Most junior doctors are smart enough to know that they will have to work hard to persuade the public that they are a genuinely needy section of society. A perception of doctors as well-paid professionals has stuck and even a semi-attentive observer knows that the harsh 100-hour-week working pattern that used to characterise medical training has been abolished.

What most people outside the medical profession are probably unaware of is that you aren’t just a junior doctor for a fleeting period after qualifying; this makes up a substantial chunk of your career – sometimes a decade, and often stretching late into your 30s. Basic salaries start at around £23,000 and are enhanced by various complicated supplements, including the antisocial hours pay that is set to be cut. Because medical training takes longer than other degrees, most junior doctors have large amounts of student debt and are expected to continue paying for the exams as part of their ongoing training, in addition to putting in large amounts of unpaid study time and paying out monthly professional payments to the General Medical Council (GMC) and the BMA.

Few people chose to go into medicine for the money, but this contract has triggered a surge of resentment about how much harder doctors work for less money than their equally ambitious and well-educated peers in other fields.
Radiologist Anushka Patchava says she will have to quit the profession if the proposals are implemented.
Anushka Patchava, 29, a radiologist who qualified in 2011 and has at least two more years as a junior doctor before she graduates to being a consultant, plans to switch careers and is midway through a rigorous interviewing process with two management consultancy firms. She is fed up with the hours and the current pay and is despondent at the prospect of getting a substantial cut to her salary. She earns £31,000, which includes a 40% supplement to her basic salary, to compensate for the antisocial hours she works. Once the new contract is imposed, she thinks she will see this reduced to £27,000 or £28,000 and she expects the hours she works will become even more antisocial. She campaigned for David Cameron in May’s general election, but has subsequently rescinded her membership of the Conservative party in protest at the contract.

If she gets the management consultancy job, Patchava will quadruple her salary on day one. “It’s horrific, isn’t it?” she says. She doesn’t consider herself to be materialistic and, in normal circumstances, would not want to leave a job she loves, but the level of needless daily stress has become wearisome and she is constantly aware of lack of morale among her colleagues.

“Going into work is a struggle – you have to psych yourself up. You’re so short staffed that you can’t offer patients everything you want to offer them. There aren’t enough doctors to fill the posts that there are available now, even before the contract is brought in,” she says. “We are not supported and morale is low. You work really long hours, taking decisions that impact on people’s lives and, at the same time, you’re worrying whether your pay check is going to be enough to cover your bills.”

The daughter of two NHS surgeons, Patchava has an deep-rooted sense of loyalty to the NHS, but her parents understand the pressure she is under and why she wants to leave. There are no perks; she has to buy expensive food and coffee from the hospital cafe and pays £12 every night shift to park in the hospital car park. She calculates that, once the long hours are factored in, she earns about £10 an hour, so these costs are not negligible. As junior doctors, her parents used to get free food and free accommodation. Four of her closest friends from Cambridge, where she studied medicine, have already left to work in the City. “One of them got a gold medal in medicine, for being top of the year, but they dropped out for exactly these reasons.”

These are not alarmist stories being spread by campaigners. Even the Conservative MP and doctor Sarah Wollaston, who chairs the Health Select Committee, knows about the brain drain – her daughter has left the NHS for Australia. Now she, her husband and eight of their friends work in a hospital where they have yet to meet an Australian junior doctor in the casualty department. “It is staffed almost entirely by British-trained junior doctors,” Wollaston wrote this week.

Patchava worries about what will happen when she wants to have children and has to organise childcare for the irregular hours. Another aspect of the new contract is that parents who take time off to look after their children will no longer see their pay rise automatically while they are on leave. People who take time out of the medical training system to do research will be similarly penalised. Other changes include the removal of a supplement paid to those going into general practice, to match those working in hospitals, which doctors believe could see trainee GPs losing a third of their pay.

“I don’t have a luxury lifestyle, but I don’t think I could support children with that money and those hours,” Patchava says. “The NHS runs on the philosophy of altruism. Everyone comes in an hour early and stays late to make sure the work is done. We love the NHS, but this has been such a kick in the teeth. I’ll have no hesitation about taking a job elsewhere.”

This sense of mismatch between the commitment put in and reward taken out is widespread. “I’m 30 years old, live in a friend’s flat with three other people, don’t own a car and have still got thousands of pounds of debt,” writes one junior doctor in an angry email. “My friends outside of medicine have bought houses, have children and the majority have their weekends and evenings for themselves. On top of my ‘48 hours a week’, I teach and lecture in my free time, attend courses (which we have to fund), study and do everything I can to be a better doctor. I love my job – I couldn’t imagine living with myself if I left. However, the prevalence of locums and holes in the rota, overstretched stressed GPs and A&E staff make the atmosphere toxic. We miss weddings, funerals, birthdays. Relationships are lost, friends estranged, all because we love our job.”

Foiz Ahmed, a junior doctor in emergency plastic surgery (who is grappling with £30,000 debt) argues that the new contracts will strike a pernicious blow to the NHS and patient safety. “This isn’t just about salaries, although of course a 10-30% pay cut is unmanageable for most of us. Let’s ignore the fact that I used to earn more an hour while working for a mobile-phone company as a student … With the continued denigration of public perception of doctors, there is a sustained attempt to make the NHS fail. A demoralised workforce performs less efficiently, and a less-efficient system can be broken up and sold to private firms.”

The Department of Heath insists these fears are misplaced. “We are not cutting the pay bill for junior doctors and want to see their basic pay go up just as average earnings are maintained. We really value the work and commitment of junior doctors, but their current contract is outdated and unfair.”

Junior doctors are not convinced. The GMC had 3,468 requests for a certificate of current professional status, the paperwork needed to register to work as a doctor outside the UK, in the 10 days since the new contract was announced; usually it processes 20 to 25 requests a day. Partly this was the result of a concerted online campaign to get junior doctors to apply as a way of showing their anger. But some doctors, such as David Watkin, 30, a paediatrician based in Birmingham, truly intend to leave if the contract is imposed. Watkin recently returned from a year working in New Zealand, has stayed in touch with his employers out there and is confident that there will be a job for him.

The day-to-day stress Watkin experiences in Birmingham, which is mainly the result of standing in for unfilled doctors’ shifts, was absent in New Zealand. “But stress is not really the issue,” he says. In New Zealand, he says he felt more looked after, with meals paid for and professional fees covered by the hospital.
Would I be a fool to return to the NHS on the new junior doctor contract?
“Here we feel very under-appreciated by the government and the Department of Health. We have sacrificed a lot – years of training and extra hours studying outside of our work. We have moved around the country every six months to go where our training jobs send us, with no say in where we go, so it’s difficult to settle anywhere and hard to buy a house. We, as a body, are feeling under attack; it feels like any concerns we raise are being misrepresented with hospitals portraying us as just wanting more money.”

At 30, he still has about £9,000 in debt (down from about £30,000). He has done seven years as a junior doctor already and has another four to go before he becomes a consultant. “I worry that this is going to lead to an exodus of doctors, and I worry about the pressure that this will put on those who stay – and on patients. I had a work-experience student with me this week; it feels harder to come out with a positive line about why they should do it.”
Holly Ni Raghallaigh: ‘I worked very hard and put myself in a lot of debt to get here.’ Photograph: Teri Pengilley for the Guardian
Holly Ni Raghallaigh, 29, a trainee urologist, is planning to go to Scotland (which, like Wales, will not impose the new contract). She has been pushed to the brink of bankruptcy by the cost of her training, and doesn’t feel able to take a pay cut. With five more years as a junior doctor, she doesn’t think she could afford to continue if her pay is reduced.


“I worked very hard and put myself in a lot of debt to get here,” she says. At one point she had to pay for a urology course ahead of an exam and was so overdrawn that she missed two consecutive monthly payments to the GMC, was temporarily removed from the medical register and subjected to a large fine. She estimates she has spent £5,000 on mandatory surgery courses and exams during surgical training; she is paying back her remaining £10,000 of student loan at a rate of £450 a month. Once her rent in London and her monthly subscriptions to the Royal College of Surgeons (£50), GMC (£40) and BMA (£18) are paid, she has nothing left. It isn’t possible to save towards a deposit on a flat.

“Every single time I found myself in my overdraft or having to borrow petrol money or forego a flight home to Ireland to book a course, or every weekend I spent working as a locum to fund my education – I would do it all over again,” she says. “I adore my job and, honestly, working in the NHS is all I have ever wanted to do. And, for the record, I am grateful to the taxpayer who has put me here.” She says she hopes the tales of difficulties she found “embarrassing and demoralising” make people understand the financial pressures junior doctors face. “I don’t want it to sound like a sob story. I could have managed my finances better, but I had no money.”

It’s been 2 weeks since I updated my blog, the last being a day before Merdeka day. I was not only busy but also came down with Chicken Pox. For the first time in 5 years of being in private sector, I had to take MC for a week. Sitting at home alone is rather boring and annoying. I wanted to write about issues concerning GMC over the last few weeks but never had the time.

Over the last 15 years or so, IMU has been running twinning program with UK universities. The students will complete their clinical years in UK. Most of them will do their Foundation Year (Internship) in UK to be eligible for full GMC registration. Most of the self sponsored students do not come back home. Sponsored students especially JPA sponsored, will usually come back home to do their housemanship. However, it means they will not be eligible for GMC full registration. When UK started to have problems with Foundation Year 1 allocation in 2012 as I had written HERE, GMC started to look at the feasibility of allowing foreign students to do foundation year in a foreign country. Basically, GMC took the responsibility to make sure those who graduated from UK universities are eligible for GMC registration since UK may not be able to provide an employment for these students. In UK, Foundation year is still considered as part of the undergraduate medical education where the universities are still actively involved in providing the Certificate of Experience. That’s the reason you can do your Foundation year under student visa and do not need a work permit.

IN October 2013, GMC issued an approval for such arrangement with effective from August 2014. However, certain criteria and regulations were set to allow this to happen. The universities were given the role to facilitate the foundation program training overseas and GMC must be informed prospectively. While I am not sure of IMU twinning program in making use of this approval, Newcastle University Malaysia has adopted the program. In June 2015, NuMed had officially made the announcement that 5 hospitals in Malaysia , namely Hospital Sultanah Aminah, Hospital Sultan Ismail, Hospital Kluang, Hospital Kuching and Hospital Queen Elizabeth will be GMC accredited Foundation year training centres. What does this mean?

Since NuMed degree is recognised by GMC, you can be provisionally registered till you complete your Foundation year. Previously, only foundation program in UK is recognised for full registration. However, since the prevailing immigration law in UK will unlikely provide any work permit for foreigners (Non-EU) to get employment, GMC has now allowed NuMed graduates to complete the foundation program in these 5 hospitals and apply for full GMC registration. Please remember that from April 2015, GMC has limited the length of time a doctor can hold a provisional registration to a maximum of 3 years and 30 days.

Does GMC full registration bring any benefit? This is the question that I am trying to find an answer over the last few weeks. As far as I know, each country have their own accreditation process or a common entry exam (e.g. USMLE in US, Canada etc). For sure, it does not make any difference when it comes to Singapore Medical Council (SMC). Their website clearly says that only degrees listed on their second schedule are recognised and branch campuses are not considered (No 3) :

Only the campus that was in existence at the time of addition to the Schedule will be recognised. Any new campus that is off-site from the recognised main campus, whether in the same country or a different country and whether the same degree is granted or not, will not be recognised by the SMC.

The only main advantage of having a GMC full registration is to work in UK, Ireland or EU countries. As mentioned before, getting a job in UK is almost impossible due to their current immigration laws. Ireland has already recognised housemanship training in Malaysia where you are eligible to apply for a post in Ireland without the need to sit for PRES examinations. I had written about the problems that Ireland is facing over HERE. Obviously, not many Malaysian will be interested to work in non-English speaking EU countries. Furthermore, the same immigration laws may apply for foreigners.

What about Australia/New Zealand? This a bit tricky to say the least. Australian Medical Board, under “Competent Authority Pathway” says:

Graduate of a medical course conducted by a medical school in the United Kingdom accredited by the General Medical Council, AND:

1) successful completion of the Foundation Year 1, or

2) 12 months supervised training (internship equivalent) in the United Kingdom, or

3)  if the 12 months supervised training (internship equivalent) is completed in another Board approved competent authority country, approved by that competent authority.”

Unfortunately, Malaysia is not a “Board approved competent authority country“. Thus, it is very unlikely that Australia will recognise GMC registration where the training is done outside UK.

Document: Medical-Board—Criteria—Requirements-for-eligibility-for-the-Competent-Authority-Pathway-2

Please also remember that there is a fee that need to be paid for GMC full registration as well as to maintain the registration every year (annual retention fee). The fees can be seen HERE. Currently 1 pound is about RM 6.80!.

So, I welcome any suggestion or informations from anyone who may know more about GMC registration. GMC registration use to be well recognised in commonwealth countries about 30 years ago. But, the situation has changed over the years. Nowadays, each country have their own way of recognising a medical degree obtained outside their country. GMC registration may not mean much anymore in terms of employment but it may still give you some sort of quality assurance, I hope.



IN 2012, the medical fraternity was shocked when our previous health minister announced that private institutions will be included as institutions conducting MQE examination. It use to be only UM, UKM and USM. With the announcement, some of the established private universities were selected to conduct the MQE examinations which is basically their own final year examination. The other shocking statement from our minister was that, unlimited number of sitting will be allowed  and the student can choose where they want to sit for the exams. I wrote about it over HERE. Personally, I feel that any professional exam should have a limit. Even nursing board examinations has a limit. Even final year medical school examinations and post-graduate examinations have a limit on the maximum number of sittings. Subsequently , MMC released the amended regulations for MQE and the list of institutions. Section 4(3) of the regulations says that the candidate will be posted to the institution of their choice. Section 5 says that , the candidates have to follow the rules of the institution in resitting of the examinations and imposition of any fee.

Early this year, while I was talking to someone in MMC, I was told that they are going to change the rules again. The new 2015 regulations for MQE has been released and gazetted on 25/03/2015. The new rule says that once MMC finds you eligible to sit for the MQE examination ( if you fulfil the minimum entry requirement), MMC will decide on the institution where you will be sitting the examination (Section 4(3) ). The fee has also been increased to Rm 1 000 for application process (from the previous RM 200). It also says that you can only resit for a maximum of 3 times ! This basically means that if you fail the MQE for 4 consecutive times ( 1 + resit 3 times), you will never be able to practise as a doctor.

Frankly, I feel it is not worth going to an unrecognised university. With the current glut, the situation will only get worst.

Happy Merdeka Day 2015

Peraturan Ujian Kelayakan Perubatan 2015_25032015

While the country is being entertained by our political masters on a daily basis on who will be voted as the stupidest of them all, the medical fraternity was yet again shocked by a picture that was circulated via social media. I received the “picture” early yesterday morning which I felt need further evidence on it’s authenticity before saying anything.Then I was informed that it happened in Johor and in one of the main hospital in Johor Bahru. I was shocked and dumb founded!

IN June 2015, I wrote HERE about professionalism and ethics of doctors. The public view us or use to view us as the most educated group of people. They expect us to behave professionally. In that article, I mentioned that doctors should remain professional at all times, mind our words and should never reveal any personal information of any patients or take any pictures of any patients without their consent. These pictures taken should never be displayed in public domains. It should only be used for teaching purposes in close group discussions.

Unfortunately, a once respected profession is going down the drain. I had predicted many things in this blog over the last 5 years and even in my MMA articles almost 10 years ago. Many, which use to be just “rumours” had become reality. Many accused me of spreading rumours and scarring the future generations but had to swallow their own words along the way. A clerk in a hospital recently said that ” if a SPM result such as this can become a doctor, I should have become one!!“. That’s how bad the SPM results was, of an houseman. Remember my article over HERE ?

There is no doubt that the quality of doctors had deteriorated. I have to admit the fact. No point hiding it anymore. Call a spade a spade!. This picture which shocked me was something that I had never expected for a doctor to do. I can’t even imagine such a thing can happen. Something that I failed to predict! All kind of words are coming out of my mouth but I am trying to be as professional as possible.

When I started to receive news that the picture was authentic and who the doctor was, I was speechless. There goes the reputation of doctors. While in my previous article I spoke on the battle between doctors and proponents of home birth, here we had just shot ourselves. It only takes one person to spoil everything. Would the public trust doctors anymore? We must understand that no matter how the public mistreat us or shout at us ( as I had written many times before), since we became doctors to “help” people, we should just keep quiet and do our work! Just make a police report if you think it is overboard. Recently, a nurse who brought her husband to a district hospital at 1am for palpitation told me that, the doctor said “ Please decide fast where you want to be admitted, I want to sleep!“.

The Star has reported that the matter is being investigated. Interestingly, it says that the doctor in also known to take selfies in operating theatres, OMG! I think it is time for MOH to do something about this. Whatever said, action must be taken against this doctor. MMC should also take action as it is considered a professional misconduct. This should never happen!



Malaysia has become a laughing-stock of the world over the last few weeks. While TM Net still has not restored my home internet service since the last 2 weeks, luckily I have an alternative internet service to be able to write this blog. ON 8th August 2015, our DG gave an interesting speech at a conference in Port Dickson. The text of the speech can also be read below. From his speech, once again it is beyond doubt that we are running short of post for both Housemen and Medical officer. While HO post are rolling post, where only the waiting period will get longer, the MO post are permanent post. According to DG, MO post are almost 95% full with certain states being over subscribed (borrowed post). I know many who had completed HO this year being posted to East Malaysia.

According to DG, the government need to create about 4 000 new MO post per year for the next 5 years to achieve the desired number of doctors needed (20 000 new post). Do the government has the financial means to do it? Assuming average salary of a MO is RM 6K/month including “On Call”allowance (U44), we need RM 288 million/year for 4000 new MO post. So, 20 000 post will cost RM 1.4 billion in total, not including the rolling salary of the earlier created post ( the actual amount will be much more, cumulatively). I assume we can request for some tax free donation. It is still less than RM 2.6 billion!

The DG has also mentioned something about HO assessment/completion report(CCHT) etc. I am also hearing rumours that the Malaysian Healthcare restructuring is in final stages. The doctor: population ratio has already hit 1: 661 as of 2014, the initial target for 2016! We are 2 years ahead. There are also rumours that HO post will be eventually given on contract basis and subsequent application to MO post will be necessary. Thus CCHT may become important in your MO application process. IT also means that not all those who are completing HO will get their MOship. It is the same in most other countries as well. DG has also mentioned about shift duty for MO which is not applicable at the moment.

Our DG has also been conducting discussion with the Royal Colleges in UK to bring back FRCS program to Malaysia. I hope it will materialise with a proper structured program in Malaysia. It will give an alternative pathway for surgeons wannabe.


Full Text of DG of Health’s Keynote Address: ‘Optimising Human Capital And Enhancing Specialist Services’ at the Medical Program Specialists’ Conference 2015
Posted on August 8, 2015 by DG of Health





8th AUGUST 2015

Thank you Mr/Ms Chairperson,

i) Y.Bhg. Datuk Dr. Jeyaindran Tan Sri Sinnadurai

Deputy Director General of Health (Medical)

ii) YBhg. Dato’ Dr.Hj. Azman Bin Abu Bakar

Director of Medical Development

iii) Dr. Abdul Rahim Bin Abdullah

State Health Director of Negeri Sembilan

Hospital directors, Profession & Department Heads, Consultants & Specialists, Ladies & Gentlemen,

Assalamua’laikum wbt, and A Very Good Morning.

Firstly, I would like to thank the organising committee for their effort in ensuring the success of this biennial event. It is my pleasure to welcome all of you to the Medical Program Specialists’ Conference 2015 here in Port Dickson. As we are still in the Aidilfitri mood, I wish all Muslims here ‘Selamat Hari Raya Aidil Fitri’.

It has been two years since our last meeting in Melaka. This biennial event is an important forum for us to interact and keep abreast with current issues and knowledge towards achieving an excellent medical and specialists care delivery system.

All organisations require human capital to function and accomplish their goals. Human Capital is defined by the Oxford Dictionary as ‘the skills, knowledge, and experience possessed by an individual or population, viewed in terms of their value or cost to an organisation or country’. Managing patient care requires a multidisciplinary team approach, and doctors comprising of housemen (HOs), medical officers (MOs) and specialists alike are the most essential members of the team.

Thus the theme of our conference today, ‘Optimising Human Capital and Enhancing Specialist Services’ is pertinent and significant considering that Human Capital is an important component in delivering quality healthcare, particularly specialists.


The number of housemen has increased tremendously from 1,059 in 2006, to 2,319 in 2008 and subsequently 4,991 in 2013. As of March 2015 there are 9,502 HOs in the programme. Currently, there are 10,803 HO posts available in the accredited government houseman training hospitals. With the large number of HOs, specialists need to re-engineer their approach to training with existing resources in order to achieve the objective and maintain the quality of the housemanship programme. Staggered appointment of Housemen has been introduced since August 2014 with the intake currently done every two months. In the meantime, the online system e-housemen has been implemented since March 2015.

MOH has proposed the introduction of a generic logbook and Certificate of Completion of Housemanship Training (CCHT), which is awarded upon completion of the housemanship training. It is hoped that CCHT can be used to determine the ‘level’ of competency of HOs and in pursuant of future specialist training. Meanwhile, the generic logbook is designed to document common procedures that can be done in any discipline. I was made to understand that these two topics have been discussed in the workshops last night and hope there will be a fruitful outcome.

The Honourable Minister of Health is also concerned about the quality of HOs these days, and thus mooted the idea of introducing theoretical assessment during the Induction Course to determine the level of knowledge before the commencement of housemanship training. In addition, to ensure the quality of HOs, MOH has recommended that the minimum requirement to enter medical school be increased from 5Bs to higher grades gradually.


Similar to HOs, the number of medical officers has also increased from year to year. As of 30th June 2015, there are 15,388 of MOs serving in the MOH. This accounted for 94% of MO posts being filled as compared to the total number of posts available. Although there are about 900 vacant posts currently, the numbers of MOs in certain states like Johor, Perak, Pahang, Kelantan and Melaka however have exceeded their allocated posts.

As we know, more posts are required to cater for the expansion of new facilities, new services and additional workload due to increase of diseases burden, increase in population and demographic changes. The doctor to population ratio in 2014 was 1:661 (inclusive of HOs). However, the doctor to population ratio based on the number of Annual Practising Certificates (APC) was 1:904. In Singapore, the ratio was 1:513 (2014). The ratio in other countries like New Zealand, UK and Korea was 1:365, 1:356 and 1:467 respectively.
The five-year 11th Malaysia Plan also projects the upgrading of selected clinics into advanced clinics that provide a full range of multi-disciplinary services to enhance and support primary healthcare teams. Read more here

On 14th July 2010, YAB Prime Minister announced that to be on par with other developed nations, Malaysia has set a target to achieve a doctor to population ratio of 1: 400 in 2020. Based on this, Malaysia requires about 87,000 doctors with the estimated proportion of 60% and 40% respectively in the government and the private sector. In the government sector, as 90% are serving in MOH, that will account for 47,075 doctors. As currently there are 26,924 posts, therefore MOH will require 20,151 additional posts in 2020. With the ample number of MOs, there is a need to relook at the ‘work processes’ in every department to optimise the resources.

Although postgraduate training focuses on specialist training, MOH also needs to pay more attention to the training of MOs who have been described as ‘the lost tribes of medicine’. Being seniors, specialists should encourage these doctors to enhance their skills and knowledge by attending courses or workshops and guide them to plan their career development.

All junior MOs are encouraged to indicate their interests in the field of choice so as to facilitate them to pursue postgraduate training in that area. Those who have passed MRCP/MRCPCH Part 1/Part A must register to the Medical Development Division for appropriate postings, including rotation in selected subspecialty areas. I also urge all senior specialists to inform their junior doctors who have passed the membership exams to immediately report to Medical Development Division; otherwise their gazettement will not commence. It is worth mentioning here that gazettment of specialists will be based on knowledge, skills and competency as well as appropriate exposure, and not merely time based.


Specialist and sub-specialist training in various clinical disciplines will continue to be a major concern in order for us to ensure that our nation has the needed numbers to deliver high quality care for individuals as well as population. Currently, there are approximately 9055 specialists in Malaysia, out of which 52% (4698) are serving in MOH. Despite notable achievements of the Masters Programme conducted by local universities, the country is still facing a shortage of specialists to meet requirements of our healthcare facilities.

Local Masters Programme

The Ministry and the universities face many challenges to ensure the smooth running of the Masters programmes. One of the issues is the low passing rate in some of the specialties. This might be related to the capability of candidates as well as to the very nature of specialist training i.e. the standards are very high and only the best and most determined to sacrifice will make it. Therefore, the selection of suitable candidates who are highly committed and motivated to complete their postgraduate training is of utmost importance.

It is important to emphasise on the supervision and monitoring of the trainees to ensure they are equipped with knowledge and skill that befit the specialist. For your information, there are cases of master graduates that need extension in their gazettment period due to competency issues and so far there was one that has failed to be gazetted.
The Health Ministry is committed to meeting the pressing need for more specialists. It is offering more local Master’s scholarships and opening up alternate pathways. Read more here

Parallel Pathway

In order to increase the number of specialists, MOH encourages MOs to pursue postgraduate training program via various parallel pathways such as the membership program. MOH is in the process of strengthening the parallel pathway to make it more structured. YAB Prime Minister, during the PM-Minister Mid Year Review 2014 on 20th August 2014 made the decision that MOH should include the budget or funding in 11th MP for the Parallel System. Through this system, while working with MOH, these doctors can sit for the relevant British qualification/exam for specialist training.

The governance of the Postgraduate Medical Specialist and Subspecialist is needed. In the near future, it is hoped that the newly set up dedicated unit of Postgraduate Medical Specialist and Subspecialist (Deanery) under the Medical Development Division of the Ministry will be able to specifically focus on the planning, implementation, promoting, recruitment, monitoring and accreditation of the programmes for clinical specialists. Subsequently, for more effective management of postgraduate training, units could also be set up at the level of the respective state health departments, hospitals and district health offices.

As you all may know, YB Minister of Health and I had recently visited several colleges in London, Edinburgh and Glasgow where they have agreed in principle to train the trainers, accredit our training centres and conduct membership exams in Malaysia. In addition, several MOUs have been signed between the Royal Colleges of Physicians and Surgeons and Academy of Medicine in the field of Cardiothoracic Surgery, Plastic Surgery, Orthopedics and Family Medicine.


There are currently 1,415 subspecialists including trainees in MOH. This number accounts for 35% of the specialists’ workforce. With the shortage of generalist, subspecialists working in the bigger hospitals are expected to provide general medical or surgical services. To optimise resources, subspecialists should not confine themselves to their subspecialty area unless the hospital is a designated tertiary centre.

In addition, among the existing pool of sub-specialists, a number will resign after completion of their training to work in the more lucrative private sector and this is definitely a great loss for us. On average there are about 150 specialists who leave MOH annually. As of May 2015, there were 95 specialists that have resigned, out of which 25% are subspecialists.

Notably in the 11th Malaysia Plan following the amendments to the Medical Act 1971, all specialists are required to be registered with the National Specialist Registry in order to practice as a specialist in that particular specialty. They have to gain certain years of experience before they can be registered in the NSR, thus it is hoped that the number of resignation will be reduced once this Act is being implemented.

The subspecialty-training programme needs to be enhanced. Subspecialty training should be structured, monitored and adequately supervised with the possibility of an exit assessment for all areas. While there is no denying the importance of developing subspecialist services to enable us to handle the small percentage of highly complex cases but it is crucial to strike a balanced mix of generalists and subspecialists. The trend in developed countries is to train generalists with subspecialty interests. At best, subspecialty care only offers organ-specific, intermittent and episodic care. On the other hand, the vast majority of patients need general and continuous care, which can only be provided by “generalists”.


Specialists including subspecialists play an important role in ensuring the quality of medical services provided by MOH. Thus, specialists should place quality of services and safety of the patients as the highest priority. Senior specialists also need to focus more on patient care and not only administrative issues. Never neglect your patients and let the juniors manage the patients on their own without direct supervision.

I would like to see our specialists be the benchmark for other categories of staff such as house officers, medical officers, nurses and others in providing clinical services to the patients so that we are able to create an effective clinical team. As a specialist, it is important for you to be a team leader and provide leadership in order to ensure effective clinical governance with the emphasis on quality of services and patient safety. This includes good medical practice; evidence-based clinical practice; continuing professional development; and patient, family or community participation in decision-making.

All of you need to play your role as specialists to ensure patient management is being carried out effectively. This will include doing daily, teaching and grand ward rounds to review complicated cases and new cases especially during on calls. Apart from the above tasks, specialists are also required to conduct research and be actively involved in training of junior doctors including HOs and Allied Health Professional.


In-patient services requires the 24 hours management of patient care by healthcare providers particularly specialists as a team leader, thus the need for specialist to be on-call. For a department that has more than one specialist, the specialists including the Head of Department (HOD) have to do calls on rotation basis. There will be only two tiers of on-call practiced for these departments i.e. specialist and consultant, hence there is no specific HOD call. Likewise for a department that only has a single specialist; he or she has to be on-call daily, which is usually a passive call.

It is crucial that the on-call system be managed with integrity to ensure patient safety. There should not be too many tiers and for each tier the number of specialist on-call must be in accordance with the need and workload. Some departments do not require active calls. Some subspecialty services in smaller hospitals do not require a dedicated subspecialty calls.

Many have suggested that we should relook at our on-call system, working hours and so on. I am open to any constructive suggestions that may help to improve the life of doctors and others in the healthcare profession.

Some have suggested that MOs also work on flexi hours. However if we were to implement this, we will need more MO posts and the on call allowance will be removed. I believe that many hospitals allow post calls off for medical officers as soon as they finish their passing over.

We might consider call sharing where 2 MOs share their calls and each does half of the call every time they are put on the roster. This concept has been implemented in Australia and we need to explore the possibility in doing it here. For those who are on call, make sure you are in hospital and actively review patients and not giving consultations from home.


Currently there are 953 (23%) specialists who have been promoted to Gred Khas with 48 on Gred Khas A, 140 and 765 respectively in B and C (inclusive of those appointed on contract basis). The promotion exercise will take place when there are vacancies and the posts are very much limited.

There are various criteria that have been identified for the promotion to Gred Khas and not merely the seniority or time based. Other important factors that are being taken into consideration include those who have shown exemplified excellence, those serving the periphery of Sabah and Sarawak and also those with critical specialty and subspecialty. In addition, we also need specialists who are not only good at local level but also recognised at the international level.

It is hoped that MOH can promote those who are well deserved but looking at our current situation; it might be a bit difficult. I understand the frustrations, as it was a long wait for some of you. Due to constraints on promotional posts, MOH has proposed to JPA to consider giving some perks to senior specialists particularly to those on Grade UD53/54.

Great efforts have been made to provide better service schemes and remunerations to encourage doctors to continue serving with the government. Year after year MOH has strived to offer better career pathways for doctors and specialists including faster promotion, increment of specialist and on-call allowances, full paying patient, Saturday elective surgery, privilege to do locum etc. Consequently, it is hoped that all these advantages would encourage the specialists to work harder and give better services to the patients as well as better guidance to the juniors.


As the medical practice has become more complex, doctors’ attitudes are also changing. Doctors remain ‘professionals’ but the traditional image of what this means in practice – a selfless clinician, motivated by a strong ethos of service, caring and compassionate is increasingly eroded. Doctors are perceived to be pursuing their own financial interests, and fail to self regulate in a way that guarantees professional competence. There has also been a disturbing change in the attitude among doctors, relating to ethical integrity, professional values and behaviour causing not only serious medico legal problems but also disrepute to the profession.

Doctors are not only required to be technically competent and knowledgeable in the field, but they are also required to embrace the appropriate ethical beliefs and act in a professional manner.


MOH has produced a Specialty and Sub-specialty Services Framework, which serves as a key driver in leading the path for infrastructure development as well as resource management and allocation.

The target is to provide 10 basic specialty services in minor specialist hospitals, 20 specialties in major specialist hospitals and 45 specialties and sub-specialties in the state hospitals and also 26 specific subspecialty services in each of the 6 zones in Malaysia. So far, only 74.4% of the regional centres have achieved the target of providing the 26 subspecialty services listed in the framework while 79% of the state hospitals are providing the 45 specialties and subspecialties listed. However, only 65.7% of major specialist hospitals and a mere 31.85% of minor specialist hospitals have managed to reach the set target.

MOH also plans to upgrade 4 services such as geriatrics, neurology, palliative care and uro-gynaecology from regional services to be provided at state hospital levels to meet the demands of the ageing population. We have also planned to establish the National Centre of Excellence for Specialised Clinical Skills to enhance the clinical skills of health personnel.

In order to face the challenges in optimising resources, the cluster hospital concept has been introduced in 3 states – namely Melaka, Pahang and Sabah. It has been proven to show positive results; hence the decision to expand the project on a national scale. Clinical leadership at non-specialist hospitals will be strengthened through the hospital cluster concept whereby hospitals within the same geographical location will work together as a unit, share common resources such as assets, amenities and personnel for betterment of patient flow and reduce waiting time for specialist treatment.

Some of the factors that limit the development of specialist services include budget constraints especially in procurement of expensive equipment and facilities as well as support team. There are also shortage of specialists in certain hospitals and specialties due to maldistribution because many refuse to serve in remote areas.


We have to realise that not only the clinical care of patients is important, but ensuring accuracy and completeness of the clinical documentations are equally essential too as it is also a medico-legal requirement.

Efforts are also being initiated to include or consider Percent (%) Accuracy of Clinical Discharge Documentation, which the Casemix Unit in Medical Development Division will monitor regularly and any recurrence on shortfall should be followed up with Root Cause Analysis. All Heads of Departments and Hospital Directors must play their role. Any national issues must be discussed further with the Medical Development Division.

I also would like to inform that the audit on the clinical documentation accuracy is under the realm of the Hospital Director, as well as all the Heads of Clinical Departments. To make the effort a rewarding activity, the audit activity has to be conducted at a regular interval, at least twice a year and will be followed up by the Casemix Unit.

I urge that all of us, the Senior Doctors, to accomplish our obligation in patient care by monitoring (keep in check) the level of accuracy on the discharge clinical documentation, so as it will attain an overall achievement of more than 70% for every clinical department. I am pleased to note that one session at this conference has been dedicated to the discussion on casemix.


Human Capital is an important component in delivering quality healthcare, particularly specialists. As we aspire to become a high-income nation in 2020, our healthcare system needs a medical workforce capable of adapting to change in service needs and the future generations of doctors must have greater understanding of the aspirations and expectations of rakyat.

Doctors must therefore be competent with the relevant knowledge and skills, in addition to the right attitude as well as capability to work as a team. Optimising human capital must be implemented through various strategies, among others through training, delivery of quality service including casemix, innovations such as lean management, cluster hospital concept, NBOS, research, and with good leadership and integrity.

On this note and with Bismillahhirahmannirrahim, it is my great pleasure to declare the Persidangan Pakar Program Perubatan KKM 2015, open. I am sure your participation in this conference will be both useful and rewarding.

Thank you.

Datuk Dr Noor Hisham Abdullah

Director General of Health Malaysia

8th August 2015

In 2012, I wrote 3 parts of the said topic above. The first was on criminal accusation of doctors and the second was on medical negligence. It looks like, the issue that I wrote in my 2nd part is being revisited by the Star today.As I said in my previous article, the current generation of patients are different compared to 20 years ago. They are more demanding, disrespectful and ever ready to sue doctors when something happens. This is something that the budding doctors should realise before doing medicine. The ” I want to help people” rhetoric is not the same as before. You can “help” thousands of patients but a single error will make you to quit medicine all together, not to mention the huge debt that our current generation of students are graduating with. Interestingly, it is the same Generation Y who are becoming doctors and complaining about the working environment/hours. Imagine your own generation will be the ones who will be suing you.

Today’s Star (see below) reported that many private obstetricians are quitting practise due to increasing litigation rate and high indemnity insurance. Well, that is a fact. The number of legal suits is increasing year by year. As our DG mentioned in his reply, the number of O&G suits for MOH last year was 18, an increase by 10 compared to the year before. That is more than 100% increase. As more and more “successful” stories begin to appear in newspaper, more people/lawyers will be going after the doctors. Recently, the court also awarded RM 6million for a spine case in Penang. The name of 3 doctors were clearly mentioned by the news.

With the increasing litigation rate, many O&G specialist are finding it difficult to cope. Their stress level is very high and they can’t afford to make any mistakes. This has resulted in many private O&G consultants pushing away high risk cases to government hospitals. Some have stopped practising Obstetrics and some only does Caesarean sections. I remember when I asked many budding O&G specialist, why they want to do O&G, the answer use to be “ I am dealing with 2 lives and I am happy to deliver a new life to the world“. Well, that was the noble intention. However, this nobel intention is not nobel anymore in this capitalist world. Very few appreciates what we do. In private sector, the word is ” I pay you to deliver my wife. So, no mistakes please!”

The last Cerebral Palsy case was awarded about RM 7 million. I know few more cases pending in high court and one of it is standing at RM 10 million. Due to this increasing amount of awards, almost all indemnity insurance companies had increased their premium since the last 2 years. MMI has increased their premium for Obstetrics by almost 100% with maximum coverage of about RM 5 million. So, if you get sued more than that, you need to pay out of your own pocket. The premium for the RM 5 million coverage is RM 35 000/year. MPS (Medical Protection Society) which is an international organisation and the oldest indemnity insurance scheme, use to cover unlimited amount with occurrence-based coverage. However, starting this year, they have made some adjustment for Obstetrics. They had reduced their premium from about RM 70K+ to about RM 45K. Unfortunately, the maximum coverage in only RM 10 million in aggregate (pending MPS council approval) and it is  “claim-based coverage“. This basically means that you may end up paying out of your own pocket if the council decide to cover only certain percentage of the amount. Furthermore, you must continue paying for years after you stop delivering babies as you must be a member of MPS at the time the legal suit is filed. Legal suits in O&G can appear at your doorsteps 5-10 years after you delivered the baby! Meanwhile, the consultation fees are regulated and limited by the government. So, the consultants can’t charge as they like to support the increasing cost.

This phenomenon will in turn increase the number of patients delivering in government hospitals. At this point, government doctors are indemnified by the government. While I do not know how long this will last, the workload and stress level in government sector will continue to increase. Remember what I said in my previous article? No matter how many doctors we have in government sector, the workload will never reduce as more and more patients are becoming ever more demanding! There is no such thing as easy life, easy money and good future in medicine anymore. Everything that I have been saying in this blog over the last 5 years is slowly appearing in mainstream news. Only those who can handle the tremendous amount of stress and true passion can endeavour. Unfortunately, even then, many will quit.

Unless, the entire healthcare system in this country changes, the situation will not get any better. With the increasing cost and litigation rate in private sector, there will come a time where the private sector will collapse. The government must come up with a Healthcare financing system to address this problem.

Obstetricians are quitting

PETALING JAYA: Senior obstetricians in private practice in the country are opting out of delivering babies as a result of changes in their professional indemnity coverage.

The shortfall of these specialists is expected to create a rise in the workload in government hospitals, increasing the possibility of sub-standards or delays in maternity care.

The Medical Protection Society (MPS), the world’s leading indemnifier of health professionals, changed its policy for obstetricians and gynaecologists this year – from occurrence-based protection to claims-based coverage, under which these doctors have to pay annual premiums for 25 years.

This means if a doctor retires at 60 after delivering a baby, he or she must continue to pay for the coverage until the age of 85.

According to the MPS, the changes were made because of global challenges and risks associated with obstetric claims and litigation.

In Malaysia, the highest protection coverage is taken up by obstetricians, who used to pay more than RM70,000 a year for unlimited indemnity.

Under the claims-based coverage, the amount to be paid annually is lower but the time frame is longer.

More than 500 obstetricians and gynaecologists are covered under MPS, which has over 4,000 members in Malaysia.

MPS has more than 300,000 doctors, dentists and medical students as members worldwide.

Dr Tang Boon Nee of Subang Jaya Medical Centre said many of her colleagues had decided to stop delivering babies as a result of the change in policy.

“As we are liable for up to 25 years after delivering a child, many of us who are older obstetricians will have to pay for coverage well after retirement,” she said.

Dr Tang, who has been an obstetrician for 20 years, said “phenomenally high” damages had been paid out in obstetric claims.

“There was a case last year in which the amount awarded was RM6.9mil. To protect ourselves, we will have to continue paying MPS well into our retirement because of the claims-based system.

“It is not fair as many of us will not be making that much money,” she said.

KPJ Damansara Specialist Hospital’s Dr Gunasegaran Rajan said the occurrence-based indemnity had no ceiling on coverage, but claims-based was capped at RM10mil.

“Recent payouts have already touched RM7mil, and this can only increase. I would have to pay out my of own pocket if the damages awarded are above RM10mil.”

He said that his best option was to stop practicing obstetrics as the future left him vulnerable.

“It is a great shame that the skills and knowledge many obstetricians have acquired over the past 25 years cannot be used to help Malaysian women’s maternal health due to this policy,” he said.

Another obstetrician and gynaecologist, Dr S. Shankar, said doctors could not run the risk of not being covered.

“We don’t have much choice. Our legislation should come up with a better system, like New Zealand which has a no-fault compensation scheme. Personally I will get out of obstetrics as fast as I can.”

In a statement to The Star, MPS defended its policy change, saying that claims-made protection was the more common form of coverage for obstetricians in many countries.

“Claims-made protection requires members to be in continuous membership both at the time an adverse incident takes place and when it is reported to MPS to make a claim.

“It was introduced to price subscriptions for obstetric risks more accurately and fairly as it can be difficult to predict long-term risks.

“This is because obstetric claims can often arise many years or even decades later,” it said.

MPS assured members that even with the new system they would continue to receive high-quality service and support.

Substandard maternity care possible, warns Health D-G
PETALING JAYA: Health Ministry director-general Datuk Dr Noor Hisham Abdullah said there would be an increase in workload in government hospitals and risk of substandard maternity care if the private sector loses its obstetricians.

“With the obstetrics and gynaecology specialists almost equal in numbers in both sectors, there is definitely going to be increased demand. We will not face a shortage of O&G specialists but rather a mismatch in the distribution and the corresponding workload.”

“It is also important to note that there will be a definite spill-over effect to the neonatal and the anaesthetic services. With this scenario, there will be an increased chance for delayed or substandard care,” he said.

Dr Noor Hisham said the excessive court awards and punitive damages used to penalise doctors would negatively impact doctor-patient relationships.

For the public sector, all negligence claims costs are borne by the Government.

Last year, 18 cases involving obstetric cases were filed against the Ministry of Health, 10 more from the eight recorded in 2013.

A total of 462,626 babies were delivered in both private and public hospitals as well as by private midwives, alternative birthing centres and estate hospitals.

Out of the number, 63,063 were delivered at private hospitals while the most, or 83.9%, were still delivered in public hospitals and clinics.

Meanwhile a medical law lecturer has called for research on the effects of changes to indemnity protection for obstetricians and gynaecologists.

Dr Sharon Kaur of Universiti Malaya said the authorities should look at court decisions, amounts awarded and gauge if the changes in policy could have a knock-on effect.

“If private healthcare services are cut, the burden will fall on public services,” she said.

ON the 8th of July 2015, the medical fraternity was yet again shocked with the death of a medical officer from Sg Buloh Hospital. My deepest condolences to the husband and family members of the deceased. Many doctors went to social media and expressed their sorrow and anger against the life that a doctor goes through in our system. Firstly, I had mentioned several times in this blog that our system is as such that it is difficult to change. No matter how many doctors we have, the job will never get any easier. While the housemen are now doing shift duty, they will end up doing “on-calls” like the old days when they become an MO. However, when each hospital and departments get enough MOs, I hope the same shift system could be implemented to MOs. This could vary from one hospital to another as well as one department to another. Each department have their own problems. Once shift system is implemented, MOs will loose their “on-call” allowances,which means a pay cut. When a pilot project of shift system was started in KKs a year ago, most doctors protested. The main reason was due to the lost of RM80/hour overtime allowance and going back home late. The project was not extended further as KKM, while do have enough MOs, did not have enough support staff to run the KKs till 9-10pm daily. However, I feel it will eventually be implemented in KKs.

Secondly, we should not jump into conclusion whenever we hear such an incident. There are many factors that causes an accident. I am sure each and everyone of us would have had minor accidents or near misses during our life time. People die on the road everyday as we have the highest number of road traffic accidents in this region. It could be due to fatigue, car malfunction (as happened to a doctor over HERE) or may not even be entire your fault. I find many become emotional and blame the “on-call” and the system immediately without further investigations. Our DG has given his response over HERE (see below). People must understand that doctors are not the only profession who work long hours. I have seen engineers, accountants, lawyers , contractors etc who also work long hours and go back home late. It is not unique to only medical profession. In JB, we have thousands of people going to work in Singapore daily. They leave their home at 4-5am and return back at around 9-10pm daily, not to forget the 1-2 hours jam they go through daily in each direction. The only difference is the fact that many other professionals can take back home their job except medicine, where we need to finish our work at work and we are dealing with life and death matters. We are also dealing with humans and not machines/computers or structures where mistakes can be tolerated. But again, it is you who chose the profession and we need to work in the system that we have chosen.

No matter, how the system changes, the workload of a doctor will never come down. Even in developed countries like UK, US, Ireland, Canada etc, doctors still work long hours. Only their total number of hours a week is limited. The profession is such that we cannot leave our work unfinished. Emergency happens all the time. I had written about this many many times since I stated blogging.

ON the other hand, the demand and expectation of patients has gone up by leaps and bounds. This is not limited to private hospitals but also in government hospitals. Thus, it increases the workload of each doctors , no matter how many extra doctors we have in a department. The number of patients visiting government hospitals will also increase year by year as the economic situation worsen. Frankly, how many can afford private healthcare if not being supported by insurance. Even insurance have a limit every year. In my hospital, almost 90-95% of the admissions are insurance supported. Very few are cash paying. Most can’t afford anything more than RM 5-10K. FYI, there is no such thing as below RM 5K in a private centre nowadays. Lately, we have been seeing many grouses in the newspaper regarding high charges in private hospital (HERE and HERE). While the consultation fees by doctors are limited by the government, the hospital fees are not regulated. DG has also spoken about this. Almost every consultant in my hospital will receive at least 1 complain a month! That’s how difficult our lives have become. I hope the younger generations will open their eyes on the real life as a doctor rather than the glorious life that the public wants you to believe.

There’s also a you tube video that has been going viral in the social media. It was about a law graduate talking about the reality she faced after she graduated.

In one of my earlier post “Passion vs Debt” I had written on how the younger generations do not understand that passion is one thing but living a life is another. This lady in the video just proves what I have been saying. High expectation that earning a degree will lead to big salary and good life. This is true in almost all profesional field. She also talks about debt and how she struggles to even own a car. From what she says, I can roughly make out where she graduated from. Her degree is not recognised by Bar council which requires her to sit and pass CLP examination in order to practise as a full fledged lawyer. If not, she can only practise as a legal assistant or advisor which would not give you a high enough salary to survive in Klang Valley or any other big towns. What she says is not much different from what most medical graduates are going to face. If you take huge debt to do medicine, whatever salary that you are going to earn will not be enough to live a life. With car loan, house loan, married life coming your way, it will never be what you had expected. I like what she said at the end : it is beyond race and politics! We are in the same ship and we will sink together if people still get carried away with race and religion issues.

Our education system do not teach our students financial literacy. I suggest students to read ” Rich Dad Poor dad” written by Robert Kiyosaki. Also read many of his books which talks about financial literacy. People who chase degrees and salaried job will never be rich. So, never do medicine for wrong  reasons and never take huge debt to do it either………..

Selamat Hari Raya to All Malaysians……………………

Ucapan Takziah buat Keluarga Allahyarhamah Dr Nur Afifah Mohd Ghazi
Posted on July 10, 2015 by DG of Health




Pada 8 Julai 2015 bersamaan 21 Ramadan 1436 Hijrah, kita telah dikejutkan dengan satu tragedi yang menyayatkan hati dengan kembalinya ke Rahmatullah Dr Nur Afifah Mohd Ghazi, seorang Pegawai Perubatan daripada Hospital Sungai Buloh. Allahyarhamah telah terlibat dalam satu kemalangan jalan raya ketika dalam perjalanan pulang setelah bertugas ‘on-call’ pada hari sebelumnya. Bagi pihak Kementerian Kesihatan, saya ingin menyampaikan salam takziah kepada keluarga Allahyarhamah dan mendoakan agar roh Allahyarhamah ditempatkan dengan para syuhada.

Pada pagi 9 Julai 2015, beberapa orang pegawai kanan dari Ibupejabat Kementerian Kesihatan Malaysia, Putrajaya dan Hospital Sungai Buloh telah berpeluang untuk menziarahi keluarga Allahyarhamah di rumah kediaman keluarganya di Taman Sri Putra, Sungai Buloh. Daripada pertemuan dengan Mohd Hafizuddin Azman, suami kepada Allahyarhamah, memang tidak dinafikan Allahyarhamah bertugas ‘on-call’ bersama 5 orang rakan yang lain daripada Jabatan Anestisiologi. Dimaklumkan Allahyarhamah tidak terus pulang pada keesokan harinya setelah ‘passing over’ jam 8.00 pagi kerana beliau telah pun mempunyai rancangan untuk bertemu seseorang bersama suaminya pada tengah hari tersebut. Allahyarhamah hanya pulang sekitar jam 2.30 petang selepas selesai pertemuan yg dijanjikan. Sementara menunggu temujanji, beliau telah pun berehat di bilik ‘on-call’ yang disediakan.

Kementerian Kesihatan mengambil maklum isu-isu yang dipertengahkan di mana ianya telah dikaitkan dengan peristiwa malang ini. Sememangnya tugasan seorang Pegawai Perubatan memang berat terutama apabila melaksanakan tugasan ‘on-call’ dan dalam kes ini, pihak pengurusan hospital telah pun berikhtiar memperbaiki keadaan persekitaran kerja dengan menjadualkan sehingga 6 orang Pegawai Perubatan daripada Jabatan Anestisiologi bertugas ‘on-call’ setiap hari. Tidak dinafikan kemalangan jalan raya mungkin terjadi disebabkan oleh keadaan seseorang yang kepenatan setelah melaksanakan tugasan yang berat, tetapi ianya boleh juga disebabkan faktor-faktor lain yang juga harus dipertimbangkan.

Walaubagaimapun, Kementerian Kesihatan mengambil maklum semua cadangan yang telah disarankan dan akan terus mengambil langkah-langkah penambahbaikan dari masa ke semasa. Semua fakta perlulah diteliti terlebih dahulu sebelum sesuatu keputusan itu dilaksanakan.

Innalillahi wa inna ilaihi roji’un


Ketua Pengarah Kesihatan Malaysia

Kementerian Kesihatan Malaysia

10 Julai 2015


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