It is now beyond any reasonable doubt that we are heading towards oversupply of doctors within the next few years. Almost 10 years ago I predicted it will happen in 2016. The waiting period for housemanship posting stands at about 4-6 months now, some extending to about 8 months in popular spots. With ALL medical schools producing graduates from 2016, we may hit 1-year waiting period by 2017. While the government is obliged to provide housemanship as it is part of compulsory training, it is not obliged to provide a job to everyone after that. Health Facts 2015 ( KKM_HEALTH_FACTS_2015) which was just released last month shows that we had achieved a doctor: population ratio of 1: 661 as of December 2014. This was initially targeted only in 2016! A total mess by our government! Doctors may soon join the 200K unemployed graduates.
2 years ago, I did mention that there might come a time where the government may consider using private hospitals for housemanship training. I also mentioned why it should never be implemented. Interestingly, behind closed doors, this issue was discussed by MOH with the Association of Private Hospitals (APHM) 2 months ago. While our DG did not deny that such an issue was discussed, APHM came out to say that it is not the best option (see below). They have also rightfully pointed out that we should address the root of the problem first!
Private hospitals are profit driven. It is consultant-based service but consultants are NOT employed by the hospital. Each consultant is just renting a room in the hospital and providing service for the hospital. That’s the reason we are not exempted from GST as we are not employees but contracted service provider. Since it is a one-man show, how much time would a consultant have to teach or guide the housemen. Secondly, private patients come to private hospitals for privacy and better service. They definitely do not want any “trainee” doctors to be seeing and managing them. The hospitals definitely do not want to be answering complains which is already piling up in all hospitals as patients are becoming more demanding. As what Dr Jacob mentioned in the article attached, who will indemnify these housemen and who will pay their salary? Why would a private hospital pay a houseman who is not going to bring them any return/profit! Oh, please don’t bring “social responsibility” crap into the picture. We are living in a capitalist world where what matters is profit and return of investment. Most hospitals are trying to cut their expenses to increase their profit, not the other way round. Same goes to medical schools. The government do not subsidise patients in private hospitals.
While private hospitals may have all the specialties needed for housemanship training, do they have a good case-mix to train doctors to be competent? Other than some big private hospitals (> 200 beds), most private hospitals are rather small-sized (less than 120 beds) and do not manage complicated cases. Frankly, the type of cases that I see in my hospital is totally irrelevant to training of housemen. Most of my cases in the wards are Dengue, AGE, Pneumonias, Bronchitis and some uncontrolled Diabetes and Hypertension. IN actual fact, most of these cases do not really need any admission. Admissions are needed, as they would not be able to use their medical card if they do not get admitted. If we really follow a tight protocol/criteria on admission (as in GH), most private hospitals will be half empty.
With increasing private healthcare cost (also due to GST), most cash paying patients are finding it difficult to seek or continue treatment at private hospitals. In fact close to 90% of patients that I see in my clinic/ward are paid by insurance or employers. This takes me to a recent article in Malaysian Digest. However, I find the statement on the number of doctors in private and government is rather inaccurate in this article. The more accurate numbers can be seen in Health facts 2015 attached above (Government 33K, Private 13K). The article has rightfully claimed that more and more patients are heading to government clinics for treatment. Due to increasing litigation rate in the field of O&G, the Ministry of Health had recently, in a letter dated 10/09/2015 increased the fee for O&G procedures and also added some new fees. This will increase the total cost for normal delivery and caesarean section by 100%. How many would be able to afford the increase? Most obstetrics cases are cash paying as insurance do not cover maternity cases. Of course, it will be the doctor’s choice to give any discounts.
On the other hand, our current generation Y seem to be collecting more and more debts. I had always said that taking huge loans to do medicine do not make any economic sense. A recent survey showed that close to 75% of Gen Y between the age of 20 and 33 have at least 1 long-term debt with 37% having more than one. It was an interesting survey (see below) which concluded that Malaysia’s Gen Y are living on the edge with huge debt!
I feel it is time for some medical schools to close shop or merge to reduce the numbers. A common entry examination or a more stringent entry criteria should be introduced. Till then, the madness will continue………
Many reasons private hospitals cannot train housemen, says industry group
BY JENNIFER GOMEZ
Published: 19 August 2015 9:00 AM
Private hospitals cannot be the solution for medical graduates who have no placements for housemen training due to a string of issues, the Association of Private Hospitals Malaysia (APHM) told The Malaysian Insider.
Speaking on the supply of newly-graduated doctors exceeding the placements available for housemen in government hospitals, APHM president Datuk Dr Jacob Thomas said the association has had talks with the Ministry of Health (MOH) and the Malaysian Medical Council on the matter of housemen in private hospitals but there is an impasse on a number of issues.
These include the question of who would indemnify trainee doctors against medico-legal issues and concerns whether there would be adequate supervision of housemen in private hospitals.
“Who will indemnify these trainee doctors against any mishaps or medico legal issues?
“Private hospitals might also want to interview and select the housemen they want to allow to be trained,” he said.
Dr Thomas added there were also issues over payment, such as who would remunerate the specialists who had to teach and take these housemen on ward rounds.
“Will these specialist be paid?
“Private hospitals manage with just sufficient staff, so additional medical officers and housemen on the payroll will incur higher expenses and result in increased private healthcare costs and higher patient charges,” he added.
Deal with root cause
The Malaysian Insider had reported on the rising number of medical graduates waiting three to six months for their housemen placements, a situation caused by the high number of medical graduates.
According to Ministry of Health records, there were 3,564 medical graduates reporting for duty as housemen in 2011, 3,743 in 2012, 4,991 in 2013, and another 3,860 last year.
Many graduates held qualifications from recognised medical colleges overseas and their number has increased from 877 in 2008 to 1,600 in 2011.
In 2012, there were 1,563 graduates from foreign medical colleges and this grew to 2,403 in 2013.
To Dr Thomas, one of the root causes of the problem of insufficient housemen placements was the high number of medical graduates each year.
This led to the issue of quality control, with the capabilities of graduates requiring further scrutiny, he added, because medical schools have mushroomed.
“Maybe some colleges should merge. We had a shortage of doctors in the past and had targets to meet.
“So, many medical schools mushroomed, but now it has to be re-looked once more. This problem will never be resolved otherwise,” he said.
Criteria for housemen training centres
The Health Ministry is open to having private hospitals provide housemen training to graduates, as long as they fulfilled certain criteria, the ministry’s director-general Datuk Dr Noor Hisham Abdullah said.
He said the ministry had already raised the possibility of implementing housemen training in private hospitals but said it needed to be explored further.
“This needs further study in terms of acceptance by patients and its long-term viability,” he told The Malaysian Insider in an email reply.
The criteria to be a houseman training centre includes the hospital having at least six basic specialist services, including internal medicine, paediatrics, general surgery and orthopaedic.
It must also have an adequate clinical workload and mix of cases in order to provide substantial exposure of different medical scenarios to housemen.
The hospital is also required to pay the salary of house officers as well as bear medical indemnity insurance to cover any medico-legal issues.
“There is also the acceptance of private patients to be examined by house officers, as they (patients) are usually those who prefer privacy and pay higher fees to be seen and treated by specialists,” Noor Hisham said.
The Malaysian Insider had earlier reported the DG as saying that training spots were tight because 30% of housemen do not finish their training in the stipulated period of two years.
Noor Hisham had explained that some of these house officers did not complete their training in the required time frame for various reasons, such as being on leave, their inability to complete their logbook, as well as absenteeism from work without approved leave and incompetency.
“Currently, the percentage of housemen who do not complete their housemanship training within the stipulated period is quite acceptable as it is not merely due to competency issues.
“However, MOH is working on various mechanisms to reduce this percentage,” he said. – August 18, 2015.
– See more at: http://www.themalaysianinsider.com/malaysia/article/many-reasons-private-hospitals-cannot-train-housemen-says-industry-group#sthash.RO97ePaw.dpuf
Malaysia’s Gen Y in debt, living on the edge, survey reveals
Published: 15 October 2015 11:08 AM
Malaysian young adults are accruing debt at an early age, a survey by the Asian Institute of Finance (AIF) has revealed, while some 40% are spending more than they can afford.
The survey among Malaysian “Gen Y” respondents between the age of 20 and 33 were living on the “financial edge” and were facing money stress, with the majority living on high cost borrowing of loans and credit cards.
“Our study reveals that 75% of Gen Ys have at least one source of long-term debt and 37% have more than one long-term debt obligation. Long-term debt obligations include car loans, education loans or mortgages,” AIF said in its report “Understanding Gen Y – Bridging the Knowledge Gap of Malaysia’s Millennials”, released today.
“To offset this debt, they are relying on high cost borrowing methods – 38% of Gen Ys reported to taking personal loans, while 47% are engaged in expensive credit card borrowing.”
Their debt woes, AIF said, were the result of “impulse-buying” behaviour, besides easy access to personal loans and credit card financing.
“The impulse buying behaviour of this young consumer is tied to the basic want for instant gratification, which is exacerbated by easy access to the world of online shopping. As a tech-savvy generation, these young adults draw on technology for everyday tasks.
“This includes seamless online purchasing, which encourages the ‘buy-now-pay-later’ behaviour amongst this generation of consumers. Reliance on credit cards for online purchasing has further encouraged this behavioural trait,” the report, targeted at banking, financial and learning institutions, said.
The report said around 16-17% was spent on maintaining lifestyles, 24% on loan repayments and 30% to 31% on living expenses, with little difference between male and female respondents.
There were also indications that there is a steady rise in loan repayment levels as Gen Ys go up the income bracket.
Of the 1,011 young professionals interviewed, 60% were single while the majority (43%) earned between RM1,500 and RM3,000. Some 32% earned between RM3,100 and RM4,500, and 8% earned below RM1,500.
The survey also showed that 40% of respondents were spending more than what they could afford, while only 30% said they were living comfortably within their current income.
“This approach therefore feeds on their impulse-buying behaviour. As a result, many of them stay in debt using credit card lending much longer than they ever intended.”
“Only 30% of Gen Ys surveyed said they live comfortably within their current income, suggesting a generation that is experiencing financial stress. It suggests that they have little knowledge about how to make wise purchasing decisions,” the report said.
Despite this, AIF said Gen Ys were much better at saving then it was believed, as 64% said they saved a portion of their income every month, with the majority keeping aside at least 20% of what they earned.
“The survey findings also reveal that Gen Ys’ appetite for savings grows with age. The highest proportion of savers was the 27 to 33 years age bracket (57%). Studies on Gen Y savings habits also show that, although they do develop good saving habits, these savings tend to be focused on short-terms goals.”
However, AIF expressed worry that youths seemed to be skeptical of professional advice by financial advisors and planners, with only 37% seeking consulting such services on money matters.
Instead, more youths (51%) tended to discuss these things with family and friends.
“This lack of engagement with financial advisors probably stems from their skeptical view of the value of financial advice itself as many of them believe they can find this information more easily by themselves. Again, this is a reflection of the DIY world they grew up with.
“The majority (63%) of Gen Ys who did not opt to seek advice from financial advisors or planners cited ‘prefer to do it on my own’, ‘not interested’ and ‘too expensive’ as the top 3 reasons for not using the latter’s services,” the report said.
Those that do seek advice from experts ask about savings and investments (56%), advice on mortgages or loans (41%) and retirement planning (32%).
As a recommendation, AIF said Gen Ys should look into consulting qualified financial advisors to get the information and confidence they need to make educated investment decisions.
“Grab opportunities to gain financial management knowledge from mainstream channels such as from higher learning institutions,” it said. – October 15, 2015.
– See more at: http://www.themalaysianinsider.com/malaysia/article/malaysias-gen-y-in-debt-living-on-the-edge-survey-reveals#sthash.fN5iYH70.dpuf