Since our new DG took over the Ministry of Health, there seem to be a lot of changes that are taking place. In my last post http://pagalavan.com/2012/05/31/for-future-doctors-recognised-specialist-degrees-and-period-of-training/, I mentioned about the new rules that are being implemented for those who are planning to sit for MRCP or MRCPCH. You need to have at least 4 years of training before even going for the gazettement process.
In March 2012, I wrote this http://pagalavan.com/2012/03/07/for-future-doctors-the-storm-is-coming-part-2/ where the new rule says that you can only apply for subspeciality training 2 years after you are gazetted as a specialist. AND during this 2 years, it is compulsory for you to serve rural areas for a minimum of 6 months, mainly in Sabah and Sarawak http://pagalavan.com/2012/02/08/for-future-doctors-panduan-penempatan-dan-pertukaran/.
There was one thing that I did not mention in all these postings : the bond with the government. I am sure everyone knows that all JPA scholars are bonded for 10 years. Almost all local university graduates are JPA scholars as it is offered to all of them. If you do Master’s, an additional bond of about 5-7 years is added depending whether you are doing under open or closed system. Since last year(2011), another new bond has been created for subspeciality training. Every subspeciality training except for cardiothoracic, urology etc is about 3 years. You are required to do 2 years locally and another 1 year overseas or at another centre locally. I was informed that the additional bond is 3 years for the 2 years local training and another 3 years if you go overseas under MOH, a total of 6 years.
Remember that these bonds do not run concurrently but one after another. So, the total number of years bonded will be 21-23 years with the government( if you are an undergraduate JPA scholar). This has created a lot of unhappiness among the doctors in Ministry of Health. Many feel that there is no point doing subspeciality now as they are already sitting at the highest salary grade of U54 and nothing to look forward in terms of salary increment. JUSA post is very much limited. I had written about this in MMA magazine in 2011 here : http://pagalavan.com/my-mma-articles/march-2011-the-great-transformation-revenge-of-the-fallen-to-the-dark-of-the-moon/.
So, with the salary being at the highest grade of U54( with RM300 annual increment for max 10 years), who wants to take another 6 years of bonding for doing subspeciality with no additional benefit? I was informed that many who wanted to go to private are already leaving the service without a plan for subspeciality ( about 100 specialist left MOH last year!). Only those who are genuinely interested in doing subspeciality for their own interest are staying on. I expected this to happen when I wrote the above article in MMA in March 2011. Again, what I said is coming true.
There are also many with MRCP or MRCPCH who are going to Singapore and IJN for a shorter route of subspeciality training. BUT a word of caution for junior doctors: the private sector is getting saturated as well in major towns and the soon to be introduced 1Care system may merge public and private healthcare in the country in near future. So, there will come a time where the income earned by a private doctor may not be much of a difference than a public doctor.
Till then, enjoy the bureaucracy in civil service, the reason I left!
all true.
But how effective are the subspecialty bonds? Most subspecialties are still very much in demand in private. Unless breaking the bond costs a million ringgit, it isn’t going to stop those with NSR from leaving if they want to leave.
Nowadays, they are strict with the bonds. Two of my specialist have to repay their Master’s bond despite appeals. I know that the JPA scholars who go overseas have to repay the entire amount if they break the bond nowadays.
So, they are keeping tract of the bonds. AND when you join private, especially in new private hospitals, your income is not going to be that high for atleast 1-2 years with the current competitive climate.
20 effing years! and here i thought 6 years of med school is long..sigh
The MOH knows that they control the key to any doctor progressing in the Malaysia now Dr Pagalavan. Unless you want to get your MMC registration done and then open a GP , all other avenues for your progress is determined by some training obtained in the Government service. I think the best option for these your doctors is to get the MMC and leave . If they stay next best option is still MRCP , MRCPH or MRCOG .. All getting tougher and tougher .. If not the above exams then Masters but be prepared to be in it for the long run because no matter what you have to fulfill criteria.
I heard for the subspeciality application , your forms go to Bahagian Perkembangan Professional and is vetted by not one not two but three officers to see that you have the 2 years post gazettement and also the rural posting locked in . If not the forms are just binned and not sent to the subspeciality chairmans . If no one qualifies but there are some applicants the DG has ordered still they should not be layan . So in terms of general surgery and subspeciality the bond is very strict.
I am a surgeon and my wife is a family Medicine specialist , we pray together as muslims do everyday and in my prayers i ask for the normal things such as long life , good health but since 2 years back we always end our prayers with ” please Allah , do not let our children look at us and choose to become doctors, let them live their lives and have time for both themselves and their own families, let them have a fair chance of being happy”
I believe in Malaysia it is truly the wrong profession to be in —at the current moment—.
Dr.Paga,
After housemanship how much does UD44 earn?
about RM 500 more then what you earn now
sorry malaysia..u made me to decide to stay back in europe…..
Dear Suthan,
Is europe offering good pay and good prospect for specialization? Some friends over there are complaining it is no good and are planning to return home. A few said they are regretting to stay back in UK because they are still on contract basis.
Master students with prior JPA bonds from undergraduate:
5 years for out-campus, 7 years for in-campus training
And if doing out-campus, the years spent during master training is still counted to pay back JPA bonds, then continue another 5 years bonding after completing JPA bond.
If doing in-campus, the years in master training is not counted for anything, and only after graduate then continue pay back previous JPA. After completing JPA bond, then only continue with 7-year bond
Come on now everyone …. bend over … do it for your tanah air
Dr Pagalavan,
Regarding the bond for local Master’s programme, I am wondering whether it is due to the taking up of JPA scholarship for the Master programme fee, or it is due to compulsory service even if we pay the Master programme fee on our own?
If it is due to the JPA scholarship, do we have a choice NOT to take up the scholarship by settling the Master programme fee on our own, hence avoiding the bond?
JPA scholarship is compulsory to enter Master’s. You need to sign it together with your Master’s acceptance. It use to be optional before 2003.
Dear Dr,
You said JPA scholarship is compulsory to enter Master’s. Does it mean even if the said MO is no good, he would still be qualified to enter Master’s?
I don’t think you understand what I wrote. I did not say that JPA scholars will be accepted into Master’s! All Master’s application will be selected by the universities. Once accepted, all will be offered JPA scholarship for the Master’s sponsorship which is compulsory.
Dear Dr,
I understand your explanation now. It is “scholarship” and not “scholars”. It is my mistake. Sorry for that.
Hello Dr Pagalavan,
A very interesting blog that you’ve got. I wished I have known about it earlier before I returned to malaysia.
Wonder what are your thoughts about my situation. I am a specialist trainee registrar in Geriatric medicine in the UK. I graduated in 2005 (UK) and passed my MRCP in 2009. I’ve completed one and a half years out of the 5 years geriatric training in the UK. Due to family reasons, I’ve returned to Klang Valley, hoping to complete my Geriatric training in malaysia. KKM insist that I complete the gazettement before i could apply to subspecialty training. That means i will start of as a Gred U51. Reading about the changes in the gov’s system, it will probably take me another 4-5years just to get into the subspecialty programme.
My other option is through the university route. Might have to spend some time as a contract MO before they get me a ‘lecturer’ post.
Am in a dilemma as to which option is better. Wonder what you think as it seems that you’re well tuned into the malaysian system.
Welcome to Malaysia. This is what I have been saying to those who are self sponsored in UK, complete your speciality there!!
I would advise you to talk to UMMC or HUKM. They may have better option for you. Geriatric is also not widely available at MOH. You may need to wait for long.
Dear Dr. Paga,
Ever since before entering medical school and now I am graduating in December, and God willing, will be going back to Malaysia from Western Australia to work next year, I have heard about the “peanut salary”, “slavery” and “bully” culture in Malaysia that has been tirelessly talked about by many doctors who are “trapped” in the system.
To be honest, I do agree that graduates of reputable medical schools, be it local or overseas should come back to Malaysia and give back, but giving the above mentioned problems, makes many shy away from giving back.
Personally, I think this culture does not nurture new doctors to become good doctors. And based on lots of stories from doctors currently working in the system about the unwillingness of many senior doctors to teach, or if they teach, lessons are given with “maki hamun” and sarcasm, sadly I do not think will nurture good educational development and de-skills new doctors trained in reputable medical schools. In the end, doctors who comes out of the system, will more likely be bitter people who are not only sarcastic, money driven, some will also become racist due to the system. I am not saying that junior doctors should be spoon fed or treated like a queen/king, it is just time for us doctors to adopt a more civilized culture in practicing medicine, seniors should understand that one day their junior peers are going to be replacing them and look after the well being of other human beings. Why not teach them with care and intention which is sincere, so that they become if not as good as you, an even better doctors. This will definitely bring better outcomes to the patient and Malaysia as a whole.
I have a question Dr. Paga, are the voices of the Malaysian doctors not loud enough or are we simply not strong enough because we are not really united to make the government bodies who employ us listen and provide better working conditions?
HI, why don’t you stay back in Western Australia ? Did you manage to get an internship in Australia?
we are simply NOt united!!
Dear Dr. Paga,
Thank you for giving me a really honest and refreshing answer. I am really relieved to learn that despite the dire work conditions in Malaysia, there are still lots of good doctors that actually cares for their colleague’s and patient’s future.
God bless you.
Dr. Pagalavan, do you think the additional bonded years under JPA scholarship is fair?
Other than that, do you think we should continue with the current Masters programme, which is not recognised elsewhere?
Would there be a major difference in the quality of specialty training between Malaysian Masters programme and overseas registrar training?
I understand that for certain specialties in Malaysia, you need to pass Part 1 of the MRCP/MRCS etc exams in order to be considered for the Masters programme. Do doctors need to complete Part 2 and 3 as well?
Just want to hear your thoughts on all these.
As long as the government sponsors you, the bond is fair. Unfortunately, forcing someone to accept the JPA scholarship as a prerequisite to be accepted into Master’s programme is not fair.
What choice do you have if you do not take the Master’s programme. If your basic degree is not recognised elsewhere, you chances getting a post overseas is very slim even if you pass their entrance exams.
The quality depends on the individual and the training centre.
IF you have completed MRCS, your chances of getting into local Master’s in surgery is better. However, it is not a necessity to be accepted into Master