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In May 2014, I wrote an article about the financial problems faced by one of the private medical college in this country. Three of the twinning universities had already pulled out. The one which was still going on was their own degree and UKM degree. Finally, the verdict is OUT. 

Early this week, I received an info from my friend in UKM that the AUCMS UKM program is in trouble. I heard that MMC likely will not accreditate the program and students will be in limbo.It will leave close to 300 students jobless. There was an emergency meeting between MOE and UKM to decide on the fate of these students. The D-Day was 15/08/2014. There were also government sponsored students in AUCMS.

Yesterday, UKM has decided to absorb all these students into their campus! UKM had to take the responsibility to what has happened. It was them who allowed an unknown university to run their program. Obviously, they would not want their reputation and degree to be badly affected. The students have to thank their lucky stars. If not, they would be left with no degree and no job!

Will UKM end up in trouble with this arrangements? I am not sure. MMC decides on the number of students that a university can take. I was given these numbers by one of the commentator in this blog:

Number of studdents in UKM (AUCMS in bracket):
Year 2: 163 (+110) = 273
Year 3: 215 + 48(UNPAD) + 75 (AUCMS) = 338
Year 4: 201 (+59) = 260
Year 5: 233 (+46) = 279

This is way off the figure that UKM can cope(especially Year 3). Would this lead to their degree being questioned especially by external bodies. Will Singapore Medical Council de-recognise UKM degree? How many parents will start making noise, in UKM accepting these students via “back door” when so many students could not get a place in local universities? Only time will tell.

This is one of the reason why I had always advised students to choose wisely. Please do not fall into the trap of entering a course which is yet to be accredited by MMC. It is a risk that you will have to take. By the time you realise, it might be too late. Many budding students came to this blog and emailed me about the generosity of some colleges giving them scholarship and loans to complete their study. I had always cautioned them. I had also always cautioned students on “unreliable info/promises” given by certain colleges. I write facts in this blog but many refuse to believe.

I read an interesting letter in Malaysia Insider yesterday (see below). It was written by a student who has questioned why JPA has stopped offering automatic scholarship to ALL medical students in public universities. Many years ago, all students were given JPA scholarship. It is up to you whether to accept it or not. Over the last 2-3 years, students were given an option between JPA scholarship and PTPTN loan. Based on this letter, JPA has stopped giving automatic scholarship. JPA has also stopped sending medical students overseas except for the top 50 students. However, MARA still sends students to do medicine overseas!! Ironic!

Is this a prelude to the fact that job is not guaranteed in the future? AS a JPA scholar, you will be bonded with the government. This means, the government must provide you with a job. 

Well, in one way, some of these happenings will reduce the number of graduates slowly. With AUCMS closing 4 of their programs, there will be a reduction of close to 400-500 graduates annually. BUT then, other colleges may continue to increase their numbers. Whatever it is, we are still in a mess!

Mara, pelajar perubatan luar negara lagi baguskah? – Wan Salman Wan Sallam
Published: 15 August 2014

Saya secara peribadi menahan saja perasaan daripada meluahkan pendapat peribadi tentang polisi baharu pemberian biasiswa Jabatan Perkhidmatan Awam (JPA) kepada pelajar perubatan Institusi Pengajian Tinggi Awam (IPTA). Polisi terbaharu itu ialah pelajar perubatan IPTA, bermula dengan kemasukan 2013/14 tidak lagi akan mendapat biasiswa JPA secara ‘de facto’ automatik.

Walaupun saya sendiri berjaya mendapat biasiswa tersebut, namun saya tetap kurang berpuas hati dengan sikap JPA yang langsung tidak memberi notis kemungkinan ini sebelum keputusan UPU tahun lalu. Walaupun benar JPA tidak pernah menjamin keautomatikan biasiswa perubatannya, polisi JPA yang selama ini sentiasa menwarkan biasiswa ‘automatik’ saban tahun pastilah membolehkan kita menganggap JPA akan terus melakukannya untuk tahun mendatang melainkan ada notis JPA untuk tidak meneruskannya.

Saya cuba melihat pada sudut positif; memandangkan pembinaan hospital tidak serancak pembinaan fakulti perubatan, saya dapat menganggap ada petanda kerajaan sendiri mungkin tidak dapat menguruskan ramai graduan perubatan akan datang. Malah pembekuan pembinaan fakulti perubatan IPTA mahupun IPTS juga bermula buat masa ini.

Sungguhpun begitu, saya lebih terkilan apabila membaca laporan berita Utusan yang menyatakan Majlis Amanah Rakyat (Mara) akan meneruskan penajaan pelajar bidang perubatan ke luar negara. Mengapakah Mara begitu beria-ia malah kelihatan berbangga dapat menaja pelajar perubatan ke luar negara?
Tanpa menafikan kecemerlangan pelajar tajaan Mara, saya melihat kerajaan amnya seharusnya juga melihat nasib pelajar perubatan dalam negeri, IPTA terutamanya yang saya kira setanding kecemerlangannya dengan pelajar luar negara dalam Sijil Pelajaran Malaysia (SPM). Bukan itu saja, rata-ratanya mereka juga amat cemerlang juga dalam program persediaan (contohnya Matrikulasi KPM, Asasi IPTA, PASUM dan STPM).

Bahkan yang ditaja kerajaan ke Timur Tengah contohnya, universiti mereka malah tidak menjadikan kelulusan program persediaan pun ada! Hendak sambung perubatan dalam negeri sangatlah susah dengan syarat kemasukan dan persaingan dahsyatnya, tetapi yang ke luar negara dengan syarat kemasukan lebih mudah ditaja pula. Bagaimanakah pertimbangan dibuat dalam keputusan ini sebenarnya?

Bukan itu saja, kerajaan sendiri mengakui jika ingin mengamal perubatan di Malaysia, amalan klinikal adalah lebih baik dijalankan dalam negeri berbanding luar negara atas faktor penolakan pesakit dan demografi penyakit. Pihak MQA sendiri juga menetapkan syarat ketat untuk akreditasi fakulti perubatan, maka adakah fakulti perubatan yang sekian banyak di Malaysia ini masih tidak dapat menampung keperluan graduan perubatan?

Tentang kos pula, menganggung seorang pelajar perubatan di negara benua Eropah memakan belanja hampir RM1 juta, jika tidak lebih! Apa rasionalnya menangung lagi dengan kos ini sedangkan kerajaan juga memberikan subsidi amat tinggi untuk menampung pengajian perubatan di IPTA? Lebih baik sempurnakan subsidi dan pemberian biasiswa pelajar IPTA semuanya daripada menaja ke luar negara.

Saya difahamkan bentuk ‘tajaan’ Mara bukanlah tajaan penuh, tetapi merupakan pinjaman boleh ubah. Apa kurangnya pelajar IPTA untuk tidak ditawarkan pinjaman yang sama? Bahkan kosnya lebih murah memandangkan IPTA bukanlah dasarnya mengaut keuntungan.

Jika Tan Sri Annuar Musa berpendapat bakal doktor perubatan ini berpeluang bergaul dengan orang luar negara, Mara mahu jadikan mereka doktor atau negarawan berjiwa rakyat? Mungkin juga Mara teringin melahirkan sosok seperti Datuk Seri Dr Wan Azizah Wan Ismail yang belajar perubatan di Ireland dan kini menjadi presiden PKR. Namun kita juga ada Tun Dr Mahathir Mohamad yang belajar di Universiti Malaya dan juga merupakan perdana menteri paling lama di Malaysia!

Untuk kerajaan, JPA terutamanya, ingatlah pelajar dalam negeri lebih setia berkhidmat untuk Malaysia. Buat yang mendapat tajaan luar negara, saya ucapkan tahniah dan berazamlah untuk kembali berbakti buat negara kita.

Untuk Mara pula, kebanyakan pelajar perubatan IPTA yang tidak mendapat biasiswa ini Bumiputera juga. Ada antara mereka hanya makan sekali sehari dan perlu menanggung kos buku teks yang hampir beribu harganya.

Cukuplah dengan polisi pilih kasih ini. Mara walaupun berasingan dengan JPA, kedua-dua agensi dan jabatan ini milik kerajaan juga. Sepatutnya wujud persefahaman den kesegerakan dalam polisi tajaan ini dengan bantuan Kementerian Kesihatan dan Kementerian Pendidikan.

Akhir sekali, mengapa ingin menyusu anak sampai ke luar negara jika susu di rumah sendiri lebih murah, berkualiti dan cukup untuk anak-anak? – 15 Ogos, 2014.

* Penulis ialah pelajar perubatan Universiti Sains Sains Islam Malaysia.

* Ini adalah pendapat peribadi penulis dan tidak semestinya mewakili pandangan The Malaysian Insider.

- See more at: http://www.themalaysianinsider.com/rencana/article/mara-pelajar-perubatan-luar-negara-lagi-baguskah-wan-salman-wan-sallam?utm_medium=twitter&utm_source=twitterfeed#sthash.Zzlsn4pP.dpuf

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My last article attracted a lot of debate in Facebook as well as a lot of “emotional” rants in the comment section. I will leave the emotional rant alone as people always get carried away with emotions and do not think rationally. Atrocities in this world will go on as long as people are emotional and do not use their brains to think and reason out.

One of the debate that took place in Facebook was about “Visiting Consultant” status in private hospitals. I wrote that Visiting consultants are not allowed to admit inpatients in any private hospitals anymore.  This was told to me when we applied for our hospital’s license renewal 2 months ago. Following this, our central management had a meeting with CKAPS unit of MOH and we were informed of the following, which is still rather confusing at times.:

1) Visiting Consultants cannot be appointed for INPATIENT services if there is no resident specialist of the same speciality e.g: you can’t appoint a Visiting Urologist if you do not have a resident Urologist etc

2) However, Visiting consultants can run outpatient and daycare services

3) Visiting Consultants can see inpatients if the patient is referred by a resident consultant aka co-managed e.g: resident orthopaedic surgeon referring to visiting plastic surgeon etc

4) Even if a Visiting consultant is appointed for INPATIENT services where there are resident consultants: the hospital MUST make sure that the consultant is “readily available” at all time! The definition of “readily available” is not clear. It basically means that the consultant must be able to attend the case as soon as possible when called.

5) The hospital MUST clearly differentiate between Visiting and Resident Consultants! From the conversation that I had with a ministry official, a resident consultant is defined based on their “Tempat Amalan Utama” in their APC. BUT hospitals may have different way of defining a “resident” consultant. Thus, it is still not clear. 

6) Maternity centres must have Resident Paediatrician and Anaesthetist.

Basically, the ministry is concerned about patient safety as what happened a hospital in Seremban. Under the PHFSA, MOH can come up with regulations which they think is important in protecting the public. Many will argue that time taken for a visiting consultant and resident consultant in attending to the patients will be almost the same, especially after office hours. Yes, I must agree that after office hours, it might be the same but it does make a difference during office hours. A resident is always there during office hours from at least 8am-6pm. The resident is also committed to the hospital (as he does not practise anywhere else)and have to take the responsibility and can always ask for help from another resident consultant/colleague if he is held up in OT etc. However, a Visiting consultant may be running his “busy” clinic outside or even doing a surgery in another visiting hospital when the hospital calls for an emergency involving his inpatient. He won’t be able to attend immediately and the resident usually do not help out either (internal politics and medico-legal issue!), especially if you do not have a resident of same speciality. Thus, I feel that the MOH concern is reasonably valid.

Let me give you an example of a case that was settled out of court for an amount close to RM 3million, recently. A patient came to a hospital in preterm labour. The patient is being followed up by a consultant in his clinic outside. He was a visiting consultant in that hospital. The MO sees the patient in the emergency department and calls the consultant. The consultant was awaiting delivery of another patient in another hospital about 1 hour away. Thus, he asked the patient to be sent to that hospital. The resident consultants definitely will not take the case as they have never seen this patient before. Patient delivered along the way and the child ended up as CP. The case was brought to court and while awaiting a verdict which was definitely going for the patient, they decided to settle it out of court, worrying that the compensation amount might be higher.

So, the ministry is now putting the pressure on the private hospitals to fulfil these requirements. There are many ways you can go around it but “IF” anything happens, the hospital will end up being penalised. Thus, most private hospitals will take the safer approach of likely not appointing a Visiting consultant if the resident do not want to work along.

As for dispensing rights mentioned in my earlier article, Dato Kuljit wrote a letter  to NST on 28/07/2014. IT was a well written letter about higher cost and inconvenience to patients if dispensing right are taken away from doctors. However, 3 subsequent letters in NST(HERE , HERE and HERE) rebuking his letter shows how much the pharmacist are pushing for it. I must admit that pharmacist are more united than doctors. I had given talks during their state AGM and I see a lot of them attending their AGM. How many attends MMA AGM, whether state or national level? How many are even members of an association, be it MMA (the official rep) or MPCN etc. Everyone just want to take care of themselves and their business and not bothered to stay together and fight. I have been active in MMA since I was a Housemen in Ipoh Hospital. We had fought for many issues concerning government service. Many do not know how MMA/SCHOMOS fought for whatever they are enjoying now but yet they just sit back and complain that MMA is doing nothing. I do not want to say how many trips I had to make to Putrajaya in submitting the paper on promotional pathway for doctors way back in 2005/2006(after a SCHOMOS workshop), something which I wrote on my ACER desktop computer with a floppy disc! I am happy it became a reality 4 years after I submitted it and I myself leaving the service. As a first step in improving the system, please join MMA and voice out your issues through the proper channel. The next step is to get involved actively in all activities of MMA and contribute effectively. If not, we are fighting a loosing battle!

Dr Krishna Kumar, our current MMA president also appeared in the press recently. You can read over HERE (below). He has also mentioned some of the issue that I had written in my earlier post.

Someone asked me about ASEAN trade agreement. For a start, you can read this agreement attached HERE. Basically, anyone from ASEAN countries can practise medicine here as long as he fulfils MMC registration criteria.

 

 

A heavy responsibility for Dr H. Krishna Kumar

 

The newly appointed president of the Malaysian Medical Association is keen to see the organisation maintain its principal aim of not compromising when it comes to the care of patients and the way doctors work.

Dr H. Krishna Kumar is a home-grown and trained doctor. He graduated from Universiti Malaya and has worked in two countries, five Malaysian states and many hospitals.

He is currently a maternal and foetal medicine specialist, and trains undergraduates, postgraduate and sub-specialty doctors.

Although he had worked as a consultant in the United Kingdom and was offered a permanent job there, he chose to come back to serve his country.

Dr Krishna, who hails from Seremban, is a proud alumnus of St Paul’s Institution.

He is quick to point out that his parents were his bedrock. They were both teachers who ingrained in him the importance of education.

“The Malaysian Medical Association (MMA) is the largest organisation that represents doctors in the country, thus, we have the largest voice among doctors in Malaysia.

“One of our core purposes is to ensure that health fees do not compromise the care of patients or doctors’ work quality.

“In order to build upon this principle, we lobby with the government to ensure that any policies that may affect doctors are addressed.

“The Health Ministry is more or less like our partner as they have similar principles,” explains Dr Krishna.

“For instance, the Malaysian Communications And Multimedia Commission with its Personal Data Protection Act (PDPA) – we are the only country that puts the health sector under this Act, while in Western countries like the UK, the health sector is excluded.

“The appearance of a third party and a new Act may in fact result in a breach of some of our ethical practices and affect the way we manage our patients.

“This is the reason why we do not support the PDPA and are in the midst of discussions with various ministers to try to get the health sector excluded.

“After all, data collected by the health sector is governed by our Medical Council and the Private Healthcare Act,” he says.

Dr Krishna also raised concerns over the current scenario where only doctors’ fees are being closely regulated, whereas there is little to no regulation of hospital fees.

“Unfortunately, this scenario is likely to go on indefinitely.

“If you look at the itemised bill from any hospital, you will find that the bulk of the bill comes from miscellaneous hospital charges while the professional charges (i.e. doctor’s fees) will only take up a small portion of it. Why this huge disparity?” he questions.

“As I do not work in the private sector, I have no vested interest in this, yet I am moved to take action because of my conscience,” he says.

Medicine is becoming a business

“If you look around, you will find that businessmen have realised that the healthcare industry is a highly profitable business.

“That is why you will find a lot of such clinics, as nowadays it’s all about making money,” Dr Krishna says.

“Gone are the days when the family doctor is in control. It has become increasingly difficult for family doctors to survive, especially in the face of numerous rules, regulations and acts that are being introduced that specifically target the health sector.

“All these are deterring independent practices as the family doctor will now have to contend with so many new conditions and administrative details that are necessary to ensure that they are not in violation of any of these new rules, regulations, and acts. They are slowly dying out as they have been squeezed at every turn,” he says.

“Every time a new ruling or law emerges, there will be a fee charged. Take the Personal Data Protection Act as an example – they would be charged RM600 a year for this. When there is an inspection of your clinic, it will cost between RM1,500-RM3,500.

“There is another charge for waste disposal; obviously, a clinic cannot throw its rubbish away in the ‘normal’ way.

“There is a charge for business practice registration, clinics that have radioactive materials orX-ray machines need to pay a fee, and employees at the clinic must also be qualified personnel.

“The cost of the fees and the increased salaries of hiring at least two to three qualified staff per shift would add to the running cost of owning and operating a clinic,” adds Dr Krishna.

“Take maternity centres as an example. In the past, you would have the option of going to a government hospital, private hospital or private maternity centres. The private maternity centre was more affordable than private hospitals, but the new rules now state that there must be a resident anaesthetist and a paediatrician.

“Since the majority of such maternity centres do not have a large volume of patients, they cannot comply with this new ruling, thus, many are forced to close down.

This new ruling also adds to the cost of having a baby as the charges will rise since there are now three professionals involved with delivering a baby instead of just the obstetrician (especially for normal deliveries),” shares Dr Krishna.

Modern challenges

Looking back over the years, Dr Krishna notes that there have been many changes in the medical practice. For one thing, medicine has become increasingly complex, with technology taking over many aspects.

Prices of drugs have also increased, and all these factors have led to an unfortunate increase in the cost of healthcare.

“The most obvious thing that has gone up is the expectations of our patients. For instance, in the past, deaths in the wards were often taken in stride, whereas nowadays, any death (even if it is a 90-year-old with all kinds of health complications) are often greeted in an accusatory manner,” states Dr Krishna.

“The Internet has also been both a boon and a bane for the health sector. Many patients often self-diagnose by surfing the Internet for information about their condition.

“The problem we often face is when they seek information from unreliable online sources as they will then approach their doctor with this dubious information and challenge them with it.

“This is a worrying trend as many patients often visit unreliable online sources, become convinced by it, visit a doctor, challenge their doctor, and refuse to believe their doctor even when asked to do their own research (but using reliable online sources that their doctor provides). Many such patients will ‘doctor-hop’ until they find one who will give them the diagnosis that they expect to hear,” he says.

Unhealthy developments

There are other problems that need to be addressed as well, including the shortage of places for new graduates who wish to do their housemanship.

This situation is not confined to just doctors, but is occurring across all the various disciplines in the healthcare industry, such as dietitians, radiographers, and so on.

“They are all affected because there has been a gross increase in the number of colleges providing the training. Unfortunately, there is also a shortage of good teachers, which has led to many universities or colleges producing inadequately trained professionals.

“This situation is especially bad as many of these graduates are then unable to find employment due to their inadequate training,” says Dr Krishna.

“This is the reason why at one time there was a shortage of nurses, yet at the same time there were 30,000 unemployed nurses, all of whom graduated from certain universities or colleges.

“In contrast, nurses that were trained by the Health Ministry can easily find a job anywhere, even in the Middle East. Similarly, I anticipate that this scenario will be repeated with the current batch of doctors who have graduated and/or are graduating,” he says.

President for a year

Dr Krishna is quick to admit that as the president of MMA, he has to shoulder a heavy responsibility.

He comments: “For most of us, this is not our primary job, rather it is a voluntary position. For an individual to take time off to run the association for a year is enough. To bear this burden for more than a year is difficult.

“Although a year may not sound like enough time, bear in mind that before becoming president, one has to spend a year as president-elect, followed by a year after one’s term as president serving as past president, so in total, one year will be around three years.

“Just as it is for any other post in MMA, you may finish what someone else has started and someone else will finish what you have started. While the focus may change from president to president, the principles will remain the same.

“This has helped ensure that there is a continuity of purpose within the association, and this ensures that the direction of MMA remains constant, although how it is approached may be different,” he says.

“It is my fervent hope that I will be able to achieve positive changes in how healthcare is practised in this country, and to do so in a manner that benefits both patient and doctor.

“After all, if the doctors are not taken care of, how will they take care of their patients? Similarly, if our patients are not cared for, it will have negative repercussions for doctors too,” he concludes.

 

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Much has been written in this blog about the future of medical graduates, the declining quality of products, oversupply of doctors and the eventual unemployment of graduates. The world is undergoing many changes. Wars are breaking out everywhere with extremist killing innocent people in the name of race and religion as well as territorial fight. Malaysians are only interested in Gaza but forgotten the fact that Syria has killed almost 170 000 of their own citizens, Boko Haram is killing their own citizens in Nigeria and ISIS in Iraq killing Christians who refuse to convert or leave. The Ukrainian crisis would not have come into the spotlight in Malaysia if not because of MH17! When people ask me why I don’t support Palestine openly, I ask them why they never bothered about what is happening in the rest of the parts of the world. Why people never marched to the Syrian embassy? Why don’t people march to the Arab country’s embassies for not helping the Palestine? Historically, more Muslims have killed Muslims compared by anyone else. I support humanity and that’s why I am a doctor! I condemn any atrocities no matter where it happens and who is involved. I do not support any particular race or religion or country. In fact, we may end up like them if our PM does not act as a leader in condemning the racial and religious bigots who are running amok in this country at the moment.

Now, coming back to the topic above, life as a practicing doctor does not seem to be getting any easier. We were just informed that the Annual Practicing Certificate (APC) fee would be increased by 2016. The proposed rate is RM 300/year, up from RM 50/year now. MMC will be corporatized as mentioned in the amended Medical Act 2012. Thus, one of the source of income for MMC will be the APC and NSR (National Specialist Register) fee. The NSR fee will remain at RM 1500 every 5 years. The renewal of APC will not be automatic anymore. You need to have a minimum amount of CME points to be renewed. I was informed that it would likely be 10 points per year for MO and 20 points per year for specialist.

Ministry of Health is also strengthening their enforcement unit and introducing many new rules and regulation for private hospitals and clinics. Recently, we were told that Visiting Consultants in a private hospital cannot admit any inpatients. They are only allowed to see outpatients. I understand that this new rule came about after the incident at the Chinese Maternity Hospital, Seremban where MOH had to close down the inpatient services, end of last year. The hospital was surviving with visiting consultants to run their inpatient services. Unfortunately, this new rule will have severe impact on hospitals and consultants. This basically means that a consultant who runs his own clinic outside would not be able to admit any patients to any private hospitals anymore. It also prevents Consultants from government sector to have any admission rights in private hospitals despite government allowing them to do locum/out of office hour’s session in private hospitals. Is this an indirect way of MOH in preventing their doctors from doing locum outside?

As for individual Maternity Centers, license is NOT going to be renewed if they do not have a full time Pediatrician and Anesthetist. This will force most maternity centers to close shop within the next 1-2 years. I have already had few O&G consultants from maternity homes calling our hospital for visiting rights. Unfortunately, it is a double whammy. We can’t accept them as visiting consultant as we can’t give them admission rights!

There is also another new rule, which says that we can’t run an ICU if we do not have at least 4 ICU trained nurses! Oh my, it looks like most of the small hospitals will have to close down their ICU services. How are we suppose to get ICU trained nurses when the training can only be done in a government hospital (under their post basic training) but they do not provide any allocation for private nurses?

By April next year, patients will have the option to choose between getting their medication from doctors as they do now, or to insist on the doctor giving them a prescription to buy the required drugs from a pharmacy. It was published in The Sun last month.This will be another big blow for the General Practitioners. It is a catch 22. Most GPs survive on the commissions they get from selling medications. If the above rule is implemented, they will have no choice but to increase their consultation fee. This in turn will chase away a lot of their patients. You can’t survive by charging RM 25-30 consultation fee! The Malaysian Pharmaceutical Society is fighting hard to get this implemented. As you would have noticed, many small pharmacies are merging to create big branded retail pharmacies almost everywhere in every town.

The cost of private healthcare is increasing tremendously. There was a saying that only 20-30% of the population seeks treatment from private hospitals. Unfortunately, the number of cash paying patients in private hospitals is dwindling over the years and only constitutes about 10-15% of the total number of patients attending a private hospital. The rest depends on insurance such as employee benefits and medical cards. In my hospital, almost 90% of patients are paid by insurance. This is where another huge problem is arising.

Since the New Fee structure was introduced by MOH in February this year, insurance companies are becoming more stringent in their assessment. For those who do not know, the fee increase of about 15-30% is the first increase after almost 16 years! And yes, our fees are regulated by the government but not the hospital fees. The insurance companies are now dictating what we should do and what we should not. They are even limiting the number of times we can see a patient in the ward. I have had insurance companies which specify that only 1 visit per day is allowed. If you visit more than once, either the patient has to pay or we have to do it for free! It does not matter whether the patient is ill or not! My surgical colleagues are having a tough time, as some of the fees are not being paid as it is deemed unnecessary by insurance companies and they decide this by sitting 400km away without even looking at the patient! Yes, I agree there are black sheep’s in our profession. I had written enough about this. Unethical and “go for money” doctors are increasing day by day due to stiff competition and reducing income. However, to query what a doctor should do and should not do, cannot be decided by some junior doctors who might not even have completed housemanship! FYI, insurance companies do take those who quit housemanship to become their underwriters! They even got the stupidity to ask why an appendicectomy cannot be done the next morning just because doing after office hours increases the cost! I hope we can say that to them when they get admitted for a similar problem. Interestingly, these insurance companies do not say these directly to their client/patients!!

All insurance companies are increasing their premiums as of now, to minimize their loss from the recent fee increase. How many percent of the population will drop out of the scheme? As the premiums increases there will definitely be certain portion of the population who will not be able to sustain their policy. This in turn may reduce the number of patients visiting private hospitals. On the other hand, the cost of private healthcare will continue to escalate. Eventually it will reach a tipping point where the private healthcare system may collapse, especially the big tertiary private hospitals. This did happen in the US in 1990s after which they started building smaller primary and secondary care hospitals to keep their overhead cost lower.

While we are having constant pressures from all these external factors, the litigation rate seem to be going up by leaps and bounds. Last year the court of appeal decided to award RM 3.5 million (before interest) in damages for a cerebral palsy case in a private hospital in Klang Valley. It has set a record as the highest amount ever awarded as well as a benchmark for future cases. Recently, a government hospital was asked to pay RM 2.78 million in damages for a similar type of case. Interestingly, the mother of the child is a doctor who is still in government service! Another consultant in a private hospital in Klang Valley was asked to pay RM 280 000 for causing death of a child due to mismanagement of labor, and the patient is a foreigner! Just today, another case involving an Orthopedic surgeon and a government hospital was found guilty of negligence. These are just the tip of the iceberg as many cases are being settled out of court!

These cases have now increased the premiums for our medical indemnity insurance and it will only go higher! A couple of months ago I had a father who said that doctors can’t be suit in court because no doctors will give evidence against another. I think he is leaving in the 80s. Those days are gone. We have many consultants hired by lawyers to attend court cases as expert witness. On the other hand, an increasing litigation rate will also increase the cost of healthcare as doctors will become over cautious and order unnecessary investigations (as happening in US). It is known as CBM: Cover Backside Medicine!  The production of poor quality doctors with poor training during housemanship will only make things worst for the field of medicine in the future.

Well, many things are changing in medical fraternity. Some are for good as it ensures safety of patients and general public. The practice of medicine will not be the same anymore as many rules and regulations are being put in place. Income of doctors will continue to decline due to various factors mentioned in this blog. Doctors will be pressurised from every corner, which include debts, high indemnity premiums, high litigation rate and high maintenance cost of practice. AND I have not even started talking about TPPA and ASEAN Trade agreement! So, never do medicine for easy life and money!

2014 has not been a good year for this country. Anyway, I wish everyone a Selamat Hari Raya and have a safe journey home……………

*** please click on the links to see the articles*** 

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FINALLY, I mean finally, the word is out from the horse’s mouth!! Of all these years of me screaming that this will happen and all the insults that I had to take from those who were in denial, the verdict is out from the Ministry of Health !!

Today’s Star reported our Health Minister as saying and admitting that we are producing too many doctors with too few training slots. Just 1 year ago, this very Health Minister denied that we have too many doctors in a dinner organised by MMA. Fortunately, he has come to terms with the fact that it is unavoidable. Now, he says that our situation is extraordinary, the Malaysia Boleh style! According to the article, a waiting list has started for Housemanship posting which is about 3-6 months now and will become longer eventually. This is happening with just below 5000 graduates last year and 20 more medical programs yet to produce graduates locally, as I had mentioned in my previous post.

Of course , he has not mentioned of what is going to happen to those who will finish housemanship but got NO MO post! That will be another issue all together which likely be addressed by an exit exam or removal of compulsory service.

Interestingly he mentioned that MOE is being asked to review the entrance criteria to do medicine. This is really difficult to be implemented as you can’t prevent anyone from doing medicine anywhere in this world. My suggestion is to limit the type of PreU courses(standardised established ones) that can be accepted as an entry requirement and to implement the MMLE. Will the government refuse to give job to those who do not have the minimum requirement but already graduated ? It looks very likely!

Another issue mentioned below is the requirement for a credit in BM. This is actually a standard requirement for all civil servants. You must have a credit in BM to join the civil service. However, to encourage doctors from overseas to return to Malaysia and work in civil service, MOH requested an exemption from JPA in 2006 when Chua Soi Lek was the Health Minister. At that time, there were severe shortage of doctors and the need to even recruit foreign MO. Unfortunately, it will not be the same anymore. So, for those who do not have a credit in BM, be prepared not being able to be employed by MOH.

Well, I hope those who do medicine for the purpose of job security will think twice before doing medicine.Do not waste your money and time. Do medicine only if you have genuine interest and passion( with the required minimum criteria), after reading about a doctor’s life in my “For Future Doctor’s” page above.

Next,  I will write another post about the situation in private sector where our income is now being determined by Insurance companies!

 

Waiting list for housemen positions at public hospitals

BY LEE YEN MUN

 

PUTRAJAYA: Public hospitals can only absorb about 5,000 housemen each year, but more than 6,500 medical graduates emerge from both local and foreign institutions annually, said Health Minister Datuk Seri Dr S. Subramaniam.

There is now a waiting list (for housemen positions) of between three to six months and the wait could be longer in time to come. As part of a measure to control the supply of new doctors, we are now in discussions with the Education Ministry to review the minimum qualifications (for entry into medical schools),” said Dr Subramaniam at a press conference here yesterday.

The two-year housemanship is part of a compulsory apprenticeship for medical graduates who, upon successful completion of their training, would be granted a full practising registration certificate by the Malaysian Medical Council (MMC).

There are now 33 medical schools offering 44 medical programmes locally but the Cabinet has imposed a five-year moratorium on new medical courses effective May 1, 2011.

Another measure which was implemented recently to increase the number of housemen’s placement included housemen being assigned to posts in public health clinics in one of their six rotations. Dr Subramaniam said the ministry was also considering introducing primary care and psychiatry as an alternative apart from the compulsory posting.

“In other countries, there is no problem like ours because the number of doctors (overseas) are under control. Our situation is extraordinary because we have a high number of (medical training) institutions.

“In addition, the employment criteria for house officers set by the Public Service Department needs to be made similar to other professions, including a mandatory credit in Bahasa Malaysia,” the minister said.

Separately, Dr Subramaniam announced the gazetting of seven locations in Johor as smoke-free zones effective June 19.

They include Taman Rekreasi Town Park 2 and Taman Rekreasi Town Park 3 in Taman Seri Austin, Johor Baru; Taman Negara Gunung Ledang, Muar; Taman Negara Endau Rompin and Taman Negara Endau Rompin Tambahan, Segamat; and Taman Negara Pulau Kukup and Taman Negara Tanjong Piai, in Pontian.

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After almost 6 months of planning and almost weekly meeting since February 2014, the 54th MMA AGM is finally over! We had a wonderful weekend with almost 400+ doctors attending the AGM held at Persada Convention Centre, Johor Bahru. The committee especially the Secretary Dr Mohan and Treasurer Dr Guruparan played the most important role in running this AGM. Despite many pharma companies declining to participate, we still manage to get close to 50 booths for the event. Despite some initial glitches, we manage to end the event with a wonderful Informal Night themed “Arabian Nights”.

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Many interesting discussions took place during the AGM. MMA AGM usually gives an opportunity for many doctors to come together and meet each other. I manage to meet and discuss many issues regarding medical education and the future of medical life in Malaysia with many senior  & junior people in MMA and MOH. I also manage to meet and be reunited with my 2003-2005 SCHOMOS Johor committee members DR Nirven ( who I last met 5 years ago) and Dr James Lew (selfie below).

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The MMA Oration was given by Dr David Quek, who is a Past President of MMA and a MMC council member. His topic was “What Ails The Medical Profession And then What Ails Our Health System? ” He reiterated the fact that we are producing  too many doctors at too fast a pace. We will see surplus of doctors by 2017 and MO jobs will not be guaranteed anymore. The government has finally come to realise this fact and making steps to minimise the “complications”. MOH and MMC is seriously considering either an entrance exam or an exit exam. Reducing compulsory service is also on the cards. The government cannot stop anyone from doing medicine despite the minimum entry requirement but they need not necessarily provide you a job. They also can’t close down the medical schools as it is a business and the government need to support businesses. Probably, some of them will die a natural death when surplus of doctors occurs.

Unfortunately, unless there is a standardised entry or exit exams, we would not be able to remove the poor quality doctors. WE will have surplus of doctors but how many of them will be of good quality? The situation is so bad that many specialist has given up. The shift system just made it worst. Some good hard-working housemen have openly told me that even though their fellow housemen are their friends but they would not send any of their relatives to these doctors.  It looks like we are releasing many with a “license to kill”.

The article below which was published in The Star on 25/03/2014 summarised what I have been saying over the last 10 years. Too many students in too few “training” hospitals and “shop-lot” medical colleges with too few academics (diluted within 36 medical schools). Many from non-medical field do not understand all these issues. Many believe that as long as the college is attached to a hospital, it is well and good! Training in medicine is more than that!

Finally, I hope doctors will be more united in becoming MMA members, take a break and attend AGMs like this to meet one another for the betterment of the medical profession…………….

I will be off again for a Family holiday starting 8/06/2014. Hopefully I will reach Hong Kong safely……..

 

Docs in govt hospitals stretched by private students

BY LOH FOON FONG

PETALING JAYA: Too many private medical programmes nationwide are over-taxing public teaching hospitals.

While the Education Ministry’s university hospital teaching staff taught mainly their students, the general hospitals under the Health Ministry doubled up as teaching hospitals for private university students, resulting in a heavy workload, said a source.

“The doctors are overstretched. They have to divide time to attend to their patients, teach students from private universities and guide house officers,” said the source.

The source was concerned this would lead to students receiving little attention.

Private hospitals in Malaysia were not used as teaching hospitals as they did not have the needed case-mix (various types of patients) and high bed capacity to provide the needed training and exposure to students.

The source said the Cabinet needed to reduce the number of programmes and the number of students entering local medical schools by 70%, or get the private schools to merge and pull their teaching staff together.

Although the Government had argued that it needed to increase the number of doctors for the nation, he said there was more than enough doctors now and it was a case of uneven distribution.

In the Klang Valley – the doctor-patient ratio was 1:100 while in Sabah and Sarawak – 1:1,000, he said.

In Putrajaya, Deputy Health director-general Datuk Dr S. Jeyaindran admitted there were too many students taxing the limited resources.

The ministry would have to look at the nation’s needs first before deciding if it could reduce the number of medical programmes in private universities.

He said the system could cope with 2,500 to 3,000 medical graduates a year currently and foresees some private schools subsequently closing down or merging.

 

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Today, another piece of news appeared in the Star regarding the same college which I wrote about, 3 weeks ago over HERE. It is rather sad to hear that hundreds of students will likely be affected. None of their programs are yet to be accredited by MMC except the abandoned twinning program with Indonesian University. What will happen if MMC decides not to accreditate this university? Looking at the current scenario, teaching facilities and staff situation, very likely MMC will NOT accreditate this university. The worst affected will be their local program and the MD UKM program.  From my previous post, i received few comments from students who were doing the twining program with the 2 Ireland universities. It was mentioned that most of the government sponsored students were absorbed into the Ireland university’s 5 year program. If I am not mistaken, they had to start from Year 1 again.  I am not sure about the self paying students. The whole idea of twinning is to reduce cost.

Over the years, I told many students who wanted to do medicine in this university NOT to accept the offer. Right from the beginning I had doubts about this university. No university in this world can run 5 medical programs. Unfortunately, due to their “generous” scholarship offer, many students/parents were “tricked” into accepting the offer without checking the background, teaching facilities etc. The human nature is to find the cheapest possible way to make their children a doctor. As I have said many times before, doing medicine is not just about getting a degree. It is more than that.

If indeed the university is in dire need of money, the only option is to sell it or ask the state government to buy over. Sheffield university was bought over by the Perak state government when they went into financial difficulties in late 1990s. It was renamed Royal College of Medicine of Perak till it was sold to UniKL few years ago. The same situation might happen over here. It is considered a bail-out but do the government have enough money now? Furthermore, the state government is under the opposition where as the owner of this uni is considered a close ally of the federal government. This was evident from past newspaper promotional activities of the college where DPM, ex-PM attended.

From today’s article in the Star (see below), it was mentioned that students are not allowed to enter the teaching government hospitals. I am not sure what is happening but very likely the university is not paying the HODs of the hospital. Generally every university has to pay each HOD of the hospital a monthly allowance of about RM 800-1500 to facilitate teaching of the students in the wards. The HODs have every right to block the students from entering the wards if there is a conflict.

Over the years, many did not believe the advice that I gave. I talked about the reality on the ground but people get carried away with the promises given by businessman. Many would like to believe what is written in the brochure and promises by the respective marketing team. For over 4 years, I wrote about all these marketing gimmicks and yet people refuse to believe. Perdana University promised their own teaching hospital by the time the first batch reaches final year! Again, I was sceptical. To date, even the ground work has not started!! The government is to be blamed for all this mess but our society also need to wake up from their sleep. WE have an ignorant society. Many refuse to believe what is written in this blog despite facts and figures. Many feel that it is all negative and nothing positive. BUT, what is written in this blog will NEVER be told to you by anyone else. It is the reality and the truth. The truth hurts. If you want to hear positive things, just open the mainstream newspaper daily!

Anyway, I hope an amicable solution will be taken by the college for the sake of the students. Many of them may need to transfer to another college and redo their entire course. UKM may even pull out their degree. Hope everything will end well.

This will likely be my last blog entry till the MMA AGM in Johor. Please do come down to JB to attend the AGM

 

 

AUCMS students badly hit by school’s financial woes

BY RAHMAH GHAZALI

 

PETALING JAYA: Hundreds of Penang-based private medical school Allianze University Medical Sciences (AUCMS) students have suffered from the school’s financial crisis, which has allegedly dragged on for a year.

An employee, who spoke on condition of anonymity, told The Star Online that the students were no longer allowed to serve their practical years in some government hospitals due to the college’s poor track record.

“There are many occasions where the students are not allowed to enter the wards as the hospital’s departments refused to accept students from AUCMS.

“They complained that the quality of teaching in AUCMS has been below the standard of medical school,” he claimed.

The plight of AUCMS employees was highlighted in The Star Online on Apr 22, with some turning to loan sharks in desperation as their salaries have allegedly not been paid in four months.

Despite repeated reminders to the college’s management including a signed petition, the employee said their concerns have been ignored.

“Our patience is running thin. It’s been five months now and we haven’t received a sen yet,” he said, adding that the employees are planning to take legal action against the college.

“More than 65 employees have signed a petition letter demanding their salaries, Employees Provident Funds contributions and scheduler tax reduction are paid according to their contracts.

“However, the management still has not responded to the petition,” he said.

He also said the employees are threatening to boycott the classes due to the ongoing problems.

“Our medical faculty is also badly hit as many high-ranked and clinical lecturers have left to other institutions,” he said.

He added that the employees have decided to take legal action against the college for the unpaid salaries.

AUCMS president Datuk Dr Zainuddin Md Wazir had previously said that they were going through some “financial hiccups” and vowed to make the outstanding payments as early as this month.

When reached for comments, Zainuddin said the management is “sorting it out the issue immediately.

“We acknowledge their problems and we are in the midst of settling it,” he said, briefly.

AUCMS is a private learning institution located at Kepala Batas, Penang that runs specialised courses of study in medicine, hospitality, tourism, sports science and allied health sciences.

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Lately I have been busy for various reasons. Thus, my blog entries has been slow with the last entry being almost 3 weeks ago. So many things has been happening over the last 2 months. My hospital life has been busy, almost weekly MMA branch meeting for the upcoming AGM, family matters, politics  etc.  I became a MMA member since I was a houseman. Currently I am a life member. I have been active in MMA Johor branch since the year 2000 as a committee member and subsequently as Johor SCHOMOS Chairman from 2002 till 2005. I was also the National SCHOMOS Treasurer from 2004 till 2006. I took a break from 2007 till 2011 as I was busy doing my subspecialty as well as starting academic life (Monash) and private practise(from 2010). I went back into the committee in 2012 and subsequently as Johor CME Chairman since 2013.  I was well known for my articles in Berita MMA since 2004, many of which has become a reality soon after. All the articles that I wrote in MMA magazine are available over HERE. I stopped writing since 2012 due to some conflict with the editor.

For the first time since 1994, Johor will be organising  the National AGM, the 54th. Almost the whole organising committee do not have any experience organising it before. Thus, it was a great challenge to organise this event despite our busy schedule. In fact, I could not attend all the weekly meetings due to my busy clinical life of being On-Call on weekly basis.  I was mainly involved in organising the symposium and booths.

We all know that the medical field is not what it use to be. Quality has deteriorate and life is not as “easy” as what many would like to think. Oversupply of doctors due to commercialisation of medical education will become a reality soon. I first wrote about this in 2005. MMA is the oldest and only medical organisation that the government talks to. Our current/outgoing President, Dr NKS Tharmaseelan has been one of the most vocal president to date. Many issues were brought forward to mainstream media including the oversupply and quality of doctors. Unfortunately, despite having close to 40 000 registered doctors in Malaysia, only about  1/4 are members of MMA. Many complain about MMA but it is the only organisation that can voice out our issues/grouses. Many in government sector do not know that most of the PERKS that they are receiving now are due to constant discussion between MMA and the government. These includes the time based promotion, on call allowance, specialist allowance etc etc.  We may have a number of splinter parties but we still need to work together with MMA to achieve our goals. Medicine is at its crossroads. I hope every doctor would at least become an ordinary member to strengthen the membership of this association and make our voice stronger.I never gave up my MMA membership despite my past dissatisfaction with them.

Thus, I hope every MMA member can take a few days off to attend this important AGM in Johor Bahru. It will be held from 29/05/2014 till 31/05/2014. Election for President Elect and Secretary will be held during this AGM.  IT will be the beginning of school holidays and thus make sure you bring along your passport for a visit to Singapore or Batam.

I hope I will see you all  in JB………………………

 

 

A4 FLYERS MMA

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