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Many things are changing in this world. The same goes to the field of medicine. It use to be a so-called glamorous job where no one will question whatever you say. Whatever you tell the patients is considered gospel truth and patients will just swallow it. However, times are changing and doctors are finding it difficult to deal with patients. Patients are becoming more demanding and do not hesitate to question you. Internet is both a gift and a curse. Patients come to you after spending some time “google-ing” their symptoms and ask you various questions which you are not prepared for. I have had patients who walk into my room with a diagnosis in their mind and they just want me to confirm it! It does irritate me but I will always tell them that I will decide what need to be done.  But then , there will always be an anxiety at the back of your mind whether you are missing something and  the patient might be right. I am still able to control this anxiety but I am seeing many consultants/doctors out there who practise CBM ( Cover Backside Medicine). They order all sorts of unnecessary investigations just to make sure they do not miss something. This was what happened in US when the litigation rate started to rise which subsequently pushed the healthcare cost up the roof. Likely , the same will happen over here , both in private and public hospitals.  Mind you, government hospitals are also seeing increasing number of medico-legal cases.

The article below was written in the Malaysian Insider today.  I decided to publish it over here as the article do bring up certain issues that are important. I had highlighted some of the sentences for easier reference. In fact, I had written many times in this blog regarding unethical practices and “Cover Backside Medicine” practices in private sector. That’s why I use to say that never judge a book by its cover. Most naive and ethical doctors do not earn much but the unethical doctors may be laughing to the banks. This is partly because, patients tend to believe a doctor who tells them what they want to hear. A doctor who removes an asymptomatic gallstone is good where as a doctor who says nothing need to be done is useless. I believe that patients are partly to be blamed for this.

Coming back to the article below, I personally do not like some of the words used in this article like ” useless doctor” and ” bastard”! This sentence ” “You wonder why we should pay these useless doctors so much when we can find reliable answers online!” is rather annoying. Internet do not really give you reliable answers. I have had many patients who ended up getting anxiety and panic attacks after reading informations in the net. Today, interestingly I even had a patient who diagnosed herself as “bipolar disorder” after reading from the internet!!

But one thing that this article proofs is that patients are becoming more educated, demanding and would not hesitate to take actions against doctors. Gone are the good old days where patients swallow what you say, forgive and forget. The situation is changing rapidly and life is not going to be easy for future doctors. With the deteriorating quality of doctors being produced, the situation is only going to get worst. Many patients are already aware of this scenario of oversupply and under trained doctors. Many of them do go to a few doctors for second opinions.

The rest I will let the readers to read the article below……………….

The sickness of our private healthcare services

OCTOBER 09, 2013

Lim Ka Ea
Lim Ka Ea is a traveller who sees travel as the answer to all the world’s woes. Writing is a grand love. Ka Ea has had NGO and legal experience.

“If I keep this oath faithfully, may I enjoy my life and practise my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.”
– The Hippocratic Oath

Mary was entering her mid-thirties when it finally dawned on her that she is reproductively challenged. The thought of her own infertility did play in her mind when she was much younger but her suspicion was only confirmed recently when she was diagnosed for polycystic ovarian syndrome (POS). The strange thing was, the diagnosis did not come from her fertility doctor, who had then been too eager to start her and her husband on the notoriously expensive and invasive in vitro treatment, without first examining their health.

The diagnosis for POS had come up through her own initiative. Once she and her husband decided that they would try to conceive through artificial insemination, Mary thought it would be prudent to go through a full medical check-up, “just to make sure my body is ready for the baby, you know. We’ve read that in vitro is very stressful and we want to make sure that we’ve tried everything possible to make sure that the conditions are conducive,” she said.

When her blood work came back, her thyroid function tests were elevated. Later, it was her endocrinologist who told her that in addition to hypothyroidism, she might be suffering from POS too. He told her that the sudden and continuous weight gain, increased cholesterol level, development of fatty liver, irregular menstruation, and acne are some of the symptoms of POS.

Mary had initially thought that these symptoms were attributed to her bad eating habits and sedentary lifestyle but it now explains why these unflattering conditions remain unchanged even after her vigorous attempts to eat and exercise better.

“The funny thing is, no one told me about it. The GP (General Practitioner) at the hospital where I did the full medical check-up did not alert me to anything after he examined my test results. All he did was to make me feel bad about my weight and asked me to take another test in three months’ time to see whether there are any changes to my thyroid functions. All this while, I had been wondering why I’ve been battling bad skin and weight gain. If only I had known earlier, I would have been less depressed and feeling hopeless all the time,” Mary said.

“You have most of the POS symptoms. Go home and do a search online. Read up and learn as much as possible about POS and then go see a gynaecologist to seek treatment. You need to solve all this hormonal issue first before you even try to get pregnant. There are other options before you start considering in vitro. Let’s get you fixed up first, ok?”

That was the most honest and reassuring conversation Mary have had with a doctor so far.

After reading up on hypothyroidism and POS on the Internet, Mary discovered that the chances of having a problematic pregnancy would have been high if she had become pregnant either through natural or artificial means. She confessed that much to her disappointment and great horror, she felt that the renowned fertility specialist she saw at a highly recommended infertility clinic in Kuala Lumpur should have informed her of this vital piece of information.

Mary and her husband initially reasoned that the specialist would have alerted them to her condition if only he had bothered to look at their medical records, which they had brought along with them during their first consultation, having thought pre-emptively that the doctor would have asked for it.

“It was going to cost us about seventeen thousand ringgit for the whole procedure and that doesn’t even cover the cost of a second treatment if the first one doesn’t work. With hypothyroidism and POS, the chances of having a miscarriage would have been great.

“Can you imagine how devastating it would have been if we hadn’t known?” Mary asked and added dejectedly, “The thing is, the doctor didn’t even bother looking at our medical records, you know. They just wanted to make money out of us.”

Mary said that on hindsight now, she is not even sure whether the doctor would have warned them of the potential complications if he had known of her conditions. Mary insisted that her endocrinologist is the minority.

“There are definitely good doctors out there, but they are extremely rare,” she said.  She revealed that she no longer trusts the medical service and would turn to her trusted online sites for all her medical diagnosis and query.

“You wonder why we should pay these useless doctors so much when we can find reliable answers online!” She laughed scornfully.

Mary is not alone when it comes to being at the receiving end of bad medical services and not trusting our medical practitioners. It would appear that more and more private hospitals are abandoning the Hippocratic Oath for personal gain.

A medical practitioner revealed that the price of medicine at a private hospital costs a lot more than an external pharmacy. He often advises his patients to buy their medicine from external pharmacies because it makes no sense for them to pay “cut-throat” prices for the same medicine. However, when Kelly tried to do precisely that, the doctor treating her apparently did not take it too well.

“Instead of giving me a prescription for six months as he had recommended, the bastard only prescribed me a month’s worth of medication. In other words, he was ‘forcing’ me to go back to him for a follow-up prescription and that would have meant paying him ninety ringgit for just a bloody piece of paper. Can you imagine that?!”

The Department of Pharmaceutical Services at the Ministry of Health informed that there is currently no law to control the prices of medication at private hospitals. However, it is encouraging when the Head of the Medicine Pricing Unit wrote, “As a patient, you have the right to obtain a prescription from your doctor to buy your medicine from any pharmacy even though it displeases the doctor. I believe that empowered patients can change the current bad habits practised by medical professions so that we can all guarantee affordable medication for the people.”

Vikram, another unhappy patient, shared the experience he had with his doctor when he was undergoing treatment for Hepatitis C. He said that he was mortified when the nurse asked about his treatment in front of other patients while he was waiting for his doctor in a clinic. He understood that the nurse probably asked out of customary politeness but he did not appreciate the fact that in the course of her doing so, other people had learned about his medical condition.

He said that patient information management is lacking in many healthcare facilities and was shocked that this clinic is part of a hospital that has received an accreditation from the Malaysian Society for Quality in Health (MSQH), the national accrediting body for healthcare facilities and services.

“On top of that, my doctor failed to inform me of all the side effects of the antiviral medication I was taking. There was no counselling or support for me and my spouse. The repercussions of the medication was so great that I felt as if the treatment had ruined an important part of our lives. 

“For each visit, I paid ninety ringgit for a five-minute consultation where the doctor did practically nothing. Thankfully I had a good insurance coverage because the medication cost an arm and a leg. To be honest, I wish I had not undergone this treatment if only I had known of the repercussions. I wasn’t informed properly,” Vikram said regretfully.

As of June this year, 75 percent of public hospitals have received the MSQH accreditation while only 25 percent of private hospitals have. At the international level, only eight hospitals have received the Joint Commission International (JCI)’s accreditation.

The JCI is created by the Joint Commission on Accreditation of Healthcare Organisations, a US government agency, aimed to improve the safety and quality of care in the international community through the provision of education and advisory services, and international accreditation and certification.

The assessment criteria used by the MSQH is quite similar to the one used by the JCI, except the latter provides additional components such as patient and family education, staff qualifications and education, medication management and use, and the assessment and care of patients; elements which seem to be sorely lacking in our own private healthcare services.

Previously, the government has made several attempts to make it mandatory for all public and private hospitals to obtain MSQH accreditation but these attempts have been put on hold thus far. Although having some sort of national or international accreditation by a recognised and credible agency does boost public confidence, alongside minimising and mitigating clinical and safety related risks, these accreditations do not take into account public rating. The application submission for accreditation is done by the hospital in question and the assessment is then carried out by a panel of surveyors appointed by the accreditation agency.

There is no consideration for public opinion on how the hospital has fared.

“As a patient, I would like us to have some sort of a scorecard for all the hospital in Malaysia. Something simple for a start and it can be done by civil society, someone independent and done from the patient’s perspectives.

“What we need is someone who will disguise as a patient to test out the hospitals. So you have this person who goes to several hospitals and says he’s got liver problem, for instance, and then he assesses how the hospitals handle him based on selected key criteria. The problem has to be the same though, so you can compare apple for apple,” Vikram suggested thoughtfully.

Kelly said the hospital’s ability to deal with complaints is something left to be desired.

“No point. I’ve written to a hospital before to express my dissatisfaction over their service. I haven’t received any response from them. This was last year. It’s like as if the hospital doesn’t really care if you’re unhappy with them. They have patients lined up anyway. So why should they care?”

Sumitra, who is married to a doctor, revealed that medical practitioners often tend to close an eye when their colleagues commit a medical error. This culture is deeply rooted on the notion of solidarity akin to “I have your back now so that when I need you, you’ll have mine.” 

This makes it virtually impossible to have a doctor testifies against the other, even when a grave error occurs at the expense of a patient’s life.

Perhaps what Malaysia needs is a patients association such as the one in the United Kingdom. The UK’s Patients Association provides a platform for the people to rate their National Health Service (NHS). The association also runs educational campaigns such as the Speaking Up Complaints Project which encourages patients to speak up against poor medical services and the NHS to improve the way it deals with patients’ complaints. The NHS is ranked as one of the top 20 best healthcare services in the world by the World Health Organisation.

Not all is lost. Malaysia seems to be doing remarkably well in the area of medical tourism. A private hospital in Kuala Lumpur is recently recognised by the Medical Travel Quality Alliance as one of the world’s top ten best hospitals for medical tourists. By taking advantage of the weaker Malaysian currency, foreigners from the Middle East, Europe and Japan are flocking to Malaysia to enjoy better medical treatment.

It would have cost the local patients an arm and a leg to receive treatment in these hospitals but Mary said, “If the service is compatible with the amount I pay for, why not? The problem with the private hospitals here is that I’m not even getting the value for my money.”

While our private hospitals continue to nurse tourists with top notch care, in order to stay competitive alongside South Korea, Thailand and Turkey, have they forgot about our own illnesses along the way? – October 9, 2013.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.

 

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I just completed the “Walk a Payung” event for SLE association of Malaysia, Johor chapter this morning.  It was the second time we were having this event in JB and we received a wonderful response despite a rainy day. I had a oppurtunity to talk to few people from MOH and a public university academic on few interesting issues.

The issue about medical education and oversupply of doctors has been discussed several times in this blog since 2010. Unfortunately, I still get asked many repeated questions about the situation and some still feel that it will not happen. A few recent comments in this blog said that they are still short of manpower in certain departments in their hospital. I have said it many times before that MALDISTRIBUTION is the main problem. The maldistribution is not only between the departments but also between hospitals and regions. The shortage now is mainly in East Peninsular states and East Malaysia ( compared to the number of post available). In terms of specialist, I do agree that we have severe shortage of specialist in government hospitals. That’s the reason why there are not enough people to train the juniors and the entire system is collapsing when it comes to quality. I was informed today that all the public universities are scaling down their intake. UM has scaled down from 200+ students to 180 this year and subsequently to 150 next year. Unfortunately, the private universities are increasing their intakes to make as much money as possible before the market gets saturated, as what happened to the nurses.

The government is chasing after the ratio of 1: 400 by 2020 which is the reason why they approved too many medical schools. Unfortunately, they have miscalculated as medical education is not like any other field. The training after graduation is very important and we need to have enough consultants to do that. Many people out there still think that post-graduate education in medicine is similar to other courses where they attend a 4 years FULL-TIME course and woolah, they are a specialist! I get asked this question again and again. Let me tell you that post-graduate education in medicine is “FULL TIME” working and “PART TIME” studying.  You still need to work as anyone else while studying for your exams and doing your thesis. That’s the reason why you can’t go overseas to do your post-graduate education if your degree is not recognised elsewhere. The Ministry is running out of post and this has been confirmed to me by many MOH officials. New posts are being created but it is unlikely to solve the problem as the numbers will not be enough. The number of Master’s slot is also being increased but again, it is unlikely to cope with the exponential increase in the number of graduates. I was informed by MOH officials that they will soon officially allow doctors to apply for other jobs.

Now, coming back to “chasing after the ratio”, it is not going to make any difference. Klang Valley has a doctor:population ratio of 1: 450 currently but why do the public hospitals still complain of shortage ? This is because, majority of the specialist are in private sector. A report in NST yesterday says that we have 200 gazetted cardiologist in Malaysia BUT only 30 is in government sector. That’s  the problem that we are facing. If you include all the private and public hospital’s number of beds and doctors in Klang valley, we have more than enough BUT 80% of patients go to public hospitals when 60-70% of the specialists are in private sector !. So, it is an “artificial ” shortage which will never end. A public -private integration will be needed to solve this problem.

Thus, achieving the ratio is not going to solve any problems. Even after the government had achieved the ratio, similar complains of shortage, long waiting hours for patients and long working hours will still be heard. By being a doctor, you can’t run away from being overworked and working long hours. You are dealing with lives and there is no such thing as “office hour” job.  Everyone(including parents) who intend to do medicine must be aware of this before doing medicine for “good life, good money and good future”, a false perception by many. An article written in this blog by a medical officer is a good read for ALL. It tells you a life as a doctor in a government hospital. The situation is unlikely to change even when the government achieves the ratio. The situation is not much of a difference compared to developed countries like US as written over here (see below).

Finally, I received the following SMS few days ago which is self-explanatory:

Vanakam, we are a medical students placement agency. We are looking for agents. WE pay commision up to RM 5,000 – interested Pls do call xxxxxxxx (Mr XXXX) TQ. www ………………com.my

When I visited their website it says ” Confirm Seat! “………………….. Gosh, how low the level of medical education has become………………

Anyone wants to make easy money? be an agent !! Recruit 10 students a month and you get RM 50K. No wonder many parents get cheated by the agents.

Long Work Hours Wreak Havoc in MDs’ Personal Lives

All Work, No Play a Recipe for Family Conflict, Depression, and Burnout

Fran Lowry

Sep 23, 2013

All work and no play is a recipe for family conflict, depression, and burnout in physicians, especially among those who are in dual-career relationships, new research shows.

A survey of some 90,000 US physicians across all specialties and their working partners shows that many respondents report frequent work-home conflicts (WHC) due to the long hours they spend at work, causing them to suffer burnout, depression, and poor quality of life.

“Work-home conflicts are common in physicians and in the partners of physicians,” lead author Liselotte N. Dyrbye, MD, from the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News.

“We found that younger physicians, female physicians, and physicians who work in academic medical centers are the ones who are more likely to have work-home conflicts, and that these conflicts are driven by a lot of work hours,” Dr. Dyrbye said.

“This makes sense, because the more hours you work, the more opportunity there is for work-home conflicts,” she said.

The study was published online September 17 in the Journal of General Internal Medicine.

Choosing Work Over Home

Previous work conducted by this same team of investigators has examined work-home conflicts in US surgeons and academic internal medicine physicians.

The current study extends this research by looking at the issue of work-home conflict in a broader, more diverse group of physicians as well as in their partners.

In the current study, Dr. Dyrbye and her research team surveyed 89,831 physicians from all specialties listed in the Physician Masterfile. Of these, 7288 (27.7%) physicians completed the survey.

Of the physicians who completed the survey, 1644 provided their partner’s contact information.

These partners were in turn surveyed, and 891 (54%) responded.

The median age of the physicians and their partners was 55 years and 51 years, respectively. Most (89.2% of physicians and 86.6% of partners) had children. The majority of physicians were male (75.2%), and most partners were female (73.0%).

Slightly more than half of the partners (n = 503, 56.5%) were employed, reporting a median of 40.0 hours of work per week. Also, most of the employed partners were working in nonmedical professions (58.2%); 40.9% worked in healthcare.

The survey results showed that 44.3% of physicians and 55.7% of employed partners experienced a work-home conflict in the last 3 weeks. Most were able to resolve their conflicts in a way that allowed their home and work responsibilities to be met.

However, physicians tended to choose work responsibilities over home responsibilities, with 28.4% reporting that they resolved their work-home conflict in favour of work, and 10.9% of physicians reporting they resolved the conflict in favor of home.

Compared with physicians, more employed partners tended to put home before work, with fewer (19.7%) choosing to resolve their work-home conflict in favour of work, and 20.1% choosing home.

Dose-Dependent Relationship

The more hours worked, the greater the work-home conflicts. Multivariate analysis showed that for each additional 10 hours per week worked, the odds ratio for a work-home conflict was 1.31 for physicians and 1.23 for their working partners (< .0001).

Work-home conflicts were also associated with more burnout, depression, and poor quality of life.

Physicians with work-home conflicts were 47.1% more likely to have symptoms of burnout, compared with 26.6% for physicians without work-home conflicts. The trend was similar for the employed partners, with 42.4% having symptoms of burnout if they had work-home conflicts, compared with 23.8% with no work-home conflicts.

Both physicians and their employed partners with a recent work-home conflict were also more likely to have symptoms of depression, substantially lower overall mental and physical quality of life, and worse fatigue. Both groups were also more likely to be less satisfied with their partner and to be considering getting a separation or a divorce.

“These work-home conflicts are very important and have serious ramifications,” Dr. Dyrbye said.

“We hope that our research draws attention to the fact that with more and more dual career relationships, work-home conflicts are something that managers and leaders of organizations need to be aware of and find solutions for, that it’s not just an individual problem, and it can’t just be up to the working spouse to try to figure it out,” she added. “I hope that people can look closely at their policies and the opportunities for dual-career professionals to thrive within the organization.”

A Warning

Commenting on the findings for Medscape Medical News, Michael Myers, MD, professor of clinical psychiatry, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, said that the study is an important warning to young professionals that too much work may be putting their quality of life and their physical and mental health at risk.

“This paper gives us more ammunition to be able to tell our medical students that if you consistently work more than 56 hours…a week, and keep doing it over time, and your spouse is working 40 hours or more a week, you are really putting your conflict level and your relationship at risk, and you are putting yourself at risk for burnout. Perhaps this is an argument for people to cut back on their work hours,” Dr. Myers, who is a coauthor, with Glen Gabbard, MD, of The Physician as Patient: A Clinical Handbook for Mental Health Professionals, said.

“I am very involved in medical education now, and it is good to have this kind of a study and to be able to explain to medical students and to residents that they have got to pay attention to these things, because these stresses are what their fathers and mothers who are a generation older are experiencing,” he added.

The study was funded by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-being. Dr. Dyrbye and Dr. Myers report no relevant financial relationships.

J Gen Intern Med. Published online September 17, 2013. Abstract

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Over the last few months, the mainstream newspaper has been writing regarding the increase in doctors fee over and over again with multiple letters to the editor. The government has “sort of” approved a 14% hike in fees which is yet to be made official but the newspapers are running articles after articles as though the world is coming to an end. I had written about the issue over here and here. Today, the Star had yet again ran an article ( here and here) regarding this issue, comparing with the proposed fee increase by MMA.

Obviously, our FOMCA representative and TPA VIce President do not know what they are talking about. The doctor’s fee has not increased since the last 15-20 years. A surgeon who has been in private practise for 20 years told me that his fee for doing an appendicectomy has not increased since he started his private practise! However, the total cost of an appendicectomy has increased from RM 2-3 000 when he first started, to about RM 7-8 000 currently! So, where are the extra charges coming from ? The answer is very simple, it is the hospital charges that has increased by leaps and bounds. But why over all these years, this so-called consumer association does not make any noise but when the doctors request for a 15-30% hike in their fee after 20 years, the whole world goes into chaos! The doctor’s fee are regulated by the government but not the hospital’s fee. If they are really sincere, they should go after the hospital’s fee which they would not, as almost all private hospitals are owned by GLC aka the government !

As what MMA President has said in the articles below, many doctors are struggling to meet the ends. The income of doctors are gradually declining as I had mentioned many times before but the cost of running a service has increased tremendously. The public feels that all doctors in private hospitals are employed by the hospital which is obviously not true. I had many of my patients who also thought the same until I told them the reality. We are just renting a room in the hospital to run our service. We have to pay a monthly rental and the hospital will also take 10-15% of our consultation fee as their administrative fee. Only the balance of our consultation and surgical fees are given to us. Then we have to pay for our indemnity insurance which is also increasing by about 8-10% annually. When there is any legal suit, the hospital will wash off their hands and you have to deal with it. The recent appeal court’s decision in awarding RM 3.5 million(not including interest) has set a new benchmark for further medico-legal suits in this country. That’s the reason MMI has increased their indemnity insurance for O&G by almost 100% this year.

As for the public, private healthcare is an option. No one is forcing you to go to a private hospital/clinic. The government hospitals and clinics are always available for you with a very minimal charge of RM 1-5. So, why complain. If you choose to go to a private hospital, then don’t make a fuss out of it. Most patient who attend private hospitals nowadays are insurance paid. Only about 10-20% of patients are self paying. This is the trend that we are seeing lately. Insurance companies on the other hand are finding it difficult to cope with the increase in private healthcare cost. They have started to question many of the decisions made by doctors in the management of the patients. They are even scrutinising each and every blood test and X-rays that are done. There will come a point where it will collapse. Any increase in premium is not sustainable and this will lead to their inability to pay the hospitals. The bigger private hospitals will then not be able to sustain the operational cost and will eventually collapse. That’s what happened in the US in 1990s and many big tertiary hospitals collapsed due to high overhead cost. They restructured their hospitals with small community based hospital and 1-2 big tertiary hospital in each district. The insurance companies now dictate everything, as I had written over here. Similar situation will happen over here eventually.

So, for those who do medicine thinking that they are going to make tonnes of money in the future by spending RM 500K for their “undergraduate” education ( which is of no value in the future without further postgraduate education) , please rethink your decision carefully. THink what you can do with that amount of money in so many other ways. Many out there think that medical postgraduate education is similar to undergraduate education. How ignorant our society has become. I had written about medical postgraduate education in this blog since I started blogging in 2010 but yet I get asked the same questions repeatedly. I can only say one thing: current generation do not read and want to be spoon-fed all the time. I don’t know how they are going to become a doctor where you need to read and search literature throughout your life………………..

Finally, I was happy to meet DR Jim Loi today in JB ( sitting beside in the photo below). He is the President of MPCAM and MPCN which is a coalition of doctors whose objective is  to create unity among doctors to stand as one voice. I wish him best of luck. I once wrote an article in MMA in 2006 ” Rebranding and Restructuring of MMA: An urgent need for a Revolution”. I hope MPCN can achieve what I had suggested then.

Good luck to you, Bro……………

Patients brace for a ‘deeper cut’ over fees for specialist procedures

BY CHRISTINA CHIN
SGCHRIS@THESTAR.COM.MY

PETALING JAYA: Patients will have to brace themselves for a “deeper cut” if a proposal to increase fees for specialist procedures is adopted by the government.

Association of Third Party Medical Claims Administrators Malaysia (TPA) vice-president Paul Cheok said the Malaysian Medical Association (MMA), in asking for a 30% increase in consultation charges last month, had also proposed staggering increases in charges for specialist procedures.

TPA members, who form part of the country’s managed care organisations, provide administrative and medical claim processing services for insurance companies and more than 1,000 employers, mostly corporations.

“We are not against the approved 14.5% hike in consultation fees agreed on by the Health Ministry, but the MMA’s proposal for an increase in surgical procedures and anaesthetist fees must not be allowed. Patient volume has increased over the years, so based on the current rates, specialists are already fairly compensated,” he said.

“Specialists think private hospitals make a lot of money, but the reverse is true.”

TPA estimates that there are about 800 to 1,000 procedures listed in the 5th Edition of the MMA Fee Schedule.

Cheok said the MMA must also justify why certain procedures have been upgraded to a higher surgical fee category.

“Some procedures which were previously categorised as minor, have been pushed into the ‘major category’.

“Coupled with the new rates, this will lead to patients paying more than 200% of current charges.

“Patients should be more concerned over the proposed cost of surgical procedures instead of worrying about a rise in consultation fees,” he said, adding that often, one operation consists of multiple surgical procedures which could lead to multiple charges.

MMA president Datuk Dr NKS Tharmaseelan however said specialist procedure fees in Malaysia were still the lowest in the region.

He said doctors should not be blamed for high hospital bills as their fees only amounted to 20% of the bills.

“If hospital bills have risen, it is due to the hospitals charging higher fees for their services and other items,” he claimed.

“Many specialists in private practice can hardly make ends meet. And, they have to pay exorbitant indemnity insurance. For example, obstetricians and gynaecologist and plastic surgeons pay almost RM80,000 per annum in premiums.”

On TPA’s claim that MMA’s proposal to increase the fees for surgical procedures would lead to patients paying more than 200% than current charges, he said their calculations for the new fee rates for specialist procedures were “mere conjecture”.

“I don’t know where they are plucking the numbers from,” he said.

Medical Practitioners Coalition Association of Malaysia (MPCAM) and Malaysian Primary Care Network (MPCN) president Dr Jim Loi said the proposed rate for procedures are justified if “100% goes to the specialists”.

“The cost of items and materials have risen in tandem with the current economic state and the total cost of procedures. Specialists need to invest a lot of money,” he said.

Consumers unhappy with ‘secrecy’ over private healthcare charges

PETALING JAYA: Consumers are unhappy that private healthcare charges are still being shrouded in secrecy, said Federation of Malaysian Consu­mers Association (Fomca) secretary-general Datuk Paul Selvaraj.

“Will consumers only find out about the increase in specialist fees after they are slapped with a hefty bill?” he asked.

“The fees must be put on hospital websites so that consumers can compare healthcare charges. Now, consumers are paying ‘5-star rates’ without knowing what it’s for.”

Health director-general Datuk Dr Noor Hisham Abdullah said most of the professional fees submitted by the Malaysian Medical Association (MMA) in its latest proposal increased by 30% from the last one.

“However, all medical practitioners in private hospitals have always adhered to the 13th Schedule of the Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulations 2006 for their professional fees,” he added.

He said the ministry would add new clauses to the regulations to reduce any attempt by medical practitioners to manipulate the cost of procedures.

MMA president Datuk N.K.S. Tharmaseelan explained that the association was preparing a new, comprehensive fee schedule which would cover new procedures, such as advanced robotic and computer-assisted navigational surgery.

Dr Tharmaseelan also dismissed a claim that specialists earn RM150,000 monthly, saying most specialists only earn an average of RM25,000 to RM30,000 per month.

On Aug 23, a reader from Kuala Lumpur claimed that a private specialist earns an average of RM150,000 per month and “have ways to fleece the patients”.

Citing an example, he said an ENT surgeon could do an operation and charge for four separate procedures.

 

Jim Loi

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In May 2011, for the first time in history, MMC came up with the minimum criteria and qualifications for entry into a medical programme. I wrote about it over here in June 2011. MMC had no choice but to introduce these criteria as there were just too many dubious foundation courses being conducted by various colleges to attract students. Unfortunately, I still felt that the criteria set was just too low. I am sure everyone knows that the standard of SPM has gone down the drain, compared to 10 years ago. Everyone seems to be scoring 10As etc. I have spoken to many who had A1 in English but could not even talk or write in proper English. Examples are aplenty in this blog comments.

Since then, MMC has amended it several times as you can see over here. One of the major amendments made last year was to allow A-level, STPM and few other well-known Pre-U courses to supersede your SPM results. Prior to that, Pre-U courses should be “in addition” to SPM results. The latest amendment was in July 2013 as seen over here. I don’t really see much changes compared to 2012 but few caught my eyes.

The last sentence in this circular clearly says that if you do not fulfil these criteria, you will NOT be allowed to sit for the MQE exams if you do medicine in an unrecognised university. In one way, this is a good start as I have seen many students with poor results who go on to do medicine in some unrecognised universities and come back to sit for MQE exams. Most of them do not pass the MQE anyway but given this new criteria, they would not even be able to sit for the exam!

Also, please be aware that you need a credit in BM & English to be able to apply for a civil service job. With the upcoming glut , I am sure you will be automatically excluded from civil service if you don’t fulfil this criteria. Previously, you can still get a job on contract basis as there were severe shortage. Once you pass the July BM paper, you can be absorbed into permanent service.

There were also rumours recently that MOH/MMC may introduce an exit exam after housemanship. I have not heard any confirmatory news about this but as far as I am concerned, it is inevitable. Can the government create almost 6000-8000 post yearly ? Obviously not. With the huge debt of the country and worsening economy, I am sure the government would not be able to absorb all these graduates, once the posts are full. I was informed that those who fail the exams will not be given a government job and those who pass borderline will be given job on contract basis. Only those who pass will be given permanent post in the government service. I felt that an entry exam would have been a better option, as suggested by our ex ex DG.

Furthermore, I am sure by then only those who fulfill the minimum criteria above will be even entitled for a government job despite having a recognised degree. The unrecognised degree will not even be sitting for the MQE if they do not fulfil the criteria.

Well, day by day, whatever I have been saying all these years is slowly becoming a reality. Who knows that some day, our smart politicians will ask private hospitals to take housemen with a pathetic salary……………….

Happy Malaysia Day…………….

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Well, we just received our first of the many presents that we are going to receive for voting the current government. I use to tell people that our debt is just too huge for the government to go on spending money by whatever name they want to call it. Unfortunately, since most of these in formations come from the so-called “opposition” supporters, the hardline pro-BN supporters will always refuse to believe despite showing the facts and figures. Tomorrow, as a Merdeka present , RON95 petrol price will go up by 20cents! With a pathetic public transport system, we’re going to see many more motorbikes on the roads soon! Wait for the budget  and I am sure you’re going to see the GST and 1Care system being mentioned. The government got no choice but to cut their expenses, after spending money like it was their grandfather’s money! Janji dicapatikan and good for those who voted for them all these years. Stop the leakages and you will earn money, as what Selangor and Penang is doing!

Now, coming back to the topic above. I had written about the realities of medicine since I started blogging in 2010. The article below (The Star) was written by a good friend of mine and a fellow UM batch mate from Penang. He is spot on about the status of medical education and practise of medicine in this country. All of it has been mentioned by myself many times before. With the economic situation as mentioned above, will the government be able to absorb ALL the graduates by 2016, amounting to about 6 – 8 000/year? The income of private doctors has been declining over the years. I just heard an O&G consultant who is only earning less than 10K/month after 2 years being in a private practise! Something that we never heard, 5 -10 years ago.

The government just increased the petrol price by 20cents, which is about 10.5%. This increase will eventually increase everything else that involves transportation. So, your cost of living will increase much more than that. Remember the headline when doctors asked for 30% hike of their fees ? Someone wrote a letter to the newspaper that doctors drive expensive cars but plumbers drive old “retired” cars and thus cannot compare apples and oranges? The person who wrote that got no clue about life in medicine. Unfortunately, what she wrote is exactly what the public perceives. They always tend to forget the cost involved in being a doctor and subsequently a specialist(debt ++), the time taken, the multiple exams that they go through, the risk taken, the quality of life that is lost etc etc. Then, when their child had to work beyond 5pm, they will complain to the hospital’s Pengarah! Their so-called “grown-up” graduated child is still an infant, I guess!

BTW, I know a plumber and an electrician who drives a luxury car and only does supervising work! His workers do all the manual work. They drive the “broken” car to work as they dumb all their instruments and tools into the car! Who wants to do that on a BMW or Benz? I know doctors who drive big cars just for glamour but has a huge amount of debt!  So, don’t judge a book by its cover!!…………….

Realities of pursuing medicine

A medical practitioner talks about why students need to think it over before pursuing medicine, and laments over the inadequate training for new doctors and other practices affecting the profession.

By Dr BA KAREEM

IT IS that time of the year again where top scorers from both Sijil Tinggi Persekolahan Malaysia and matriculation courses, slog it out for extremely limited seats in critical courses offered by local universities.

The government of course is unable to provide places for everyone especially with the increasing number of perfect A scorers, every year.

This has led to many unhappy parents taking the issue to politicians, followed by promises by the government to look into the matter. Civil servants and university authorities are usually at the receiving end of an unforgiving public.

Almost all top scorers in the science stream eagerly state their intention to do medicine. The reasons given usually vary from their noble intention of wanting to serve the public, fulfilling their parents’ wishes to job security.

However, the prestige and guaranteed good income are serious considerations which are usually not stated by the students. As a senior doctor in the government service and with exposure teaching medical students, I would like to comment on this puzzling obsession (prestige and guaranteed good income) and perception that students and parents have in pursuing a medical degree.

It is now acknowledged in the medical fraternity that there are too many doctors and about 40 medical schools in the country, producing 5,000 doctors yearly.

Approvals for private and public medical schools contributed to the problem. Many private colleges lack facilities and senior lecturers. They usually take the easy route of “hitchhiking” to a public hospital in the area.

This will save costs as the colleges will usually engage public hospital consultants to carry out the teaching on a part-time basis.

The Health Ministry had recently issued a circular on the matter where doctors are now prohibited from teaching students during office hours.

The Malaysian Medical Association (MMA) in its June newsletter quoting statistics from the ministry which stated that there were 28,309 medical officer postitions available in 2011 of which 21,765 of them were filled.

Therefore, the remaining vacancies must have already been filled considering the annual number of graduating doctors.

These numbers were presented by the MMA President Datuk Dr NKS Tharmaseelan during the association’s 53rd annual general meeting recently. He also stated that there were 130 government hospitals in 2007 and 132 in 2011 — only two hospitals within four years.

The fact is we are not building enough new hospitals to place and train all our new doctors. Thus, job security in the medical field has become a fallacy.

In the near future, doctors will be left on their own to seek jobs while the government only undertakes to provide internship opportunities.

This is already a reality in many developed countries including the United Kingdom, where I was trained. Doctors there have to prove themselves to be capable and pass numerous interviews, coupled with good referee reports before they can get jobs.

I am aware of parents who sell their property so as to enrol their children in medical schools. Let me remind them that job prospects in the profession, is one matter they should give serious consideration.

While the authorities might argue that the situation (a large supply of doctors) is good for the health sector, with only competent doctors being employed, chances are “half-baked” doctors might still end up serving in rural areas where there is less competition for posts.

Ultimately there will be doctors, still unemployed in urban areas. In some departments in the hospital I work at, there are about 40 house doctors, and the head of department is unable to remember their names and faces.

Senior doctors do not even notice when house doctors are absent from work. These house doctors work on shifts which was completely unheard off before. During my training. a 48-hour call duty used to be the norm. They certainly drain you out, but the process makes you a better doctor.

The number of admissions at night are sometimes lower than the number of house doctors on duty. In medicine, you are as good as the number of patients you see and examine daily.

Doctors learn all the time from their patients and seniors. So, questions arise over the quality of training for house doctors before they are allowed to work independently in district hospitals.

For candidates who intend to become specialists, I don’t have much good news either.

According to the MMA president, only 690 medical officers were offered to pursue post graduate medical programmes in local universities in 2011. Masters training positions are very limited as only a few universities with an adequate number of consultants are offering them.

Take note that to train specialists, we need to have senior consultants. A majority of our senior consultants are already in the private sector.

The ministry has set strict conditions where applications are only allowed after a four-year service period, making it a gruelling marathon before a junior doctor can become a specialist.

Having said that, let me point out that I have also come across medical students who don’t want to attend classes that I have, after office hours. This is because of my own hectic schedule. Interestingly, the reasons given range from dinner appointments with parents, evening tennis or swimming lessons.

In situations like this, I wonder if our academic top scorers have the aptitude to study medicine albeit participate in this gruelling race. For those who aim for greener pastures in the private sector, the picture is not rosy either.

The private sector also has too many doctors. Private hospitals which are essentially business entities do not actually employ doctors, but rather hire them on a contractual basis.

This has already resulted in too many doctors trying to meet the needs of a minority group of patients who have insurance coverage or the funding sources to pay for private medical care.

Talentcorp Malaysia has also successfully persuaded Malaysian doctors to return from abroad. These senior doctors are exempted from compulsory government service and are allowed to directly work in the private sector.

Many friends in the private sector actually have difficulty in making ends meet because of the severe competition in treating the dwindling numbers of patients.

Some hospitals actually charge rental for clinic premises and also ask doctors to employ their own clinic assistants.

With increasing overhead costs 1Malaysia clinics are certainly here to stay. It cannot be denied however that they have caused a dent in the practice of general practitioners, especially in urban areas.

On the contrary, remuneration packages and promotional prospects for public sector doctors have improved significantly over the years.

The ministry has to be commended for promoting many senior doctors recently to Superscale C levels.

For the first time, prospects in the public sector do not look so gloomy, but it has to be remembered that vacancies here are running out fast especially with the retirement age extended to 60.

In conclusion, I would ask aspiring doctors to think again. Just because they have the required grades, does not mean that they should be automatically allowed to pursue a medical course.

This article is not meant to dissuade Malaysian students from pursuing medicine. In fact, it is to enable students and their parents to be informed and to consider the issues affecting the profession today. This in turn will help them make the best decision before students pursue their line of study.

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Here we go again. On and off, news like this appears in the mainstream newspaper over the last 2 years.  BUT nothing has changed!

Today, The Star produced an article of possible “unemployed doctors” coming, very soon. You can read the article below. Well, I have been talking about this since 2006! When I first wrote an article in MMA magazine in 2006, even the MMA President then said that I am over exaggerating. Now, it has become a reality. Just few days ago, I wrote on Health Facts 2013 which clearly explains what the situation is going to be in the next 2-3 years. How many graduates can the government absorb? I was also recently informed in this blog that a UKM graduate is still waiting for 4 months to be posted ! This is something that I had never heard of. Usually, public university graduates ,where the SPA interview is conducted within the university before the students graduate,  will get their posting letter within 1 month! Does this mean that MOH is running out of post and waiting for those who finish housemanship to become MO first? The MO post is also getting filled up very fast. Don’t forget about the type of training these doctors are receiving and issues concerning limited post-graduate training. I just heard that a “locum” MO gave calamine cream for vaginal discharge!! Looks like a joke? Well, that’s what happening out there! Poorly trained graduates coupled with poor training during housemanship/MO.

The article below also has some factual mistakes. It claims that there are 33 medical colleges in “Full Production” mode which is not right. We only have 20 medical programs in production mode! The remaining 23 is yet to produce any graduates. So, if there are 5000 graduates even by 2014 (as mentioned in the article), what will happen when all 43 medical programs are in “Full Production” mode? You can do your maths!

What happened to the moratorium issued in 2011 ? Only GOD knows. It only remains on paper, I guess.

There was also another interesting article in the same news paper, concerning doctor’s consultation fee. As I have written before, doctor’s charges are regulated by the government under the Private Healthcare Services and Facilities Act 1998 and it has not changed over the last 20 years ! The article has rightfully said that even a plumber, Hairstylist and electrician can charge more than that. An electrician can earn about RM 20-30K a month single-handedly. What about doctors ? Well, I had written enough about declining income and many are being forced to close shop or go into unethical practices as I had written over here. As I had said before, only less than 20% of the hospital’s bill belong to doctors. The rests are hospital’s fee. Unfortunately, these are NOT regulated, as most private hospitals are GLC owned! YOu know what I mean………………

Too many doctors, too little training

BY CHRISTINA CHIN
SGCHRIS@THESTAR.COM.MY

The future remains uncertain for aspiring doctors unless more training hospitals are opened.

COME next year, some 5,000 doctors are expected to be jobless.

This is because there are not enough government hospitals to train the large number of medical graduates being churned out, says Malaysian Medical Association (MMA) president Datuk Dr N.K.S. Tharmaseelan.

“There are just too many doctors and too many medical institutions flooding the market,” he claims, adding that there are now about 40,000 active doctors in the country.

“Some 5,000 doctors are graduating yearly but where are they going to do their housemanship and compulsory training?

“Currently in government hospitals, there are some 60 doctors in one unit so how are they going to learn?” he asks, adding that soon there will not be enough posts for medical officers in government hospitals.

According to the 2011 Health Ministry Annual Report, 21,765 out of 28,309 vacancies for medical officers have been filled, he says.

“This means that by now, the 6,544 available posts would have almost been filled. Where will the fresh graduates go next year?”

Dr Tharmaseelan calls on the government to build more hospitals, increase the number of beds in existing ones and equip the district hospitals with training facilities to accommodate the influx of aspiring doctors.

There were 130 government hospitals in 2007 and 132 in 2011 – that’s an increase of only two hospitals in four years. It’s definitely insufficient. If this continues, doctors will soon join the flock of some 15,000 unemployed nurses,” he claims.

He adds that although the Health Ministry has assured the association that there are some 1,000 vacancies for doctors this year, the future remains uncertain for aspiring doctors unless more training hospitals are opened.

He believes the problem of unemployed doctors would be worse if the compulsory two-year government service is stopped.

“There is talk that after completing their housemanship, the doctors won’t need to serve at government hospitals anymore. MMA is concerned because this will result in doctors who are not adequately trained,” he says. MMA is urging the Education Ministry to monitor closely the many medical colleges that have sprouted recently, adding that entry requirements are too low for most.

“Students from colleges that are not recognised can sit for an examination to make them eligible to practice locally.

“We have an Air Asia ‘everyone can fly’ syndrome – it seems that everyone can become a doctor. Adopting Henry Ford’s industrialisation of car production to training doctors will result in poor quality medical practitioners,” he adds.

He attributes the glut to a lack of co-ordination between Education Ministry and Health Ministry, with the former bent on allowing medical colleges to mushroom without considering the Health Ministry’s needs.

He adds that medical colleges should have their own hospitals instead of sending their graduates to train in government hospitals.

“Another way to prevent unemployment from setting in is for doctors to become specialists and ‘super specialists’ in niche areas of medicine,” he says.

MMC member and senior medical practitioner Dr Milton Lum points out that there are currently almost 9,000 housemen nationwide.

“How many of them can the government hospitals absorb? Unemployment is not a possibility – it’s a probability.

“In one to two years’ time, government hospitals won’t be able to take in housemen anymore so medical graduates will have to leave the country to find work because they can’t get registered here,” he says, adding that less than 50 hospitals in the country are equipped with the necessary training facilities.

Quoting a Health Ministry study done last year, he says housemen now see less than three new patients daily.

“When I was doing my housemanship 40 years ago, I was seeing between 15 and 25 patients daily.

“Medical graduates today are not getting enough exposure and experience which will definitely result in a drop in quality for doctors,” he cautions, adding that in recent years, the MMC had received more than 100 complaints concerning doctors yearly. Before 2005, the council only received about two or three complaints.

Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) president Dr Steven Chow says there are more than 33 local medical schools in “full production” excluding overseas institutions.

“The total number of posts for doctors available in the Health Ministry, universities and other public institutions is about 25,000.

“We are already seeing difficulties in getting enough training posts for housemen and medical officers.

“This will worsen with influx from neighbouring countries in due course,” he adds.

Comenting on the “glut of doctors”, Health director-general Datuk Dr Noor Hisham Abdullah says the phrase is “very relative”.

The Health Ministry, he says, is working closely with the Malaysian Medical Council (MMC) and the Education Ministry in managing the supply of doctors for the country.

The country has been producing more doctors yearly with almost 85% of the ministry’s vacancies for doctors already filled, he adds.

“However, the posts available do not commensurate with the needs of the country.

“Malaysia will definitely need more doctors when we reach the status of a high income country.

“By 2020, the population is expected to reach 34 million so Malaysia will need a total of 85,000 doctors to attain the ratio of 1:400,” he says, adding that the ministry will apply to Public Service Department (JPA) for additional posts for doctors.

More doctors are needed to accommodate the fast expanding private healthcare services, health tourism, new health facilities, higher level of care by the Health Ministry, rise in specialisation and sub-specialisation of medical practice, expansion of more complex speciality services like cardiothoracic and hepatobiliary surgeries, and the emergence of new infectious diseases, lifestyle-associated diseases and chronic disease patients.

“More are joining the post graduate and sub-speciality programmes and coupled with the brain drain of medical practitioners, we need doctors.”

Doctors call for 30% hike

BY CHRISTINA CHIN
SGCHRIS@THESTAR.COM.MY

A doctor checking a young boy as his mother looks on. -filepic A doctor checking a young boy as his mother looks on. -filepic

PETALING JAYA: Doctors in private clinics and hospitals are asking for a 30% increase in consultation fees, saying it is impossible for them to survive with rising operating costs.

Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan said the proposed hike was more than a decade overdue.

He claimed that doctors were now paid less than plumbers, electricians, hairstylists and food outlet operators.

General practitioners get between RM30 and RM50 per consultation while specialists charge between RM50 and RM80.

Dr Tharmaseelan said: “It is a misconception that doctors are rich and greedy. Many doctors are scraping the barrel with rising utility, rent and salary costs, and quite a few have even quit practice as it’s just too expensive to maintain a clinic.

“On average, the operating cost for a general practitioner to run a clinic in Kuala Lumpur is about RM20,000 per month.”

There are over 7,600 private clinics and hospitals nationwide. The association represents over 3,000 members.

Dr Tharmaseelan added that a general practitioner charged cough and cold patients between RM45 and RM50, including medication.

“It does not make sense that people are paying more for a haircut or a meal than for treatment,” he said.

He said that a rise was necessary for doctors to cover their “basic costs” in light of mandatory rulings like paying minimum wage.

“We are also required by law to have medical indemnity insurance, hire radiographers and engage waste disposal contractors at our clinics.

“It’s been three decades and our fees have remained unchanged,” he said.

He said the MMA submitted the new fee schedule to the Health Ministry two years ago but the proposal was rejected because the Government felt it was steep.

He said the MMA could not agree to the Government’s 14% fee increase proposal made last year as it would result in a bleak future for its members.

Malaysian Medical Council member and senior medical practitioner Dr Milton Lum said: “A plumber charges between RM50 and RM100 just to check my pipes – that’s way more than what a general practitioner charges (for a consultation).

“These days, RM100,000 medical bills are not uncommon but doctors only receive a fraction.

“Between 75% and 85% of the bill goes to the hospital and managed care organisations,” he said.

Federation of Private Medical Practitioners Associations Malaysia president Dr Steven Chow said the existing schedule amounted to only 2.3% per year since 2000.

“Bearing in mind the inflation rate, the 30% hike is a fair request,” he said.

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In September 2012, I wrote about Health Facts 2012. The data was till 31/12/2011 which shows that the doctor: population ratio has already reached 1: 791. This figure included all the housemen with the total number of doctors standing at 36 607. The data for 2012 was just released by MOH. The ratio has come down to 1: 758 with the total number of doctors standing at 38 718. However, I feel that the data may not have captured all the housemen who joined the civil service towards the end of the year 2012 (the major bulk).  This is because the rise in the number of doctors seem to be smaller than the year before which is obviously not right (3 626 in 2011 vs 2 111 in 2012) when the number of graduates/medical schools has actually increased! Something is not right about this statistics unless there are about 2000 doctors who either left the country or resigned from being a doctor! . From my MMC sources, I was informed that the number of new doctors reported last year was about 4000, which will make the ratio very much less.

Below, I list the 34 functioning medical schools in Malaysia at the time of writing:

1)    University Malaya (UM)

2)    UNiversiti Kebangsaa n Malaysia (UKM)

3)    Universiti Sains Malaysia (USM) : 2 programmes

4)    Universiti Putra Malaysia (UPM)

5)    UiTM

6)    University Sains Islam Malaysia (USIM)

7)    Universiti Darul Iman

8)    Universiti Sarawak Malaysia (UNIMAS)

9)    Universiti Sabah

10) Universiti Malaysia Kelantan

11) Melaka-Manipal Medical College

12) Monash University Malaysia

13) International Medical University (IMU):  2 batches + twinning program)

14) SEGI University College

15) Allianze College of Medical Sciences (ACMS): 5 programmes

16) Penang Medical College (PMC)

17) Mahsa University College

18) Masterskills University College of Health Sciences (Asian Metropolitan University)

19) Royal College of Medicine Perak (UNIKL) : 2 programmes

20) Universiti Islam Antarabangsa (UIA)

21) Newcastle University Malaysia

22) Perdana University : Graduate Medical School

23) Perdana University : RCSI

24) Inssaniah University College

25) Quest International University Perak

26) Cyberjaya School of Medical Sciences

27) AIMST

28) Taylor’s University College

29) Management and Science University (MSU) : 2 programs

30) University Tunku Abdul Rahman (UTAR)

31) University College Sedaya International (UCSI)

32) University Pertahanan Nasional Malaysia (UPNM)

33) Lincoln University College 

34) University College Shahputra

We have atleast another 2 on the cards : Xiamen University, China (Medicine, Salak Tinggi, 2015) and Shanghai Jiao Tong University, China (Kuching, 2014/2015). Even though the number of medical schools is 34, we have close to 43 medical programs as some of the medical schools conduct more than 1 program/batches.

MMC had only accredited 20 medical programs as of June 2013 as listed over here. This means that only 20 medical programs have produced graduates (not in maximum capacity yet) and the remaining 20 ( about 50%) have yet to produce any graduates. So, everyone who can count will know the situation in near future. If each produces 100 students (most medical schools will need atleast 150 students to make profit), we will have 4000 graduates locally by 2016. Another 1000-2000 will come from overseas, making a total of atleast 6000 graduates annually !! I presume it will hit 8 000 by 2018!

In March 2013, I wrote and published a circular from MOH that almost 95% of the post for MOs has been filled in most states. Today, I received an info via Facebook that almost 80-85% of the post for doctors in Malaysia has been filled ( see below). The shortage now is in Sabah and Sarawak.

As for 1 June 2013

Total Dr Post in KKM/PPUKM/HUKM/HUSM (Uni only have HO):  27573

Filled: 22374 (81%)

Vacant: 5199

Vacancy in Sabah/Sarawak : ~1500

Total HO post: 10387 (about 5 000/each year)

Vacancy: 1707 (16%)

Vacancy in Sabah/Sarawak : ~500

Total MO post: 17186

MO vacancy: 3487 (20%)

Vacancy in Sabah/Sarawak: ~1000

Post filled at present: 80%-84%

Eventhough, new hospitals and posts will be created by the government, the number of new post will not be sufficient to absorb all these graduates. This will likely happen by 2017/2018 when most of the 40 medical programs would have started to produce graduates. Likely, the government may still give Housemanship post on contract basis after which, there will be no guarantee that you will get an MO post. Likely, the compulsory service will be scrapped. How the selection is done remained to be seen. Obviously, government sponsored and public university graduates will be given priority. The rest may need to sit for some sort of exams or evaluation after housemanship.

It is really going to get very messy by then. I just hope our current Health Minister will make some serious attempt to stabilise the situation by closing down some of these sub-par medical schools. Anything related to healthcare sector use to have guaranteed job just a few years ago. Unfortunately, our great Human resource planning has screwed up most of it. We have jobless nurses, radiographers, physiotherapist and recently even teachers! Welcome to the education hub of this region!

Enough said, I hope people will make wise decisions for their future. Never do medicine for wrong reasons…………..

 

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I read 2 interesting articles over the last 2 days. The first was in Malay mail which basically tells the truth of what is happening out there (see below). Many students nowadays do not know what they are getting into. Just because they score a good result in their exams, they feel that they are destined to do courses like medicine, dentistry, engineer, lawyer etc etc. Over the last few weeks I received many queries about which university to choose, which course to choose etc etc. Who am I to tell you which course you should do? It is entirely up to you to find a course that you feel you will have the passion to work for the rest of your life. Talk to people and friends who are working and get a feel of what the job is all about. In this blog I had written what medicine is all about and what kind of life a doctor undergoes. Similarly, you should find out what the other professions do. Unfortunately, many of the students are only interested on whether they will get a job, what is the income going to be and whether they can get a job overseas. Nothing is guaranteed in the future. Job opportunities changes over time. Who would have thought that doctors would become jobless ? But it is happening in many countries including developed countries.

The other article that I found interesting was ” 10 things to give up to become a doctor” which was written over here (see below). All those points had already been mentioned in this blog over the last 3 years. Nothing has changed no matter where you practise. One thing I always tell people is that, you will never become rich with a salaried job. Do you see any millionaires who are not businessman or politicians ? Even doctors are not going to earn a lot of money unless they start their medical business. The difference is, you would have spent tonnes of money studying and years of training even before considering opening a medical business. Furthermore, medical business is a 1 man show unlike other businesses where you can become a boss by the age of 35/40 and the business will run by itself. In medicine, that’s when you even think of starting your business. The era of opening medical business after 4 years of service is coming to an end due to stiff competition. Many GPs are now selling their clinic to companies that are running franchise clinics. That will be the future. You will not be able to run an individual clinic all by yourself. Without panels you will not survive. I just got to know that 1 more clinic just closed down near my place.

The articles below are worth reading…………………….

Tired of doctor, lawyer, engineer and accountant wannabes… — Cass Shan

JULY 26, 2013

JULY 26 — The truth is, most students don’t know much about the world after secondary education. They simply assume that the best career options are to be either a doctor, lawyer, engineer or accountant. And if they are good academically, they automatically get pigeonholed into these career paths.

While these professions are noble and worth aspiring to, too many students simply fail to grasp what it means to have a career and fall for the assumed social status and prestige associated with these careers.

And sure, some can argue that vying for social status and prestige isn’t all that bad, but surely there’s more to a career than that?

The recent spate of students complaining about not being offered courses of their choice is nothing new in Malaysia. Institutionalised racism aside, students should already know that if everyone got the course of their choice, there would be an over supply of doctors, lawyers, engineers and accountants — thereby driving down the market rate and value of these occupations. Thus, demand must exceed supply to ensure the value of these professions.

For those who fail to get a course of their choice; they can appeal or look elsewhere — either going abroad or seeking scholarships (which if they are worthy, they are more likely than not to get). For others who don’t have that option, it may not be such a bad thing to look at other career options.

For one, I sincerely question how many of these applicants are genuinely passionate about these courses they are applying for. True passion is when you are willing to do something for nothing, because just doing it gives you a sense of achievement or satisfaction. I am willing to bet that if the medical profession didn’t pay as much as it does in comparison to other professions, there would be a lot less takers despite it being a noble profession.

For instance, how many people actually grow up saying “My dream is to spend my working hours looking into people’s mouths and attacking cavities?” And yet, dentistry is a competitive course. I’m not saying that dentistry is not something to aspire to but essentially, a lot of students are taken in by the “halo” effect that the medicine line has.

I know a classmate in school who studied nursing because she truly cared for the sick. When offered a chance to pursue her career as a doctor with her already sound knowledge of healthcare, she turned it down as she saw how little doctors interacted with patients compared to nurses and stuck to being a nurse for the pure joy of caring for the sick. Now, Pamela Patricia Perera can truly hold her head high as someone who is truly passionate about helping the sick. How many of our doctor wannabes, if denied the option of studying medicine, would opt for nursing and still get to care for patients? And how many would take the longer path towards being a doctor by becoming a nurse first in their so-called ambition to be a doctor?

I know a girl who loved airplanes since she was young, collecting model airplanes and watching “Airwolf” with anticipation in the ‘80s. This is someone who cuts out articles on aircraft engineering when she was in school despite not being requested to by the school syllabus. Not surprisingly, Ruth Anandaraj went on to study aircraft engineering and is now working for Airbus in the UK and will soon be working for Boeing in the US. This is what true passion is about — reading up information about your career choice with hunger in between studying for school exams.

On the other hand, I know a Mara scholarship recipient who studied engineering in the UK (and yes, he was academically bright with straight As) and came back to Malaysia only to ditch a career in engineering. It turned out a career as a sales manager was more rewarding to him and possibly the best turn of events that could have happened where he achieved money, respect and a fancy job title as a sales director at the age of 33 to boot.

Now, how many students say their dream is to be a salesperson? Not many I’m sure. In fact, among the so-called respected community of academic high achievers, a salesperson is akin to being a pariah in society.

I know of an accounting graduate who studied accounting on scholarship (yes, she was sent abroad to the UK) who called a floor of salespersons a “sweatshop” and equated salespeople to being “con artists”. She would never lower herself to that job title, yet she was happy to stay in her prestigious, high-paying, but unfulfilling job.

The point is, there is more to a career than academic results, money and presumed prestige.

A career isn’t necessarily about how good your exams results are. I’m sorry to break the news to you but scoring straight As in our education system only mean you’re good at memorising, it doesn’t guarantee that you are a critical thinker. A career is about whether your personality is the right fit for the job requirement. Many professions in Asia tend to require long hours and — before you make it — most graduates have to climb their way up the salary scale. So you better enjoy your work if you are going to be spending a lot of time in it.

The crucial test — would you do it if you weren’t paid for it — comes to mind.

In the instance of not getting a course you want, the world suddenly opens up with new possibilities. You may find out that nursing helps you care for the sick more than doctors do. Or that you really love doing PR because you love interacting with people more than you do staying in the office. You may find out that a career as a teacher is more rewarding than a fat paycheque when you see the improvements in your students. Or maybe, that “pariah” job as a salesperson is more fulfilling to your go-getter type of personality.

We face many setbacks in life and often, when a door closes, another opens.

Students shouldn’t be preoccupied with prestigious jobs and ask themselves hard questions of what personality type they have. They should ask themselves what they would still do even if there was no money on the table, and that they’d do it because it gives them fulfilment.

Too many students have a myopic view of life after secondary education and think that a prestigious job is the only way up. It may be a way up — but does it truly satisfy you or are you just looking for the next family reunion where you get to proudly mention your job title?

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malay Mail Online. 

- See more at: http://www.themalaymailonline.com/what-you-think/article/tired-of-doctor-lawyer-engineer-and-accountant-wannabes-cass-shan#sthash.KiOb9gVJ.dpuf

 

 10 things to give up to be a doctor 

 

BY    

Following a recent article elsewhere which generated an interesting discussion, I started thinking about the things one must give up on the road to becoming a doctor. It’s a long road, beginning with an initial decision, some early voluntary experiences, an application to university and some hard work trying to achieve the barely possible at GCSE and AS / A2.

But it doesn’t even end there. The hard work really only begins at medical school where long hours and repeated exams are considered normal and where you need your patients more than they need you.
There are plenty of things you have to give up along the way, here are my top 10:

1. Your desire to be wealthy
Very few people in medicine ever become hugely wealthy, at least not in Europe. If riches are what you desire there are many many easier ways of getting that involve alot less heartache, money and stress. If you want to be a millionnaire before you’re 30, my advice would be to avoid university altogether. Most doctors are in the profession for genuinely altruistic reasons as well as the satisfaction that comes from knowing that you have the skills and knowledge to save lives and apply these every single day as a routine part of your work.

2. Your desire to change the world
Equally you must, eventually, give up on the idea of becoming some sort of medical superhero who can solve the worlds medical problems one by one. Yes doctors can do some impressive things when applying their skills to the right situation. But remember that however good your intentions, you will not be able to overcome the problems caused by poverty, war, government neglect or abuse, or coorporate profiteering at the expense of the sick. That doesn’t mean you can’t try to help people afflicted by any of these, you’ll just find that you are usually too small to make any real systemic difference.

3. Your free weekends
It starts at medical school when the work starts to pile up, and weekends are sacrificed to meet deadlines and for exam revision. Once you start working as a junior doctor, you’ll find yourself scanning each new doctors rota to work out where your on-call weekends have landed and who can swop with you so that you can still go on that holiday or get married or whatever. There will be sunny weekends when your non-medic friends will be having a barbecue whilst you sweat it out on a ward seeing yet another gastrointestinal bleed wondering why you chose this path.


4. A good nights sleep

Gone are the days where doctors would be on call for 48 or 72 hours and then do a clinic for the boss before retiring to bed. However, modern working arrangements have brought into existence the ‘week of nights’ where you work 4 or 5 and sometimes 7 night shifts in a row.

As someone who has done these I can confirm that doing nights is pretty inhumane. The talk amongst doctors doing nights together often centres around changing specialty or leaving the profession. Don’t worry, it all gets forgotten once normal daytime duties are restored.


5. Your desire to avoid feeling like a fool

You will make mistakes from time to time in this job and your mistakes will all be potentially serious ones, simply because everything you do affects your patients’ lives directly.
Furthermore, there will be times when you have to withstand an onslaught from senior doctors who feel that teaching by humiliation is the only way forward. You will feel like an idiot at times and if the thought of that frightens you you should promptly pick a different profession.


6. Your desire to always put friends and family first

As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him.

Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.

7. Your desire to please everyone.
Whether it’s your friends or family, as above, or your future patients you’d better get used to upsetting people from time to time. Telling your wife you need to postpone an evening engagement because you are still operating on a difficult case, or telling a patient you won’t be operating on them as they only have three months to live, are both likely to be met with upset. Each situation has it’s unique challenges and needs some communication skills, but the bottom line is that you will have times when you will have to make someone want to either hit you or cry in despair.

8. Your creativity
Not many people admit this but medicine takes people who are often very creative and turns them into workaholic, automatons who have little room left in their lives for creativity. If you want evidence for this, go to any dinner party that includes more than one doctor. Chief discussion topic will be work and medicine.That’s partly because anecdotes from doctoring are entertaining, but also because if the medics stray from this conversation topic, they will rapidly expose their banality and limited insights in other areas particularly all things creative.

Much of medicine does not allow much creativity in it’s day to day practice and the intensity of the work beats any desire for creative thinking right out of you before you even realise it’s happening.* Of course whilst accepting this fact you must fight this tendency and attempt to keep up your other interests, otherwise, I can guarantee medicine will invade everything you do.

*There are a few notable exceptions to this!

9. Your desire to stay in one place / live close to friends and family.
Want to do something competitive, like medicine? You have to realise that choosing your location is a luxury and you may have to follow your dream in a less than ideal location. Even after you graduate, having your heart set on one speciality is a sure way to geographical instability. Some people don’t mind this, but some with strong family ties or a mortgage, the need to move frequently is a pain.
I began to come to terms with this when I found that even the most obscure places have hospitals. Working in these places you’re just as likely to meet doctors who have also had to move from here from the other side of the country. It’s a great way to meet people but easy to lose touch once you move on.

10. Good health
You may not know it, but you’re joining a profession that has high rates of physical and mental illness as well as drug and alcohol misuse. Doctors are also less likely to seek help than other professions which all adds to a rather worrying picture.
Although ill health isn’t guaranteed in a medical profession you should realise the future risk now and take steps to formulate good lifestyle habits to minimise your risk factors. A good network of non-medical friends should also protect you from neglecting your own needs while you’re treating your patients.


That’s plenty to sacrifice just for a job isn’t it? However, I guess the reason you’re in medicine (or trying to get in) is that you’ve realised that medicine is not just a job, it’s a whole way of life, that’s difficult to let go of once you’ve decided to enter it, and these sacrifices are simply part of the deal.

Well, those are the 10 points I thought were worth including. If you have more I’d love to hear about them.

Leo

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I am sure many of us would have read the article that was published in the Star 2 days ago. You can read it below. This is the first time a title such as that has been published in a main stream newspaper. I had written many times about unethical doctors and how the competitive market is creating more and more of them. It is a known fact, mainly in private sector. Fortunately, the numbers are still small. Unfortunately, the example that this writer pointed out is NOT about unethical practise (at least the first example). The writer obviously do not know how to differentiate between unethical practices and management issues. As for the second case highlighted, it can be. In fact, I had seen many patients who presented with AGE symptoms without any abdominal pain, ending up with an appendicectomy done! However, it is still defendable in the court of law as symptoms can change. MMA has given it’s response over here

Unethical practise is when a doctor does an upper and lower endoscopy in a 16 year old girl presenting with acute gastroenteritis, doing multiple lumpectomy in a 17 year old with lumpy breast, doing upper scope in a patient with neck pain, doing angiogram is a 24 year old with iron deficiency anaemia with no chest pain etc etc! These are the type of unethical practices that we do see, on and off. It is not uncommon as I had written before. Doing further test to rule out any other possibilities/diseases is not unethical. For example, if a middle age heavy smoker comes with chronic cough and left basal pneumonia, you may want to do a CT Thorax to rule out Cancer of the Lung causing proximal obstruction. If not, he may sue you 3 years down the line for missing a cancer. It is a delicate balance between treating a disease and not to miss out something that can be life threatening. The first case is about that, nothing unethical. MMI (Malaysian Medical Indemnity) insurance has just tripled the premium for Obstetrics and Gynaecologist. MMI is a Malaysian based indemnity insurance company unlike MPS (Medical protection Society) which is global society providing indemnity to doctors all over the world, where the rates are much higher. Click on the links to see the rate. This basically shows that the litigation and payout rate in Malaysia is increasing exponentially.  BTW, the doctors consultation and surgical fees are controlled by the government and the rate has not changed since 1998 !

Surprisingly, the same newspaper published another interesting article yesterday. It is about finding reliable doctor !. Well, to be frank, due to some bad apples in the profession, the public are now advised to be more vigilant and find a reliable doctor. The public has the right to choose. BUT how do you choose ? How do you know that the particular doctor is good, reliable and trustworthy ? It is interesting to read Dr Alan Teh’s response over here .The enforcement is weak in Malaysia and the enquiries conducted by MMC is troublesome for the complainant. Thus, not many complains are made. Private hospitals on the other hand rarely takes action against a consultant despite unethical practices as the hospital gets money out of it as well. It is a business entity and profit is what matters.

However, the second article do mention a lot about the reality and future of the medical field. Somehow, I feel that all those that was mentioned came from my blog! It has all been explained in this blog with facts and figures:  oversupply of doctors, competitive private practise, declining income, limited postgraduate opportunities, venturing into aesthetics, beauty therapy, selling supplements etc etc.

MY advise to budding doctors whose sole intention in doing medicine is for money; please don’t do medicine. It is a long way to go and money is what that drives you to do unethical practices. Money that is earned “illegally” will disappear as fast as it comes. I believe that no matter what you do, if you do it sincerely, work hard and be truthful, you can be successful, live a decent and comfortable life.

Beware of unethical doctors

DIFFERENT SPIN BY SHEILA STANLEY

Public regard for the medical profession has dropped and this is due to greedy doctors who dupe patients into undergoing unnecessary procedures and tests.

Society has always had high regard for medical professionals as they represent our path to a healthy mind and body.

We rely on their opinions and medical advice and tend to take their recommendations very seriously.

Currently, however, regard for the medical profession has dropped a little.

This is due to a small number of unethical doctors who have taken advantage of our trust in them and used it to make more money through unnecessary procedures.

More often than not, this happens in private medical institutions.

A number of anecdotal stories among people I know underscore this. Take for example, a recent story told to me by a 33-year-old woman, pregnant with her first child, who went to a private maternity centre to give birth instead of a government hospital.

Her periodic check-ups went along fine until she was about seven months pregnant.

At that point in time, she was informed by her doctors that her blood tests indicated there was something wrong with the child she was carrying and there was a strong possibility that the child had Down Syndrome.

She was informed that she had to go for a number of different tests – all of which would obviously cost a lot of money.

Although she wasn’t that concerned about the cost, she became very afraid for the future of her unborn child.

So, after speaking to her family members, she decided to go to a public hospital to get a second opinion.

At the public hospital, they conducted a number of tests on her.

These were all free under the Malaysian public health system. After results were obtained, she was informed that the baby seemed perfectly fine and she had nothing to worry about.

She then decided to deliver her baby in the public hospital. When her child was born, it was perfect, and there was nothing wrong. Other stories such as this exist, although probably not as horrifying.

There is another story about an eight-year-old boy who suffered from fever, cough and was vomiting for a day.

He did not have any abdominal pains. His father took him to see a general practitioner who then told him to take his son to a particular surgeon at a private medical centre.

At the centre, the surgeon, when examining, pressed down so hard on the boy’s abdomen that it caused him pain.

The surgeon then insisted that the boy had a perforated appendix and insisted that he undergo an operation that very night.

However, about an hour before the surgery, the father, feeling uneasy, decided to get a second opinion. He asked for his son to be discharged and took him to another doctor.

This doctor found that the son did not have a perforated appendix and instead treated him for an upper respiratory tract infection, something common among children of that age.

I am sure that many other stories like these exist out there and readers have been through similar experiences.

The outrage we feel when faced with such incidents has to do with a betrayal of our trust.

As far as I know, doctors take the age-old Hippocratic Oath when they begin practising medicine.

Considered a rite of passage, the oath hinges on the duty of the doctor to practise medicine in an ethical manner, in the best interest of his or her patient.

When faced with stories like these, one can’t help but wonder what has happened to the Hippocratic Oath?

Do doctors these days, especially those in private medical institutions, no longer take this oath?

Or does the making of money trump any public duty they hold to practise their profession in an ethical manner?

It is clear that we have to be aware of our rights as consumers when it comes to doctors as well. In fact, the Malaysian Medical Association (MMA) has procedures where a complaint can be filed against any doctor practising medicine in Malaysia.

To file a formal complaint, the MMA requires the person making the complaint to submit the full facts of the case, clearly stating the allegations against the medical practitioner.

The Consumer Association of Penang also advises consumers on their rights under the Private Healthcare Facilities and Services Regulations 2006.

These regulations provide patients with the right to request and receive information on the estimated charges for services provided as well as other unanticipated charges for routine services.

The public also have the right to complain to the hospital or medical centre in question about any issues they may have about their treatment at the hospital.

In such cases, the private hospital must establish a patient grievance mechanism which includes the appointment of a Patient Relations Officer to act as a liaison between the patient and the hospital.

It is clear that we have to be more aware of our rights when it comes to private medical practitioners.

In many cases, it would involve doing some independent research into the symptoms of the illness and the appropriate care required.

Also, getting a second opinion when doubtful seems to be the best course of action.

Do you have any stories to share on bad encounters with private medical practitioners?

If you do, share them with me, and in my next column, I will share your stories.

It is time we start being more aware of our rights as patients.

> Sheila Stanley is a writer, TV producer and PR/media consultant based in Kuala Lumpur. You can share your thoughts with her on Twitter @sheila_stanley or via e-mail atsheila106@live.ie.

Finding reliable doctors

BY FOONG PEK YEE

CHAN was bleeding profusely from his left nose after he tripped and fell in front of his house in Gopeng.

The nearby general practitioner (GP) whom he sought treatment from told him to go to the Ipoh Hospital (Hospital Raja Permaisuri Bainun), but refused to give him a referral letter.

At the hospital about 30km away, the doctor there told him his blood pressure was 120\80 and the reading was perfect, and that he can go home.

However, his nose was still bleeding then.

When met at his house recently, Chan, in his 70s, said he felt the left side of his body had been weak since the episode.

Over in the Kuala Lumpur Hospital, a young doctor told the sister of a patient, “I have so many patients and some are dying.”

This doctor, who was sitting on the nurses’ counter in the accident and emergency ward and shaking his legs, said this when the woman asked him about her brother’s condition.

She reported the case to the Health Ministry director-general, who also heads the Malaysia Medical Council (MMC).

Any doctor must be registered with the MMC before he can practise in Malaysia.

I believe the two cases are just the tip of the iceberg because victims either do not know how to complain to the MMC or they are afraid of doing so, one reason being the fear of retaliation from the doctor or doctors.

While having a perfect score, like 4 for CGPA (cumulative grade point average) may qualify an STPM student academically to do medicine, it certainly takes more to become a good doctor.

I am not saying that this is reason for the government to reject top scorers who wished to pursue medicine in local public universities.

But I feel it will be good if those wanting to study medicine are aware of what it takes to be a good doctor.

And what is the purpose of their desires of being a doctor.

If one is induced by the perceived earning power of doctors, it may be good to do some research on the situation.

These high income doctors are medical specialists in disciplines in demand, like cardiology, obstetrics, gynaechology and eye surgeons to name a few.

They usually are very skillful, have a good track record and reputation and are attached to big private hospitals.

I do not know the remunerations for specialists in local public hospitals or teaching hospitals.

Apart from that, it is not easy to specialise as there are limited places locally if one somehow could not do it overseas.

Besides being expensive to specialise abroad, it is also very competitive in terms of getting a good place to do so.

The country does face a shortage of specialists, for now.

However, its capacity to train specialists is limited because the requirements for training facilities are very stringent.

Well, if one somehow is contented to just become a doctor or general practitioner, the market out there is also increasingly competitive.

In June 2010, MCA president Datuk Seri Dr Chua Soi Lek said there would be an oversupply of doctors in five to six years’ time.

The former health minister, who is a doctor by training, said the country, produced some 4,500 doctors a year starting 2011 and would see the 30,000 doctors in 2010 doubling to between 55,000 and 60,000 doctors by 2015 or 2016.

Even if the government somehow can absorb the doctors in local public hospitals, I supposed the doctors must be prepared to be posted to wherever their services are needed.

And I will not be surprised when a time will come, likely in the near future, that doctors who wish to join government service will need to be shortlisted for interviews first, and no longer wait to be posted.

It is a situation of supply more than demand, and, not surprisingly, doctors could join the ranks of the jobless through oversupply.

There is also a bright side, though.

Assuming meritocracy is in place, the patient care and the country’s healthcare standards stand to gain when there is a big pool of doctors to choose from.

And some arrogant or rude doctors will think twice if they think they are a cut above the rest.

For those who want to be a GP, the market is very competitive, if not saturated.

Private clinics are usually set up in towns and cities where the demand is there.

It seems GPs also have to seek to be panel doctors to boost their business these days.

The mushrooming of 1Malaysia Clinics in urban and rural areas is also another concern for GPs.

I heard there are also GPs who diversify their business, like selling health food and supplements.

A friend of mine told me a husband-and-wife team of doctors from Malacca are no longer practising medicine, but using their titles to peddle expensive health supplements in the name of disease prevention.

I have heard that many doctors are also going into aesthetic medicine and peddling skincare products to their patients.

With supply more than demand for doctors, there will certainly come a time when more and more doctors have to find alternative jobs or business to survive.

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Over the last 2 weeks, I have been receiving numerous emails and blog queries about which university he/she should choose to do medicine. It is rather surprising to see that each student seem to be have received at least 3 university/college offers to do medicine ! This is what happens when you have close to 36 medical schools with almost 45 medical programs. It is surely an Air Asia theme like scenario “Now, everyone can become a doctor…….” This does not include those who go to various other countries to do medicine. Shockingly, after writing so much about medicine in this blog, I still get questions that I find rather irritating at times. There are many students out there ( some are already 4th/5th year medical student) who still do not understand about degree recognition issue and post-graduate educations. They still think they can go to another country and easily get a job! They still think that postgraduate education is as simple as reading books and sitting for exams. Gosh, what do our schools teach the current generation of students ! They really fulfil the criteria of “katak bawah tempurung” .

As I have been saying many times over the last 3 years, just imagine the glut of doctors that we are going to face in 3-4 years time. When the market is saturated, the income of all doctors will decline. Even now, I see new clinics being open just few doors away from another clinic. That is how competitive it has become. In fact, I was just informed that some insurance companies have started to reduce their consultation fees for doctors by at least half ! If you don’t agree, they will go to another doctor who will ! The newer GPs will obviously agree, to get some income, rather than nothing. To add salt to the wound, our Health Ministry is planning to open another 40-50 1Malaysia clinics throughout the country as mentioned here and below. The 1Care system is still being kept under the carpet till further announcement.

In January 2012, I wrote an article on how doctors in US are going broke. Well, the situation has not changed much. The latest news from US says that many private practices are being closed/sold due to poor income (insurance companies have started to slash the payment), increasing litigation rate and high maintenance cost. Thus, many of the specialist are running back to hospital based practices with a fixed income. The situation is the same in many other countries as well. Even in Malaysia, some of the private hospitals have started to employ doctors compared to “self-employed version” which use to be the norm for a long time. This clearly shows that we are now at the mercy of the private hospitals and they can now demand what they want. A fixed income means that your income will be generally lower with higher tax, since you can’t play around with your tax. Furthermore, your income will not be much of a difference from what a government consultant earns.

The declining income has increased the amount of unethical practices. Whatever said , a private practice is a business to earn income for a living. Once you are used to a specific amount of income, you will try to achieve it no mater what. Thus, unethical practices will surface. That’s why I alway tell people that,never let money to buy over you. Keep your commitment low and earn a decent living. Medical business is a “one man” show. If anything happens to you, your income is ZERO!

 

Doctors bail out on their practices

By Parija Kavilanz  @CNNMoney July 16, 2013: 9:18 AM E

docotrs selling practices cobbDr. Patrick Cobb sold his private oncology practice in December 2012. “It just wasn’t feasible for us to stay in practice,” he said.

NEW YORK (CNNMoney)

Doctors who own private practices are looking for a way out. Fed up with their rising business expenses and shrinking payouts from insurers, many are selling their practices to hospitals.

It’s happening nationwide and has picked up pace, said Tony Stajduhar, president at Jackson & Coker, a physician recruitment firm.

Experts say the number of physicians unloading their practices to hospitals is up 30% to 40% in the last five years. Doctors who sell typically become employees of the hospital, as do the people who work for them.

The reasons for the trend vary. Doctors are tired of the hassle of filing insurance claims and collecting payments from patients and want to only focus on medicine again, Stajduhar said.

Obamacare has also created more fear of the unknown. Doctors are worried that new regulations will add to their administrative work and require them to pour more money into their businesses, Stajduhar said.

Related Story: One doctor gave up on health care in America

Dr. Patrick Cobb, an oncologist in Montana, sold his 30-year group practice Frontier Cancer Center to a hospital in December. His practice was struggling for years even before health reform passed.

Changes in chemotherapy drug reimbursements badly hurt the business, he said. In cancer treatment, patients don’t buy the drugs themselves. Oncologists buy the drugs and then bill insurers for the cost. Medicare significantly reduced reimbursements in 2003 for chemotherapy drugs.

That was a turning point, said Cobb. “We spent millions on drugs that we bought directly from distributors. When reimbursements fell, our costs went up,” he said. Cobb and four other oncologists at the practice took pay cuts to offset declining revenues, but it wasn’t enough. In 2008, the practice closed one of its four locations.

Cobb and his partners looked for a buyer in 2012 and found one in Billings, Mont.-based St. Vincent Healthcare. The hospital system hired Cobb and the rest of the practice’s staff. “It just wasn’t feasible for us to stay in practice,” said Cobb.

Related Story: Doctors driven to bankruptcy

The cycle of hospitals buying private practices has happened before. In the early 1990s, hospitals went on a buying spree as a way to get access to more patients, said Thomas Anthony, an attorney with Frost Brown Todd in Cincinnati. At the time, it was a sellers’ market and the deals were financially rewarding for doctors.

This time, the market dynamics are different. Doctors are eager to sell and might not be able to make as much as they did in the first wave of acquisitions, said Anthony.

But, for sure, hospitals are buying.

As more of Obamacare is put in place, hospitals are rushing to increase their market share in anticipation of millions more Americans getting access to health care. Buying practices is a quick way to do that, Anthony said. And more private practice doctors want to enjoy steady salaries and hours again as hospital employees.

Dr. Dwayne Smith, a bariatric surgeon, sold his group practice to a hospital two years ago. His practice was profitable but costs were creeping higher in recent years because of shrinking reimbursements.

Related Story: Why doctors can’t stay afloat

One big cost coming down the pike was tied to electronic medical records. Federal law gives physicians until 2015 to implement digital records technology or face a 1% reduction in Medicare payments.

“This would have been a very difficult investment for us,” said Smith.

Smith’s practice approached Cincinnati-based St. Elizabeth Healthcare in 2011 with an offer to sell. The hospital bought the practice and Smith became a hospital employee. He’s happy with the decision even though he has had to adjust to the loss of autonomy.

“My hours are better. I’m not spending hours on administrative work or worrying about my business,” said Smith.

The private practice model is very expensive to operate, said John Dubis, CEO of St. Elizabeth Healthcare. “That’s why it’s diminishing,” he said. Most of the 300 physicians employed by the hospital’s specialty physicians group have come from private practices.

Said Cobb, the oncologist: “We have a joke that there are two kinds of private practices left in America. Those that sold to hospitals and those that are about to be sold.” To top of page

Are you a private practice oncologist struggling to keep the business going? E-mail Parija Kavilanz and you could be featured in an upcoming story for CNNMoney.com.

 

40 To 50 More 1Malaysia Clinics To Be Set Up From Next Year

KUALA LUMPUR, July 18 (Bernama) — Forty to 50 more 1Malaysia clinics (K1M) will be set up nationwide from next year to meet the demand from the public, especially in the rural areas.

Health Minister Datuk Seri Dr S. Subramaniam said the clinics would be concentrated in areas with many residents from the low-income group.

“Despite grumblings from the operators of private clinics when K1M was set up, K1M still receive encouraging response from the people because of the low charge imposed.

“It is a successful 1Malaysia product and can benefit the people by ensuring a good level of healthcare,” he told reporters after attending a gathering, here, Thursday night.

There are now more than 200 K1M nationwide serving about 1.5 million people with the minimum charge of RM1 for citizens and RM15 for non-citizens.

K1M is one of the initiatives under the 1Malaysia concept mooted by Prime Minister Datuk Seri Najib Tun Razak.

– BERNAMA

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