Archive for the ‘Education’ Category

For 3 weeks I am battling with a virus. Started with an Upper Respiratory Tract Infection just after CNY which subsequently led to severe pharyngo-laryngitis causing me to almost lose my voice a week ago. While I am still recovering from this massive viral assault, with my voice still not back to normal, it has been work as usual. Being a private practitioner with own business to run, you have to work no matter what happens. It is a one man show. Appointments had been given and on-calls has been arranged. As long as you can walk and talk, work goes on. That’s the life as a doctor.

As per the years before, there will always be a surge in the number of visitors to my blog after the SPM/STPM results are announced. As expected thousands of students have scored straight As, close to 11 300 students. Despite being less than last year, it is still a huge number. I can’t imagine the number of students who would have scored at least 5Bs to be eligible to enter medical school. I was made to understand that MMC is in the middle of revising the minimum entry requirement and should be announcing it anytime soon , hopefully.

Again, I will be asked the same questions again and again by these budding doctors. Despite this blog having full of information written over the last 5 years, somehow the current generation of students do not READ. As per our education system, they prefer to be spoon-fed all the way. For those who are interested to do medicine, please spend a couple of days READING ALL the information written under ” For Future Doctors” page.

My advise for budding doctors has always been the same: NEVER DO MEDICINE FOR WRONG REASONS! Life as a doctor is never easy. Even in UK, doctors are struggling with work load. Many of their own doctors are migrating to other countries especially Australia. I had written enough about this in all my previous posts.

I had also proven many times in this blog, even before the Minister confirmed it last year, that we are heading towards surplus of doctors. The 5 years moratorium for new medical schools which was imposed in 2010 is coming to an end this year. I heard the moratorium will be extended. I also heard from reliable sources that MMC has asked some of the universities to slowly terminate some of their twinning programmes to cut down the intake of students. We also know that AUCMS has closed shop last year, reducing the number of medical programmes by 5. I also heard that UniKL’s Vinayaka Mission University twinning program may also be terminated by the college. We heard the withdrawal of John Hopkins collaboration with Perdana University last year. However, they manage to get a new collaboration with University of California, San Diego. Hopefully it won’t end up with the same problem. Our healthcare system is completely different than the US. Even their “suppose” to be ready private teaching hospital has not taken of the ground yet. Almost all other private universities which wanted to build their own teaching hospital have abandoned their plans (Monash, UCSI, MMMC, AUCMS). The career pathway is also not the same as in the US which is clearly shown on their website. PUGSOM is a graduate medical school which is the way forward in many developed countries. The students are more matured and know what they are getting themselves into. However, you will end up doing housemanship at an older age(roughly at the age of 30) and will have to compete for post graduate post at the same level as your juniors, by age. By the time you become a specialist, you will be in your 40s. The only advantage of PUGSOM for time being is the full JPA scholarship!

Public universities were also asked to reduce their intake last year. Remember the magic number 418 which turn out to be a “moronic” statement by a deputy minister? The total intake for public medical schools last year was about 1100 students. However, personally I feel that the government should not limit the intake of public medical schools. Unfortunately, the selection process to public universities are never fair! MMC on the other hand should concentrate in reducing the intake into many of the dubious local and overseas private medical schools. How can we allow “shop-lot” colleges to run medical schools? Only in Malaysia! The truly Malaysia Boleh style.

Once again, I would advise those who intend to migrate that doing medicine is the worst decision you will make! I had written enough regarding this over the last 1-2 years. However, I still get emails and blog comments on intention to migrate with an unrecognised degree obtained locally. Please spend some time reading THIS and THIS blog entry. All the answers are there. I just received the following email from an Indian citizen:

Sir I am an indian citizen , did my medicine in china graduated in 2011 and ever since I have been on constant run from exams after exams I cleared my USMLE with 247 in part 1 and 258 in part 2 applied to more than 400 surgical programmes and got turned down…

With Australia and UK almost shutting their doors to foreigners, even after passing their entrance exams (AMC/PLAB), getting into US is also not easy. I know many who spent huge amount of money sitting for exams (USMLE etc) and never got any residency post. Only very few lucky ones manage to get it. Your chances of getting a job overseas is better if you graduate from one of their own medical schools. With the current political climate in this country, almost every non-Bumis that I talk to have intention to migrate, especially for their children. Unfortunately choosing medicine is the worst thing you can do. As my Ophthalmologist friend  said “doing medicine is a trap, you can’t move anywhere!”. I just met a couple who are succesfull GPs and has 3 clinics. They are NOT sending any of their 2 children to do medicine. Of course, their intention is also to let their children migrate.

Thus, I would advise budding doctors to open your eyes and READ…………….. Don’t get glorified with statement like, doctors are needed everywhere and you can work anywhere in this world. There is NO such thing! There are so many information in this blog. Please spend some time READING it. There is NO short cut to life. The more you read , the more successful you will become. Knowledge is key to success and the only way you are going to achieve it is by reading. Enough of spoon feeding in your schooling days! It is time to wake up and face the reality out there!

Please READ…………….

Read Full Post »

It has been almost 3 weeks since I last updated my blog as I was very busy. The above topic had 3 parts written before over HERE, HERE and HERE. I discussed how the medical profession is gradually changing with introduction of many new rules and regulations. A recent meeting between MMA president and Ministry of Education had yet again confirmed the fact that we are heading towards oversupply of doctors and unemployment (Berita MMA January 2015). The Ministry officials admitted the fact and are considering to increase the entry requirement to 5As in SPM. I will not elaborate any further as I had written enough.

In July 2014, I wrote the 1st part of the above topic. One of the issues discussed was about dispensing separation (DS). It was announced that the dispensing separation would begin in April 2015. Over the last few weeks, this is the hottest topic being discussed among the medical fraternity, especially among the GPs. It was informed that the Pharmacy Bill would be tabled in Parliament this March, which suppose to move the dispensing rights from doctors to pharmacist. This will have great impact to the GPs. As I had written before, most GP’s income comes from the sale of medications. If they were to survive by just charging consultation fee, most GPs may not earn enough to even maintain their clinic. They may have no choice but to increase their consultation fees, which in turn will increase the overall cost of medical care and chase away their patients.

I must agree that in most developed countries, doctors are not allowed to dispense their own medicines. However, are we ready for such practice over here? The best people to answer this question will be the public themselves. Is the public ready to pay consultation fee to the doctors and then go to the nearest pharmacy to collect their medications? I am sure the one stop center that is currently being practiced is a much better option. However, the patients have every right to request to buy their medications from elsewhere. We cannot deny that fact. The patients also have every right to know what medications they are taking, aka name of medicines. No doctors can refuse to inform the name of medications to the patients. In fact, under PHFSA, all medicines must be labeled.

Over the last 1-2 months, multiple letters were published in newspapers, even RTM had invited a pharmacist representative to talk about it, and last week, most major newspaper carried topics regarding dispensing separations. One issue that I noticed during these few months is the fact that the pharmacists are more united in supporting this change. What happen to the doctors? Sorry to say, we are the most disunited profession in this country! We had MMA as the sole representative of doctors in this country till a few years ago. MMA is the only body that the government communicates with, officially. Some felt that MMA is not representing them enough and not vocal enough. MMA, as a professional body and not a union will have to settle any issues with the government via diplomatic way. Unfortunately, many out there, who are NOT even a member of MMA and do not even know what MMA is doing, will only know how to complain without contributing anything.

Few years ago, social media aka Facebook was used to start a new organization known as Malaysian Primary Care Network aka MPCN. The main agenda is to unite all doctors. The group grew in size and subsequently registered as an organization. I am also a member of this Facebook group and supported the call for unity. I have been a member of MMA since I was a houseman and had been active with MMA since then. I have been a committee member of MMA Johor since 2000, SCHOMOS Chairman of Johor for 3 years and National SCHOMOS Treasurer for 2 years. Currently I am the CME Chairman since 2013. While I support MPCN’s call for unity, I always felt that they should work with MMA and all their members should also become MMA members. Only with total strength we can fight.

Unfortunately, doctors are far more divided than before. Not only we have MPCN, we also have GPs united and don’t forget the race and religion based association such as Persatuan Doktor Islam Malaysia (PERDIM), Muslim GPs united and even Kumpulan GP Melayu etc etc. IT is very sad to see that after almost 60 years of achieving independence, we still want to fight a course by differentiating ourselves along racial and religious lines. While all of us are doctors through western education and sworn to help human beings irrespective of who they are, I wonder how differentiating ourselves along racial and religious line will help mankind. These include backstabbing each other etc.

We must not forget that we are all in the same ship. We leave in symbiosis. If one falls, everyone falls. Frankly, our ship is sinking! Politicians will find whatever way to keep their power and thus, the increasing rhetoric on protecting race and religion. We, the so-called most educated people in this country should be the uniting factor. Unfortunately, day-by-day, I see the most educated people believing in conspiracy theories and prefer to hold on to their race and religion cards. Sad indeed.

I see each of these groups organising separate forums and agendas to fight the dispensing separation (DS). The only unity I see is the fight against DS. Why not we merge into a single group and fight the battle together? Why must we fight separately? Is it because, everyone wants to become a hero of their own group? I see sincerity in MPCN’s boss Jim Loi. Being in an organisation for almost 17 years thought me one thing: backstabbing is common. There are many armchair critics and keyboard warriors who will only talk but will never help you when the need arises. There will be many who may be nice to you but will say the opposite behind your back. I have seen and heard enough. A person who you thought is your best friend may have a totally different agenda behind your back. This is becoming more common as our politicians use race and religion to their benefit. Many minds are being polluted with multiple conspiracy theories. Even a sincere help is considered as a conspiracy to “take over” the country, convert people etc etc!

Well, enough of my rant. Coming back to the DS story, our “MIC troubled” Minister issued a statement yesterday that DS is still in discussion stage and the government has not decided anything yet! Hah? There will never be smoke without fire !. Remember PHFSA in 1998? Before we knew, it was tabled in Parliament and passed!

Somehow I feel DS is inevitable as the government prepares for the next major restructuring after GST. It will be the health care system. The government will never be able to sustain the current public healthcare system. It will have no choice but to introduce a National Healthcare Financing Scheme. Whether it is for good or bad, we must be prepared for it. The future landscape for doctors will change. The only people who can challenge this will be the public……………


Gong Xi Fa Chai…………………. May the year of Goat bring us good luck.


Doctors meet to diagnose ailing industry
By Haresh Deol
Published: February 6, 2015 07:05 AM


KUALA LUMPUR, Feb 6 — As the debate for separation of the roles of doctors and pharmacists lingers, general practitioners (GPs) are racing to safeguard their interests in the wake of impending losses and additional costs imposed on them.

More than 50 doctors will gather in a closed-door meeting in Kuantan tomorrow to discuss the implications of:

• Separating roles of doctors and pharmacies;

• Implementation of the goods and services (GST) tax;

• Upgrading equipment involved in treating foreign workers;
• Growing number of clinics folding up;

• Over 4,000 private doctors who have quit in 2013 alone, mostly due to losses.

The disgruntled doctors insist these factors will impact their practice come April 1, leaving them little choice but to charge their patients more.

They cited rising cost of living and “bullying tactics” adopted by third party administrators as among the reasons for closure of more than 500 clinics between 2012 and last year.

But Health Ministry insiders claim, while nothing has been confirmed, the doctors are kicking up a fuss as they stand to lose their side-incomes from selling drugs.

“Dispensing separation will hurt the people not only in terms of more financial burden but other things like waiting time and other inconveniences,” said Medical Practitioners Coalition Association of Malaysia president Dr Jim Loi Duan Kong.

“The inconvenience of driving around for another parking space and paying for another parking coupon … that will happen if clinics no longer dispense medicine. What about the elderly? It’s just more troublesome for the man on the street. We’re not ready for it.”

Dr Loi admitted doctors would be able to “cut corners” if they continued to buy and dispense medicine.

“It has nothing to do with GPs enjoying kickbacks. It’s pure economics as doctors get to balance their accounts. We don’t dare to charge more than RM25 for consultation for a common flu or fever. We can’t hike prices of medicine as people know how much a strip of paracetamol cost. But many members insisted if the dispensing of medicine is taken away, then they would be forced to charge higher consultation fees.”

When told talk of dispensing separation has made its rounds since last year, he insisted: “This time it’s going to happen and it’s going to start in April.

“Right now will be what has been termed as the hybrid period where patients will be allowed to choose to either buy from the clinics or pharmacy. The dispensing of medicine will be phased out by April next year,” he said.

He has also received complains members have not received their dues from third party administrators on time.

“According to our statistics, there were 11,240 private doctors in 2012. The number dropped to 6,675 in 2013. In 2014 there were 6,865 private doctors nationwide. So many have quit as they cannot sustain.”

Another doctor from Jerantut, who declined to be named, said the introduction of dispensing separation will kick-start the 1Care for 1Malaysia health transformation plan — which mirrors the national health care service of developed nations including US and UK.

“But if you study the US and UK health care service, they have plenty of woes. It is not perfect. It is now even a top issue in Britain ahead of the May elections,” he said.

He said the rental of clinics and other administrative and operating matters were not exempted of the GST.

A Malaysian Medical Association top official said they have received numerous queries pertaining to the issues.

“There’s just so many elements disrupting doctors, especially those running their own clinics. Yes, many had quit and intend to quit. Some thought they could earn a steady income by becoming associated with companies through third party administrators but have instead been incurring losses. They also worry of the GST.

“But the dispensing of medicine is the final straw. It will be difficult for both doctors and patients. Let’s be logical, you’re already sick and the last thing you would want to do is to go in circles finding a pharmacy to buy medicine. Doctors will eventually hike their consultation fee as the current regulation states GPs can charge consultation fee of not more than RM120. So if a doctor used to charge RM25, if the dispensing separation kicks in, he or she could now charge RM35 or RM40.”

“Doctors face many woes and often suffer the end rot of it.”

– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-meet-to-diagnose-ailing-industry#sthash.vdpE6cZW.dpuf


Pharmacies to dispense medicines if proposal accepted

PETALING JAYA: Instead of getting their medicine from private clinics, patients will have to obtain it from pharmacies if the Health Ministry accepts the proposed “Doc­tors diagnose, pharmacists dispense” system.

While the system may cause some inconvenience to patients, pharmacists say it will help bring down the prices of medicine and give doctors access to many more drugs to prescribe.

It is learnt that doctors and pharmacists have held several discussions on the issue over the last year and they plan to meet the Health Minister soon.

They are represented by the Malaysian Medical Association (MMA), Medical Practitioners Coalition Association of Ma­­lay­­sia, Islamic Medical Association of Ma­­­laysia, Malaysian Pharmaceutical So­­ciety (MPS) and Malaysian Community Phar­­macy Guild (MCPG).

According to MCPG president Wong Sie Sing, the five organisations had, at their last meeting on Nov 8, agreed in principle that dispensing be left to pharmacists.

Representatives of pharmacists later met Health Ministry director-general Datuk Dr Noor Hisham Abdul­lah on Nov 26.

He said the two professions met to work out a timeframe to introduce the new system, adding: “I hope we can implement it by April.” Debate on the issue has been going on from as far back as 2008.

“If pharmacists are allowed to dispense, doctors would have access to 10 times more drugs to prescribe than what they have in stock. This will benefit the patients,” Wong said.

MCPG represents more than 2,000 community pharmacies employing some 2,500 pharmacists.

MPS president Datuk Nancy Ho said patients would receive further counselling from another group of well-trained healthcare professionals if pharmacists were to dis­­pense medication.

“The check-and-balance reduces prescription and dispensing errors. Dispensing separation is about professional medication management and only pharmacists are trained in this specialised practice. We know everything about a drug’s healing value and possible harm,” she said.

MMA president Dr H. Krishna Kumar confirmed that the associations had met on the proposed new system but said nothing had been agreed on yet.

Dr Noor Hisham confirmed meeting representatives of pharmacists, and said they discussed about integrating and consolidating the Pharmacy Act.

Stating that nothing had been decided on, he stressed that the ministry’s main priority was to ensure quality and safety.

Universiti Sains Malaysia (School of Phar­maceutical Sciences) Assoc Prof Mohamed Azmi Ahmad Hasalli said a 2013 study of 40 clinics and 100 pharmacies in Penang found that doctors dispensed more medicine and antibiotics and charged more than pharmacists.

Read Full Post »

The government recently had slashed the 2015 budget by at least RM 5.5b, mainly operational budget. I am not sure whether it will affect civil servant promotions for this year as promotions involves a lot of money. Generally, during any economic recession, promotions will be postponed. If the oil prices do not increase or the ringgit falls further, we may be in for a roller coaster ride this year. FYI, Petronas contributes at least a third of our government’s revenue! The government has also started to charge maximum full rate for any foreigners seeking treatment in government hospitals/clinics. This is also to generate more income for the government as they become desperate for money.

In my previous blog post, I mentioned that the waiting period for Housemanship stands at about 6 months as of end of last year. The waiting time is expected to get longer this year as more and more medical schools starts to produce their graduates. However, from March 2015(hopefully), MOH will be introducing what is known as e-Houseman! NO, IT IS NOT Housemen working from HOME for heaven’s sake but a way to shorten the waiting period (see below).

MOH will be introducing an on-line housemanship placement portal for newly graduated doctors. Fresh graduates will first need to apply for Temporary Registration with MMC after which they need to apply to SPA/JPA. Once you  are accepted into civil service, you will be given a password and user ID to log into ” e-Housemen”. This portal will list all the available post in various hospitals and the vacancies. The waiting period will also be mentioned. It will be available online twice a month.

Thus, it is entirely up to you on where you want to do your housemanship. You decide based on vacancies and waiting period. If you decide to choose the popular hospitals aka Klang Valley, the waiting period will be even longer. It will subsequently affect your seniority in civil service. I hope this system will work flawlessly but as usual, I am a bit skeptical about it. How the system works will depend on how fast the system is updated by the respective hospitals/MOH. Human and system errors can occur.

ON another note, this will eventually overcome the maldistribution issues between rural and urban hospitals as well as East and West Malaysia. If you want a job early, go where the vacancy is. Similar situation will occur when the MO post becomes full. As I said many years ago,  as the situation becomes tight, maldistribution will be solved.

Happy Thaipusam and Chinese New Year ………………….

Massage from Dr Krishna Kumar MMA President

Massage from Dr Krishna Kumar MMA President


e-houseman bantu graduan pilih penempatan dengan cepat (http://bm.therakyatpost.com/berita/2014/12/19/e-houseman-bantu-graduan-pilih-penempatan-dengan-cepat)

KUALA LUMPUR, 19 Disember:
Kementerian Kesihatan Malaysia (KKM) hari ini melancarkan sistem penempatan graduan perubatan yang dikenali sebagai e-houseman, bagi memperbaiki sistem sedia ada.
Menterinya, Datuk Seri Dr S. Subramaniam berkata, sistem itu yang akan mula beroperasi pada 15 Mac 2015, memberi peluang kepada graduan perubatan untuk memilih hospital pilihan mereka.
“Kami mengenal pasti kelemahan dalam sistem penempatan graduan perubatan sebelum ini dan melihat sistem baru yang diperkenalkan ini lebih telus dan mudah.
“Ini sekaligus mengikis persepsi orang ramai terhadap kementerian yang kononnya memilih kakitangan dalam proses penempatan,” katanya selepas merasmikan Persidangan Pengurusan KKM di Hotel Royal Chulan, hari ini.
Beliau berkata, graduan perubatan yang berdaftar dengan Suruhanjaya Perkhidmatan Awam (SPA) dan mendapat sijil pendaftaran sementara daripada Majlis Perubatan Malaysia (MMC), layak menggunakan sistem ini dan proses seterusnya dilaksanakan serta diluluskan KKM.

Tambahnya, proses ini hanya memakan masa 10 minit, jika graduan sudah memilih penempatan mereka dan bersetuju dengan syarat ditetapkan.
Katanya lagi, sebelum ini proses penempatan memakan masa lama dan kerjasama dengan SPA serta MMC dapat mempermudahkan semua urusan.
“Sebelum ini, KKM akan memilih penempatan untuk graduan dan kini mereka boleh memilih sendiri, sekiranya ada kekosongan. Permohonan itu akan dibuka dua kali sebulan dan prosesnya adalah mudah,” katanya.
Dalam perkembangan lain, Subramaniam berkata, persidangan bertemakan ‘Towards a seamless organisations’ bertepatan usaha mentransformasikan sektor kesihatan, bagi memberi perkhidmatan lebih cekap dan berkesan.
Seramai 229 peserta menyertai persidangan itu, bagi menambah pengetahuan dalam aspek pengurusan menyeluruh, untuk mendokong visi dan misi KKM, selaras peranannya sebagai peneraju perkhidmatan kesihatan negara.
Read more: http://bm.therakyatpost.com/berita/2014/12/19/e-houseman-bantu-graduan-pilih-penempatan-dengan-cepat/#ixzz3PpH9dGQp


Just 10 mins for emplacement of interns under e-Houseman system
Posted on December 20, 2014, Saturday

KUALA LUMPUR: The Health Ministry yesterday launched the cutting edge ‘e-Housemen’ system for emplacement of medical graduates during their housemanship.
Its minister Datuk Seri Dr S. Subramaniam saw the new system would expedite processing of housemanship applications from one month currently to just 10 minutes.
“Before this system, medical graduates had to register with the Malaysian Medical Council (MMC), Public Services Commission (PSC) and the Health Ministry.
Now they just have to register with MMC only.
“After registration with MMC, they will be given a temporary registration certificate following which they can use the ‘e-Housemen’ system that will be operational from March 15,” he told a press conference after opening Health Ministry’s Administrative Conference and Innovation Night 2014 here yesterday.
Elaborating on the system, Dr Subramaniam said medical graduates could choose which hospital they wanted to do their internship and if there were no vacancies, they could defer it until that particular hospital had an opening.
He added that system would also put an end to perceptions that the housemanship system was bogged with bureacracy and favouritism.
The three-day conference themed ‘Towards a Seamless Organisation’ which began yesterdaY is being attended by 229 senior officers of the ministry and hospitals. — Bernama
Read more: http://www.theborneopost.com/2014/12/20/just-10-mins-for-emplacement-of-interns-under-e-houseman-system/#ixzz3PpHQMw8e

Read Full Post »

It’s been a while since I updated my blog. It has been a hectic year-end for me with so many stuffs to settle including registration for GST etc. Interestingly, along the way I received a lot of information regarding issues surrounding the field of medicine. After my last post, I received a lot of comments in this blog, some questioning the bullying and long working hours etc. As I have said many times before, doctors cannot run away from working long hours. The recent floods in many of the states in Peninsular tells you how doctors had to work when situation demands. Hospitals in Kelantan were flooded and many critically ill patients had to be transferred to other hospitals including to Klang Valley hospitals. Doctors in these hospitals who worked tirelessly trying to save lives never even considered how many hours they had worked! When the situation demands, as it always does, doctors work. That’s the reality. So, for junior doctors who thought that doctor’s life is just sitting in a cozy room and seeing patients as they walk into your clinic, please change your perception. If you can’t handle it, it is better to change your profession or do something that is not clinically related. As for bullying, I had said enough. Unless the system changes, nothing will change.

Since almost 8 years ago, I have been constantly writing about possible future unemployment of doctors. Despite producing all the facts in this blog over the last 5 years, many refuse to believe and accused me of trying to take care of my rice bowl. Some even said that there is no such thing as unemployed doctors! The reality is now right in front of our eyes. In fact, it is happening 2 years earlier than I predicted (2016). Please remember that 50% of the medical schools in Malaysia just started to produce their graduates since 2014 onwards and these medical schools have not reached their maximum production capacity yet.

MMA had a meeting with the Minister of Health last month and the Minister finally admits (he refuted the allegation last year during a dinner meeting with MMA) that we are facing shortage of post for doctors. I attach the snapshot of the interview below. He said that the waiting period stands at 6 months now and will get longer. He also said that they might raise the min requirement to 5As in SPM. However, he declined any possible pre-employment exams, likely due to political pressure. As I had said many times before, I disagree that SPM being used as sole criteria. A better method would be to limit the type of Pre-U courses that can be accepted for medical schools. Foundation studies, which are NOT standardized, should NOT be used. Established standardized Pre-U courses like STPM, A-Level, IB, AUSMAT etc should be the sole entry qualifications. I also support a common entry exam as practiced in many other countries but of course it is a politically unwise move as many MARA, Majlis Agama and JPA scholars may have a problem if they do not pass the exam.

There are still many out there who do not understand the field of medicine. Just last week I was talking to a Marketing executive regarding the 6 months waiting period for housemen and possible limitation of employment for doctors. His immediate respond was: why not do Masters while waiting for employment!! Their perception is that Masters in medicine is equivalent to any other Masters program as for other fields. In any other field, you can directly go for Masters after graduating without any employment. BUT in medicine, post-graduate training is a FULL TIME WORKING AND PART TIME STUDYING. You can’t get into a Master’s program without completing your housemanship ( aka full MMC registration) and at least a year of MOship. It is the same anywhere in this world.

Recently I received an email from a doctor in Bahrain. He allowed me to share his predicament in my blog, as below:

“I discovered your blog website some time back, and I have to say your words and experiences are a strong confirmation about what I have been feeling about Medicine even before I graduated as a doctor in 2004.                            My parents are old school folks from Karachi, settled in Bahrain since 1979. I was educated in Bahrain, and was sent to Pakistan to study Medicine.                           

During my time as a medical student in Pakistan, I had to suffer a dysfunctional and rotten state education system, and students willing to do anything unethical to cut corners to jump ahead. Following the crowd and herd thinking has always been something I hated.                           

I always had a strong suspicion in medical school that conditions were going to be worse, and the western nations would close their doors and opportunities for everyone taking the USMLE/PLAB path. I really wanted to get myself away from all those problems and study healthcare management in the UK.                           

Business and politics has interested me more than clinical practice. I don’t necessarily hate Medicine, I just hate the lack of opportunities and deep problems that await you even before graduation from Medicine.                           

I told my parents before my graduation that I would change my career after gaining the MBBS degree, but was forced to continue after my housemanship.                           

I passed MRCS part 1, PLAB 1 and PLAB 2 after a lot of investment of time while not working in Bahrain. I really wanted to train as a surgeon in the UK, because I seemed to have been mentally competing against my professor of surgery. But during my time in the UK after gaining full GMC registration, I realised that the market and training job/post for which I had struggled for was non existent.                             

After making no headway in the UK, I returned to Bahrain, cleared the licensing examination and subsequently joined a private medical centre as a General Practitioner. I am grateful to Almighty God for allowing me to earn and save money while living with my father. My saved income has made me feel confident, and allowed me to think about what to do in the following 5 and 10 years ahead.                             

My advice to everyone around me is to avoid medical school at all costs and try achieving more at less financial and mental investment. That is in line with Sun Tzu’s principles in the Art of War. A senior UK registrar from the UK agreed with me when I said studying Medicine does not make any business sense in this day and age.                           

Hope to meet you one day soon to talk about the abysmal state of affairs of doctors worldwide.  

Regards & Best Wishes “  

He also said the following, which I had already mentioned long time ago:

Most, if not all of the children wishing to become doctors have had no real exposure to hard economic facts of life and the job market. It’s very easy to say one wishes to serve mankind, but once you graduate and your family can no longer support you, and you have utility bills, rent etc to pay every month, then feelings of charity gradually fades away. The world and society have no patience with anyone who can’t pay their way or find a job, why should medical graduates be treated or regarded any different from everyone else?”

As mentioned by him, when you ask anyone who wants to do medicine, the standard answer will always be “ I want to help people”. Of course at that young age, many do not know anything about medicine or just get carried away with what is shown on TV. Furthermore, they are living with their parent’s money with no commitments. I have had many medical students who wanted to help people in war-torn countries and work with WHO etc but ended up going nowhere. I know some students who said that they want to set up charity clinics and even start a foundation to help the poor etc. Do you see any doctors doing as such? Life starts after you graduate, when you start collecting debts (if not already), get married, have children and your parent’s financial help gets cut off (unless your parents are millionaires). This is where you will realize that no matter what your earlier intention was, reality bites. You will realize that being a doctor is just another job to earn a living. All the noble intention will disappear into thin air. Very few will endeavor.

Here I attach another email from a lawyer who reads my blog, which is self-explanatory:

I think one of the main reasons for the deteriorating quality of HOs is because they don’t understand the profession before leaping into it. This is a  “fast-food generation” where people seek instant gratification and get all disappointed when things do not immediately live up to their expectations. A lot of parents are still under the delusion that doctors immediately earn a lot of money and live a comfortable life with guaranteed jobs, so they keep encouraging their children to do Medicine for all those wrong reasons. It makes me very sad – more people should read your blog in order to quell these misconceptions.”

Doing medicine is not a good idea if you intend to migrate. However, I use to say that if you intend to migrate, please do medicine in the country where you intend to migrate. Unfortunately, even that may change soon. Just last month, there was a suggestion in UK that all foreign students graduating from UK must leave the country before applying for a job. This will have a great impact to medical graduates as they are usually given internship post under student visa. Graduates from outside UK are almost impossible to get an internship post in UK despite passing PLAB due to their immigration laws. The situation in Australia is also the same as I had written over HERE as well as what was written HERE. The reason why I keep saying this is because due to the current political climate of this country, almost 80% of non-bumis that I talk to are planning to migrate, atleast for their children.

Some may argue that we are still short of doctors as you can see hospitals being overcrowded with doctors running around. While I agree that we are short of specialist, I disagree that we are short of general doctors. What we are facing is actually MALDISTRIBUTION of doctors, between urban and rural, between public and private, between hospitals, between departments and between East and West Malaysia. Klang Valley has a doctor: population ratio of 1: 400 but why are we seeing the public hospitals overcrowded with patients? That’s because, public hospitals and clinics are catering for 80% of the population. If you add up all the beds in Klang Valley (private and public), we have enough number of beds to cater for the population. Same goes for the number of doctors but many of these doctors are either running their own clinics (GP clinics), in private hospitals or doing administrative work. The only way this “presumed” shortage of doctors would be solved is when we integrate the private and public health sector into a single entity paid by a National Health Financing Scheme. The supposedly 1CARE scheme is still in limbo for time being. The private healthcare is almost 80-90% supported by insurance. If insurance companies collapses, the private healthcare will collapse! Specialist can also become jobless.

The government on the other hand would not be able to sustain the ballooning healthcare cost by building more hospitals or creating more post. We are one of the very few countries in the world, which is still surviving with a system created by the British almost 50 years ago. It is not sustainable. Thus, as long as housemanship is under civil service, there will come a time where the government will not be able to give employment to everyone as what is happening to the nurses. The filtering has begun with the re-introduction of compulsory SPM BM paper for all, including foreign spouses and non-availability of post for PRs as mentioned in my earlier post.

We also know that government is financially hard pressed now. The fall of the oil and commodity prices, the rise of US dollars etc is putting a lot of burden to our financial coffers. Our ruling regime has wasted enough money. The 47% who voted for them were deceived by the false promises from the ruling government. When the opposition said that we are heading for bankruptcy before the election, many supporters of the ruling government refuse to believe. We have a bloated civil service (one of the highest per capita population in the world), which is also not sustainable in long run. Almost 50% of our budget is allocated as operational budget, meaning paying civil servants (25% of the budget) and to maintain and run the civil service. As much as I don’t like Dr M for his social engineering and the reason for racial polarization in this country, I must agree to some of his long-term policies such as Dasar Pensyarikatan and Dasar Penswastaan. The whole idea is to reduce the number of civil servants to about 500K to reduce the financial burden of the country. Unfortunately, the number has bloated to almost 1.5million in just less than 10 years after he left! No job is going to be guaranteed in the future.

My advice for students is to do what you are interested in after doing some research and not based on which field can make more money and which field has more prospect etc. If money is your intention, than there are many ways you can make money. Most millionaires do not even have a degree! If migrating is your intention, never do medicine. Jobs that are most needed nowadays are not professional jobs but technical jobs like interior designing, any form of designing, architecture, software engineers, accountancy, technicians etc. Professional jobs limits you in many ways. Do it only if you have real passion for it.

Happy New Year  to everyone……………… May 2015 be a better year for Malaysians……….


Read Full Post »

I attach a request by a medical student to publish the following survey in my blog. Please support her. The closing date will be 15/01/2015.

A dead body can create miracles. Do you believe that it can rise from death and save lives? We want to know how much you know about this mighty act of organ donation. So, please help us to complete this online survey by just a few clicks. 4 minutes of your time means a lot for us, thank you!

English version: http://goo.gl/forms/C0UJSwVPzQ
Malay version: http://goo.gl/forms/84sSK6Y69y

Yours sincerely, UniKL-RCMP Year 4 medical students.

Read Full Post »

Well, I just returned from my holidays down under. During my holiday, I read a lot of news regarding housemanship situation back home. In fact, before I left to Australia, I did receive few emails and phone calls regarding latest development in housemanship postings. However, I did not have the time to write anything till today.

In my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among housemen. I would not elaborate further on these 2 matters. Before I left for my holidays I received at least 3 emails/blog comments regarding new developments in housemanship employment. We all know that Malaysia do not provide housemanship for foreigners. I had received many queries from foreigners in India, Pakistan etc enquiring about this. However, foreigners who are married to Malaysian can be given housemanship post under contract if your degree is recognised in Malaysia. Unfortunately, the situation seem to be changing rapidly.

About 2 months ago, I received information that a Malaysian PR was told that she will not be given a job by KKM. She is a Singaporean who grew up in Malaysia right from kindergarten days. She graduated from one of the private college here. Following that, I received 2 emails from foreigners ( one from India and another from Indonesia) who are married to locals. Both had degrees which were not recognised by MMC. Thus, they spend almost RM25K going for attachment and sitting for MQE exams. They passed. Unfortunately, when they applied for housemanship, KKM told them that a new rule will be implemented . They will need to sit and pass/get credit for SPM BM paper!! It is very clear that KKM do not have enough post to provide housemanship for foreigners or PR holders. Thus, they are creating “so-called” new rules as an excuse. As I have said many times before, passing MQE do not guarantee you a job. This applies to any country in this world. Every country will give priority to their citizens followed by PR. BTW, even Malaysians who do not have BM credits may not get a job soon!!

Many at times, when graduating students ask me whether they should start their housemanship while planning to sit for USMLE or AMC exams, I had always advised them to do so. This is because, passing AMC or USMLE or PLAB DO NOT mean you will get a job in those countries. Unfortunately, there are students who felt otherwise. They felt that if they start housemanship, they will not have enough time to prepare for these foreign exams. Well, they may be right but life in medicine only gets tougher and never gets easier. As I had mentioned since 2012, Australia is also facing internship crisis. The situation will only get worst from next year, as mentioned over HERE. So, if even their own medical school graduates may not be able to get internship post, what more foreigners, who are sitting for AMC exams. So far, I heard only 5 Monash Malaysia graduates manage to get internship post in Australia for 2015.

I received an email from a local university graduate who wanted to migrate to Australia. She declined housemanship posting in Malaysia mid of this year and decided to sit for AMC exams. She had passed her Part 1 and planning to sit for her Part 2 soon. Then came the bad news. Her senior of 1 year who had already passed her AMC exams is returning to Malaysia to apply for housemanship as she could not get an internship post in Australia. It is the same for USMLE as well. I know many who never manage to get residency of their choice. Thus, I will say this again : NEVER do medicine if your intention is to migrate!!

Over the last few weeks there have been multiple letters to newspapers regarding the working condition of house officers. While I had written many times about these issues before, what interested me most was the letter written to Prime Minister’s office. I received a copy of this letter which I would not publish over here, presumably written by a group of housemen from Klang Valley. The letter states 2 main  issues: one on bullying and another on long working hours(supposedly 17-18 hours). Few days after I received the letter, I also saw the letter from PM’s office instructing the state health department to investigate the truth of the matter. It also appeared in the Star. Let me elaborate on both.

2 days before I left to Australia, I received a phone call from a mother whose daughter is doing housemanship for the last 3 months. She informed me that her daughter is very depressed and wants to quit housemanship. She claim that she is being bullied and she is unable to handle it any further. Surprisingly, according to her, the biggest bullies are NOT specialist or even MOs. It is the senior house officers!! Firstly, we need to define what is bullying and what is scolding. Medicine deals with patient’s life and thus certain mistakes have serious repercussions. You go to medical school to learn the basics of medicine and housemanship is to apply those basics in real world clinical medicine. The problem now is the fact that the quality of house officers has deteriorated tremendously to the extend that the senior doctors just throw their tantrum all over the place. Who will not get angry when you do not know how many chambers does a heart has? They should not have graduated in the first place! While I agree that scolding your juniors in front of patients and public should not happen but sometimes, the hectic work life of specialist or MOs just shoots them off the roof.

Bullying on the other hand has nothing to do with scolding for making mistakes.Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Unfortunately, this seem to be an Asian culture. I had said it many times in this blog that the very same person who is complaining about bullying, will become a bully when he becomes a senior. I had personally seen this right in front of my eyes. AND that is exactly what is happening in the case above. The biggest bullies for her daughter were Senior HOs!! As long as these happens, bullying will not end. While KKM do have protocols to make complains on bullying, the line that demarcate bullying and scolding is blurry. The deteriorating quality and the surge in the number of housemen will only make bullying worst.

The second issue was ” working hours”. I had also written about this before over HERE in 2011. While I don’t agree working 32 hours continuously  as what we did when we were housemen, being a doctor means we have to work long hours! That is a fact that most students should know before doing medicine. We cannot just let go of our responsibility to the patient before going home. WE must make sure we have done what we need to do. There is NO such thing as office hour job for doctors. In the court of law, patient safety is the most important consideration. These housemen think that they are the only one working 17-18 hours a day. Most doctors do and even people in other profession work long hours. The only difference is in other profession, you can bring your work back home where as in medicine, your work is done in the hospital. Even after 18 years of service, I am still working 24hours a day, 7 days a week. I can be called anytime of the day, even on weekends. Life in medicine will never get any easier. You must learn to work long hours. If you can’t, then leave.

Our DG has given a good reply to those who complain about working hours over HERE(see below). Another reply from a Paediatrician is also worth reading for those who complain about working hours (see below). Interestingly, a recent study in US showed that work hour limit for trainee doctors do not improve patient safety!! I know many who complains about working hours but will be sitting in a clinic doing locum when they are free!.

You chose this path and you need to adapt to what medicine wants you to be. Life’s are at stake and medicine is a life long learning. Even now, I am still learning. The most important teachers are your patients! The more time you spend with your patients, the more you will learn. I may be harsh but my advise to those who complain of long working hours is : please leave if you can’t handle it.

Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
Posted on December 10, 2014 by DG of Health
I refer to the article published in The Star entitled ‘Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.

The Ministry of Health (MOH) appreciates all feedbacks which have been provided on the housemanship training. Housemanship programme emphasises on training rather than merely employment, whereas the medical officers’ main role is to provide medical service, hence their roles are different. The 2-year housemanship has started since 2008. It encompasses training in 6 disciplines namely General Medicine, Paediatrics, Surgery, Orthopedics, Obstetics and Gynaecology, and alternative postings (either Emergency medicine, Psychiatry, Anaesthesia or Primary Care) for a period of 4 months each.

The housemen flexy working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexy system is among the continuing efforts by the government to maximise the houseman’s learning process which aims to further improve their working conditions. It provides a chance for them to gain experience and take advantage of the learning opportunities to be competent and safe doctors.The flexy system requires the housemen to work an average of 65-75 hours per week. Housemen are entitled to a one day off per week but it is not necessary for it to fall on weekends. Housemen are doctors under training and they must fully utilise the opportunity given to them to improve their competency. MOH is monitoring closely the housemanship training in government hospitals to ensure the flexy system is successfully implemented.
Feedback pertaining to Housemanship Training need to be chanelled to the Housemanship Training Committee at the hospital and State Health Department. It is worth mentioning here that the doctors’ utmost responsibility and inherent value is providing safe and quality care to the patients. The nature of doctors’ working hours is different than other civil servants because patient care requires continuous services of 24 hours a day or 7 days a week.
In appreciating our doctors’ commitment, the Government has given various incentives such as the critical allowance of RM 750 per month and a special allowance for housemen of RM 600 per month. It is hoped that with all the efforts made by the Government, the aspiration to produce quality and competent doctors for the nation will be achieved.

Director-General of Health Malaysia.

HOs must stop griping and learn the job
I REFER to the letter “Trauma faced by some housemen in hospitals” (The Star, Dec 8) on the trauma faced by House Officers (HO) at the hands of seemingly sadistic Medical Officers (MO).

I would like to offer a different view of the matter lest the public gets the wrong impression of how medical supervision is practised here and worldwide.

No MO will willingly traumatise a HO unless the former is extremely overworked or the HO is so hopelessly trained that the MO is so exasperated by the inadequacy of medical knowledge and lack of responsibility.

With the current standard of medical graduates coming back, some of whom with dubious medical training in institutions that have been approved through political means, it is not surprising that the MOs are stressed by these incoming HOs.

The extension of a HO after the stipulated period is the decision of the supervising specialist, and he or she has to justify appropriate reasons for extension.

If the performance is still below par after the extension, the HO’s name will be forwarded to the Health Ministry’s director-general to send him to another specialist for supervision.

Nobody likes to extend a HO because of the paperwork that is involved but due to the maintenance of a respectable standard and the future safety of patients whom the HO will be entrusted with, these MOs and specialists have to maintain these standards of care.

The writer has to understand that getting a paper with MBBS or MD is just the beginning of a lifelong journey of training and retraining.

The initial degree should have taught a basic foundation in medical knowledge, ethics and basic practice to allow the HO to function with further supervision for another one to two years and be trained to be a specialist of his or her choice after that.

Without any further training, the MO can become a general practitioner in this country.

If the HO’s performance and knowledge is below par compared to his peers, it will not be fair to let him “loose” to the general public.

This training of HOs occurs all over the world and it is one way of ensuring that the public will be given safe young doctors to treat them in the future.

Ask any supervising specialist in the profession and one hears of the deteriorating standard and responsibility of new incoming HOs.

There are good ones who perform and never write in the newspapers and there are bad ones who complain about working 32 hours at a stretch. They just have to get used to it!

That’s what they signed up when they chose medicine where the patient is paramount to our sleep, food or toilet habits.

I think the writer exaggerated about the predicament of HOs. There is not a trained specialist who has not slept in the operating theatre, patient’s bed, at the table or in the toilet in his lifetime.

A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.

These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.

The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.


Kuala Lumpur

Read Full Post »

My last blog post received almost 27, 000 views in a single day on 5/11/2014. Numerous comments were made. My comment was very simple, a once well-respected and trusted profession to whom the community looked up upon, has gone to a stage where the authorities have to ask sisters/nurses of the ward to monitor their discipline. Some commented that there are only a few bad apples in our profession BUT let me tell you, for those who are not in the system will not know that it is NO MORE a few bad apples. The fact that the Minister has to instruct and give extra job to the sisters to monitor the discipline of house officers is enough to explain the gravity of the situation. BTW, the topic discussed had nothing to do with insulting the nursing profession. It was all about the deteriorating attitude of OUR profession! We brought it to ourselves.

The same situation seems to be happening in smaller district hospitals and Klinik Kesihatans. I am beginning to hear stories that taking MCs, EL and coming late to work is becoming very common nowadays, despite having more MOs. Sometimes I wonder whether it is better to keep less number of doctors than having more as it is easier to monitor. I always believed in quality than quantity. Recently I heard that 4 MOs did not turn up to work in a KK on the first day of the week! 2 decided to take MC, 1 took EL and another claim stuck in traffic jam! Some MOs were found to be taking frequent MCs (must be immunocompromised I guess!), given to each other by themselves! What will MOH do about this ? I am sure sooner or later, another similar circular will be issued to KK sisters to monitor the situation. Few years ago, there was already a circular stating that MOs can only be given MC by a specialist but no one seem to be following this anymore. What impression does the other staffs of the clinic will have on us? An unreliable bunch of ………..?

Every now and then, I hear that HOs and MOs do not turn up to work because they are busy doing locum in 24hr clinics. Some has been caught before. Let me remind those HOs that doing locum before full registration(aka completing housemanship) is ILLEGAL! MOs are allowed to do locum with permission from the Hospital Pengarah. However, the place where you are doing locum must be written in your APC. As a doctor, you can only practise at the places mentioned in your APC. Practise at any other place can be deemed illegal.

All these years, even after locum was legalised in 2006, MOs/Specialists locum incomes are never properly declared to LHDN(IRB). While the clinic may declare the locum fees paid as an expense, I am not sure how many doctors who do locum ever declare their income generated from locum. Remember, every income that you receive are taxable. We all know that the government is running out of money! The last Budget 2015 and the impending GST are clear indications. The drop in oil and oil palm prices in international market will further reduce our country’s income. So, the government has to fall back upon the people to get the money back! Thanks to the 47% who voted in the last election. The toll prices are going up next year, electricity tariffs may go up in June 2015 and petrol/diesel subsidies are being removed effective 1/12/2014. While doctors who are running clinics cannot charge GST to patients (GST exempt), they have to pay and absorb all the GST charged by their vendors on supplying equipment, drugs and clinic rentals. Thus, the overhead cost will definitely increase which in turn reduces your net income further. ON the other hand, an increase in your consultation fee is limited by the government and the patient’s ability to pay! Patient’s cost of living will also increase after GST implementation.

While GST comes under Customs department and follows a completely different set of protocols, income tax comes under LHDN. Doctors in private hospitals who are generally self-employed are still confused about GST. Negotiation and discussions are still going on, between MMA, APHM, Hospital Managements and Customs.

LHDN on the other hand is going around blocking all the loopholes they have, to generate more income for the government. Coming back to the locum incomes mentioned above, LHDN is sending circulars to clinics making it compulsory to declare who their locums are!! The circular (see below) clearly says that, it is needed for LHDN to collect more MONEY! So, for those who thought can do locum and escape without paying tax, please beware. LHDN may come knocking at your doors one of these days. The penalty can be an additional 20% of the tax not paid! Furthermore, you can be barred from leaving the country!

As I wrote in my Part 1 and 1b of the above topic, life is not going to get any easier for doctors. So many rules and regulations are changing nowadays. If the separation of dispensing rights happens in April 2015, income of doctors will further decline. The medico-legal cases and seeking compensation from doctors are also increasing day by day!

Well, it’s time to take another holiday to clear my mind and release my stress. I will be away and may not be able to answer the comments in this blog from 26/11/2014 till 7/12/2014. It’s time for me to go for another round of thrill rides down under!

Good Day mate!




Read Full Post »

« Newer Posts - Older Posts »


Get every new post delivered to your Inbox.

Join 1,504 other followers