Archive for the ‘Education’ Category

For a physician in Malaysia, Dengue is considered as a bread and butter disease. Since Dengue was first discovered in Malaysia in early 1900, it had claimed many lives. Unfortunately, to date, there is NO cure for this disease.

The current Dengue epidemic/outbreak, which started almost 11 months ago, somewhere in April 2013, is one of the longest and most disastrous episodes I have ever seen during my 17 years of service. I have never seen such a long epidemic before and it looks like there is no end coming.  Unfortunately, our public who screams when they hear about 3-4 H1N1 cases or Hand Foot Mouth syndrome seems not to be bothered about Dengue. They take it very lightly as though it is a non-fatal disease. For the year 2013, Dengue had claimed almost 94 lives. The number has reached 17 deaths in just 37 days of this year! Remember, majority of these patients are young and healthy individuals. JB hospital is having 1 death every week since November 2013!!

Where are we going wrong? It is a preventable disease and a holistic approach is needed. Our public health officers seem to be overloaded with this epidemic, so much so, they do not even come and interview any dengue cases in the wards anymore. Personally, I feel it is of no value. As long as they are aware the number of patients and where they are from, actions should be taken. Unfortunately, I feel that we are losing the battle. We are still deploying the same strategy since the last 50 years or so, which clearly has failed to control the disease this time around! The actions taken also seem to be rather slow due to shortage of manpower and lack of budget. What is the point of notifying within 24hrs when no action is taken within 48 hours?

Opening “Klinik Kesihatans” up to 10pm is not going to solve any problems either. Our Health Minister announced before the Chinese New Year that KKs would be opened till 10pm in Dengue Hotspot areas to reduce the congestion at Government Hospital emergency departments (ER). I think the more important issue is to educate the public that emergency department is for emergencies and not for cold cases. In 2003, MOH introduced outpatient clinics in Emergency Department with a rate of RM 40/hour. It was open to all doctors in the hospital. It failed. Subsequently, with the same reason of reducing ER patient load, most major KKs were asked to open till 9.30pm with a locum rate of RM 80/hour since 2008. Again, did this reduce the ER department patient load? The answer is NO. What we need is “public-private” integration, which will make our GPs as part of the primary health care system supported by a National Health Financing Scheme. This is what 1Care “suppose” to do but due to the current political situation, it has been postponed once again.

Now, with the excuse of Dengue, all KKs in hotspot areas are being asked to open till 10pm. Likely, even after this epidemic settles (hopefully), the opening hours of these clinics will remain, with the excuse of “ receiving good response from the public” as the 1Malaysia clinics supposedly did. The GPs nearby these clinics will definitely be affected. Eventually, MOs in KKs will be asked to work shift duties in order for KKM not to pay the “overtime allowance” of RM 80/hour. A pilot project of shift duty was conducted in KK PD last year. With close to 15 MOs in major KKs, it is not impossible to introduce shift duty. It will come, whether you like it or not. The only problem will be safety issues especially for female doctors and lack of support staffs despite having enough doctors.

What are we lacking in the preventive measures for Dengue?  Firstly, we are still going after the Aedes mosquito after the incidence has already occurred (chasing from the back). Fogging and house inspection are only done almost 2-3 weeks after a case is reported in a particular area. By this time, the mosquito would have bitten hundreds more and would have laid hundreds of eggs all over the place. Should we think about detecting Aedes mosquito breeding area before it even starts to infect people with the Dengue Virus? During the 2003 outbreak, the then Johor state Pengarah Dr Prethapa Senan came up with a good idea.  He decided to place a half cut mineral water bottle(small), on a wooden stick, pricked to the ground every few kilometers in a hotspot area. The health inspector will periodically check these bottles and immediate fogging and cleaning of the affected area with residence help is done, if an Aedes mosquito larva is detected. I found it rather interesting and  although it involves a lot of work, it did bring down the number of dengue cases and the epidemic was over in just 6 months. Another issue that I always wonder is to what happened to discussions between MOH and researchers and academics from our universities?? I am sure many academics are involved in Dengue research and their expertise may be useful in controlling the disease.

As far as I am concerned, this Dengue outbreak should be considered as a National Disaster and a proper disaster plan should be developed for an all out war against Dengue. BUT I don’t see it happening from our political masters who are more interested in making “jokes” everyday in public. I don’t see any massive adverts to “scare” the people in the mainstream news, papers as well as alternative medias. This disaster should send chills through the spines of every resident so that the people will get frightened and do the needful to help the authorities. The Ministry should work hand in hand with the residence rather than working on their own. There is no point having mortality meeting after a death has occurred and only after that, inspections are done at the deceased house and surroundings to “prevent” another death!! Whatever said, Dengue is a public health issue and not a clinical issue.

There is NO cure for Dengue. IT is your own body’s immune system that kills you. That’s why the complications occur after the fever settles as your immune system starts to produce antibodies. It is also the reason why a secondary infection is more fatal than the primary infection. Many patients have the idea that early admission to hospital can cure their Dengue but frankly, the body cures itself. The only thing that doctors do is to keep you well hydrated and treat the complications, hoping that your body will over come it’s own immune system’s assault. Thus, there are also many Dengue cases that can be managed on an outpatient basis. The most important thing is that the patients need to be monitored by an experienced doctor. From my experience, when complications occur, many will die no matter what we as doctors do! You survive purely by luck!

Whether anyone realize it or not, this outbreak is a huge public health burden and draining huge amount of money. The insurance companies are bleeding billions of ringgits due to huge amount of admission to private hospitals. Many of these admissions may not be necessary but the fact remains that a patient can only use his medical card if he/she gets admitted. Thus, there are many unnecessary admission to private hospitals simply because the insurance companies do not cover outpatient treatment. I would suggest that insurance companies should make some adjustment during this outbreak to cover outpatient treatments of Dengue. This will definitely save a lot of cost for them.

It is rather sad to see young patients dying from a tiny virus and a mosquito. Many at times, we just watch this patient’s die right in front of our eyes as we stand helpless! May this epidemic come to an end soon………………

National dengue alert

Posted on 6 February 2014 – 10:15pm
Last updated on 6 February 2014 – 10:34pm

Annie Freeda Cruez

KUALA LUMPUR (Feb 6, 2014): The dengue fever and dengue hemorrhagic fever situation is worsening nationwide, with the number of cases hitting 9,453 and 17 deaths, all within the first 37 days of this year.

For the same period last year, the figures were only 2,559 cases and five deaths.

Expressing concern, Deputy Director-General of Health (Public Health) Datuk Dr Lokman Hakim Sulaiman said today: “Dengue is not only a big issue in Malaysia but also globally, as countries worldwide are experiencing an increase in deaths and cases and this is very worrying.”

According to the World Health Organisation (WHO), dengue cases has grown dramatically around the world in recent decades. Over 2.5 billion people – more than 40% of the world’s population – are now at risk from dengue and WHO currently estimates that there may be 50 million to 100 million dengue infections worldwide every year.

Lokman said the ministry has intensified its efforts to contain the outbreak but added that the public also needs to play an important role by keeping their houses and surroundings clean and free of mosquito breeding grounds.

“We can only contain the outbreak with public cooperation, especially from people living in urban areas,” he said, adding that three states have shown high incidences of the disease – Negri Sembilan, Federal Territories of Kuala Lumpur and Putrajaya and Sarawak.

He said that in view of the situation, even Health Minister Datuk Seri Dr S. Subramaniam was going to the ground once every two weeks to check on the situation.

The ministry has identified 594 dengue hotspots in the country, with 115 in Selangor, Negri Sembilan, Kuala Lumpur and Putrajaya, Lokman said.

He urged members of the public suffering from high fever (40°C/ 104°F) accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rashes, to seek immediate medical help.

“Do not wait till the situation worsens as severe dengue is a potentially deadly complication,” he said, adding that all hospitals and clinics were on the alert for dengue cases.

Extension of govt health clinics hours soon

PUTRAJAYA: Plans are afoot to extend the operating hours of government health clinics to accommodate the rising number of dengue patients, said Health Minister Datuk Seri Dr S. Subramaniam.

The move followed a 251% increase in dengue cases recorded in the first four weeks of this month, when 7,370 cases were reported against 2,098 in the same period last year.

A total of 2,229 cases were recorded throughout last week alone, marking a new weekly record high for dengue cases in the country’s history, he added.

“The number of patients in hospitals has increased significantly, especially at the emergency departments, where there is a need to reduce the load.

“There are already some health clinics that are open until 10pm, but we will study the possibility of extending their operating hours, especially at high-density areas in Selangor and Kuala Lumpur, where the load is heavy at the hospitals.

“Not all dengue cases require patients to be warded as some can be monitored without being warded depending on the doctor’s instructions,” he said at the ministry here yesterday.

He said a recent study conducted by the ministry found that the reproduction rate of the Aedes mosquitoes remained high in Penang (3.8%), followed by Sarawak (3.7%), Perlis (2.6%), Malacca (2.2%), Negri Sembilan (2.1%), Selangor (1.7%), Sabah (1.6%), and Kuala Lumpur and Putrajaya (1.5%).

Dr Subramaniam called on owners of premises that ensure that their places are free of Aedes mosquitos.


On dengue, what is the Health Ministry’s action plan? – Malaysian Doctor

FEBRUARY 07, 2014

Since early this year we have been hearing a lot of statistical data on the rise of dengue cases especially in Kuala Lumpur and Selangor.

The number of deaths is rising and number of aedes index statistics is also rising.

Dengue is a disease spread by a known vector the aedes mosquito. Control of the vector is an integral approach in managing the disease.

The Ministry of Health (MoH) has been very reactive in their approach of the problem so far by having many mortality review meetings and now extending clinic hours of its Klinik Kesihatan.

In other words more work for their clinical arm i.e. doctors that are seeing patients. The same doctors that are already overworked with increased number of patients are now expected to work longer hours to see more patients.

What we have yet to hear from MoH is what is their Public Health approach in preventing the continuing rise of the disease? The whole Public Health campaign against dengue has clearly failed with the rise in cases.

We wonder how much has been spent on the dengue awareness campaign last year by the District Health Officers in Selangor and Kuala Lumpur. We also wonder why when there are deaths in dengue only clinicians are questioned on their duties and not the District Health Offices.

When crime rates are high we question what is the police doing about it? Similarly when preventable disease rate is high we should be questioning what is the public health officers doing about it?

So is there someone in MoH that can provide holistic solution rather than spewing out statistical data only? – February 7, 2014.

* Malaysian Doctor reads The Malaysian Insider.

* 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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As of this month, my blog is 4 years old. As of today, this blog has hit 1.5million views since it started. Over the years, I wrote about many issues surrounding the field of medicine to wake people up from their “guaranteed job, money and good life” dreams. I was ridiculed many times and even given rude comments for telling the truth but no one can argue with the facts provided in this blog. After 4 years, finally the government admits that we are going to have surplus of doctors within the next few years. When I wrote this 4 years ago, in fact 6 years ago, I was laughed at!

Our Health Minister recently spoke on this issue and have recommended that the entry qualifications into medical school to be reviewed. He admits that we are reaching the doctor: population ratio of 1: 600. Thus, all application of new medical schools and application for increase of intake will be frozen. But yet again, we did hear this 2 years ago (May 2011) but nothing happened. Politics and money takes priority, I guess.

Frankly, getting 5Bs in SPM is nothing nowadays. The latest PMR results shows that close to 8% of students got straight As. So, how many students would have got at least 5Cs and above. Interestingly, these results are not for public viewing. I tried looking for the statistics in Ministry of Education/LPM website but I could not find. Is it a national secret? What I could get is only the media statement regarding the general performance of the students. IN 2011, almost 70% of PMR students got at least  all Ds and above. If you ask anyone who had interviewed graduates etc, they will definitely tell you that the standards of our exams and universities have gone down the drain. The quality of graduates are atrocious. Even from some of the comments in this blog, you can guess the intelligence of the students. Personally, I don’t blame them as the education system do not encourage students to think or learn.They don’t read anything other than what is thought in school. According to World Bank report, the standards of our teachers are also going down the drain. Almost 93% of our teachers do not even have 3 distinctions or more in SPM but yet the intake of teachers have increased by 30% over the last 5 years. We are more worried about quantity than quality, similar to the situation of medical graduates now. We should never compromise quality for quantity!!

The mushrooming of private universities/colleges since 1990s is partly the reason for this deterioration. The fact remains that these private entities are a profit driven venture. What they need is money but who cares of the quality of products. It is not them who are going to employ these graduates. The same goes to medial schools as well. We have had nurses with GCPA of near 4.0 but you will be shocked when you interview them. They can’t even answer simple questions which should have been thought in the nursing college. When you check their SPM results, you are in for another shock!

The fact remains that we have too many universities/colleges in this Bolehland with too few academics and many “kangkung” professors! We simply do not have enough human resource to support such a number, as I have written BEFORE. The politicians just wanted to make money and decided to make Malaysia into an “education hub” of Asia. God save this country!



Entry requirements for medical school may be tightened, says Subramaniam

JANUARY 17, 2014

KUALA LUMPUR, Jan 17 — The government may tighten the minimum entry requirement for students who want to pursue higher education in medicine, in future.

Health Minister Datuk Seri Dr S. Subramaniam(picture) said a study and discussion with the Education Ministry had been carried out on this matter.

He said the proposal was to ensure that only truly qualified students would take up medicine and in the long-run, would control the number of new medical graduates entering the job market.

“Now it’s (minimum entry requirement) 4Bs. We may raise it because a lot of students are getting A’s now. We will also make this mandatory for students who are taking up medicine overseas,” he told reporters after the Thaipusam celebration at Batu Caves, near here, today.

There are currently 33 medical schools in the country which produce about 5,000 new medical graduates each year and causing an influx of new doctors in the job market.

“Our ratio has almost reached one doctor per 600 population and as far as training is concerned, the Health Ministry ensures that everybody will get adequate amount of training. We won’t compromise on the level of training and exposure,” he said.

Dr Subramaniam said the government had also frozen the registration of new medical schools in the country and applications to increase the student intake into their medical programmes.

Earlier, Dr Subramaniam who is also MIC deputy president, said Thaipusam at Batu Caves this year had attracted some one million visitors over the past 10 days.

He said a medical team from the ministry, assisted by members of the Red Crescent Society and St. John Ambulance as well as the Fire and Rescue Department, had been on duty at the site to provide medical help to those in need.

Up to today, the medical camp had registered 85 cases of visitors seeking medical help, he added. — Bernama

- See more at: http://www.themalaymailonline.com/malaysia/article/entry-requirements-for-medical-school-may-be-tightened-says-subramaniam#sthash.C9dDrhQ6.dpuf

World Bank: Worsening education obstacle to Malaysia’s high-income hopes

DECEMBER 11, 2013

Children attend their first day of elementary school in Standard One (Primary One) at a local school on the start of the new school year in Kuala Lumpur 06 January 2003. — AFP picKUALA LUMPUR, Dec 11 — Education standards that were deteriorating despite Putrajaya spending twice as much as neighbouring countries on schools could stand in the way of Malaysia’s plans to join the ranks of developed nations, according to a recent World Bank report.

In a report titled “Malaysia Economic Monitor: High Performing Education” that echoes criticism over the recent performance of Malaysian schools, the World Bank highlighted the critical role quality education plays in a country’s aims to gain a high-income status.

In 2011, Malaysia spent the equivalent of 3.8 per cent of its gross domestic product on education, or more than twice the average 1.8 per cent within Asean nations.

“A nation’s human capital, which is largely built by its education system, is a fundamental driver of economic growth,” it said in the report.

“The quality of cognitive skills of Malaysian students, as measured by standardized international tests, is not on par with the country’s aspirations to become a high-income economy.”

In its report, the World Bank noted that while Malaysia has extensive coverage with its schools and achieved near-universal access that has nine in 10 Malaysian adults undergoing at least lower secondary education, a commensurate increase in quality was not observed.

“In addition to ensuring the system has the broadest possible coverage (quantity), the quality of education is perhaps even more critical.”

Pointing to the Programme for International Student Assessment (PISA) survey results released last week, the World Bank was blunt with its assessment of Malaysia’s underperformance.

It said Malaysia did not only trail high-performing education systems in East Asia, but also poorer nations such as Vietnam, which outperformed the country by a significant margin.

In the latest edition of PISA, Malaysian students lagged far behind their peers in Singapore, who placed second behind top-scorers in Shanghai, China, as well as 15-year-olds in Thailand.

While Malaysian students registered marginal improvement for mathematics, they lost ground in both science and reading ability.

The combined results meant Malaysia was 52nd overall out of the 65 countries, and firmly entrenched in the bottom third of the survey.

Aside from the stagnant PISA performance, the World Bank also highlighted Malaysia’s continued decline in the Trends in International Mathematics and Science Study (TIMSS) benchmark in which the country once performed well.

“Learning outcomes in the TIMSS were above the international average between 1999 and 2003, but declined sharply in 2007 and further in 2011,” it said.

To arrest the decline, the World Bank said Malaysia needed to prioritise teacher quality over quantity, noting that the sharpest fall in education standards coincided with an aggressively expanded recruitment programme for educators.

It noted that the teacher population shot up by 30 per cent between 2004 and 2013, an issue that it said may have since worsened; the number of trainees enrolled in teacher training institutes have ballooned from 37,439 in 2011 to 46,491 this year.

Another problem was the low standards of those seeking to become teachers. It noted that 93 per cent of those applying for the Bachelor of Education programme did not have the necessary academic qualifications (3 distinctions or more at SPM level), while 70 per cent offered a place in the programme also fell into the category.

Only 3 per cent of offers went to applicants considered high-performers.

- See more at: http://www.themalaymailonline.com/malaysia/article/world-bank-worsening-education-obstacle-to-malaysias-high-income-hopes#sthash.861eV0lE.dpuf

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One of the common questions I get asked via email and this blog from SPM/STPM leavers is as above. Just recently I had an SPM leaver asking me how much do a heart surgeon earn? From the random survey that I have done looking at these questions, I can only say one thing: majority are only interested in medicine for “good money, good future and good life”, a general misconception. And the reason why many want to become Neurosurgeons and Cardiothoracic Surgeons is also for the same reason: they feel that these are the highest earners in medical field!! Despite explaining many times in this blog, I still get these questions asked to me on a daily basis.

Thus, I thought of writing a separate “thesis” on this topic. Someone asked me a few days ago, how much do I earn as a Rheumatologist? Frankly if I were to practice only as a Rheumatologist, my income per-month would not even cross RM 7K! My major bulk of income comes from Internal Medicine practice, which I am also gazetted for. How much am I going to earn per-month depends on many factors such as, how many hours I work, how many calls I do, how many patients I see in the ward and clinic, how many holidays I take etc etc. As I have said many times in this blog, private consultants are NOT paid a salary by private hospitals. You earn what you receive from your patients as consultation and surgical fees, minus 10-15% administrative fee by the hospital.  These consultation and surgical fees are regulated by the government via the Private Healthcare Services and Facility Act 1998 (PHSFA), gazetted 2006. So, you are not allowed to charge anything more than what is stipulated in the act. Your license to practice can be withdrawn if you are found guilty of charging more. FYI, these rates have not been reviewed since 1998!! Everything has increased except doctor’s fee……….. The Hospital charges, on the other hand have increased by leaps and bounds since the last 20 years. An appendicectomy that cost about 2-4K in 1998 is RM 7-10K now with the same surgeon fee!!

Thus, I know some consultants in private sector who are earning barely 15-20K/month and I also know some who are earning up to 100K/month. Now, before everyone gets excited, please let me explain how these consultants work! Many people out there only look at the figures but not what is hidden behind these figures. Firstly, for you to become a consultant, you would have spent almost 10-15 years of trainings/exams after MBBS. If you include the MBBS, it will be 15-20 years of education/practical training. I had written enough about pathways to become a specialist in this blog (many still think that they can become a specialist by just doing another full-time master course!). These means, you will be around 40 years old when you decide to open up your own practice in a private hospital. At this age, you are going to a private hospital where you are the housemen, MO and specialist. You have to run your clinic everyday from 9-5pm, do surgeries in OT and do rounds in the ward. If you don’t do it, no one else is going to do it for you. It is you and ONLY you. Sometimes your “good” colleague can help you but generally all consultants in that particular hospital are fighting for the same pool of patients. So, who is going to share their patients? Loosing a patient means loosing money. It is a business. You work 24hours a day, 7 days a week, whether you are on-call or not, as all your in-patients are your responsibility

I also know a few consultants who earn RM 100K per-month and their home is the HOSPITAL!! They hardly see their children and do not even take any holidays to be with their family. Either they are obsessed with money or too much passion with their job till they forget their family. For me, family comes first. It is the most important thing in your life and seeing your children grow in front of your eyes is really amazing. How can someone not see this and spend their entire life in the hospital? You can talk about dedication etc but whatever said, family comes first! Secondly, do not think that all those who are earning as such, are angels! Many of them do unethical practices to make up that amount of money. Thirdly, this private practice is a ONE MAN show. If anything happens to you, like you are involved in an accident or acquire serious illnesses, your income will be ZERO!! This is not a business where you can hire someone else to run the show as patients come to see you and not anyone else. Whenever I hire a locum to cover me when I go on-leave, I will always be at a loss! Frankly, it is a very RISKY business model. I know one ophthalmologist who told me that he has stopped doing any work to fix anything in his house by himself because he is worried that a small injury to his hand may close down his business!! Also, don’t forget the higher tax that you will have to pay in private sector. Generally, even with all the tax planning, you will end up paying 1 month of your income to Income Tax department! So, work hard to pay the government ………….

As for government sector, everyone is paid the same depending on your grade. It does not matter whether you are a cardiothoracic surgeon, cardiologist, neurosurgeons, a dead wood etc etc, you will still be paid the same amount. Even if you don’t do any surgery, you will still be paid the same! In fact, recently many at grade JUSA C and above have to take a pay cut due to government’s financial situation. Even though government doctor’s salary has improved tremendously over the last 15 years, so does the cost of living and cost of going to a medical school. I was talking to a father who wanted his son to do medicine. His son refused and jumped to accountancy after 1 year of medical course. Well, if the son is not interested, he should not force him. Unfortunately, despite being a businessman (have few construction companies), the father still insists that his son should pursue medicine. What surprises me was the reason why he is asking his son to do medicine! It seems that his son has started “internship” in accountancy and working almost 24hrs a day with a salary of only about RM 2K+. BUT his niece is doing housemanship with salary of RM 4K+.  He does not seem to mind working 24hrs a day as long as the salary is higher! So, basically, he wants his son to do medicine for good money and life, based on his perception!! This brings me to another important discussion.

There was an interesting article by a doctor from US  ( A Deceptive Income of Physicians)who has written on how pathetic the income of doctors compared to the time, money and hard work spent in becoming a specialist in US. To quote : Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher. It is the truth anywhere else as well. Please read the article, which is very interesting with facts and figures. There was also another interesting survey in US regarding Physician’s job satisfaction and burnt out rate at different career stages. To quote:

  • Physicians in middle career worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and their work-life balance, and had the highest rates of emotional exhaustion and burnout.
  • Middle career physicians were most likely to plan to leave the practice of medicine for reasons other than retirement in the next 24 months.

Now, coming back to the starting salary of a doctor, no doubt it looks good on paper (minus the work that you have to do). Many will argue that there is no other job in “Malaysia” that will give you that amount of starting salary. BUT there are many issues that people forget. Firstly, all other professions start their working career almost 2-3 years before you start your housemanship. I know many engineers and even pharmacist who earns more by the time you start your working life as a houseman. My hospital was willing to offer a Pharmacist of 4 years working experience (equivalent to 1st year MO) RM 7K/month salary! Secondly, you can find a job in another country with any other profession unlike medicine. I know many engineers who graduated from UTM working in Singapore. Their starting salary is almost RM 6-7000/month with car and petrol allowance provided! Can you do that with medicine? Only UM and UKM degrees are recognized in Singapore. The rest just have to remain in Malaysia unless you pass any Singapore recognized college exams. Thirdly, how fast does your salary increase after that? My wife has been in service for 17 years. She is now in U54 grade with a net salary of RM 8K +(without EPF deduction as she is under pension scheme). If you are a specialist, you will be at U54 at 10 years of service with a salary of about RM 10-11K, after which your salary will only jump if you get JUSA C promotion. So, don’t get excited looking at the starting figure! It is very slow thereafter despite the introduction of time-based promotion in 2010.

When I first entered medical school after STPM, I do not even know how much doctor’s earn. I just did what I felt that I would be good at. Of course, as I have said many times before, no matter how much passion you have, there will come a time where money does matter., especially once you have a family of your own. A person who wants to dedicate their life to mankind by doing medicine would not even be bothered to leave government service. Frankly, government service is where you can serve the people. Unfortunately, there are also many doctors who leave government service due to frustrations with the system. Some of these frustrations have slowly disappeared when the time-based promotion was introduced. These coupled with increasing competitiveness and declining income of private doctors, have reduced the number of doctors leaving civil service over the past 2-3 years.  15 years ago, a private specialist could easily earn about 30-50K/month but now, reaching RM 30K is considered doing VERY well!! And to earn this much you will be working single-handedly, 24hrs a day 7 days a week after 15 years of postgraduate training and  after spending almost RM 700K or more (undergraduate and post-graduate, if you are not sponsored by government)…………………..

With the glut of doctors coming soon, GPs life is also getting very tough for those who intend to open up a clinic. Many may become jobless. I hope one day, we don’t land up as what the cartoon below portrays………

My advise is always, never to do medicine for wrong reasons !! You will regret it later. If making money is your intention, there are many other jobs and careers you can choose from (much cheaper to do) which can make you a director of a company etc by the time you reach 40. Many of my friends who did other courses have already migrated to other country with good job, salary and life. Some have become managers of their own company flying all over the world. And here I am working day and night treating patients with minimal holidays per year………………………..and worrying everyday as to what will happen to my family if I drop death today!


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Since my last post on 1/12/2013, I received numerous insights on what is being planned for the future. Just few days after my post, there was a symposium held in UM regarding this issue. One of the recommendation that was proposed was  for a common entry exam known as MMLE (Malaysian Medical Licensing Exam), similar to USMLE. The 1st Part of this exam can be sat when you are a student. As I had predicted long time ago, there will come a time where this will be inevitable. The government will not be able to provide job to everyone and thus some sort of screening test must be done. It is either a common entry exam or a common exit exam after housemanship. The only problem in Malaysia is transparency ! Being in Malaysia, we are so used to being influenced by political masters to artificially implement a quota system. What will happen to JPA scholars, MARA scholars and public university graduates? Will they be given priority or will they be in the same boat? Even though I support such a move to eradicate the poor quality students, transparency is always my concern. Who will conduct these exams and how will it be conducted remained to be seen.

When I was admitted to UM Medical Faculty in early 1990s, every single one of us will be given JPA scholarship. It is up to us whether we want to accept it or not. Over the last few years, the students were given an option whether to choose JPA scholarship or PTPTN loan. The latest news that I heard was that many students this year were not offered JPA scholarship at all. Many of those who applied were also rejected. This was across the board for all universities. Is this a prelude to the fact that jobs are not guaranteed in the future ? Being a JPA scholar means the government must provide a job for you as you will be bonded for 10 years. I was also informed that JPA has stopped giving overseas scholarship for medicine.

Many people do not realise the implication of oversupply of doctors. Many are just talking about quality which I had written many times. Introducing a common entry or exit exam will overcome the issue of quality (hopefully) but what will happen to the rest? Many would have spent almost RM 300-500K not knowing that they will become unemployed. Likely they will venture into selling products either pharmaceutical products or supplements. The public will be convinced with what they are selling as they are “doctors” on paper. It has already started. I know a few who had quit housemanship and working as “medical consultant” for companies selling supplements and health products. It is a business and capitalist world out there, where everyone wants to make money out of our society’s ignorance, similar to our many medical schools in this Bolehland.

And for those who completed housemanship but could not get a MO job in government service, they may end up opening GP clinics or venturing into complimentary medicine like Ozone therapy, chelation therapy, homeopathy etc etc. Unethical practices will become a norm and cheating public will be a daily affair in the name of survival. You can already see it happening when GPs are selling supplements, traditional medicines and venturing into aesthetic medicine, anti ageing etc etc. I know one GP who wanted to give growth hormone injection and hydrocortisone tablets to a 75 years old lady to make her “younger”!!

I spoke to one GP who is doing law. He told me that when he opened his clinic, it was the only clinic for surrounding 8 Tamans. Now, each Taman has about 3-4 clinics, fighting for the same pool of patients! Thus, he decided to do law and soon to become a medico-legal lawyer! A good move I must say as looking at the current situation, the number of medico-legal cases will definitely increase in coming years. As for the GPs, their income will gradually decline to the extend that they will end up closing shop or end up doing what I described above. Overall, it will be the public who will be at the loosing end………….

Well, I will be going on leave again from tomorrow till Next Thursday. So, I may not be able to answer any comments till I am back. The dengue epidemic has drained me enough over the last few months, Thus, for the first time, I will be taking my family not overseas, not to a land but “on the sea” ……………Welcome to Starcruise………………

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It’s December 2013, time flies! By next month, this blog will be 4 years old. From the time I started this blog in January 2010, the number of views has increased tremendously. Currently, I receive almost 1500 views per day with sometimes reaching close to 4-5000 views/day.

Yesterday, I attended a function which was graced by many government doctors and top civil servants. It was also attended by our MMA president Dato Dr K Tharmaseelan. Interesting facts were revealed, which just made whatever I predicted all these years to become  a reality soon. Over the last few years, the government was trying to improve the income and working condition of the civil service doctors. The salary was increased with time based promotion and shift duty was introduced for housemanship from September 2011.  Whenever something like this is done without proper consultation, setbacks will occur.

The shift duty was introduced not only to reduce the working hours but also to reduce the number of housemen walking around in the ward at any one time. If not, close to 50 housemen will be in each department during office hours. When it was first mooted, I wrote about it over here. As I predicted then, it has happened. Quality of training has deteriorated and patient care has gone down the drain. Many just leave the ward the moment their shift duty finishes without completing their work and promises to the patients. They just don’t bother what happens to the patient till their next shift. They also do not know what is happening to the patients when they come back for their next shift! The situation has caused concerns among the top guys in MOH and thus effective this month, the total working hours for Housemen will be increased from 60 hours with 2 days off to 75 hours with 1 day off !! Will this change anything ? I don’t think so. A better option is to go back to the old system but give them off, based on the total number of hours they have worked. If they have completed the 75 hours for that week, then they should be given the next few days off . This is what practiced in Australia and you can’t run away from your responsibility.

Unemployment of future medical graduates has been written many times in this blog and recently our MMA president voiced it out openly in mainstream newspaper. Public universities have started to cut down their intakes as of this year but private universities have to maintain certain number of students to make profit. Starting from next year, there will ONLY be certain number of intakes into civil service every year. Currently, whenever an application is sent, immediately it is processed and job offer is given within 1-2 months. Starting from next year, the intake dates will be fixed to 2-3 times/year. Whether everyone who applies will get their posting is still a mystery but likely you may need to wait longer. Thus, if you finish your degree in January and the intake is only in July , you need to wait 6 months hoping that enough post is available for all the applicants.

There are also talks at MOH level on giving housemanship on contract basis. It is very likely the time will come for this as the number of post will be limited. The discussion is to offer housemanship on contract basis for 2 years, after which you need to reapply into civil service. How it will be decided on who will receive the job offer is still being determined. Likely an exam plus performance review by HOD will be used. If you do not get a job in civil service, you need to find your own job outside. It also means, you can forget about postgraduate training.

From next year, the 6th posing of housemanship will be done at primary care clinics. I had written about this over here. I do not want to elaborate any further.

The time based promotion has also caused a lot of unhappiness among the senior doctors. When it was introduced in 2010, I wrote this. Whatever I wrote in that article is now becoming a reality. Many senior consultants are still stuck at U54 grade when their previous housemen(who is now a senior MO or junior specialist) are also in the same grade with almost same salary. There is no incentive for any further progress. Thus, why bother doing anything new or challenging when you are going to be paid the same. If you are going to remain in civil service , why even bother doing subspecialty! No new perks or appreciation. Well, didn’t I say that in my article way back in 2010?

Well, enough said in this blog. I will stop here till further information arrives on my table. Sadly, the medical community in Johor lost another great consultant yesterday at a young age. A well-known  Consultant Ophthalmologist and a Head of Department who is from a very well-known family in Johor passed away yesterday after battling with a primary brain tumour. God bless him. RIP. Life is always short……………..

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While in Malaysia we are talking about the entry qualifications to do medicine, a more interesting but rather sad incidences are happening in other parts of the world. I had talked about increasing litigation rate, declining income of doctors, doctors closing shops due to high maintenance cost and declining income etc etc, but in our neighbouring country as well as in UK, laws are being created to send doctors to jail!.

In Indonesia, there was a recent uproar by the O&G community when 3 gynaecologist were sent to jail for negligence. I do not know the real story behind this event except from what was reported over here and here.  Indonesian health system is still developing and due to their poor control of the medical education,poor accessibility of healthcare and a huge area to cover,the quality of products/healthcare is questionable. Singapore and Malaysia benefits a lot as the major contributor of medical tourism in Malaysia are Indonesians. I do see quite a number of them and they practically DO NOT trust their doctors! I don’t blame them as when I see the medications and the diagnosis made, it is worst than whatever I had seen over here. However, some of their top universities are better than ours. Nowadays I see more Indonesian academics presenting papers in international conferences than Malaysians, despite their poorer command of English. One day, they might overtake us, who knows?

IN the UK, the Prime Minister is drafting a law to send doctors/healthcare staffs who neglect patients, to prison! It’s interesting when a politician talks about neglecting people!!  The NHS itself need a lot of rectifications before you implement such a law. The GMC in UK is already an independent strict body in monitoring the practice of doctors.  In March 2012, I wrote THIS where the GMC had warned that doctors will face stern action for ignoring poor care. It basically says that if you are a doctor who notice a poor care is being provided to a patient by another doctor, it is your duty to report it. If not, you will also be penalised!

So, what’s happening in our Bolehland? The quality of products are deteriorating day by day as we speak. We are still fighting over entry requirement when it should have been decided long time ago. The education system has gone down the drain with countless number of people scoring straight As. The deteriorating quality of junior doctors are very obvious as I had mentioned and shown evidences many times before. Will the same situation and laws be implemented in Malaysia in the future? I was saying that Indonesians are coming to Malaysia as they do not trust their doctors. Will the same scenario happen to Malaysians very soon? I can already see it happening when many patients who came to see me, openly said that they do not trust the junior doctors in KKs and government hospitals (not to say that the private doctors can be trusted either!). And, these were patients who have been going to government clinics/hospitals for a long time. Thus, they can see the difference.

There was also an interesting news in Malaysia when MOH withdrew the admitting/inpatient license of a private hospital in Seremban. This is one of the oldest private hospital in Seremban which started as a maternity centre. Unfortunately, over the last few years, I heard that many of the resident consultants left due to internal problems. They were surviving on visiting consultants. Hope the MOH and MMC will take similar stern actions on under-performing, unethical, doctors and hospitals.

OB/GYN Strike Reaches Jakarta as Doctors Threaten National Walk Out

By Arientha Primanita & Ezra Sihite on 7:57 pm November 26, 2013.

Indonesia’s gynecologists continued to rally on Tuesday behind a pair of doctors jailed over the death of a patient, calling for a nationwide shutdown and protests in the capital over the alleged “criminalization” of medical professionals.

“It’s not a strike. It’s a solidarity action that we will take to stop the criminalization of doctors,” Nurdadi Saleh, the chairman of Indonesia Obstetrics and Gynecology Association (POGI), said on Tuesday. ”We are not fighting for doctors to be immune from the law, but the cause of the death was not negligence. It was due to a gas embolism.”

The Supreme Court agrees, in part, with Nurdadi’s statement. The mother, Julia Fransiska Makatey, did die of heart complications resulting from a gas embolism, but the panel of judges placed the blame in the hands of Dewa Ayu Sasiary Prawani and her peers. Three OB/GYNs, Ayu, Hendy Siagian and Hendry Simanjuntak, were found guilty of negligence over Julia’s death at Rumah Sakit Umum Pusat Prof. Dr. R.D Kandou by the Supreme Court on Sept. 18, 2012.

The three doctors failed to receive the consent of Julia or her family before beginning a Cesarean section. Before the procedure, the doctors did not check the patient’s vital signs with an electrocardiogram (EKG), the court ruled. Julia died a short time later as a substantial amount of gas trapped in her vascular system reached her heart.

While it is normal for air to enter the circulatory system during surgery, it takes a sizable amount of gas — in excess of 100 ml — to stop the heart. Gas embolisms are a common risk for surgeries like Cesarean sections, but deaths resulting from embolisms following C-sections are rare in countries like Singapore where proper preventative measures have greatly reduced the risk.

Indonesia has made strides in recent years to reduce maternal mortality rates, but the nation still has one of the highest rates of death for pregnant mothers in Southeast Asia. According to data compiled by the World Bank, 220 mothers die for every 100,000 live births. Vietnam, the Philippines, Malaysia, Singapore and Myanmar all reported lower death rates.

Gas embolisms caused only 2 percent of those deaths region-wide, according to World Health Organization data tracking maternal deaths from 1997 to 2007. Hemorrhaging, or blood loss, resulted in 32 percent of maternal deaths in Southeast Asia during the same period.

Allegations of malpractice are common in Indonesia, but doctors’ so-called “conspiracy of silence,” has hindered efforts to prosecute negligent health care professionals. When Ayu, Hendry and Hendy were first brought up on malpractice charges, the three were declared innocent by a local court. The verdict was later overturned by the Supreme Court but by that point the doctors were already missing.

All were sentenced to 10 months in prison and were ordered to report to the jail to begin their sentences in early Nov. The Attorney General’s Office declared the doctors fugitives from justice after none of them reported to prison. Ayu was found working in Balikpapan on Nov 8 and detained. Her former colleague Hendry was detained a short time later.

Hendy is still at large.

The arrests sent shockwaves through the nation’s OB/GYN community. Gynecologists in North Sulawesi and Gorontalo walked out on a three-day strike last week over allegations of a witch hunt. The anger has now spread to the capital, where some 600 doctors plan to march on the Supreme Court on Wednesday. Gynecologists will wear a black armband and pins in solidarity with the three OB/GYNs, Nurdadi said.

“We have all been working nicely, but if we are still being stepped on how can we not shout with a protest,” he said.

The association is calling for the Supreme Court to revoke its decision and allow the doctors to walk free. The Indonesian Doctors Association (IDI) and POGI North Sulawesi have already filed for a judicial review. The case sets a dangerous precedent in Indonesia, IDI chairman Zaenal Abidin said.

“It could be bad jurisprudence as the doctors could be charged if the patients died or did not recover from illnesses,” Zaenal said. ”We will prove that the Supreme Court is wrong in implementing the law.”

The IDI itself admits that a gas embolism was found in Julia’s autopsy. But the POGI alleged that complications like gas embolisms are unpredictable and unpreventable. The patient was admitted to the emergency room and was only 26 years old, too young to necessitate a EKG reading before her surgery, Nurdadi said. She needed fast treatment to save the life of her child, which the OB/GYN staff successfully did, he said.

The doctors cannot be held liable for deaths that are out of their hands, Nurdadi said.

“How could something outside doctors’ capabilities be caused by negligence?,” he said.

The case received the backing of Indonesian Health Minister Nafsiah Mboi on Tuesday who said she supported the protest. The Ministry of Health will assemble a team to investigate the death, she said.

“The media and public must understand [the doctors'] feelings,” Nafsiah said. ”[What] if friends of yours were treated unfairly like this? Ayu was trying to help a pregnant woman and her unborn baby. She was in critical condition.

“The baby survived but the mother did not.”

David Cameron: Bad doctors and nurses will face jail

DOCTORS and nurses who “wilfully neglect” patients will face up to five years in prison, it was announced last night.

Published: Sat, November 16, 2013

Prime Minister David Cameron is promising tough actionPrime Minister David Cameron is promising tough action [REUTERS]
David Cameron said NHS workers who mistreated and abused patients would face “the full force of the law”, under the creation of the new criminal offence.The Prime Minister revealed one of the recommendations from a review of patient safety, set up following the Mid Staffs scandal.

Earlier this year, a public inquiry found poor care may have led to hundreds of needless patient deaths at Stafford Hospital.

A package of measures will be unveiled by Health Secretary Jeremy Hunt in Parliament on Tuesday.

Staff who mistreat and abuse patients will face punishment modelled on laws against the wilful neglect of adults under the Mental Capacity Act.

These include fines and prison sentences of up to five years.Mr Cameron said: “The NHS is full of brilliant doctors, nurses and other health workers who dedicate their lives to caring for our loved ones.

“But Mid-Staffordshire hospital showed that sometimes the standard of care is not good enough.

“That is why we have taken a number of different steps that will improve patient care and improve how we spot bad practice.

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished.”

He added: “This is not about a hospital worker who makes a mistake, but specific cases where a patient has been neglected or ill-treated.

“This offence will make clear that neglect is unacceptable and those who do so will feel the full force of the law.”

Health chiefs urged the Government to make sure the new offence is accompanied by legally enforceable staffing levels on hospital wards, especially in the case of elderly care.

Dr Peter Carter, chief executive of the Royal College of Nursing, told BBC Radio 4’s Today programme: “This on its own will not be a remedy, it will not be a panacea to cure the perceived ills of the NHS.

“What you need to do is to ensure that you have legally enforceable staffing levels so that you don’t end up with the situation that we are finding increasingly with the care of the older people.”

The Government is acting on the recommendations of a report into the Mid Staffs scandal [EPA]

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished”

David Cameron

NHS campaigners also want the new charges to include hospital managers who suppress or ignore whistleblowers.”This alone will not avoid another Mid Staffs,” said Julie Bailey, who set up the Cure the NHS group which campaigned for a public inquiry into Mid Staffs.

“When staff try and reach out and inform managers there is a problem on those wards, staff need to be listened to.

“And if they are not listened to by the managers, that’s when we need that criminal offence.

“It may be extreme, but it will save lives.”

But, the chair of the Royal College of GPs, Dr Maureen Baker, said proper, effective systems were more important than the introduction of new criminal charges.

“Doctors, nurses – we are human, human beings make mistakes. You can’t change the human condition, but you can help support the humans in having systems around them that help keep them safe, caring and compassionate,” she said.

“You can’t rely on the law to properly regulate how people do their jobs. We need to rely on the professionalism of doctors, nurses, managers.

“What we need to do is let the professionalism take more centrality so that people can flag up the way they need to work in a safe system to care for patients properly.”

Health Ministry shuts down Chinese Maternity Hospital

NOVEMBER 22, 2013

KUALA LUMPUR, Nov 22 — The Health Ministry has issued an order to the N.S. Chinese Maternity Hospital and Medical Centre (NSCMH) to suspend its in-patient services with immediate effect.

Health director-general Datuk Dr Noor Hisham Abdullah said this was because the hospital was found to have committed 10 violations of the Private Healthcare Facilities and Services Act 1998.

“These violations encompass matters involving both in-patient and out-patient services. One such example is that NSCMH lacks full-time resident doctors in certain core disciplines, thus raising concerns about patient safety,” he said in a statement, here.

The statement dated yesterday was faxed to Bernama, here, today.

Dr Noor Hisham said the hospital was now not allowed to admit new patients and the existing in-patients were to be transferred to other hospitals as patient safety and quality of healthcare were of paramount importance to the ministry.

He said the suspension order followed a thorough investigation into a complaint received by the ministry in August and was substantiated by findings obtained during a verification visit to the hospital on Sept 4.

“The ministry had twice issued show-cause letters on Sept 18 and Oct 21 respectively, asking for the hospital to provide detailed response regarding the remedial actions that had been taken and those that were being planned in order to overcome these 10 violations.”

He said a special meeting was convened on Oct 17 with the hospital’s representatives and NSCMH life members, seeking detailed explanation for the 10 violations noted during the verification visit and also to discuss possible solutions to the problems faced by the hospital.

“The hospital’s management was given 14 working days to respond to the second show-cause letter dated Oct 21 and that period lapsed on Nov 8.

“Hence, due to the failure of the hospital’s management to adequately address and overcome these 10 violations, the ministry was left with no other option but to issue a notice of immediate suspension of in-patient services at the hospital in order to ensure safe medical practices and to protect the interest of the patients,” he said. — Bernama

- See more at: http://www.themalaymailonline.com/malaysia/article/health-ministry-shuts-down-chinese-maternity-hospital#sthash.sjdkWGbM.dpuf

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Since my last article on 10/11/2013, I read quite a number of letters in the newspaper regarding the issue of oversupply of doctors in Malaysia and the deteriorating quality of graduates.  There were 2 letters over here and here which was written by lay persons who were deeply concerned about our “doctor’s mill” and “obsession in doing medicine”. Something that I have been screaming about since the last 4 years or longer!

What interest me most was the statement from Datuk Dr Jayaindran who is the Head of Department of Medicine in HKL and a Deputy DG. Even though he decline to admit directly that there will be surplus of doctors, if you read in-between the lines, it is very clear that we are heading in that direction. He admits that the local medical schools are producing about 4000 graduates a year with another 1-2000 returning from overseas (remember, close to 50% of the medical schools in Malaysia have not produced graduates yet). However, he goes on to say that we have about 10 000 posts available? I got no idea from where he got this figure but even if it is true, based on his own calculation of graduates, it should be filled in less than 2 years! He also admits that there will come a time where the job will not be automatic and the graduates will have go through the necessary process and wait in line………….

It is also interesting to note that not only we have the highest number of medical schools per capita population in the world, we have now the best housemen: patient ratio in the world. We have conveniently beaten UK with 800 years of medical education with a ratio of 1: 3 compared to 1: 12 in the UK. Welcome to the true BOLEHLAND!! And now, the MOH will be discussing with MOE to increase the minimum entry qualifications !! So, are we admitting officially that our entry qualifications are low and any tom, dick and harry are becoming doctors? Are we admitting that the quality of students who are doing medicine is low ? No wonder the outputs are generally of low quality as well!

Finally, the madness is now hitting the sky. MOH is coming up with a brilliant plan of sending housemen to polyclinics and district hospitals for “training”, in line with the changing needs of our healthcare system and disease pattern!! Why can’t they just admit that they are running out of post/jobs! Again, we will be the first in the world! Today, our great Health Minister, who is a doctor by training has declared that housemanship training will soon be conducted at polyclinics, likely as early as next year ! As far as I am concerned, this is the most stupidest idea I have ever heard. Housemanship training is not about seeing primary care patients. This is done after completing ward-based horsemanship training. Of course, being a Miniter , he has to toe the line……….. Remember, our PM’s advise to Wathyamoorthy!

Despite admitting that the quality of graduates are going downhill, they seem to be introducing more and more programs which are going to make it worst. Let me tell you an example which I just saw few days ago. An 82 year old lady who is known to have Diabetes and renal impairment came to see me with lethargy, poor oral intake and feeling unwell. She is under a Klinik Kesihatan follow-up with the following medications:

1) Metformin 1g bd

2) Frusemide 40mg od

3) Hydrochlorothiazide 50mg od

4) Spironolactone 25mg od (just added 2 weeks ago for high BP !!)

5) Aspirin 100mg od

I think this is a good MCQ question. What do you think would have happened to this patient ? Obviously, this 82 year old lady is dehydrated with a Creatinine of 330 and Potassium of 6.2 mmol/L !! And this is a doctor who has completed 2 years of housemanship. An 82 year old lady with renal impairment taking all these medications which are contraindicated in renal impairment? I have said many times that doctors can be life savers as well as killers, with a license to kill! The situation is only going to get worst! They can’t even supervise their own MOs but want HOs to undergo training in KKs!  God bless this country……………..

The madness indeed has hit the sky……………..

Ministry reviewing entry qualifications

THE Health Ministry is looking into the possibility of increasing the minimum entry qualifications into medical colleges in a move to improve the standard of healthcare in the country and the competency of doctors.

The ministry, together with the Ministry of Education, has embarked on a study to review the existing entry requirements.

According to the Malaysian Medical Council website, the minimum entry requirement into medical school currently is five Bs at SPM level in biology, physics, chemistry, mathematics or additional mathematics and another subject.

“We’re investigating whether the minimum qualification needs to be re-looked. Nursing colleges started with three credits which was later increased to five.

“Similarly, we are looking at this possible scenario for those applying to medical colleges,” said the ministry’s deputy director-general of health (medical) Datuk Dr Jeyaindran Sinnadurai.

On claims that many junior doctors are not as competent or passionate about their job because of insufficient training, he admitted this was partly true.

“We have had several meetings to address the training of house officers (HOs). For example, their training used to run for 12 months, but now it has been extended to 24 months.”

He said this was because those trained overseas did not have similar exposure to patients, as local graduates did. Hence, it was necessary for them to relearn various aspects of all the six mandatory disciplines in medicine.

“Many are very stressed out because they have not been exposed to this type of clinical practice in their medical schools and it comes as a culture shock.”

He also said the flexi-system introduced some time ago for house officers had some limitations in that it did not give the HOs ownership and accountability for their patients.

“To overcome this we have made several modifications and are confident that it will address these areas of concern.

“With our proposed new system, we’re certain that HOs will have adequate supervision to ensure they take ownership of their patient and be accountable for their management. This will result in them working 65 to 75 hours a week, which we think is acceptable,” he added.

To ensure adequate exposure to clinical procedures and other ward-based work, the ministry is working on implementing a one HO to four patients ratio.

Dr Jeyaindran said that when he was a HO in the early 1980s, it used to be a 1:20 patients ratio. While the original ministry quota was 1:14, today it’s 1:3 patients. Other countries, such as Singapore have a ratio of 1:8 while in the United Kingdom it is 1:12.

“Still, some HOs are complaining about too much work and too many hours. It was recently brought up that HOs shouldn’t work more than 60 hours a week.

“However, they should consider their housemanship as a period of training, not focusing on how many hours they worked but the amount of experience that was gained.”

He said of the 144 government hospitals, 48 are designated as training hospitals for HOs, with close to 35,000 beds.

The ministry is hoping to open two more training hospitals soon.

“Over and above this, as non-communicable diseases (NCD) are beginning to be a burden to the healthcare system, we’re looking at HOs to be trained at primary care clinics (klinik kesihatan) under the supervision of family physicians.

“This pilot project will start early next year. We need to realign the training of our future doctors based on changing needs of the nation and evolving disease patterns.”

Dr Jeyaindran, however, does not foresee medical graduates becoming jobless in the near future, despite the fears expressed by the MMA.

“Admittedly there will come a time when they will have to wait a while to find suitable training posts. They will not get a vacancy straight away. They’ll have to apply and wait their turn. It’s a worldwide phenomenon.

“It’s not a minibus, you can’t shove in as many people at one time as you like. And, when a graduate applies to the government, he or she has to go through the process; it’s not about not having enough posts.”

He said the ministry was also studying the current status of medical colleges, particularly the number of students admitted per year.

“There are close to 360 medical colleges all over the world. Locally, we are producing about 4,000 medical graduates annually.

“This does not include the 2,000 to 3,000 who come back every year. But we don’t really know the numbers because many are privately funded, mostly by their parents.

“The study has already been mooted and the outcome will be out next year.”

On accusations that there aren’t sufficient postings for HOs, Dr Jeyaindran said there was enough capacity.

“We have 9,500 medical postings and 10,000 available medical posts, so there is capacity.

“When we re-look the numbers, 9,000 might be the optimal figure but we are changing gradually, it must be a progressive move.

“How fast we do it will depend on the outcome of the two studies.

“The data will help us make rational decisions. We have to ask ourselves what is a safe number to attain in delivering safe healthcare; it’s a numbers game.

“We are getting there but it may take a longer time.”

He added that as of now, there were no plans to reduce the duration of HO training.

“We are still maintaining the need for HOs to undergo two years of housemanship and two years of compulsory service.

“If you come from an unrecognised college, you must sit for a compulsory exam. Unfortunately, it was decided that this medical qualifying exam can be taken almost anywhere.

“Before, it was only available in Universiti Sains Malaysia (USM), Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM).

“MMC strongly feels that the standard should be the same.

“Although we have many local colleges, the final assessment is very different from university to university.

“Building two, three or four more hospitals is not the solution, and MMA’s suggestion to have training hospitals for medical colleges is not the answer either.

“We must have specialists of sufficient seniority; we want to get it right the first time and not make hasty decisions.”

Read more: Ministry reviewing entry qualifications – General – New Straits Times http://www.nst.com.my/nation/general/ministry-reviewing-entry-qualifications-1.396547#ixzz2kuMUDh1O

More Training Centres Needed To House Newly Graduated Doctors – Dr Subramaniam

KUALA LUMPUR, Nov 16 (Bernama) — The Health Ministry hopes to create more opportunities for newly graduated doctors to undergo housemanship due to an increase in the number of doctors graduating every year, said Datuk Seri Dr S. Subramaniam.Subramaniam said the number of graduates (doctors) has increased from 2,267 in 2008 to 3,655 in 2012 but the number of centres where they can be trained is only 42 hospitals throughout the country.“The ministry is therefore considering to place new doctors at polyclinics and hospitals in districts so that they can gain experience, exposure and acquire the necessary skills and the communication capabilities in medical services for two years,” he said after opening a seminar on “Housemanship Training in Malaysia” here, Saturday.

Also present was Malaysia Medical Association (MMA) President Datuk Dr N.K.S Tharmaseelan.

Subramaniam said new doctors may also undergo their housemanship at hospitals under the Defence Ministry.


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