Here we go again. On and off, news like this appears in the mainstream newspaper over the last 2 years. BUT nothing has changed!
Today, The Star produced an article of possible “unemployed doctors” coming, very soon. You can read the article below. Well, I have been talking about this since 2006! When I first wrote an article in MMA magazine in 2006, even the MMA President then said that I am over exaggerating. Now, it has become a reality. Just few days ago, I wrote on Health Facts 2013 which clearly explains what the situation is going to be in the next 2-3 years. How many graduates can the government absorb? I was also recently informed in this blog that a UKM graduate is still waiting for 4 months to be posted ! This is something that I had never heard of. Usually, public university graduates ,where the SPA interview is conducted within the university before the students graduate, will get their posting letter within 1 month! Does this mean that MOH is running out of post and waiting for those who finish housemanship to become MO first? The MO post is also getting filled up very fast. Don’t forget about the type of training these doctors are receiving and issues concerning limited post-graduate training. I just heard that a “locum” MO gave calamine cream for vaginal discharge!! Looks like a joke? Well, that’s what happening out there! Poorly trained graduates coupled with poor training during housemanship/MO.
The article below also has some factual mistakes. It claims that there are 33 medical colleges in “Full Production” mode which is not right. We only have 20 medical programs in production mode! The remaining 23 is yet to produce any graduates. So, if there are 5000 graduates even by 2014 (as mentioned in the article), what will happen when all 43 medical programs are in “Full Production” mode? You can do your maths!
What happened to the moratorium issued in 2011 ? Only GOD knows. It only remains on paper, I guess.
There was also another interesting article in the same news paper, concerning doctor’s consultation fee. As I have written before, doctor’s charges are regulated by the government under the Private Healthcare Services and Facilities Act 1998 and it has not changed over the last 20 years ! The article has rightfully said that even a plumber, Hairstylist and electrician can charge more than that. An electrician can earn about RM 20-30K a month single-handedly. What about doctors ? Well, I had written enough about declining income and many are being forced to close shop or go into unethical practices as I had written over here. As I had said before, only less than 20% of the hospital’s bill belong to doctors. The rests are hospital’s fee. Unfortunately, these are NOT regulated, as most private hospitals are GLC owned! YOu know what I mean………………
Too many doctors, too little training
BY CHRISTINA CHIN
The future remains uncertain for aspiring doctors unless more training hospitals are opened.
COME next year, some 5,000 doctors are expected to be jobless.
This is because there are not enough government hospitals to train the large number of medical graduates being churned out, says Malaysian Medical Association (MMA) president Datuk Dr N.K.S. Tharmaseelan.
“There are just too many doctors and too many medical institutions flooding the market,” he claims, adding that there are now about 40,000 active doctors in the country.
“Some 5,000 doctors are graduating yearly but where are they going to do their housemanship and compulsory training?
“Currently in government hospitals, there are some 60 doctors in one unit so how are they going to learn?” he asks, adding that soon there will not be enough posts for medical officers in government hospitals.
According to the 2011 Health Ministry Annual Report, 21,765 out of 28,309 vacancies for medical officers have been filled, he says.
“This means that by now, the 6,544 available posts would have almost been filled. Where will the fresh graduates go next year?”
Dr Tharmaseelan calls on the government to build more hospitals, increase the number of beds in existing ones and equip the district hospitals with training facilities to accommodate the influx of aspiring doctors.
“There were 130 government hospitals in 2007 and 132 in 2011 – that’s an increase of only two hospitals in four years. It’s definitely insufficient. If this continues, doctors will soon join the flock of some 15,000 unemployed nurses,” he claims.
He adds that although the Health Ministry has assured the association that there are some 1,000 vacancies for doctors this year, the future remains uncertain for aspiring doctors unless more training hospitals are opened.
He believes the problem of unemployed doctors would be worse if the compulsory two-year government service is stopped.
“There is talk that after completing their housemanship, the doctors won’t need to serve at government hospitals anymore. MMA is concerned because this will result in doctors who are not adequately trained,” he says. MMA is urging the Education Ministry to monitor closely the many medical colleges that have sprouted recently, adding that entry requirements are too low for most.
“Students from colleges that are not recognised can sit for an examination to make them eligible to practice locally.
“We have an Air Asia ‘everyone can fly’ syndrome – it seems that everyone can become a doctor. Adopting Henry Ford’s industrialisation of car production to training doctors will result in poor quality medical practitioners,” he adds.
He attributes the glut to a lack of co-ordination between Education Ministry and Health Ministry, with the former bent on allowing medical colleges to mushroom without considering the Health Ministry’s needs.
He adds that medical colleges should have their own hospitals instead of sending their graduates to train in government hospitals.
“Another way to prevent unemployment from setting in is for doctors to become specialists and ‘super specialists’ in niche areas of medicine,” he says.
MMC member and senior medical practitioner Dr Milton Lum points out that there are currently almost 9,000 housemen nationwide.
“How many of them can the government hospitals absorb? Unemployment is not a possibility – it’s a probability.
“In one to two years’ time, government hospitals won’t be able to take in housemen anymore so medical graduates will have to leave the country to find work because they can’t get registered here,” he says, adding that less than 50 hospitals in the country are equipped with the necessary training facilities.
Quoting a Health Ministry study done last year, he says housemen now see less than three new patients daily.
“When I was doing my housemanship 40 years ago, I was seeing between 15 and 25 patients daily.
“Medical graduates today are not getting enough exposure and experience which will definitely result in a drop in quality for doctors,” he cautions, adding that in recent years, the MMC had received more than 100 complaints concerning doctors yearly. Before 2005, the council only received about two or three complaints.
Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) president Dr Steven Chow says there are more than 33 local medical schools in “full production” excluding overseas institutions.
“The total number of posts for doctors available in the Health Ministry, universities and other public institutions is about 25,000.
“We are already seeing difficulties in getting enough training posts for housemen and medical officers.
“This will worsen with influx from neighbouring countries in due course,” he adds.
Comenting on the “glut of doctors”, Health director-general Datuk Dr Noor Hisham Abdullah says the phrase is “very relative”.
The Health Ministry, he says, is working closely with the Malaysian Medical Council (MMC) and the Education Ministry in managing the supply of doctors for the country.
The country has been producing more doctors yearly with almost 85% of the ministry’s vacancies for doctors already filled, he adds.
“However, the posts available do not commensurate with the needs of the country.
“Malaysia will definitely need more doctors when we reach the status of a high income country.
“By 2020, the population is expected to reach 34 million so Malaysia will need a total of 85,000 doctors to attain the ratio of 1:400,” he says, adding that the ministry will apply to Public Service Department (JPA) for additional posts for doctors.
More doctors are needed to accommodate the fast expanding private healthcare services, health tourism, new health facilities, higher level of care by the Health Ministry, rise in specialisation and sub-specialisation of medical practice, expansion of more complex speciality services like cardiothoracic and hepatobiliary surgeries, and the emergence of new infectious diseases, lifestyle-associated diseases and chronic disease patients.
“More are joining the post graduate and sub-speciality programmes and coupled with the brain drain of medical practitioners, we need doctors.”
Doctors call for 30% hike
BY CHRISTINA CHIN
PETALING JAYA: Doctors in private clinics and hospitals are asking for a 30% increase in consultation fees, saying it is impossible for them to survive with rising operating costs.
Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan said the proposed hike was more than a decade overdue.
He claimed that doctors were now paid less than plumbers, electricians, hairstylists and food outlet operators.
General practitioners get between RM30 and RM50 per consultation while specialists charge between RM50 and RM80.
Dr Tharmaseelan said: “It is a misconception that doctors are rich and greedy. Many doctors are scraping the barrel with rising utility, rent and salary costs, and quite a few have even quit practice as it’s just too expensive to maintain a clinic.
“On average, the operating cost for a general practitioner to run a clinic in Kuala Lumpur is about RM20,000 per month.”
There are over 7,600 private clinics and hospitals nationwide. The association represents over 3,000 members.
Dr Tharmaseelan added that a general practitioner charged cough and cold patients between RM45 and RM50, including medication.
“It does not make sense that people are paying more for a haircut or a meal than for treatment,” he said.
He said that a rise was necessary for doctors to cover their “basic costs” in light of mandatory rulings like paying minimum wage.
“We are also required by law to have medical indemnity insurance, hire radiographers and engage waste disposal contractors at our clinics.
“It’s been three decades and our fees have remained unchanged,” he said.
He said the MMA submitted the new fee schedule to the Health Ministry two years ago but the proposal was rejected because the Government felt it was steep.
He said the MMA could not agree to the Government’s 14% fee increase proposal made last year as it would result in a bleak future for its members.
Malaysian Medical Council member and senior medical practitioner Dr Milton Lum said: “A plumber charges between RM50 and RM100 just to check my pipes – that’s way more than what a general practitioner charges (for a consultation).
“These days, RM100,000 medical bills are not uncommon but doctors only receive a fraction.
“Between 75% and 85% of the bill goes to the hospital and managed care organisations,” he said.
Federation of Private Medical Practitioners Associations Malaysia president Dr Steven Chow said the existing schedule amounted to only 2.3% per year since 2000.
“Bearing in mind the inflation rate, the 30% hike is a fair request,” he said.