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Archive for the ‘Education’ Category

My last blog entry on 17/02/2014 received the highest number of views in a single day since it started, 4 years ago. It achieved 11 195 views in a single day!! This goes to show that there are many who are worried about the situation. I also received few emails and blog comments from students who are doing medicine elsewhere without the minimum requirement introduced by MMC in 2011. It is very sad that our society is still a very ignorant society. Some of them are not even aware of the guideline! Are we leaving in caves?  With the information technology, there is no excuse! I would blame it on our education system!

When I read some of the comments and emails, I realize that there are many who are doing medicine with pathetic SPM results. Majority do not understand what medicine is all about.  With many dubious and mediocre medical schools out there, getting an MBBS degree is as easy as any other course. What you need is just money!! Money talks! How many students who go to Russia ever failed their 5 years medical course?  We have heard and seen many mediocre students doing medicine in Russia as well as in some other universities in Indonesia, China and Eastern European countries. I know one who got 9Fs in SPM but was doing medicine in Ukraine! Some of the comments that I received in my last blog entry just proved the scenario. The poor entry qualification is one of the main reasons why you see graduates with poor quality from Russian universities ( the talk of the town). On another note, there are good students who go to Russia, as they could not afford any of the local medical colleges. These students generally do much better when they start working. I have heard horror stories of what actually goes on in some of the medical schools!! The fact that they do not even know how to take history and examine the patient, tells you a lot. The very basic reason why you go to a medical school !

Many were tricked by agents who promised guaranteed job, similar to what happened to thousands of nurses. They were told that as long as they have a MMC recognized degree, they would get a job when they return. Well, it is true at the moment but not anymore. With limited number of post within the next 2 years, having a MMC recognized degree does not mean anything. Having a degree, which is registrable by MMC, does not mean you will get a job. It is the same in any other country. In Malaysia, job is given by SPA and Ministry of Health. MMC only provides Temporary MMC registration for you to undergo Housemanship.

With so many dubious Foundation programs organized by many universities as a “short-cut” to attract students into their medical school, MMC had no choice but to introduce the minimum requirement based on SPM results in addition to pre-university results (only A level, STPM and few other courses can supersede)!! We are probably one of the very few countries in the world, which do not use a standardised pre-university qualifications as a sole requirement. I would rather prefer if MMC makes a few well-known Pre-U courses as the minimum requirement, such as STPM, A-Level, IB, Australian Matriculation etc etc. As far as I am concerned, Foundation studies SHOULD NOT be used as an entry qualifications into medical course. Not only it is NOT standardized but prepared and marked by the university itself!! Whatever said, you need certain level of intelligence to do medicine. You may not need to be a A-star student but at least the top 5-10% of the cohort.  Medicine is not for any tom, dick and harry. That having been said, you also need genuine interest and passion to function as a good doctor.

Since the minimum requirement was introduced in 2011, all students accepted into local private medical schools have to submit their results to MMC for verification. The universities will do this. However, despite this I have heard and seen many students being accepted into medical schools locally without the minimum requirement.  The students are accepted and subsequently asked to appeal to MMC. When Crimea Medical University was derecognized in 2005, the NOC was introduced. The government noticed that there are students who have very poor SPM/STPMresults, from Arts stream and even those who fail SPM, were doing medicine in Crimea.  Unfortunately, there are still many students out there who are doing medicine WITHOUT NOC. This is simply because, they were told that as long as they have a recognized degree, it is not a problem.

Sad to say, the situation will change soon. Last year’s MMC’s guideline clearly says that those who do medicine in an unrecognized university without minimum requirement, will NOT be permitted to sit for the MQE exams. This basically means that you can forget about practicing medicine all together in this country. You can try to get a job in another country where your degree might be recognized.

When the job market gets saturated, the government will become choosy as any other profession in civil service. Preference will be given to government-sponsored students and local public university graduates. This will be followed, by the rest. With limited number of post available, what criteria will SPA use to offer employment? This is where your NOC will come into force. Very likely that those who do not have NOC or the Minimum entry criteria will be the last choice to be offered a job. You may end up jobless as there will be almost 6-7,000 graduates/per-year by 2017.

Obviously, there is no law to do this but getting a post in civil service is a privilege and not a must. The only problem in medicine is the fact that if you do not do housemanship, you will not be able to practise as a doctor in this country. Thus, MOH is working on a few formulas to decide on who will get a job in MOH in the future. With the civil service being controlled by almost 90% from a single race, the people as well as the politicians will make transparency and biasness as an issue. So, we need to come up with fair and transparent criteria.

Over the last few months, many suggestions are being discussed at MOH level. The first suggestion is to give housemanship post on contract basis, after which you need to sit for an exit exam. The exit exam as well as your superior’s assessment will be used to decide who will get a MO post. Basically, you need to reapply into government service after Housemanship. What happens to those who fail? Obviously, you may not be able to work as a doctor or may need to redo housemanship.

The latest suggestion, which is seriously being considered, is the common entry/licensing exam or MMLE. Many countries as well as many other professions do this. Even our nursing board has exams similar to this.  The lawyers have CLP but they can still work as legal adviser without CLP. For me, this will be the best option. MMLE should include all graduates including the local public and private universities. It should be standardized and centralized by MMC unlike the current MQE exams. Only those who pass will be able to get a job. This will definitely remove the mediocre ones as long as it is fair and transparent.  Unfortunately, this was suggested by our ex ex DG (Tan Sri Dato Dr Ismail Merican) but was shot down by cabinet due to political reasons!! In Malaysia, education is always politicized!

So, for those students who do not have the minimum criteria, please do some other course. This is my advise to you. Firstly, unless you do well in a well established, standardized Pre-U course, you do not qualify to do medicine. Secondly, with the soon to be surplus of doctors, your chances to get a job in Malaysia will be slim. Finally, do not waste your parent’s money. Put that money to good use. I would also like to advise parents that they should not force their child to do medicine and please do not ask your child with mediocre results to do medicine. You are committing  a crime to the society. I have seen enough mistakes being done by the current generation of doctors, life threatening mistakes that I have hardly seen before. It clearly shows the deteriorating quality of doctors in our community. We do not want to see students with SPM results like below to do medicine. In “real and genuine” medical schools, they will not even survive the first year. I am not saying that all good grade students will become good doctors but you need certain level of intelligence to do medicine coupled with passion and genuine interest.

FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.

Our ignorant society needs a wake up call……………………

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Over the last few days, I received and read few information regarding the situation of employment of doctors in Malaysia. As I predicted almost 8 years ago, every single prediction of mine is becoming a reality sooner than I had expected. I read the latest Berita MMA (Feb 2014) yesterday where both the editor and the President was talking about the oversupply of doctors and the fact that JPA is asking MMC to remove the compulsory service. It is interesting because when I first wrote about this possibility in 2005 and 2006, the then MMA president said that I am over exaggerating ! While MMA is adamant that the compulsory service of 4 years (including 2 years horsemanship) should remain, how long can the government remain silent that there will be unemployed doctors in near future? As I have written over here, by 2016/17,  housemanship will likely be given on contract basis, after which there is no guarantee that you will get a  job. In order for them to do this, compulsory service of 4 years must be removed.

2 days ago, our Health Minister has confirmed that MOH and MOE are strongly looking into introducing a common entry exam (MMLE) for ALL medical graduates. At the moment, they will only enforce the minimum entry qualifications as per MMC guideline. It is very likely that those who DO NOT have the minimum entry qualifications after 2011 will not be able to get a job upon their return to the country. Thus, I would like to remind all those who are doing medicine elsewhere without NOC and without the minimum entry requirement, to be prepared to get unemployed. Even though I had not received the official statistics for the year 2013, it is mentioned in the same article that Malaysia has achieved a doctor:population ratio of 1: 600 (1: 790 in 2012) which suppose to be only achieved in 2016!! We are 2 years ahead! Remember that 50% of the 40+ local medical programs have not produced any graduates. I am very sure we can achieve the target of 1:400 by 2017 instead of 2020.

On another note, I was informed that the MO’s post for Peninsular Malaysia is almost FULL.  Almost a year ago, I published this circular from MOH which stated that the MO’s post in certain states are deemed full. One year forward, I am pretty sure almost all states are facing the same problem except East Malaysia. Thus, most of those who will be finishing housemanship this year will be posted to Sabah and Sarawak. “You Tak Suka You Boleh Keluar! ” will become  MOH’s motto. Be grateful that at least you have a job in MOH. Soon would be graduating doctors may not even get a MO job! It is also confirmed that those who finish Housemanship in Klang Valley and Seremban will be transferred out of the state for MOship.

In my last article about Dengue, I wrote about the extension of Klinik Kesihatan working hours to 10pm in Dengue hotspot areas. I did say that it will remain so even after the Dengue epidemic is over simply because it is the most politically correct thing to do. However, the government will not be able to pay RM 80/hour for all the doctors as overtime allowance for the staffs due to the current financial situation. I mentioned that there will come a time (very soon) that the shift system will be introduced to KKs. In fact, a pilot project was initiated in KK PD last year but did not receive good response from the doctors. I was told that they have started another pilot project at Putrajaya KK recently. With close to 15 MOs in most major KKs now ( use to be less than 5), it is inevitable. Some KKs do not even have enough rooms for the number of doctors.

Today, it was mentioned in the Malaysian Medical Resources website (see below) that the shift system for KKs is almost confirmed coming, very soon. The word came from DG’s mouth itself. Of course, it will start with the KKs in major towns followed by semi-rural and rural areas. The only issue I worry about is the safety of doctors and staffs. As a government servant, you just have to follow what the Ministry says. You can’t overrule MOH. Discussion will be held but whatever decision made by MOH need to be followed. Otherwise ” You Tak Suka, You Boleh Keluar!”

For those who went to KK hoping to have an office hour job and better family life, the time has come to do night calls. Since you decided to become a doctor to help mankind, duty calls……………..

 

Licensing exam for docs?

| February 14, 2014

Subra says his ministry is considering several ideas aimed at improving health and medical care.

 PETALING JAYA: The Health Ministry is proposing that the government require doctors to pass a licensing examination before allowing them to practise in the country.

Health Minister Dr S Subramaniam has said that he would propose that Malaysia follow a system similar to the one used in the United States, where there is a qualifying exam for those who wish to practise medicine.

“If this idea is accepted, we have to ensure that those graduating from local and foreign universities have to go through a common exam,” he told FMT in recent interview.

However, he added, his ministry would need the cooperation of the Education Ministry and the Public Services Commission in order to push the proposal.

He also confirmed that the government would raise the minimum educational qualifications for students intending to pursue a medical degree.

At present, a student needs 4Bs in the core science subjects at SPM level and a CGPA score of 3.0 at the STPM/Matriculation level as the minimum requirement for acceptance into the medical programmes of local universities.

Dr Subramaniam said this needed to be reviewed to ensure that standards were not compromised.

However, he acknowledged that this would be difficult to enforce in cases of students going overseas for their degrees because Malaysia could not legally bind foreign institutions to impose minimum requirements.

He said the government would have to work out some legal mechanism to ensure that students going overseas would be subjected to the same requirements imposed upon those entering local universities.

Logistics

Dr Subramaniam also spoke of the country’s need for more specialist doctors, saying the government was providing “various avenues” for general physicians to get specialist training.

He said the total number of places for specialist training in local institutions had been increased from 300 to 1,000.

“We also want to provide more opportunities for the younger doctors to specialise in certain fields so that there will be a range of specialists to cater to future needs,” he added.

He also spoke of the current shortage of doctors, saying his ministry was particularly concerned about increasing their numbers in rural areas.

Malaysia has a doctor-population ratio of 1 to 600, whereas the World Health Organisation (WHO) recommends a ratio of 1 to 400.

But Dr Subramaniam said he was confident that Malaysia would reach the WHO ideal before 2020.

The future of Klinik Kesihatan

Posted on February 17, 2014 by palmdoc

Klinik Kesihatan

Dr. Masliha Harun posted in the DG Datuk Noor Hisham’s FB page

Now because of the workload (at ED) they will sent all the non emergency cases to us (urticaria-3yrs,MC seekers,chronic disease-defaulters and etc) during the extended hours up to 11pm everyday and including public holiday or Sunday whole day. Which actually,as stated earlier,we suppose to “utamakan” dengue and fever as our priority cases,but if this going on- (since we can’t never reject patient) so our workload is getting heavier and heavier,is like we see OPD cases for non stop untill 11pm everyday.
Just because of that,our beloved government would like to make a shift system for all the staff. But only one question i would ask??why we need to please them (people who abuse the system rm1) when we make all our staff suffer…
If u agreed to shift system,we can never had extra allowance to claim,we can never get same cuti (weekend) like other people and we can never enjoy our working area and we getting more stress everyday as a doctor.

to which the DG replied

The future of KK will be in the form of shift duty and the working hours will not be more than what is expected from each and everyone. Extended hours was given because each doctors are doing more than the requirement allocated time. First we need to get more doctors and staff to be posted to KK. Once we have enough staff of all categories the extended hours call allowance will be reviewed. Being a doctors we must adopt to on call system and even shift duty so that’s the future and I agree the implementation will be in stages

As a result of the current surge in Dengue, the MOH has admirably responded with more KKs with extended hours from 8am to 11pm

Working in the Kelinik Kesihatan is no longer that 9 to 5 job which was seen easier than the hospitalists going on night call. However with more and more KKs opening up till 11pm it means doctors serving in KK have to work up to 11 pm. It’s the outpatient equivalent of going on night call and it’s tough on the doctor’s personal life.

When you take up medicine, know that it is not an easy job. It was never meant to be a 9 to 5 “regular office hours” type of job for the clinicians. If you want that, then do something else other than clinical medicine.

When there are more and more MOs in service – inevitable given the current glut in junior doctors and only pending the number of posts allocated for MOs if there is enough money to pay for them (the “staffing issue”) – things will change. As the DG alluded to, it will eventually change to a shift system. No more extended hours call allowance but the working hours won’t be so long.

The issue of abuse of the KK extended hours system needs to be addressed by the administrators in MOH. Get tough on MC seekers, and for chronic disease defaulters, they should be given a short follow-up to regular hours clinic times.
Perhaps the KKs should be strict on the number of patients seen per day. The practice of taking all walk-ins no matter what has to stop. If you want to improve the standard of outpatient care, enough time has to be allocated for the consultation. Patients too should follow an appointment system and walk-ins discouraged.

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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
newsdesk@thesundaily.com

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!

GONG XI FA CAI TO EVERYONE………………………..

 

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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