Foreign Doctors in Ministry Of Health: What is the impact on our health system?
“22 FOREIGN DOCTORS SACKED”. This was the headline in NST on 14th August 2004 quoting from what our Honourable Health Minister said. Is this a good news or a bad one for our health system? To the ears of many of our government doctors like us, it would probably be the best news that we wanted to hear. 2 years ago, the government decided to bring in foreign doctors to serve our country to alleviate the acute shortage of doctors in our country. Almost 1000 over post were created for these doctors. The Public Service Department (JPA) and the Public Service Commission (SPA) advertised in countries such as India, Pakistan, Myanmar and Egypt. The first batch of these doctors arrived to our country around mid of last year, mainly from Pakistan and India followed by Egypt.
This is not the first time our country is recruiting foreign doctors. It has been done before in the 1980s and in 1996. Many of us, who were in the Health Ministry then, would definitely know what happened. Are we repeating the same mistakes again? There are many questions that need to be answered;
1) What are the qualities of these doctors who are being recruited?
2) How are they being selected and what are the criteria used?
3) How are they being assessed here in their competency?
4) Why are they being paid more than our doctors?
5) Who are going to take responsibilities for these doctors’ wrong doings or negligence?
Let’s look at the first 2 questions. To date, I am sure Ministry of Health (MOH) would have heard numerous complaints about these foreign doctors. Their incompetence and lack of interest in managing our very own people of Malaysia is striking. They lack in many clinical skills and knowledge, what more in communication skills. Let me give some examples of this lack in competencies that I have come to know so far. We have an Orthopaediac surgeon who has not done surgery for 5 years in his country as he was mainly involved in Research and Development field. He has been recruited and paid U47 pay but even our Medical Officers could do a better job. Many of our very own specialists are still in U41 salary scale and doing the entire job which these foreign doctors suppose to help out.
We have doctors from Myanmar who don’t even know the name of drugs and their indications, don’t even know how to read ECG etc. etc… I was shocked to hear a Myanmar doctor saying that Gliclazide (antidiabetic) is an antibiotic! And yet we are continuing to recruit doctors from Myanmar. We have doctors who don’t even know how to do simple procedures such as inserting Central Venous Lines (CVP) and intubations. Cases are being transferred from Labuan to Kota Kinabalu just to insert CVP lines! Unfortunately these doctors are being paid at a higher salary scale. We have a medical officer from Pakistan who does nothing much but receiving a pay at P1T19 of RM 3 400 basic. We have doctors who are recruited as surgeons but can’t even do a simple appendicectomy, what more an appendicectomy scar as big as cesarean section. Are these the quality of doctors that we are recruiting to serve our people? Would we allow these doctors to treat our family members? Are they safe doctors? In fact we are actually doing a favour for their country of origin by training these doctors to be a better doctors and surgeons. Is this the reason they are being recruited? I thought they are supposed to help us?
Let’s face the reality. The doctors that we are recruiting are actually 3rd class doctors in their country, sorry to say. Most of the brilliant and good doctors from Pakistan, India, Egypt and Myanmar would probably be working in countries like UK, USA and Europe. The next class of doctors would be doing well, back in their country. So who are we recruiting? The doctors that are not doing well in their very own country. This is not something that I created but was told to me by some of these doctors themselves. According to them, if they do well in their country, they can earn much more then what our government is offering them. So these doctors are here mainly to earn money and not to serve our country and at the same time to get adequate practical experience. In my hospital, the A&E locum services are run by these doctors and earning another extra RM 2000 to 3000 a month. They know that what ever “screw up” they do, they are safe.
What about attitude of these doctors. So far we had doctor caught stealing Pethidine from OT, thank god he was terminated. We had doctors who refuse to work up to 4.30pm as they claim it is not stated in their contract. Doctors from Pakistan and Egypt claim that they only work till 12.00pm in their country as they are allowed to run their private clinic after that. We had one doctor from Pakistan who was just recently terminated as he seems to have migraine and diarrhea almost every other day. He is also known to be an alcoholic; probably he was having “hang overs” rather then migraine! The most interesting thing about this doctor is that he was recruited from 1996 till 1999 and his contract was not renewed due to the bad report given by head of department in Mersing, Johor. He was found drunk by the road side and brought to the hospital by the police then. We were shocked to see him being recruited again this time and were sent to Kuching from 1/01/2004 and subsequently transferred to Johor from 16/08/2004 on his request. It’s rather surprising that a contract doctor can request where he wants to be posted! Thank god he was terminated based on report given by Kuching.
What is MOH doing about all these complaints? Well, we can’t blame the ministry all together. They have come up with an assessment form since September 2003 which has to be filled by the Head of Department (HOD) within 3 months. Unfortunately, there are many HODs who are not keen to submit any report to the ministry. I personally encountered a HOD who said that this is a Government’s policy and thus he has nothing to do with it. He rather asks our very own specialist to cover the foreign doctor. Is this fair for our doctors? They are doing double the work but paid almost RM 2000 less. How many HODs have given good narrative report to the ministry for termination of contract? Are they afraid that they will be blacklisted by the Ministry? But they must realize that if anything major happens in their department caused by these foreign doctors, the HOD has to take the responsibility and answer to the Ministry and the people. So it’s better to say the truth and write a report now then never. MOH can only terminate their contract based on strong report from the HODs. If MOH does not want to take any action then the MOH needs to take the responsibility.
Whatever said and done, not all foreign doctors are bad, incompetent and irresponsible even though this comprises of a small group only. What do they say about our health system and our country? Many of them claim that they have been cheated by the JPA and SPA. I am sure ministry knows that quite many of them have left this country voluntarily after a few months. Why did they leave? During the interview conducted back in their country by our JPA and SPA friends, these doctors were told juicy stories about our health system. They had been told that accommodation would be provided, monthly expenditure for the whole family would not cross RM 1000/month, there are many English medium schools in our country where they can send their children etc. etc. In fact one of them were surprised that the doctors in this country are not protesting over the bad working condition and the salary provided. One of the physicians from Egypt was told that our health system is comparable to the best health system in the world and we have all kind of advanced technology such as CT scans in every district hospitals! When he came here he was shocked and puzzled to hear that there are only 2 CT scan machines in the state of Johor and districts don’t even have ultrasound facilities. He clearly said that this was not what he was told during the interview. He is currently applying to go to UK or Australia.
Many of these doctors’ wrongdoings and negligence are being covered up by our very own doctors. But till when? We had a patient who has been prescribed insulin in full doses together with oral hypoglycaemic agents by a foreign doctor. Patient presented with hypoglycaemia 2 days later to our wards. Our very own doctor again has to cover it up for our ministry. With increasing number of medico-legal cases in this country, the ministry can’t run away from it. If the patient sues the hospital, the Ministry will have to pay. These doctors would have already left the country by then. This goes back to our very own Malaysians tax payers’ money!
With increasing health awareness among the people of this country, the demand for our health system is going to increase tremendously over the years. Health tourism promotion would also take the toll on our health system. Unfortunately the number of frustrated doctors in our public health system seems to be increasing day by day since last year. Government willing to spent RM 400 000 for every contract foreign doctor over a period of 3 years. If this money is converted to allowances for our doctors, I am sure more doctors will stay on in government service. The recruitment of foreign doctors at a higher salary scale then our very own doctors but at lower quality has created a lot of dissatisfaction among our doctors. This together with the introduction of SSM and PTK has resulted in abnormally high number of doctors resigning from government sector this year. I am sure MOH is aware of this. If the government continues to neglect local doctors and recruit foreign doctors, our public health sector will soon be run by contract foreign doctors and the “rakyat” would suffer eventually.