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It has been 4 weeks since my last post on the Black Monday campaign by SCHOMOS and the hartal that is being organised by a separate group of junior doctors. I had received a lot of feedbacks for my previous post personally and via my blog. In the background, SCHOMOS/MMA has been working with MOH and finally had a direct meeting with PM on 23/07/2021. On the very same day, the PM’s office issued the following circular:

As I mentioned in my previous post, absorbing all graduates into a permanent position is NOT a long term solution. I had explained the reasons for this very clearly. It is almost impossible for the government to do this looking at the number of graduates being produced. My recommendation is for all doctors who are into post graduate training should have their contract renewed till they complete their training and get gazetted. The postgraduate training should be standardised. I also said that the permanent government positions is not sustainable anymore and all positions should be changed to contract from now onwards but they need equal opportunities etc, similar to other developed countries.

The circular above basically agrees to what I have been saying all this while. The government has guaranteed that they will provide a minimum of 6 years contract (4+2), increase from 5 years (3+2) currently. During the last 2 years extension, if you are enrolled into a post graduate training program, the contract will be extended to a maximum of 4 years. I presume this 4 years comes about due to the 4 years Master’s program. Those who are already in parallel pathway, they should be in their specialist training by the time the 6 years is done, especially for MRCP, MRCPCH and MRCOG. This 4 years extension hopefully will support their subspeciality training programme. So, overall, if you are in specialist training program, you will be guaranteed a job and training for at least 10 years. The government has also agreed to provide Cuti Belajar Bergaji Penuh and HLP if you are enrolled into the Master’s program. The only problem I foresee are for those who are dependent on local Master’s program which predominantly will be the surgical fields.

With large number of graduates applying for local Master’s program, the waiting period is going to get longer. I did mention this many years ago. The number of slots for Masters program is only about 1000 per year for all speciality included. My question is whether these doctors would even be able to get into the Master’s program within 4 years after housemanship. If they don’t , would their contract be not extended? What if they do not complete the training within 4 years, like they get extended etc? What if they do complete their training but wants to do subspeciality training? Would the contract be extended further? There are many unanswered questions but at least this circular clarifies some of the urgent matters and hopefully, further improvement could be made in the future.

However I noticed that the letter did mention about amending the Medical Act which I find it puzzling. The medical act has nothing to do with employment EXCEPT in regards to the compulsory service. Are we looking at an official reduction in the compulsory service in the future? Currently MMC (since Oct 2020) do allow junior doctors to leave the service 18 months after completing housemanship, pending Minister’s approval individually. Would this be lowered further, permanently? Or are we looking at a common licensing exam applicable for all graduates? It will be interesting to watch but again, it is all a political ball game!

Unfortunately, the above circular and reassurance did not seem to satisfy the group of doctors who were organising the Hartal. Yesterday, they issued the following circular, insisting that the hartal will go ahead today:

I also understood that many warnings have been issued to the junior doctors by the hospital Pengarahs and DG himself has issued a reminder on his FB post as below:

Interestingly, the DG has said that the Pension Act will be amended. This again goes back to my last post where I said, permanent post with pension is not sustainable anymore and all government positions should be changed to contract basis with continuous extension as long as the post is needed and for post graduate training. The hospital should be given the right to choose their own doctors based on need. I feel this is how this scenario is heading into the future. In fact, if the pension act is going to be amended, it may affect all other civil service jobs as well.

The world is changing. Jobs are changing as well. Unemployment of doctors is also a norm in many countries. Consultant without full time job is also common in developed countries but at least they get to complete their training. We need to change. We can’t keep on harping on the same benefits and perks as the baby boomers generation where the world population was a third of what they are now!

I will stick to what I have said in my previous blog post. The era of guaranteed job and permanent pensionable job in civil service is over. Every job is the same and will be treated as the same based on need. Doctors are not an exemption. Everything should be based on merit. I hope the selection of doctors into postgraduate training will be done on merit and be transparent. I also hope that a single post graduate training system will be implemented rather than 2 separate system. I might be dreaming but it is the only way forward. A total revamp of the healthcare system will be needed. A National Health financing scheme is needed to sustain at least the GP practise. A Restructured healthcare system is needed to move away from tertiary health care to primary based healthcare!

The question is , are the politicians ready to make this unpopular decisions? Looking at the current scenario, I don’t see it coming anytime soon!

At the time of me writing this piece, this is happening :

Frankly , you don’t need to be a rocket scientist to predict what I had predicted since 2006. It’s just simple mathematics and statistics. When I first started writing about the future of doctors in Malaysia in the MMA Magazine, I was brushed aside by MMA itself. No one took it seriously. In July and November 2006, just before I left the civil service, I wrote my last 2 articles about the civil service doctor’s future. I started my blog in 2010 where I spent the most amount of time writing about the mushrooming of medical schools, quality of medical schools and the very likely scenario of future doctors: unemployment! I was again called by all kind of names by parents and students themselves. Well, all those are history now. My blog posts since 2010 are still available in this blog. I had never removed any of it and even the books I published in 2016 are still available.

Let’s come to the topic. There are various social media and news agencies highlighting the upcoming “Hartal” by contract doctors which is being scheduled on 26th July 2021. Meanwhile SCHOMOS is starting the “Code Black” campaign from 1st-12th July 2021 which will end on 12th July 2021 with Black Monday event. Many have asked for my comment. In August 2020, I had a discussion about contract doctors in DOBBS which was posted in this blog. On 17th April 2021, I gave a talk via Zoom to a group of medical students in UKM for the Career Progression workshop where I spoke about the current situation, how we reached this stage and what are the options for graduates, concentrating on foreign countries’ opportunities. It was an interesting discussion. Some of the slides I will reproduce below.

We must face the fact that we are producing just too many doctors. Poor planning and knee jerk reaction is the reason for this. You can read all these information from my blog post dating back to 2010. We have one of the highest number of medical schools per capita population in the world. Have a look at the slides below ……..

With our typical Malaysia Boleh style, we lead the world, on how to start a medical school in the shortest time possible. Quality? Who cares, we just need the numbers! It is just too fast too soon. Our government is always obsessed with numbers. Let’s look at the doctor’s figures below……

These figures are from our government’s statistics (MMC and MOH). As of 2019, we had achieved the ratio that the government always wanted (1: 400). Almost 50% of the 31 medical schools started to produce their graduates between 2011 and 2018. Fifty percent of that 50% only started to produce their graduates between 2014 and 2018. Basically, we have not even reached the peak yet! This is what I call planning human resource with your butt! We are producing close to 5000 graduates annually since the past 3 years and these figures will continue to increase till about 2023 before it stabilises. But look at the number of new health facilities built since 2010? On paper, we have enough doctors, the issue is maldistribution ( I have written about this many times before) and the healthcare system.

Now, did the government ever promised you a job? The answer is NO. No government in the world promises you a job. These goes to all other profession as well. Do the government stop producing engineers just because engineers are jobless? Obviously NO. However, Malaysia is a unique country. Instead of investing in public universities , we started private universities since 1996. Once education is made into a business, 3 scenarios will happen: mushrooming of poor quality education centres, low quality graduates and mass production. These universities do not give a damn whether there are job markets for their graduates. They are just degree mills and profit driven. The government can only control the public universities intake(which is hardly done) but private universities are driven by market force. Few years ago, MOE did reduce the intake of medical students into public universities which I feel is the dumbest thing to do. It should be the opposite but hey, who do you think are the board of directors of these private universities?

Almost in all developed countries, doctors work on contract basis. Malaysians are just not used to it. The main problem is the fact that we are still stuck in a civil service system which was left behind by the British. Most countries have already restructured their civil service into a contract based system, including Britain. The old permanent civil service system and pension system is not sustainable. It is a huge burden to the financial coffers of a country. Remember, for every permanent post created, the burden is not just the salary you are guaranteed of receiving till the age of 60 (aka 35 years with increment and promotion) but also the life long pension that you will get after that, which your spouse will continue to receive after your passing. If you have a 2nd wife , she will also continue to receive 70% of your pension till she gets remarried or dies! Imagine if your wife or second wife is 20 years younger than you! Thus, it is a huge financial burden to the country which may even bankrupt a nation, similar to what happened to Greece few years ago.

Basically, what I am saying is that the government will never be able to create 5000 post annually. It is simply not possible. Based on what the Minister had said, out of about 23 000 contract doctors since December 2016(when it was first introduced) only 789 received permanent post after completing their 1st 3 year contract. Even if against all odds, the government agrees to create 22000 post to absorb all these contract doctors into permanent position, it will be, as usual a knee jerk reaction to satisfy the masses due to COVID. The next question will be on where these posts will be located and whether these doctors will be willing to go there.

Unfortunately, medicine is once again a unique profession. Our training and education does not stop after graduation. It goes on and on with various laws and regulation governing us. I am very sure not all of those 23 000 contract doctors planned to stay in civil service after completing their compulsory service. I have already heard many who had resigned after the 3 year contract and MMC even allowed them to be released before they completed their 4 years compulsory service (less than 1 year short).Some did not even take up the extended 2 years contract. Some left to overseas whenever possible (not to say it is greener out there). The problem with our healthcare system is the fact that specialisation can only be done in KKM hospitals and the local Master’s program. Parallel pathways are available but the training can only be done in KKM hospitals till you are gazetted as a specialist. Private hospitals are simply not suitable for this except for some big tertiary private hospitals but, would the patients allow trainees to treat them?This training process will easily take about 5-10 years depending on whether you want to pursue the subspeciality program. As for our local Master’s program, at the moment, this is only open for KKM staffs who are holding a permanent post (as HLP is only for permanent staffs). Of course you can still enroll as a private candidate and pay the full fee which may be in the range of RM50K/year. While the number of slots for private candidates may be small currently, if the contract system continues, it will likely increase.

I believe the contract system is here to stay. We just have to get used to it. At least you are given the opportunity to complete your housemanship, receive your full registration and complete your compulsory service. You would still have a job for at least the first 5 years. I understand that the 1st batch of contract doctors who started in December 2016 and did not receive permanent post, who are scheduled to complete their extended contract in December 2021 are being promised that their contract will be extended another year. The real problem is for those who want to continue to specialise. Other options are university hospitals and military hospitals.

The entire healthcare system has to be revamped. We have to move on to a more sustainable system. Like many other countries, I believe eventually all doctors will be hired on contract basis. This means that the government employs based on need except for the guaranteed first 3 year contract. Nothing is permanent. You need to reapply for a new contract whenever the previous contract comes to an end (this is how it is done in other countries). However, the way a person is recruited and trained to become a specialist has to change. Both Master’s system and the parallel pathway have to be merged into a single training system under a single body (academic colleges?). Those who wants to do any basic specialist training have to apply directly to this body before their 1st 3 year contract ends. If you are accepted into the training program then your chances of extending the contract till you graduate is almost certain. However, you need to pay whatever training and exam fees needed, by yourself.

What is the purpose for this Hartal? If it is to ask the government to absorb everyone into permanent post, than I feel it is NOT going to happen. It is not the long term solution. If it is to threaten the government, then it is also not going to work as the government never promised you a job anyway. If you think the public is going to support you, rest assured it will not happen (except your family members)! The public will only consider you as a selfish group of people. There are many people out there who have lost their jobs during this pandemic (commiting suicide) and here we have a group of doctors who are earning monthly salary and demanding to be absorbed into permanent jobs and endangering public’s life, if it is really going to be a proper strike. The public will never treat you as someone special. Trust me!

My opinion is to have a complete restructuring of the healthcare system to enable doctors who are interested in specialisation to remain on contract till they complete their training and gazetted as a specialist and continue till they decide to leave. I believe the way forward is to abolish permanent system and only go by contract system with full transparency in selection. Individual hospitals should be given full right to recruit the contract doctors and also determine their workforce numbers. Unfortunately, the word “transparency” do not exist in our government dictionary as you would have noticed from our controversial Minister’s reply letter. As I have said many times before since 2010, the days of guaranteed job for medical graduates is all OVER. Doctors, like any other profession have to find their own way. In Australia, there are consultants who do not have a full time job and ALL medical jobs are given on contract basis, between 3-5 years duration. No one complains as they are simply, used to it!

Stay Safe…………………..

Continued………..

In 1989, I sat for my SPM examination. As I mentioned earlier, there were 3 science stream classes in my school, out of which there was only 1 Malay student. The rest have all disappeared to MARA colleges, Boarding schools, military college, agama schools etc. I took the maximum of 9 subjects and received 7A1,1A2 and 1C3(in BM). I applied for JPA scholarship but decided not to attend the interview as I was told beforehand that medicine is only for Bumiputera. Some of my friends who attended the interview were told point blank that medicine is only for Bumiputera but they can request for other fields. For those who are from the 21st century, scoring 8As in those days were less than 10 students per state, unlike now where we have 10K students scoring straight As in the country!

Thus, I had to bite the bullet and go on to do STPM which is a 2-year program run by national schools (not all but selected national schools). It is considered as the toughest pre university exam in the world. Two years of knowledge tested by 1 exam at the end of the 2 years. We are allowed to choose 5 subjects. It was the only way for us to attempt to enter the public universities. There were only 3 universities offering medical program. Matriculation/Asasi science were reserved for Bumiputeras till 2003 when 10% of seats, in some programs were given to non-Bumiputeras.  Most Asasi programs in major universities are still reserved for Bumiputeras, till today. By God’s grace, I scored 5As in my STPM science examination, the only Indian student to do so in Malaysia. There were 72 students who scored 5As in the country, in 1991 STPM.

As I had mentioned in my earlier articles, our universities work on a quota system. While the Bumiputeras enter via an exclusive matriculation pathway, all non-Bumiputeras must use the STPM pathway. Two different system with 2 different standards. Further to this, we had the quota system. There were hardly any private colleges except for some which were running twinning law programs. Otherwise, you need to go overseas under your own parent’s sponsorship. As far as the medical faculty is concerned, 60% is given to the Bumiputeras, 30% to the Chinese and 10% to the Indians. The total intake for the 1992 UM medical faculty was 180 students. The ratio is the same for all other faculties. It supposed to follow the population ratio of the country. The number of intakes were fewer in UKM (150) and USM (110). Chinese students will need at least 5As or 4As in their STPM while the Indians can get away with 3As, to enter the medical faculty. Well, we had to accept the fact that we are treated differently. It became part and parcel of our life. It made us a better person and a fighter as we need to fight for entry into local public universities for 40% of the seats that are allocated to the non-Bumiputeras. BUT we were all Malaysians and I only had Malaysia as my country.

It was in the university that we yet again see all the 3 major races coming together. It is also here that I realised what “educational segregation” at primary and secondary school levels has done to our social integration. Many of the Malays were totally isolated for at least 7 years before they start to see non-Malays again. Many of them were from boarding schools, MARA colleges and agama schools, before entering matriculation. All these schools were reserved for the Malays. For some, even their primary schools were predominantly Malays as they were from rural schools where there were hardly any non-Malays. Some did do up to SPM in a national schools before entering matriculation/Asasi. As a non-Malay, I could clearly see the difference among these people. The ones that mingle around without any issues are those who were in the national schools up to SPM or from a major city where they are used to non-Malays. Many seem to have a culture shock looking at the non-Malays, not to mention the inferiority complex, being brought up in a non-competitive environment. They don’t mix around much and tend to keep to themselves. They did improve along the way especially when we started our clinical years. But I must say that there were some excellent Malay students as well, who had now achieved successful career in their respective field. It is sad that the society may still look down upon them just because of the different entry pathway and the quota system. Society’s perception cannot be changed unless everyone is at a level playing field.

Similar issue could also be said about some of the Chinese students. Many were from Chinese vernacular schools up to Form 5 or even STPM. I could clearly see how they prefer to be among themselves and speak their own dialect even when they are among the non-Chinese, because they are so used to do so. They don’t realise how rude it is, to the others. While the national school educated Chinese were able to mingle around more freely and more proficient in English, the vernacular school educated prefer to stick to themselves. As they enter the clinical years, some of them do improve and mingle around more with the other races.

As for the Indians, all of us are from national schools. If I can remember, there was only 1 among us who was from a Tamil primary school. As there are no secondary Tamil language vernacular school, even if they do go to Tamil primary schools, they will end up in a secondary national school. We were among the students who can get along with anyone in the university. Almost always we speak in English as even many among us are not Tamilians. We were a rojak group.

Did religion affect us in any way? Yes, it did. When I was in the 1st year, the Malays will form their own study group and the Chinese will form the own study group. The Indians usually play around. We don’t form any study group. We only play football together. So does the national school educated Chinese. We are happy go lucky kind of people. There were also some Malay boys who are in the same category. In my batch there were 2 Indian Muslims who entered the medical school under the Indian quota, via STPM. They used to mingle around more with the Indian students at first. Both were approached by the so called “dakwah people” who are usually students from the religious faculties. They were told openly that they should not be with the non-Muslims. They should only help the Muslims. They were told that they should avoid being close friends with the non-Muslims but spend more time with the Muslim students. One of these Indian Muslim student heeded their advice and moved away from the other Indian students. He eventually came closer to us when we started our clinical years. The other student remained close to the Indian students and became one of my best friends. We were roommates from Year 2 to Year 4. He now heads one of the top cardiothoracic unit in KKM.

Every residential college in UM use to organise respective religious festival celebrations. We had Malam Raya, Chinese New Year celebration, Deepavali Night and even Chrismast night. Everyone in the college will participate as it is considered as a cultural event. I was the Director of Deepavali night in 1996 for my 6th residential college. I even worn the best director award for the college. Deepavali night is considered the biggest event of the college every year. Unfortunately, I was informed that 2 years after I graduated, UM banned any other religious celebration in individual residential college. I am not sure what is the current status.

It is also in the university days I realise that many of these Malay students do not know what is happening out there. The more you talk to them, the more you understand that they are totally unaware of the racial policies in education and scholarships. While they understand that the Malays are given privileges in boarding schools, MARA colleges and Matriculation, they felt that the “others” are also given equal opportunities. They felt that the special opportunities given to them were because they are from rural /poor areas. Some are not even aware of the quota system and lack of scholarship for poor non-Bumiputeras. Many do empathise with us as they learn about the situation.

Five years of my medical school came to an end in May 1997. What appeared to be a long journey at the beginning, appeared rather short when I completed the course. It was a fun filled journey. I made new friends and learned a lot. Our lecturers were excellent. It was the days when Professors teach undergraduate students. I could still remember those great names like the late Prof John Bosco, Prof CT Chua, Prof Siva, Prof Raman, Prof Deva, Prof Fatimah, Prof Annuar Zaini, Prof Alan Teh and many more great teachers who thought us at the time. Many of them had retired but many did resign when I was about to graduate. As the private hospitals began to mushroom from late 1990s, many of our great lecturers left for greener pastures. It was a great loss to the faculty.

It was when I was about to start my Final year that I met my wife, who apparently is in the same batch! Since we had 180 students, sometimes we only knew those who are in our group or partner group. It was very difficult to get to know everyone in our batch by name. Sometimes we can recognise that they are part of our batch but do not know the name. How ironic! My wife was in my partner group starting Year 4. We first got to know that we exist somewhere towards the end of Year 4 and became friends when we started Year 5. By the time we sat for our final exams, we had confessions to be made! The rest is history…..

To Be Continued …………

Continued ……….

Education should never be politicised. Unfortunately, in Malaysia everything is politics unless stated otherwise. When I started my Standard 1 in 1979, the education system had already been converted from English to Bahasa Malaysia. If I am not mistaken, I was the 2nd batch of Standard 1 which was conducted in BM. English was thought as a second language. However, we were still a lucky batch of students as the books were still Cambridge books translated into Malay. Our teachers, almost all of them had excellent English language proficiency as they were educated in English medium. My school was a missionary school which is technically a semi-aided school. I did not see any racial or religious issues within my school. The Malays, Indians and Chinese were all playing, studying and eating together. Our canteen was run by a Chinese family till I completed my Form 6 in 1991. There was no such rule as only Muslims owners can run public canteens. They don’t sell pork or beef to respect everyone’s religious requirements. The vernacular schools on the other end were dying a slow death. Many non-Malays wanted to enrol themselves into national schools as they expected to be treated equally. My father, who was once a Tamil school Headmaster before becoming a national schoolteacher (after doing a degree), decided to send all of us to a national school albeit a missionary school (the top schools at that time). He still says that the reason he did so is to make us Malaysians. Many small Chinese and Tamil schools were on the verge of closing down by late 1980s due to lack of enrolment.

Unfortunately, after 1981 everything changed. The quota system of universities was in full force. MARA colleges and boarding schools were raised everywhere since 1970s to cater for a single race. Scholarships were limited to non-Bumiputras. Civil servants were reserved for a single race. As more and more non-Malay teachers began to retire, the pool of teachers were predominantly Malays by early 2000. Worst still, unemployed graduates were recruited as teachers under KPLI (Kursus Perguruan Lepasan Ijazah) program. When my daughter went to Convent JB in 2011, there was only 1 non-Malay teacher in the entire afternoon session!

As I said earlier, the government must lead by example. On one end, you claim vernacular schools are causing disunity but on the other end, you do the same. I remember very clearly how most of my Malay friends disappeared after Standard 5 (before UPSR, lower school exams were held when you were in Standard 5) to MARA colleges, Agama schools, boarding schools and royal military college. Another batch of my remaining Malay friends disappeared after Form 3 SRP exams (PTK equivalent), also to MARA colleges, Agama schools and boarding schools. By the time I reach Form 4, the entire science stream only had 1 Malay student. By Form 6, all my classes were filled with only non-Malays. The remaining Malays who use to come from other schools to my school for Form 6 Science classes disappeared within 2 months, as they enrolled into university run matriculation system. Mind you, my school (St Paul’s Institution) was one of the premier top schools in Negeri Sembilan. By removing the Malay students to agama schools, boarding schools, MARA colleges and Matriculation, the government was basically doing the same. Lee Kuan Yew of Singapore took 20 years to abolish the vernacular schools in Singapore. Did he do it overnight by just banning the schools? Nope. He created a merit-based system, a common language of English with mother tongue language as mandatory 2nd language, offered scholarship to Chinese school top scorers to move to national schools which is valid till they reach university, no religious elements in school curriculum etc. The vernacular schools died a natural death. You can read this in his book “My Lifelong Challenge: Singapore’s Bilingual Journey”.

By mid 1990s, many non-Malay parents were moving their children back to vernacular schools. A new national education system was introduced in 1983 known as KBSR and KBSM. Religious education was made a mandatory subject for Muslims and as part of the national curriculum. Prior to this, it was not part of the national education curriculum. We had a period, if I can remember, once or twice a week known as POL (People’s own language) classes. The Muslims will go to Pengajian Agama Islam class whereas the Indians will go to Tamil classes and Chinese to Chinese classes. I grew up in this system and KBSR and KBSM did not affect me as it only affected those who started their Standard 1 in 1983 onwards. When KBSR and KBSM was introduced, these POL classes were abolished and replaced with Pendidikan Moral for the non-Muslims. The mother tongue language classes were abolished for good under the new national education policy known as KBSR and KBSM. Some schools still continued with these as an optional out of ordinary classes. These were done after school hours. Language is an asset to a country but we decided to do the opposite.

With the formal introduction of religious education into our education system from 1983 onwards, the national schools slowly but surely were moving towards a monoethnic and mono religious centric schools. The Ustaz and Ustazah became very influential. MOE barred any other religious events or celebration in schools by 1990s. Openly telling the Muslims students that non-Muslims are kafirs who only deserve to go to hell were a norm. Islamic religious activities were held openly including saying daily prayers during assembly. The non-Muslims became very anxious, uneasy and started to move their kids out of the national schools. Religion should never be part of any official education system. It only serves to divide people. By 2000s, these phenomena had become toxic enough that many decided not to even send their children to national schools.

What options does these parents had? The cheapest option is to send to vernacular schools. Vernacular schools were becoming very popular and some schools did not even have enough classes to accommodate everyone. Schools that were on the verge of shutting down by early 1990s got a new lifeline. Many non-Chinese, including the Malays began to send their children to Chinese medium schools. If I am not mistaken, the current statistics shows that close to 20% of students in Chinese schools are non-Chinese.

By 2004 under the leadership of our new PM Abdullah Badawi, another new “education policy” started to take place. International schools which were once only available for expats or to students who had at least 1 parent being a foreigner, were allowed to take Malaysian citizens. It started with 30% quota but by 2008, almost 100% of the students can be Malaysians. These created another mess in our education system. Mushrooming of private and international schools started. It’s all about making money, I guess. Now, we not only have racially and religiously divided nation by education but also a class divide. The “Bangsa Malaysia” of Wawasan 2020 were just going down the drain. So, whoever who claim that the vernacular schools are the cause of disunity, think again. Digest what had happened and look at yourself. Assimilation will NEVER occur if everyone is not treated equally. That’s the reality.

To be continued……………….

continued.……….

While many countries in the world were attracting the best brains, we were happily removing them. The biggest beneficiary of our best brains was Singapore. Singapore, a country without any natural resources has to depend on its best brains to become a regional business, financial and research centre. They knew the only way to survive and develop is via knowledge-based economy or k-economy. They started their Asean scholarship program in the 80s to attract the best brains of the region to come and study in their university and be bonded to work in Singapore for at least 7-10 years (no one leaves after that). Those who enrol into their university by merit were also given scholarship with a bond. These not only attracted the best brains to study, work and remain in Singapore but also made their universities, one of the best in the world. Across the causeway, we were doing the opposite. We chased away the best brains using race factor. We sent our best students of certain race to overseas countries to study via MARA and JPA scholarship, instead of retaining them in the country. Many never returned back to serve the country. MARA loans/scholarship never had any bond with the government. I have seen many Malays who were under MARA and JPA scholarship happily working in Australia, UK, Ireland and New Zealand till today. As far as I know, neither MARA nor JPA had ever released the figures of how many remained overseas upon completing their education. It was only in 2016 when JPA decided to stop sending students overseas (except for those courses that are not available locally and the top 50 students) but indeed sponsored them locally in private universities. MARA was still sending students overseas but gradually reduced those who were sent to western developed countries due to cost.

Australia removed their all-white policy in 1973 and started their planned migration policy. The motto was “either you populate or perish”. They started one of the best migration policies in the world, attracting skilled workers into the country. Skilled workers, especially of young age were automatically given residency status even before they sat foot into the country. They were given the same benefit as the citizens, minus eligibility to vote. Racial Discrimination Act was passed in 1976. In 2001, they allowed dual citizenship. For those who are working in Australia under other visas, they were given residency status (PR) in 2 years. Due to some abuse of the system, it has now been extended to 3 years since 2018. And after 4 years of residency in total (including the 3 years of stay for PR), you are eligible to apply for citizenship. In Malaysia, we were too proud of our nationalism. I had foreign friends who were married to Malaysians who received their PR status after more than 10 years, going up and down the immigration office multiple times and being insulted several times. Till then they had to renew their social visa yearly which do not allow them to work unless you are granted a work permit.  These were skilled professionals. We were going into negative balance. The best leaving the country, none coming into the country. I have seen some comments saying, who said people are not rushing to Malaysia to work, look at the number of foreign workers in Malaysia! They forgot one thing for sure, these are unskilled labour force! They don’t contribute anything to the country except building structures. Do they pay tax? Do they provide any intellectual ideas? Nope. They are lowly paid untrained labourers, and they send their money back to their homeland, outflow of money.

By mid 1990s, Malaysia was a rich country. We had all the natural resources that was giving us all the money we wanted. We had industries coming and investing in Malaysia. Our surrounding neighbours except Singapore and Thailand were in turmoil. Indonesia was facing dictatorship of Suharto (till 1998), Philippines was being swindled by Marcos and family till late 1980s (still suffering from its aftermath for past 30 years), Vietnam recovering from war, Cambodia was recovering from civil war, Burma was under military rule and China was just starting its open market policy in early 1980s. We were plain lucky to be able to attract investment with a good english speaking professionals, good infrastructure etc. Unfortunately, we did not have skilled workers or even the labour force as the time went by (people refuse to work in these sectors due to low pay). The investors had no choice but to import foreign workers which resulted in more money than expected being spent. Corruption in the civil service increased the cost further. We did not have minimum wage policy till 2018. We were in the middle-income trap. Instead of investing in k-economy, we were more interested in keeping cost low so that investors will come into the country. We were more interested in having grandiose and delusional ideas of building the tallest, biggest, longest this and that when other countries have moved way beyond that philosophy. Buildings do not make you a developed country, knowledge does. Cronyism became rampant and millions were lost. Unfinished projects were a norm, but the money was gone. All in the name of supporting Bumiputera entrepreneurs. That’s why it is known as “piratisation”! By 1999, when the Asian Financial crisis happened, we were doomed. We never actually recovered since.

Within the country, we were more interested in privatisation, or shall I say “piratisation”. Education and Health should be government’s responsibility. Instead of building more hospitals and recruiting more brains, we were more interested in allowing private hospitals to mushroom. Almost all private hospitals in Malaysia are GLC owned aka government owned, basically government’s left pocket! The public health system was stretched to the maximum with minimum number of staffs to run it, the effect of which can be seen now during the COVID outbreak. “You tak suka, you boleh keluar” motto prevails. Many of the best brains again left to the private sector and overseas. Doctors demanding higher pay? we shall flood the market with doctors! Then came the mushrooming of private medical colleges, which can even run in a shop lot complexes (the first in the world). We currently have the highest number of medical schools’ per capita population in the world. I had written enough about this for the past 10 years. Whatever I predicted since 2006 has come true. I shall not repeat those over here. We are in total mess. The dire need of our healthcare system was exposed by a virus. We are like an emperor with no cloths!

To Be Continued……………

** a word of caution : this blog post is a general statement /opinion of mine based on facts, looking at what is happening in Malaysia, the country where I grew up. There are sensitive issues discussed, which people may or may not agree. Just keep an open mind and think deeply. It will be in several parts, ending with my story………….***

I was 19 years old when I was sitting in the Parliament on 17/06/1991 listening to our then Prime Minister Dr Mahathir Mohamad launching the Dasar Pembangunan Nasional (DPN). It was the replacement for Dasar Ekonomi Baru(DEB) which was a 20-year plan introduced in 1971. I was in Upper Six at St Paul’s Institution, Seremban and this was our educational tour as part of our “Pengajian Am” subject. DPN supposed to be part of Wawasan 2020 (1991-2020) to elevate us from a developing country to a developed country. Wawasan 2020 was just introduced 5 months prior on 28/02/1991.

At that young age, listening to the word “Bangsa Malaysia” and becoming a high-income nation was mesmerising. As a student, I wasn’t very much interested in politics then, except to accept the fact that we have something known as Bumiputera and non-Bumiputera terminology. I know that we need to fight to enter local public universities just among the non-Bumiputeras, due to quota system. Among the 3 of my school’s Form 6 Science classes there was only 1 Malay student. Every Malay science student was accepted into matriculation after completing SPM. We accepted the fact that we have to fight for whatever we need as we will never be treated the same. But Wawasan 2020 gave us some hope.

Along the way, the country took the wrong direction. Instead of uniting the people as a single race, we decided to divide it further. Instead of building more public universities to cater for all citizens, we decided to keep the quota system and different entry system into the public universities. We decided to privatise education in 1997 to make more money and to make every single citizen of the country to become a debtor, by making someone else rich. PTPTN was established for both private and public university students. Generally public university fees are heavily subsidised and most do not need to take any loans. Civil service, which forms the backbone of a nation was pre-determined to be run by a single race. From a 40% non-Bumiputera containing civil service in 1970s, we became almost 95% (some say 98%) consisting of a single race. To provide more jobs to people, we became one of the largest civil service in the world, based on population ratio. The financial burden to the country was and is exorbitant.

Malaysia was considered as one of the most successful post-independence countries in the world. Within 30 years after our independence in 1957, we were the most progressive and industrialised country in SEA. We discovered oil in 1970s and formed Petronas in 1974. By the 1980s, we were an oil producing nation. This, together with rubber and oil palm were already making Malaysia a rich country. With industrialisation and investment from Japan etc, we were going in the right direction. We were known as the Tiger of Asia! BUT we have forgotten an important part of our history! Migrants!

One of the reasons I always ask my kids to read about history (not for exams but for knowledge) is because through history you will learn how not to repeat a history. History teaches us a lesson so that we do not do the same thing again. Unfortunately, history nowadays is thought in school as just a “point form” text to pass exams. During my time in 1980s, history books are like story books, not in “point forms”. If anyone bother to read history, you will know that the most successful countries in this world are countries who embraced migrants. They made migrants as part of their country and equal citizens. Every country that chased away migrants after independence has collapsed. Look at the African countries which did this after their independence from colonial power. Every one of them went downhill. Zimbabwe chased away all the whites who were doing farming. It was the biggest agricultural producing nation in Africa at that time. See where they are now. All these farming lands were taken over by cronies of Robert Mugabe and successfully destroyed it for money. Sounds familiar?

Malaysia was gifted with almost 40-45% migrant population at independence. These were migrants who were brought by the British to work at mining sites, roads, railways, plantation etc. They worked hard for pea nut money, many died of infectious diseases but without these migrants, Malaysia would not have been where it was 30 years ago. My grandparents worked in rubber plantations, roads and railways. When they were given citizenship, they were happy and continued to dedicate their life serving the country in whatever capacity they could. The Chinese even helped the military and police to defeat the communist. Who worked as spies for the Malaysian police and military? Without the Chinese help in Malaysia, it would have been impossible to defeat the communist. Malaysia was one of the most successful country in the world to defeat communism. Who thought the children in schools? It was the missionaries and Indians. Most of our teachers in 1970s and 1980s were non-Malays. My Headmaster was an Irish missionary guy, Bro James Macken. Did they not teach our children without any prejudice etc? Racial and religious matters were never an issue. What happened?

In 1981, someone took over the reign of our country. He was a smart doctor and a cunning politician. His motto is very simple. Malaysia belongs to the Malays. Thus, everything that represent Malaysia should be by the Malays (please read his autobiography). These includes the civil service, military, police and sports. Have you ever wondered why we were once a football powerhouse of Asia in 1970s up to mid 1980s, after which we just went downhill? Politics! Many politicians were appointed to sporting agencies. Their duty is to make sure that majority of those who represent Malaysia in sports must come from a single race. Token of appreciation can be given to a few non-Malays. The non-Malays can do whatever they want in the private sector and the government will collect their taxes. Malaysia is the only country in the world that I know which has a different tax structure for civil servants and the rest of the population. Civil servants do not pay any tax for their allowances, which most of the time can be higher than their basic pay (which is the taxable income). But this blame does not go to Dr M. It was by his successor Abdullah Badawi. The government should always set an example as being fair to everyone. Unfortunately, in Malaysia that is not the case.

Nothing was based on merit. Quota system was introduced in the universities in late 1970s (guess who was the education minister?). Matriculation was introduced as a short cut pathway into university for certain race (he himself had admitted this in 2018!). We even have a race-based University, funded by the government via tax payers money! Talent and merits were thrown into the drain, not only in civil service, sports, university intellectuals, graduates but in almost everything that made Malaysia great once. All in the pretext that Malays can do it if given the opportunity (from his autobiography) aka short-cuts. He undermined the very capability of the Malays to succeed on merit. Crony businessmen cropped up overnight with directly negotiated contracts. Open tender became a dirty word. Many instant millionaires of a particular race were created, all in the name of creating Malay entrepreneurs to compete with the Chinese. Did these people help the rest? History would have given you the answer by now. He was a man in a hurry.

In the process, he wasn’t interested on what the non-Bumiputeras wanted. You want to go to university; I give you private university. Sorry, overseas scholarship is not for you except for a few tokens of appreciation. Overseas JPA scholarship to do Medicine and Dentistry was only reserved for Bumiputera till late 1990s. Lower merit individual from certain race were given priority. Obviously, migrants will always find a way around. They will work hard and sell whatever they have to educate their children. They will send their children overseas and ask them not to come back etc. The exodus started in 1980s and still ongoing. Many best brains left the country gradually, not that they want to, but forced to. Our failure is another country’s gain. I wonder why our newspapers keep reporting of “Malaysian born” so and so is a Hollywood director, international star etc. They have left Malaysia and are not even a Malaysian citizen anymore. If at all, we should be ashamed that they did not achieve this for Malaysia. Why did we chase them to be somewhere else achieving their glory?

TO BE CONTINUED………………………………

Five years ago I wrote an article in my blog ” Patient’s Confidentiality and Autonomy” . It was about an article in the Malay Mail discussing on the issue of doctors posting confidential informations of patients being treated in hospital and using it to make remarks against certain group of people on Facebook etc. I wrote in detail my opinions on these matters and did warn the doctors that every patient has the right to choose what they want. Our job is to educate and advise, period. I wrote this same article in my books that was published in June 2016 (Chapter 9, page 185). Along the way I had written numerous articles on issues of doctors and social media. Interestingly, the exact issue that I spoke about in 2015 has taken a centre stage again, over the past 1 week.

We as doctors should learn to control our emotions. The public look at us as a highly educated person and we should not tarnish our names by making mocking or defamatory statement to any particular individuals, especially if we do not know the exact details of a case or never involved in it etc. Making general statements are fine. The issue that has been circulating around over the past 1 week started in early 2018, almost 3 years after i wrote my article. The court has decided that the said doctor has made defamatory statement against an individual and was asked to pay RM 230K in total, as damages and legal cost. I do not want to discuss in detail about this court case unless I have the detail judgement, which may only be released at a much later date.

What I want to talk about are comments made by many medical practitioners claiming that doctors have now lost the ability to advise people on quack practitioners, medical notes are neglected as evidence in courts etc. Some even gone to the extend of saying that doctors should be protected from being sued by member of the public for trying to protect the public from quack practitioners.

Firstly, let me explain that a defamation case is NOT a medico-legal case. In a medico-legal case, your case notes becomes a hardcore evidence against a negligent suit. Medico-legal cases/notes are only applicable from the time the patient seeks your treatment till the time the so-called negligence happens and so forth. The court will take the medical notes as evidence. So, if the patient has lied to you, they cannot turn the case against you as our management plan depends on what patient informs you. The legal test used to determine negligence is way different than a defamatory case.

In a defamation case, you need to proof that the accusation you have levelled against an individual is, on a balance of probabilities, true and proven. The legal test used is totally different than a medico-legal suit. So, when a doctor accuses a member of public of something serious, like causing death of a baby etc, she need to proof this statement in court. Can the medical note be used as an evidence?

My answer is NO, especially if you are not even involved personally in this case. Anything that happened outside a hospital/medical facility is hearsay. That’s the reason when a patient comes to emergency department and says that she/he met with an accident, we say ” Alleged MVA”. This is because we don’t know whether what the patient tells you is the truth and nothing but the truth, as proclaimed in court of law. No such proclamation is made when a patient comes to hospital. That’s also the reason why we always say ” claimed by patient” in our history taking. I hope the medical schools are still teaching this, as I learned it when I was a medical student.

Now, let’s go back to this particular case in general. The case revolves around a doctor who supposedly made remarks on FB against another “complimentary medicine” practitioner, accusing that the said practitioner caused the death of a child. I can vaguely remember the hot issue that was circulating at that time in regards to this case. The doctor made direct accusation and thus, it can definitely be deemed defamatory. No two way about it. If it was a general advisory statement without pointing to any particular person directly or indirectly, then it is not an issue and cannot be deemed defamatory.

Anything that happens outside of an hospital have to be reported to the relevant authorities to investigate. For example, if we suspect child abuse, we need to report to the police and social welfare department. It is up to these departments to take further actions. Just because the child said that she has been abused to you, it does not mean she is telling the truth and we should not depend on that story to throw accusation to anyone. Our job is to report. If we accuse so and so as responsible based on what the child said but subsequent investigations by police showed otherwise, you are liable for defamation and you can never win. Similarly, if any patients makes public accusation against a doctor in social media etc, you have every right to sue them. However, if the patient makes a report to MMC and MMC finds you not guilty, you can’t sue the patient, as she has made the right move. This is similar of us making a police report when we suspect something. The person cannot sue you for making the report.

In this particular case, police reports were made by both MOH and the person being accused of killing the child (directly or indirectly), who is the plaintiff in this case. Unfortunately, police investigations found no evidence that the plaintiff was responsible for the death of the child. This alone is enough to proof that the statement made by the doctor is defamatory. Some said that the mother lied in court and changed her statement, comparing to what was recorded in medical notes. Again, what the mother told the doctor is considered hearsay as it happened outside the hospital. In my 24 years of medical practise, I have seen countless number of patients not telling the truth. Many at times, they make up stories so that you don’t scold them or find them stupid. In the court of law, it is up to the defence lawyers to proof that the person is a liar and to expunge the entire witness statement. Till the judgement details are out, we would not know what happened in the court. I understand the said plaintiff in this case has also won another case in Shah Alam against a doctor as well, who supposedly did not turn up in court to defend himself.

Many young doctors out there do not understand the field of medicine. Defamation and medical negligent cases are 2 different entity. Medical notes evidence is only valid for something that happened within the medical facility, aka from the time the patient come to you. It is only applicable for treatment related issues. Secondly, what patient tells you is confidential and cannot be made public. A doctor who accuses someone publicly of wrongdoing by using this case notes has technically breached patient confidentiality. He or she can be reported to MMC. So, be very careful when you make emotional post on social media on certain issues when it involves specific patient etc. I have written an article on this in 2018.

Some doctors have said that they will stop advising the public against going to traditional practitioners to prevent being sued. Again, many don’t understand the scenario. You can always advise and educate the public in general terms. But what you can’t do is directly accusing someone of doing something. That is defamatory unless you have solid proof. Please do not forget that despite all the advise and education, it is every patient’s right to follow or not to follow. You can’t push your ideas into anyone even if it is based on solid evidence. Always remember your medical ethics: patient’s autonomy. My article in 2015 had explained this in detail.

Our country is in a mess right now and the world is in recession. I know this year’s Deepavali would be uneventful to many. However, I would still like to wish ” Happy Deepavali” for all those who are celebrating at home.

 

Recently I took part in one of the discussion in DOBBS forum in regards to contract doctors. I attach the video above for those who are interested to know how the discussion went about.

 

 

I have finally reached another milestone ……… as of 13/01/2020, my blog is 10 years old! Over the past 10 years, I have written hundreds of articles and even published 2 books from these articles! I probably achieved my wawasan by educating the public on what medical field is all about and how the world is changing.

My last article was written on 24/12/2019, just before the new year started. It has been almost 5 months now and the world has changed. In just a short period of time, our lives have gone upside down and we are still looking at months down the line before everything comes back to normal. 2020 suppose to be the year where Wawasan 2020 should have been achieved, transforming Malaysia into a developed nation, but unfortunately we are in a mess with recession coming soon, if not already. We have had 5 months of political drama and a brainless RNA virus terrorising the world. Let’s start with where I left you on 24/12/2019……

Critical Allowance

Based on JPA circular dated 20/12/2019, critical allowance for all new appointments into MOH will be removed. As I mentioned in my article, it is rather unfair when those who are already in the system will continue to receive the allowance but the new ones will be without the allowance. I said unfair because everyone is doing the same job and same amount of work. It does not make any logical sense, while I did predict and expected the allowance to go one day when we have more body than post. Following this announcement, there were huge outcries from various organisation and members of the public. Thus, on 9th January 2020, this proposal was postponed for further review, scheduled to be updated by end of this year. REMEMBER, it is only postponed and not cancelled!

U41 Contract Renewal

As I have written in several articles towards the end of last year, the number of permanent appointments given out following completion of housemanship has been dwindling down from about 500 for the first batch(December 2018 cohort) to almost 0 in subsequent batch(May 2019). This is again not unexpected. KKM simply do not have enough post to offer everyone. The slides below is self explanatory…..

It is very clear that KKM do not have any post to even offer permanent positions. Thus, almost everyone will be given an extended contract which will be the final contract before you say sayonara to KKM. The issue of being offered U41 post instead of U44 has not been resolved either, despite promising to do so in November 2019 by the cabinet, KKM and JPA. The new contracts are still renewed at U41 as of April 2020. On 29th October 2019, I wrote this :

The best is yet to come: those who receive extension of contract can remain at the same place where they were transferred as a floating officer! In another word (the way I interpret this), your life in civil service ends there within another year aka completing 4 years of compulsory service. It’s just a diplomatic way of putting it !

Interestingly, this is now proven true when the newer contract renewals categorically says that ” this will be the last contract!” ………

So, basically whoever received the U41 contract extension of 2 years, after their 3 year initial housemen contract, have to start planning their future. I believe this clause was added after the Sarawak doctors debacle that was publicised widely in newspapers in January 2020. These were doctors who returned from overseas in 2017 and was given a 2 year contract to complete their compulsory service. Unfortunately , they were told that their contract would not be renewed. To be frank, no contract is permanent. A contract is a contract and the employer can decide not to renew your contract once it expires. It is the same in any profession including the medical profession. Even in private hospitals, the hospital can decide not to renew your contract if they feel they do not need your service anymore or simply, if they don’t like your face!. It has happened before and there is nothing you can do about it. There is a clear difference between ” termination” and “non-renewal of contract”. While the Sarawak doctor’s contract were finally renewed, to avoid any such scenarios happening again, JPA has now clearly stated the above clause in the newer contracts. So, now no one can claim ignorance.

What about those who received a permanent post? Again, they were given a U41 post! However, they were told that this is due to technical reasons. The U41 permanent post will be backdated to the day they started housemanship and soon, they will receive their promotion to U44 backdated to the day they completed housemanship. Whether this has happened with all the chaos that is going on now, I do not know! We shall wait and see.

In a sudden turn of events in April 2020, about 102 permanent post were created in Sarawak. This could be part of about 1000 post that suppose to be created over the next few years as I wrote in December 2019. So, about 102 of them were sent an urgent email early April 2020 offering them this permanent post in Sarawak and NO appeal will be entertained……..

Whether there is a political reason for this, I got no idea. Based on the report by Codeblue, about 28 of them declined the offer and decided to stay on their final contract appointments. We just have to face the fact that the government will never be able to absorb all graduates. With the current economic situation, the scenario will only get worst. No job is guaranteed in this world. What is happening in Malaysia, is also happening in many developed countries but at-least, these countries have a better control over the number of graduates being produced, unlike Bolehland.

COVID-19

The world is yet again faced with another Pandemic. I would say that this is the 4th viral outbreak I am facing in my 23 years working as a doctor. It started with SARS in 2003 followed by H1N1, MesCOV and now COVID 19. Facing these viruses or any infectious diseases are part of our occupational hazard. I know many doctors who have contracted infectious diseases and some even succumbed to the illness. So, those who think that doctor’s job is sitting in a cozy room and earning big bucks, please think again. We are not only at risk of being infected with a disease but also high litigation rate and verbal insults.

We may be considered as a hero at the moment for tirelessly facing this pandemic. But trust me, once all this is over, we will be back to square one. No one will even remember what you did. That is the reality out there. But COVID 19 also thought us a lot of other lessons. The Earth is breathing better and animals seem to be enjoying their life. We must understand that the entire ecological system on Earth lives in a balance. It evolved over millions of years keeping everything in an absolute balance. The very fact that we produce CO2 and plants converts it back to O2 proves this balance. BUT humans are always greedy. We feel we can do anything to mother earth and get away with it. I had always said this to my children ” Never play with nature, take care of it. If not, nature will always get back to you!” COVID 19 just proves how nature can get back to you. A simple brainless RNA virus can shut down everything on EARTH! Viruses have been around before humans came about. So, never play with nature. Stop destroying nature and learn to live in harmony. As Sir David Attenborough said in one of his famous documentary “ If you kill a whale in the ocean, the entire ocean ecology changes!” If there are no animals which eat insects, the world will be overrun by insects, which by the way have the highest population number in the world.

What else has this pandemic thought us? Good hygiene and social distancing keep doctors away! Many would have realised that there has been 70-80% drop in the number of cases attending private hospitals and GP clinics. Some GP clinics have even decided to close their clinic as their income has dropped drastically. It is better to close than to continue to maintain the running of the clinic. Private consultant’s income has definitely taken a beating. With lock-down, there were hardly any accidents. People were afraid to go to hospitals as they were worried of getting infected in the hospital. Social distancing, stay at home and good hygiene has drastically dropped the rate of infectious diseases like URTI, respiratory infections and gastroenteritis which generally forms the bulk of private hospitals admissions. Elective cases has also been postponed. It just shows that any job can be affected if something like this happens. It happens in all outbreaks but COVID 19 has been the worst. The only job which will continue to be not affected are civil service jobs! The government has no choice but to keep civil service running and paid. While you may end up taking a pay cut eventually, you will still get paid. In fact you will even get Raya goodies!

BTW, KKM has also offered 6 months contract jobs for those who are interested to be the frontliners. Specialist will be paid RM 12K/month and MOs will be paid RM 6K/month. I understand the offer is not available anymore. I heard some GPs did take up the offer.

Democracy

On 9th May 2018, everyone thought that Malaysia has woken up. In my article titled ” Towards Malaysia Baru?” on 4th June 2018, I wrote this

With all the euphoria that we are having now, it is just too early to say how this new government will perform. Statistic shows that Pakatan only received 48% of the votes with BN & PAS taking 52% of the votes. Pakatan won in many areas due to split votes. PAS benefited from split votes in Kelantan and Terengganu. Personally, I feel that the Pakatan government is not really in a very stable situation. Tides can change by next election if they do not outperform the previous government by leaps and bounds.

Again my words have come through! One of my friends told me to stop predicting anything as everything I predict seem to be happening again and again. The Sheraton move on 27/02/2020 and subsequent fall of PH is something I expected to happen sooner or later. The politics in Malaysia is as such. Everything is tied to race and religion. Whoever plays the right card, will win. Who cares about corruption and good governance? Whatever said and whatever mockery that has happened to Malaysian democracy, the country seem to be going downhill. Years of brain drain and racial politics will only take this country to the dungeon. With COVID 19, fall in oil price and dry coffers, we are surely heading into a recession and disaster. Never in world history I have heard of a 1 day Parliament sitting with nothing more than the royal address! It is the joke of the century.

After 10 years of writing this blog, I hope readers would have learnt something. My predictions are all based on facts and statistics. It is not rocket science!

Have a blessed Ramadan and SELAMAT HARI RAYA………………………. a different Raya I must say………….

It has been more than a month since I last wrote an article which caused a storm among the medical fraternity. My article prompted Codeblue to publish what I had written, in their portal, which was subsequently brought to the attention of the Minister. During the initial press conference , MOH officials claimed that the salary difference between U41 and U44/43 contract officers are merely RM100-200 which is definitely not correct. The total difference when allowances are included will be in the range of RM 1000. Subsequently MMA made several press statements and had several meetings with MOH and MOF. After much discussion, MOH/Cabinet sort of agreed that they will “discuss” with JPA to renew the contract under U43/44 for those who have completed housemanship and did not receive permanent position. Unfortunately, to my knowledge, till today no such change has been made. Probably they are still discussing.

Subsequently, the cabinet has agreed for approval of new posts for MOH which has been frozen since 2014. The new posts will be for the newer facilities that are in the pipeline for MOH. On 2/12/2019, JPA issued a circular that about 10 675 new posts will be created for MOH within the next couple of years. Before everyone get excited, please be informed that these posts include all category of staffs. I was informed that only about 1000 post are for doctors. With 5-6000 doctors graduating annually, it is once again very obvious that most of the graduates will not be receiving a permanent post in KKM. The Minister once again has reiterated this in the Parliament few weeks ago that MOH will not be able to provide jobs to all graduates. It is a fact and it is also the fact in many other countries.

Then, out of no where, the cabinet suddenly decided that doctor’s consultation fees (not procedure fee) will be deregulated. This caught everyone by surprise as the GPs have been fighting to increase their regulated fee for years. I have written  about this few months ago. Just before the decision, MMA was informed that the government did not agree to increase the fee. However, I feel this is just the tip of the iceberg that we are seeing. I feel something big is coming along the way. With doctors flooding the market by 2020, the government got nothing to loose. Doctors will be undercutting and fighting among themselves to survive. If doctors are not united (which has never been) the biggest beneficiary would be TPAs/Insurance companies. Now, these fellows will go around doctor shopping for the best rate in town. It is called market force. Let the market force decide! With the deregulation, all clinics must display their consultation charges clearly in their clinic for patients to decide whether they want to see the doctor or not. It will become an offence if you don’t do so. I smell something is coming………… the Sith lords are never without a bigger plan………

Over the last 10-15 years, many of my predictions have come true. Mushrooming of medical schools producing thousands of medical graduates with questionable quality flooding the market and eventual unemployment in civil sector was predicted by me almost 15 years ago. It is all based on simple mathematical calculation. I am not Nostradamus! Limited postgraduate pathways due to this has been mentioned many times by me. I also spoke about the increasing waiting time for internship and internship under contract in 2014 when the actual implementation came about in 2016. Almost everything eventually happened, just the timing varied. In my MMA article 2011 & 2012 and my blog posts as well as in my books (2016), I had said that there will come a time when the Critical allowance for doctors will be removed! Critical allowance is given when you have more post than body. It is reviewed every 5 years. It use to be 5% of your basic salary till 2001 when it was increased to RM 500 by the Finance Minister who was also the PM at that time , who is also our current PM! He is also responsible in introducing this allowance when SSB was announced in 1992. Subsequently, these amount was increased to RM 750 in 2007 when the last review was undertaken.

On 20/12/2019, once again my prediction has come true. JPA issued a circular dated 20/12/2019 stating that the Critical allowance will be removed for all new appointments effective 1/01/2020. WAWASAN 2020 has been achieved! We have enough doctors to serve, we have enough civil servants, no category is considered critical anymore as we have more bodies than post. Unfortunately, we are not a developed nation yet! Interestingly, the PM who initiated Wawasan 2020 lived long enough to see himself becoming the PM again in 2020, not achieving what he envisioned. What is rather amusing is the fact that those who are already in service will continue to receive the RM750 critical allowance till they retire or resign. So, the newcomers will be doing the same amount of work but receiving a lower pay. But then, “you tak suka, you boleh keluar bukak klinik lor…………” it is called market force……….. supply and demand, more supply than demand, employer calls the shot! You have to thank your lucky stars to be even given a job!

Hit me with all your anger, use your lightsaber and I shall become stronger and the most powerful resurrected Sith of all time………

Welcome to the Rise of Palpatine …………………. where the dark lord rules………………once and for all…………..

 

Merry Christmas and a very Happy New Year 2020…………………..