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Time flies…… I did not even realise that it has been 1 year since I launched my first set of books. The sale of my books has been quite encouraging without any major promotion. Since September 2016, these books are available at Kinukuniya and selected MPH bookstores. It is also available at MPH Online, Kinokuniya Online and Google Play Store(soft copy)You can also visit http://www.hardtruthsofbeingadoctor.com if you wish to buy using credit card/pay pal.

AND, to celebrate my 1st year anniversary of launching my first set of books, for a limited time ONLY, I will be selling the books(a set of both volumes) for RM 85(including courier within Malaysia) till end of May 2017. For those who have NOT purchased these books, this is the best time you can buy it cheaper than the bookstores, directly from me. Each Book will be personally signed by me. Please see below on how to purchase the books.

These books are meant for budding doctors, parents, medical students and even junior doctors. Despite all the articles in this blog, I keep being asked the same questions repeatedly. Thus I thought of compiling everything into a book. Unfortunately, due to high volume of the book, it has to be divided into 2 books of about 250 pages each. Foreword is written by A/Prof Wong Yin Onn from Monash Malaysia. Here are the titles:

HARD TRUTHS AI BLUE - New Blue

HARD TRUTHS AI BK2- New Red

HARD TRUTHS AI BLUE - New Blue (2)

Please be informed that there are many updated information in these books compared to some of my old articles. Information about income, salary, post-graduate educations etc have been updated. There are 5 chapters in Book 1 and 4 chapters in Book 2 with the following titles:

Book 1:

  1. General Misconception of Being a Doctor
  2. General Information for budding doctors
  3. Malaysian Healthcare system for Dummies
  4. Housemanship, Medical Officer and Post Graduate Education in Malaysia
  5. Employment and Job Opportunities

Book 2:

  1. Housemanship
  2. Post Graduate Training
  3. Income of Doctors
  4. The Doctor’s Dilemma

These books will be sold as a set of 2 books , purchased directly from me.

This is how you can order your copy:

  1. Make a payment of RM 85 (including postage within Malaysia) to CIMB Bank Account No: 8006158099 (Pagalavan Letchumanan)
  2. Send your Bank-In Slip to email hardtruths2016@gmail.com with your name and address/particulars
  3. Give me 1-2 days to courier the books.
  4. Courier tracking number and invoice will be sent to you via email after it has been mailed.
  5. An Invoice will be provided for Tax purposes
  6. For those who are ordering from overseas, please email me first as I need to check on courier charges.

Hope everyone will enjoy reading this, one of its kind book in Malaysia……………

For those SPM leavers, this is the time to grab the books………..

 

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Sometimes I really feel sorry for some students or graduates who expect everything to come to them on a silver plate. Life is never easy. It only gets tougher day by day. You have to live with what you have and try to be better in every sense in order to be a successful person in the future. Unfortunately, the current generation of graduates grew up in a comfortable environment with everything being provided by their parents. Their parents on the other hand do not want their precious child to get his/her hand dirty! They want their child to be in a chamber, work from 9-5 and come back home and live a comfortable life and earn a lot of money! In reality, that will never happen!

Over the last 1 week, there were many interesting letters to the Star. The chain reaction was started by THIS letter, supposedly written by a graduate who is yet to even start his housemanship. How ironic! The issue brought forward was about “tagging”.  I must say that I don’t totally disagree with the author but he must understand that, it is the reality and part & parcel of life. For years people are talking about it but why are there no changes to the environment? I agree that our working environment is pathetic. Most of the older hospitals do not even have proper room for doctors(HO/MO) to rest or sleep. Housemen need to use whatever room available to rest/sleep during their calls. However, some of the newer hospitals do have proper call rooms but the numbers are generally not adequate. When I was in SCHOMOS/MMA Johor, I had to put multiple request to change all the “worn-out” air-conds in all the so-called “call” rooms in the hospital. It took me almost 1 year to get it done. Thank fully I had a wonderful hospital and state pengarah who supported my request. In the 2000s, we only had 1-2 HOs in each ward and thus we did not require that many rooms to even start with. Only 2 MOs and 3 HOs were “on-call” every night. Unfortunately, we have tons of HOs in a hospital nowadays.

Coming to the issue of tagging, I feel someone will never complain if his/her intention to do medicine is to learn and help people. After all, tagging is just 2 weeks in the first posting and usually will become 1 week in subsequent postings. I don’t see a big fuss about that. The tagging period is to enable you to learn how the system works and at the same time to build up your physical and mental strength of being a doctor. Medical graduates feel that they are the only one working “so” hard compared to other graduates. I beg to differ. Almost all graduates in any other critical field do the same during their early career stages. The only difference is, you are dealing with life and death matter and your job is in the hospital. You can’t bring your work back home like engineers, lawyers etc. Till today, I am still working 24hrs a day 7 days a week!

Medicine is a life long learning. Till today I am still learning and discovering new things which I had never seen before. The most crucial part of medicine is the early years of housemanship and MOship. During this time, you are always guided by someone senior who is much more experienced than you. Your responsibility is actually the lowest as you don’t have to make life and death decision. Medicine cannot be learned from books. Medicine is on the job learning. The more patients you see and the more time you spend in the ward, the more you learn. If you want to be a good doctor, then stop whining and spend your time learning the most during the early years.

The next day, another letter supposedly written by a parent was published in the Star. Again, I don’t totally disagree with the letter especially about the working environment but the “parent” must realise that being a doctor is not an “office” hour job! You have to make sure your job is done before going home as you are dealing with lives. I don’t understand why is he complaining about 12 hours shift? I presume he wants a “start at 8am and go back at 5pm ” kind of job! Than I am sorry, he is in a wrong profession. These issue arises because parents and even students do medicine thinking that it is a cosy job, sitting in an air-cond room and earning quick bugs! The reality is totally the opposite. That’s why I keep saying that EVERYONE who intend to do medicine MUST read my books! Know the reality before putting your foot into anything. I have also said this many times, never get married during housemanship (in reference to the letter which talks about parenting!). And please stop comparing with other countries. Each country have their own problems as the healthcare structure and system are different. In Australia, you do not have hospitals without specialist. Here, you are thrown to a district hospital after housemanship where you will be the one who will be making decisions! You will be doing vacuum/forcep delivery, inserting chest tubes, doing minor surgeries etc. The competency level needed is totally different!

These letters were discussed extensively in social media and some senior doctors did write to the Star. “Doctors NO Different from Soldiers” in The Star and “An appropriate baseline in quality and quantity of training” in Malay Mail are worth reading. You will only know how important housemanship is when you are posted to a district hospital or alone in a hospital without anyone to consult! Till today, I still remember what I learned from my seniors during housemanship. I still remember who thought me to do a CVP line at 4am in the morning and he is a succesful cardiologist now. Looking back, I enjoyed my housemanship as all of us back then, helped each other very well, without being calculative. Unfortunately, we have too many housemen nowadays who are calculative and do not help each other. Trust me, housemanship will be a wonderful experience if your colleagues help each other.

And for those housemen/parents who are whining , there is an important message from our Deputy DG:

 

MESSAGE FROM THE DEPUTY DIRECTOR GENERAL OF HEALTH THIS MORNING 22nd March 2017

There appears to be some confusion on what is being said on HOs and the contract system.

The current modified flexi system was formulated by a group lead by myself where a HO will work between 68-74 hours per week with HO : patient of 1:4 ( in most other countries 81 hrs and HO patient ration 1: 8-10)

So for starters they are working less hours and with less patients to look after.

But the system is designed to ensure ownership and accountability of patients to each HO. So much so only HO training in Malaysia is accepted by the GMC uk as equal to their training for those who have degrees registrable with the GMC .

In order to ensure adequate clinical exposure and competence each posting has 16 mandatory topics which they need to know before they can exit a posting , it is very transparent and questions asked are within these topics and answers given are documented for reference in disputes on unfairness and I was asked a postgraduate question !

Also they are given protected time to ensure they attend 75% of the CMEs.

So if a HO working under these conditions can’t complete his/ her work within the shift period I have no comments , would you find them safe to run your clinic ?

They are given 16 weeks to complete each posting and allowed 2 extensions of 8 weeks i.e. another 16 weeks if still not competent a final 24 weeks at another hospital to given them a fair chance ,then terminated . So they are given more than enough opportunities to remedy their short comings .

With this in place and only 5000 places for each year , when HOs get extended or disappear and as they are permanent civil servants , it takes more than a year to terminate them !

So I have on an average 6-700 who are non performing each year added to those who don’t want to take up their post HO , MO posting by refusing to move they by depriving others getting into the system !

So with the contract system you disappear for 7 days out you go and in comes the next person in the queue , if you finish you HO training and don’t want to go to your new MO posting when your 24 mths is up so too is your salary , so they will not be able to work till they accept their new posting and once there is a lapse in pay it will take about 3 mths to get the system back Bec MOH has almost 40k Drs !

Next those who don’t complete due to not being competent and are terminated that is the end of the road .

Those who have disappearance and return they have a 6 mth cooling off period before JPA allows them to reapply so in reality it will be about 9 mths before they get a job.

When numbers are high , we have no option but to be fair to those who have not been given a job , we hope those given a chance will value the job given .

Work is very different from being a student and the reality is many students don ‘t spend long hours in the wards so working in the ward for ” long” works is alien to them!

This is compounded by the fact that all private medical colleges don’t have their own teaching hospital which to me makes a big difference , how many lectures and professors of private medical schools actually work in the wards ? So this to me is another reason for the standards and attitudes of the newer medical students .

With the contract system compulsory service is still there 2yrs as a HO and 2 more as an MO , once you have completed the 4 yrs then we cross the bridge , the MOH as it stands with it’s future needs can only take in about 2-2500 max per year so about 50% will not be given a job in MOH .

Who will be taken ? , those pursuing a postgraduate program either the Masters or the parallel pathway of the Royal college exams Bec for every masters slot now there 5-7 applicants ! So to give an opportunity to the others we are developing the parallel pathway including Primary care .

So I have put a lot of thought and effort into planning for the future of healthcare delivery in Malaysia to ensure we have a truly great system with competent and safe doctors delivering quality health care .

I am open to comments if you can suggest ways to make it better Bec this is a dynamic process that may need to be adjusted from time to time .

I am now working on the rationalisation of MO post to ensure workload levelling , it took my team 9 mths to ensure equitable HO distribution , so in the next 3 mths the MOs issue will be resolved and finally the Specialist will be next Bec not all of them are working just as hard !

Once that is done my work is done and I can leave my job , I have delivered on what I was tasked to do as DDG in MOH , other task of mine are also in various stages of completion.

🙏 DATUK JEYAINDRAN TAN SRI DATUK DR C SINNADURAI

 

So, just to summarise:

  1. those who go missing for 7 days: out you go!
  2. those who return, have 6 month’s cooling off period for even JPA to re-consider
  3. those who don’t complete HO in 3 years, out you go!
  4. those who refuse to transfer out to wherever you are posted, salary will stop within 24 hrs
  5. only 50% of HOs completing will be given Moship post in MOH
  6. the rest have to “cari makan” on your own
  7. preference for MO permanent post will be given to those who have postgraduate interest

Did anyone say that doctors will never be jobless? Well, the reality is here. When we have more bodies than post, the employer aka MOH have the right to pick and choose. Dr M once said, he want to flood the market with doctors! His ambition has come true……

SPM results were just out 2 weeks ago. For those who intend to do medicine, please buy and read my books! You can visit my blog post HERE on instructions on how to buy the books.

 

 

Time flies…… I have so much work to do and so little time to handle it. As a doctor, you will never have free time. Just when you thought you would sit down and do something, comes a phone call from the hospital. There goes your time. I always believe that family come first but being a doctor, sacrifices have to be made. If you are not ready for sacrifices, then you need to find some other course.

It is now confirmed that job is not guaranteed for doctors. All housemanship post will be given under contract. A maximum of 3 years is allocated for you to complete your housemanship. After housemanship, you will be renewed to complete your compulsory service (4 years in total including housemanship). You can apply for permanent post based on criteria mentioned in my earlier post. Whether the selection process will be transparent or not, time will tell. The latest Berita MMA had some information regarding these issues and the issues of promotion/sponsorship, after a meeting with MOH, as attached below:

 

Most of the issues discussed above are self-explanatory. Recently , the deputy minister of health did mention in the parliament that 2 more hospitals will join the list of housemanship training hospitals which include Hospital Shah Alam and Hospital Langkawi. Military hospitals were included this year. Interestingly, he said there are 44 medical programs in this country!! If I am not mistaken, there are close to 35 medical schools in the country but a lot of them have more than 1 intake and some have more than 1 program. So, even if we say that each program produces an average of 100 graduates, we will have close to 5K graduates locally alone, may hit as high as 6k. This coupled with those returning from overseas, the numbers may hit about 7-8K graduates. An excellent Bolehland achievement. Enough said! A recent article by Malaysian Pre-Houseman Joint (MPHJ) which I never knew existed was a good read(see below). He had summarised what I have been saying for almost 10 years.

I heard rumours that MMC will be corporatised in compliance with Amended Medical Act 2012, somewhere in July this year. It is likely that APC fee will increase and NSR registration for specialist will become mandatory(not sure who will pay for civil servants). Minimum CME points requirement will be needed for APC renewal. I heard it will be about 20 points annually. NSR renewal every 5 years will also need minimum CME points of about 100. BUT we still need to wait for the official announcement on these issues as discussion is still ongoing. Please be also informed of NSR new rule effective 2017:

General Requirement On Post Qualification Experience
Effective January 2017, applicants must have at least ONE (1) year post qualification working experience for medical related specialties/fields of practice and at least TWO (2) years for surgical related specialties/fields of practice.

This new NSR rule makes it impossible for anyone to leave to private sector immediately after post-graduate/subspecialist qualifications. Once NSR is made mandatory, only those who are NSR registered are considered a specialist. Frankly, I feel it is a good move as medicine is a life long learning process and having a qualification alone does not make you competent.

Then came several other information regarding U56 promotion and issues in KKM. This message below is nothing new but it is a very important information for doctors in civil service.

UD56 post

1.Only for gazetted NSR Specialist

2.5 years after gazzetemnt & 5 years after being a UD54

3.Will get around RM 2100 more than what is being earned currently by a UD 54 specialist

4. No car or petrol card given to UD56

5. Not everyone will have to go through UD56, some an jump straight to JUSA C

Other matters raised

1. No subspeciality allowance will be given once sub completed

2.Anyone can do locum but need to register/inform Pengarah

3. Doing locum – buy own insurance ( MO doing in private clinic & specialist )

4.No more contract doctors – JPA phasing out . 

5.Senior consultants who retire & reemployed as contract will not be in the same hospital

6.Husband & Wife who are specialist as far as possible will not be placed in same department

7. Optimize the use of resources & consumables 

8.No direct sponsorship by Pharma companies

9. Sponsorship via societies allowed , but has  to be transparent – documented in the minutes of the society meeting

10.Those who want to go for voluntary medical relieve work overseas have to be registered with KKM – special form to be filled up .

11.FPP – not for foreigners

12.Pharma company reps only allowed to see HOD , should not see MOs & specialist

As you can see, life as a doctor is never going to be easy with new rules and regulation being put in place. Sometimes we doctors are to be blamed for all these issues. Greed took over some of the doctors, giving rise to unethical practices to survive. The recent press release by MMC on disciplinary actions against errant doctors is rather shocking but it is just the tip of the iceberg. The recent MACC arrest of doctors for signing heavy vehicle driving license medical certification without examining the patient is rather worrying but not surprising. At the end of the day, it is all about survival…………

Once the election is over, more surprises may be coming for doctors. …………….

Junior doctors trapped in catch-22 predicament

March 10, 2017

Unemployment is high among medical graduates because housemanship training is only provided by accredited government and university hospitals and places are scarce.

By Dr Muhammad Firdaus Syukri B Ahmad Zubaidi

In the past decade or so, the number of university graduates has soared in most professional fields. This, coupled with the current challenging global economic slowdown, has consequently led to higher unemployment among graduates.

Until recently, the medical field has been relatively spared from this crisis. With promises of guaranteed employment, more and more people have ventured into the medical field. However, unemployment has finally caught up. Many spend hundreds of thousands, if not millions, on their medical education, only to graduate and realise that the paradigm has shifted.

The past few years have witnessed an exponential increase in medical graduates produced both locally and abroad. The increment in number would not normally be as big an issue in other fields; however the medical field is unique.

A graduate interested in pursuing a career as a doctor has limited options to continue his or her junior training – in fact, they only have one. In order to be recognised to practise in a country, a graduate must obtain a full medical licence, which they receive upon completion of housemanship training.

Housemanship training is only provided by accredited government and university hospitals, and junior doctors are solely dependent on these limited training posts to continue their careers in medicine. Yet, as the number of graduates has increased in the past five years, the number of training centres and houseman posts has remained relatively static.

Inevitably, this has led to a mismatch between the number of graduates produced and the places for their training. With limited posts available, graduates now have to wait many more months before it is finally their turn to enrol into housemanship.

And as the number of medical graduates increases year by year, so does the waiting period for housemanship. Medical graduates of 2013 waited an average of three months before starting housemanship while graduates of 2016 have yet to be employed after eight months of waiting. The promise of a secure career in medicine is now a thing of the past.

The long waiting period does not come without a cost. As graduates are not able to put their knowledge into practice, their medical knowledge becomes rusty and withers by the day. Not to mention the skills learned in medical school – the art of communicating with patients and carrying out procedures such as drawing blood will surely be lost without constant practice.

Corporations and non-governmental bodies offering pre-housemanship courses have mushroomed of late, but the fees charged are steep and can only be afforded by the more affluent graduates; even then, how much can a two- to three-day crash course substantiate five years of medical school teaching?

This is probably the major cause of the ever growing complaints of poorly performing house officers, and less the “failures” of medical school programmes to nurture the passion to care and heal. House officers are doomed even before they begin work.

And when a house officer performs badly, they are viciously scolded and harassed by their superiors as mistakes in the medical profession could potentially costs lives. Is it any wonder that the rates of depressive illnesses are high among junior doctors in training?

This further leads to poor learning and poorer performances, aggravating an already vicious cycle. Poorly performing house officers have to undergo extended training, taking up posts designated for new house officer intakes and further escalating the problem of limited posts. As house officers are the first line of doctors serving in tertiary government facilities, at the end of the day it is the rakyat who bear the brunt of the housemanship crisis.

You may be wondering what most graduates do while waiting for their housemanship. According to an online survey conducted by the Malaysian Pre-Housemanship Joint, a whopping 80% of graduates remain unemployed during this waiting period.

The remaining 20% are mostly employed in part-time jobs such as tutoring, sales marketing, driving for ride-hailing services or as research assistants. Many complain that it is difficult for them to get jobs because not many companies are keen to employ medical graduates, some even citing “over qualification” as an excuse.

The frustrating and ambiguous housemanship waiting period deters employers from hiring medical graduates as they prefer hiring workers who can commit to the job for a decent period of time.

On the other hand, the uncertainty also makes it cumbersome for graduates to decide whether to take up job offers such as research assistants which require commitment for a stipulated period. These employment obstacles results in most medical graduates being without a job and faced with a looming socio-economic catastrophe.

The landscape of the medical field has changed dramatically. But the rakyat has been virtually oblivious of the severe and dramatic repercussions that have befallen junior doctors entering the work force.

Society needs to revise their perspectives of the medical profession. Those intent on a career in medicine and surgery must be made cognisant of the damning changes currently at play and not be misled by false societal perceptions of this once noble vocation.

It is no longer the safe haven it used to be where graduates were virtually guaranteed a good livelihood post-graduation. The private sector is not willing to employ a doctor without a full medical licence, while other countries have laid out strict entrance and linguistic examinations for foreign doctors.

Thus, neither the private sector nor working abroad are viable options for junior doctors – public service is the only option. We are beholden to the mercy of the Public Services Department (PSD) and the health ministry.

In the final analysis, medical graduates are worst off compared with other graduates. Junior doctors are trapped in a catch-22 predicament not entirely of their making. They bear the brunt of the policies of the PSD and healthcare systems (MOH).

Dr Muhammad Firdaus Syukri B Ahmad Zubaidi is spokesman for Malaysian Pre-Houseman Joint (MPHJ).

With a firm belief in freedom of expression and without prejudice, FMT tries its best to share reliable content from third parties. Such articles are strictly the writer’s (or organisation’s) personal opinion. FMT does not necessarily endorse the views or opinions given by any third party content provider.

 

It looks like we are making headlines again. Few days ago, the Chief Secretary of the Government publicly announced that housemen are the highest number of civil servants being terminated. As for me, it did not come as a surprise.  This is something that is well-known to the medical profession. Many housemen just go missing without any notice. I had said this before that it is better for them to give a resignation letter than just go missing in action. The government’s procedure is as such that it will take almost a year to terminate someone from civil service. During this time, no one else can occupy your post. This is one of the reason I support giving housemanship under contract. It will be much easier to terminate someone who goes missing. It will also keep everyone on their toes.

Today, NST published several reports on these issues as below. I had said it many times since I started this blog that you should know what you are getting yourself into when you decide to do medicine. That is the reason why I started this blog in 2010. Unfortunately, many still refuse to believe what is written and in denial. Parents on the other hand do not even bother to ask their child what they want to do in their life. They pressurize their child in doing medicine by promising a good life and money.

Medicine is a stressful job. It is not about sitting in an office and having a chat with a patient and pocketing RM 50-70. IT is much more than that. The time taken to be competent and the amount of responsibility taken is huge. With increasing literacy rate and demand of patients, it further adds to the stress level. Some times I get amused when the person who makes the most fuss in a clinic or a hospital actually sends his own child to be a doctor! I know another parent who do not believe in western medicine and takes only complementary medicine but sent his son to do medicine overseas! Is this called hypocrisy or they simply believe that medicine brings easy money for their children?

As a response to the issue, our Health Minister says that all future housemen would be given counselling! Sometimes I simply don’t understand the logic behind some of the answers coming out of our politician’s mouth! Why do counselling after they graduate? Why don’t we start counselling before they even enter a medical school? Or even conduct some form of standardised entrance exam and interview? Tell them and their parents the reality out there. Unfortunately this will not happen as it will affect the enrolment into our 35 medical schools. Then the medical schools will start making noise as they will be loosing money! The very moment our policy makers decided to commercialised medical education and put quantity ahead of quality, we know where we are heading!

For those who intend to do medicine, please read this blog or buy my books! I had many comments which said that I am discouraging many budding doctors by being very negative. I had explained many times that what I write over here are the REALITY out there which you should know before putting your foot into medicine. If you only going to realise it after you graduate, then it is simply too late…… Trust me : Life in Medicine never gets easier…….

My Books are still available and can be purchased directly from me by following the instructions over HERE. Each and every budding medical students should read this book before deciding to do medicine. Softcopy is available at Google Play Store.

HARD TRUTHS AI BLUE - New Blue

 

HARD TRUTHS AI BK2- New Red

 

Doctor dilemma: Why are Malaysia’s housemen buckling under pressure?

BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:03

 MANY housemen find it difficult to cope with the pressure when they cannot adapt to the rigorous training regimen in hospitals. Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said this had led to many housemen not completing their training, especially those who studied abroad, as the systems were different. “In some countries, interns are not even allowed to touch patients, and they do not even know how to get a patient’s history. “There is also the language barrier. If they studied in Indonesia, the common language is Bahasa Indonesia, but in Malaysia, we use English,” he said, adding that this had increased the pressure on housemen. Dr Hilmi said there were about 10,000 housemen from various backgrounds in Malaysia, including graduates from local, overseas and unrecognised universities. He said of the number, at least 20 per cent had difficulties with training and were asked to extend their internships up to six to eight months. “Last year, 1.2 per cent of housemen were either terminated or had quit because they could not take the heat. “Many went to other countries to complete their internship, while those who did not show up for many months were sacked.” On why it took so long to identify absent housemen, Dr Hilmi said there were so many housemen that sometimes their superiors did not notice that they had gone missing. “That is why some have gone missing for up to 400 days,” he said after launching World Leprosy Day at the Gombak Orang Asli Hospital in Selangor yesterday. He was responding to Chief Secretary to the Government Tan Sri Dr Ali Hamsa, who had said trainee doctors made up the highest number of civil servants who were given termination notices. Health Minister Datuk Seri Dr S. Subramaniam said about 20 to 30 per cent of about 5,000 housemen who joined the service every year opted to extend their housemanship. He said there were cases of housemen leaving the profession or were removed after they disappeared after finding out that they could not meet the expected requirements of working as a doctor. “I’ve seen some who resigned within 24 hours. “Many don’t resign, but they are not in the system because they don’t go to work. “Later, when we identify them, but can’t trace them, we have to take disciplinary action,” said Dr Subramaniam at a seminar on workplace health here yesterday. He said stress was the main reason housemen dropped out, were absent or extended their housemanship. “People who take up medicine and don’t know what it is all about (often find that) they can’t fit in the system.” However, he said, the number of such incident s had dropped as the ministry had taken steps to intervene by counselling the housemen. He said the respective sections had been instructed to counsel and train housemen before they began their programme and to offer them transfers to other facilities to help them adjust. Dr Subramaniam said universities should consider using an aptitude test. He said to address the problem, the ministry’s main job was to ensure that working conditions were conducive. He said universities might need to regulate interviews to ensure the screening system was compatible with the ministry’s requirements. He said imposing such requirements on private institutions was a tall order as a strict vetting process would reduce the number of students who passed,thus leading them to collect less fees. He said housemen who dropped out and wanted to rejoin the service would not be given a second chance. “Once they drop out, it is the end of their medical career. “The Malaysian Medical Council will not recognise them as practising doctors. “The ones with major disciplinary issues will not have a certification of good standard and they will find it difficult to find jobs in other countries.” Ali Hamsa had said some housemen were laid off because they went missing for up to 400 days. He said some of them had studied abroad on government scholarships. It was reported that sponsoring a medical student overseas could cost as much as RM1 million or more, while the cost in local universities was far lower, but still hefty. Ali Hamsa attributed the policy of permitting hospital interns to follow their spouses overseas for study purposes as another possible reason many went missing from work, and called for a policy review.

Read More : http://www.nst.com.my/news/2017/02/212611/doctor-dilemma-why-are-malaysias-housemen-buckling-under-pressure?d=1

Planning to become a doctor? Get set for burnouts, depression

BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:00 PM

While many consider being a doctor a dream profession, a growing number of those working in the field find it miserable. Numerous reports can be found on how a growing number of physicians and trainees are going through dark periods of turmoil due to stress. Dr Elaine Cox, in an article on health.usnews.com, said statistics on the number of doctors-in-training and those practising medicine who faced stress was alarming, with about one-third of physicians reporting experiencing burnout at any given point. “As a matter of fact, doctors are 15 times more likely to burn out than professionals in any other line of work, and 45 per cent of primary care physicians report that they would quit if they could afford to do so. “Physicians have a 10 to 20 per cent higher divorce rate than the general population and, sadly, there are 300 to 400 physician suicide deaths each year.” She said the lack of control over schedules and time could contribute to high-stress situations for physicians. “This can result in poor sleep patterns, interference with family activities and events, and poor self-care. “Because there is a patient in need at the end of every phone call and every office or hospital interaction, setting limits is beyond difficult. “The result can be physical and emotional exhaustion, leading to cynicism and burnout. Add to that the increasingly litigious society in which we live, and there is a recipe for quite a few failures.” Dr Cox said in a study published recently, medical students reported a rate of depression that was 15 to 30 per cent higher than the general population. “This can lead to poorer performance, such as 6.2 times more medication errors, exactly the opposite of what we are striving for through the education process.” She said many physicians did not recognise and seek help when they experienced early signs of burnout, primarily because of fear. “Frequently, privileges and licences could be denied if physicians are under treatment for substance abuse or depression. Without those certifications, the source of livelihood, not to mention identity and many years spent in training, is lost.” She said many feared that the struggles they faced would be noticed by the doctor they were getting the treatment from, and, as a result, many self-medicate, which was not a good strategy. Alexandra Sifferlin, writing for Time.com, said research showed that almost 40 per cent of doctors in the United States experienced emotional, physical and psychological burnout from their jobs. “The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the healthcare system, leading to less motivation to improve conditions, both for themselves and for patients,” she said. 2106 reads NST Infographic

Read More : http://www.nst.com.my/news/2017/02/212607/planning-become-doctor-get-set-burnouts-depression?d=1

So, finally it has made the headlines. After many years of me talking about it, finally the reality was reported by mainstream newspapers few days ago. When many of us in the medical line brought up the issue of too many medical schools and too little training position, we were condemned. This is partly because the government itself, till 2014 denied that such a thing will happen. For those who know our government very well, surely know that not all said are trustable. Despite overwhelming evidence, people refuse to believe. As I had always said, people would only want to listen to good stuffs. When I tell them the truth and reality, I am accused of discouraging, very negative etc. No job is going to be guaranteed….. The only difference is , you will be spending RM 300-600K for a medical degree locally!

On 19/01/2017, The Star as well as Malay mail published an extensive report regarding contract HO post and no guarantee of a civil service post thereafter. Since I wrote about the contract HO post in November 2016, a Malay mail reporter was trying to get in touch with me to get my views on the issues. However, I did not respond to her since I was overseas till mid December 2016. She contacted me again few days before the articles were published and I gave my views. She was more interested about the JPA scholars. She wanted a copy of the contract which I refused, as the doctor’s name is written on the contract.

As usual, all these happened because there is no such thing as “planning” by our ministries. Each ministry works on its own without proper consultation with other ministries. For Ministry of Education(MOE), their goal is to make Malaysia an education hub, quality aside. It is a money-making business. My stand has always been that education should never be commercialised! License to start medical schools were given like peanuts. Only in Malaysia, colleges in a shop-lot can be given license to run a medical program. Accreditation works on minimum criteria and not based on an expected standard. As long as the college achieve a minimum standard, they will get the green light to continue. It’s like saying, 20% is enough to pass. You don’t need 70% to prove you are good and excellent. MOE treated medicine just like any other educational program!

Medicine is not like any other course. The 5 years undergraduate program is just the beginning. It is a life long learning. You learn by apprenticeship. You are dealing with life and death mater. A simple prescription error can cause a death! Training can only be done in accredited training centres. Many parents live in a delusional world thinking that jobs for doctors are guaranteed. The fact is, not anymore. Even in countries like US, UK, Australia etc, doctors work on contract basis. However, most of these countries have enough internship post for their graduates, due to proper planning strategy. Apart from internship, there is no guarantee that you will get a permanent job. Some survive by doing locum. Malaysia is now entering the same situation. And don’t forget that if your degree is not recognised elsewhere, you can’t work in another country without first sitting and clearing their qualification exam, with no guarantee of a job. This will cost you more money!

From the newspaper report, it is also obvious that all HO post will be given under contract basis from now onwards, even for JPA scholars. Permanent post is only eligible after you complete your housemanship and there is no guarantee that JPA scholars will be given a permanent post. As I mentioned earlier, this is good to kick out the poor performers and retain the best  in civil service. However, the selection process must be transparent. If not, many accusation will be floating around in the next few years. Please be informed that if you do get a permanent post after housemanship, you have to go where the post is vacant! You cannot choose or appeal. If you don’t want to go, someone else would be willing. You can’t choose where you want to work. You are also not eligible for car or house loan from the government if you are not holding a permanent post. Even bank loans can be a problem is you don’t have a permanent job.

With 32 medical schools and close to 38 medical programs, oversupply of doctors is inevitable. As of 31/12/2015, based on MOH statistics, the doctor : population ratio is already 1: 656, not including doctors from non-MOH public hospitals. So, we are already 2 years ahead. Chasing after numbers do not make any difference. Quantity does not equate to quality!

Well, I had spoken enough about these issues many times before, including in my books that was published last year. So, I will not repeat it all over again.

It is time for medical graduates to look for other jobs. GP market will be flooded in few years time and as I had mentioned in my last article, unethical practices will become a norm in the name of survival……..

Gong Xi Fa Chai everyone…………..

Contract doctors judged on merit, not government scholarship, MOH says

BY BOO SU-LYN

Published: January 19, 2017 08:50 AM GMT+8

Dr Noor Hisham confirmed that permanent positions for graduating house officers were not guaranteed. ― Malay Mail pic

KUALA LUMPUR, Jan 19 — Permanent positions will be offered to contract house officers depending on their performance rather than any government scholarship they may or may not have received, the Health Ministry said today.

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with Public Service Department (PSD) scholars among the graduate doctors on contract as no permanent positions were offered at all.

“Based on merits, not based on scholarships,” Dr Noor Hisham told Malay Mail Online, when asked if PSD scholars will be prioritised for permanent positions given that they are bonded to the government.

“Bond still the same and when they are absorbed to permanent post, their service from Dec 5 will be taken into permanent service too,” he added.

Dr Noor Hisham also confirmed that permanent positions for graduating house officers were not guaranteed.

“If you are competent and good, then no worries. Those non-performers and MIA [missing in action] should be worried as it’s based on merits. For this, anywhere you go it’s the same — public or private.

“Who wants to employ incompetent and missing in action doctors?” the Health DG said.

Dr Pagalavan Letchumanan, a consultant physician and rheumatologist, said he was made to understand that 1,300 contract housemanship placements were given out, including for PSD scholars, after the last Public Services Commission of Malaysia interview in October 2016.

“There is no guarantee that you will be continued to be employed just because you are a PSD scholar! This comes as a surprise even to me as the scholarship contract specifically says that you will be bonded with the government for 10 years,” Dr Pagalavan posted on his bloglast November.

“What happens if the scholar is not able to get a permanent job with the government? Does he need to pay his bond? An interesting question,” he added.

Dr Pagalavan told Malay Mail Online that a PSD scholar had told him that he was given a contract post and was informed that the government bond was between the scholar and PSD, and had nothing to do with the Health Ministry.

Among the criteria listed on the house officer’s contract for the offer of a permanent position, “depending on the availability of positions”, were completion of one’s housemanship, a good track record and a recommendation from the head of department.

The copy of the contract that Dr Pagalavan posted on his blog also stated that the government could terminate the contract at any time if the house officer’s performance was not satisfactory and that a 30-day notice, or one month’s basic salary, would be given.

“Somehow, I feel this will remove all the dead wood graduates from the system. However, I am also worried about lack of transparency in making such [a] selection,” Dr Pagalavan said, adding that a committee should be formed to ensure that such decisions were fair.

Malaysian Medical Association president Dr John Chew claimed that before the implementation of the contract housemanship system, 20 per cent of doctors holding such posts were not performing.

“So the new system will be better,” Dr Chew told Malay Mail Online.

“For most of us, employment and work are more important. Most people are happy that they have started work”.

Health Minister Datuk Seri Dr S. Subramaniam reportedly said last October that offering contract housemanship would help about 2,600 graduate doctors on the waiting list every year, saying that they could wait for up to a year because there were not enough permanent positions.

– See more at: http://m.themalaymailonline.com/malaysia/article/contract-doctors-judged-on-merit-not-government-scholarship-moh-says#sthash.2nwRcPoG.dpuf

Medicos no longer guaranteed civil service employment

BY LOH FOON FONG

‘Permanent appointments will be based on their merit during housemanship training and recommendation by the Health director-general.’ – Datuk Seri Dr Chen Chaw Min

EXCLUSIVE: PETALING JAYA: Permanent employment for doctors, pharmacists and dentists in the civil service is no longer guaranteed.

The Government has started issuing jobs on a contract basis for them since last month as announced in Budget 2017.

According to the Health Ministry, if doctors successfully completed their housemanship within the three years of contract, they would have another two-year contract for compulsory service as a medical officer.

Pharmacists will be hired as provisionally registered pharmacists (PRP) for one year, with a maximum contract offered for two years and for the compulsory service thereafter, one year, with a maximum contract offered for one year.

There is no compulsory internship for dentists and compulsory service for them is one year, with a maximum contract offered for three years.

Health Ministry secretary-general Datuk Seri Dr Chen Chaw Min said from last month, 1,219 candidates had been offered jobs on a contract basis by the Public Service Commission.

“Permanent appointments will be based on their merit during housemanship training and recommendation by the Health director-general,” he said in an e-mail to The Star.

The move, he said, is expected to reduce waiting time for housemanship training and compulsory service.

Dr Chen said competent staff who fulfilled specific requirements will get permanent posts but they may not immediately get the posts until there are vacancies.

Their salaries will be backdated to the date of appointment once the posts are available, he said.

He said for government scholars who have not been offered permanent posts in the ministry upon completion of their compulsory service, they could seek jobs in the university and military hospitals and the private sector.

He also said that for this year, the ministry planned to take in 9,300 candidates – six batches of intakes which will involve 5,425 candidates for house officers (housemen), three batches (1,921) for dental officers and four batches (1,954) for pharmacists.

He added that housemen will enjoy the same benefits received by permanent house officers as stipulated in a 2008 circular on contract of service with additional advantages.

Those under this “modified contract” will have full-pay medical leave up to 90 days, and the extension of medical treatment for parents in government hospitals and clinics, he said.

But only those who are appointed as permanent medical officers and have obtained their confirmation in service are eligible to apply for government housing loans, he said.

The monthly basic pay of a houseman is the same as the grade category UD41 of the permanent service which is RM2,947, while a dentist (grade UG41) gets RM2,844 and a pharmacist (UF41) RM2,740. With allowances, they could get RM4,000.

On the criteria for a permanent medical officer post, Dr Chen said doctors must fulfil the service requirements, including attaining a good level of competency and performance of at least 85% in the yearly performance review during their house­man­­­ship training or compulsory service.

The permanent posts would also be given to the best talents who have the potential for specialty training and are willing to serve at any place in the ministry’s facilities during their tenure, he added.

PSD confirms no permanent spot in public hospitals for scholars

Published: January 20, 2017 03:00 PM GMT+8      

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with PSD scholars among the graduate doctors on contract as no permanent positions were offered at all. — File pic

KUALA LUMPUR, Jan 20 — The Public Services Department (PSD) has confirmed reports that only performing scholars will be offered permanent contracts at public hospitals.

In an email response to a query by Malay Mail Online, the agency said that the government is currently looking at alternatives on how to absorb scholars who failed to secure permanent jobs despite being offered housemanship contracts by its hospitals.

“Students who qualify for our scholarships are excellent students. With that we hope that they can continue to display similar performance as they do with their studies, and show high commitment when executing their duties under their housemanship contracts so that they can be offered permanent jobs,” the agency said.

“Nevertheless, the government is currently looking at several alternatives should PSD medical scholars already offered housemanship contracts fail to secure permanent jobs once their contract ends,” it added.

Yesterday Malay Mail Online reported that public hospitals will only offer permanent contracts to  house officers based on their performance, and not to any government scholarship students.

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with PSD scholars among the graduate doctors on contract as no permanent positions were offered at all.

“Based on merits, not based on scholarships,” Dr Noor Hisham told Malay Mail Online, when asked if PSD scholars will be prioritised for permanent positions given that they are bonded to the government.

“Bond still the same and when they are absorbed to permanent post, their service from Dec 5 will be taken into permanent service too,” he added.

Dr Noor Hisham also confirmed that permanent positions for graduating house officers were not guaranteed.

Health Minister Datuk Seri Dr S. Subramaniam reportedly said last October that offering contract housemanship would help about 2,600 graduate doctors on the waiting list every year, saying that they could wait for up to a year because there were not enough permanent positions.

 

– See more at: http://m.themalaymailonline.com/malaysia/article/psd-confirms-no-permanent-spot-in-public-hospitals-for-scholars#sthash.UYFxAzZA.dpuf

It’s been one and a half month since I last updated my blog. As I wrote in my last post, I was going for a long holiday after an hectic year dealing with IRB. Coming back from a long holiday is the worst nightmare. Clinic was packed to the brim, multiple medical reports to write and multiple reply letters to type. Then came Christmas, New Year and finally my hospitals MSQH audit which just ended today! Phew………

Unfortunately, doctors were in the limelight for the wrong reasons towards the end of last year and the beginning of this year. A daring expose by Al-Jazeera regarding baby selling syndicate in Malaysia on 24/11/2016 was a disaster for doctors. The faces of many doctors involved were clearly shown. Unfortunately this is nothing new. Many years ago, a similar syndicate was exposed and caught in Johor. The police acted swiftly and did manage to arrest few of the members of the syndicate that was exposed by Al Jazeera.

Just when we thought it was already damaging enough, came another exclusive expose from NST. Doctors venturing into unethical practices of cosmetic products. Frankly, this is nothing new as well. I have seen enough doctors practising what was exposed by the report. Injecting IV Vit C for whitening/anti ageing and many more so called aesthetic practices are common nowadays.  In 2012, MOH (tr-vitamin-c-injection) had already issued statement that there is NO evidence that IV Vit C has any benefit. In fact, ViT C is NOT approved by MOH for intravenous injections for cosmetic reasons. Anyone found doing it can be charged for unethical practice. Ozone therapy is another major complimentary medicine practise that doctors are widely involved. Way back in 2011, MMC had already issued a statement that ozone therapy do not provide any health benefit and any doctors found guilty of providing ozone therapy by claiming that it can cure diseases, can be charged for unethical practices. Unfortunately it did not prevent many doctors from doing it. In fact I even know nurses who are openly promoting such centres on Facebook and showing many VIPs who are taking their ozone treatment. Again, on 3/01/2017, our DG issued another press statement regarding ozone therapy. The press statement came after NST reported that many celebrities who were openly promoting ozone therapy for advertisement purposes expressed their regrets. I have heard of reports of people dying during the procedure and even developing cardiac and renal failure. It is not a procedure without complications.

The question is, why are doctors venturing into such practices? The answer is simple : money and survival! Since I started blogging in 2010, I had written several times regarding these issues. In fact in 2012, I wrote on how desperate have doctors become. That is the reality out there. No matter what passion that you talk about before going into medicine, at the end of the day, it all boils down to money and survival. There is no such thing as easy money or easy life in medicine. Many doctors especially GPs are struggling to survive. Thus, to keep their income and their clinic running, they venture into these unethical businesses.

I get a lot of query regarding aesthetic medicine etc. My reply has always been to ask yourself why you became a doctor! Is it to treat and cure people with sickness or to become a glorified beautician! Yes, there is a lot of money in aesthetic medicine. There are huge financial backup from big suppliers all over the world. Cosmetic and aesthetic suppliers are one of the largest companies in the world. The companies need doctors as doctors are the only people licensed to inject substance into a person! At the end, no doctor will do it if not paid well!

The situation will only get worst. My last article talked about the introduction of contract HO post with no guarantee of a permanent post. I had mentioned that those who do not get a permanent post will end up flooding the GP market. Imagine what will happen then. Issues mentioned above will only get worst day by day, in the name of survival. WE have to blame ourselves for loosing the respect and trust once given by the public. Worst still, many of these young doctors would have huge amount of debts to pay! As I had always said, never take huge loans to do medicine!

Well, it did not end there. Just when 2016 was coming to an end, 2 cases of botched circumcision were reported. Interestingly, the first clinic was reported as not having a  license to run! Interesting indeed if the report was true.

On the other end, MMC has now started their own qualification exam for those from unrecognised universities. It is now known as EPR (Exam for Provisional Registration). Is this a prelude for a common entry exam? Only time will tell……….  As the years pass by, almost everything I predicted is becoming a reality. God save this country……

So, finally the first batch of HOs under contract has been given. I was made to understand that 1300 contract posts were given out after the last SPA interview conducted in October 2016. These were graduates who were waiting since early this year. Interestingly, I was told that none received permanent post. Even JPA scholars were only given contract post and it seems, the agreement that you have with JPA has nothing to do with MOH. There is no guarantee that you will be continued to be employed just because you are a JPA scholar! This comes as a surprise even to me as the scholarship contract specifically says that you will be bonded with the government for 10 years. Only from this year, the scholarship contract was redefined as convertible loan. What happens if the scholar is not able to get a permanent job with the government? Does he need to pay his bond? An interesting question.

The good news is, those who received these contract post were able to get their posting in December 2016(in just 2 months after interview), as long as they are not choosy in picking their hospital on e-housemen portal. But they still waited for close to 7 months to even be called for interview.

There were many questions on the pros and cons of being under contract. Frankly, as long as you are under contract, the salary and leave benefits will be the same. However, you do not get to enjoy other benefits such as house or car loan. Applying for a bank loan may also be difficult as you do not have a permanent job. The government can also terminate you immediately if they find you are incompetent, missing in action or have poor track record. These will definitely keep the HOs on their toes. Below I attach snapshot of some of the “Syarat-syarat pelantikan secara kontrak

Part 1

Part 3

 

 

Part 4

 

Number 13, 14 and 15 might be on interest for some who intend to pursue post graduate education. Number 13 and 14 clearly says that the government can terminate you anytime by giving a 30 days notice or immediately by giving 1 month salary. Number 15 is another interesting statement about application to be absorbed into permanent post. The first and foremost criteria is “availability of post“! This is were I am worried as the number of permanent post available may not be the same as the number of HO’s graduating. They have also listed the criteria that may be used to decide on who will get the permanent post. Basically, you need to complete your housemanship as per requirement (which means within 3 years), have good track record and gets good recommendation from HOD. …………

Somehow, I feel this will remove all the dead wood graduates from the system. However, I am also worried about lack of transparency in making such selection. Those who are hard working and got no issues in completing housemanship should not have any problems. I feel there should be some sort of committee to make such decisions to be fair. Contract post also means that HOs can stop demanding this and that. The motto will be ” you tak suka, you boleh keluar“, the most favourite statement from our politicians. Your contract can be terminated.

The contract also clearly says that government is not obliged to provide permanent jobs to everyone:

Part 6

So, what happens to those who do not get permanent post after 4 years contract? Firstly, you need to find a job: either open a clinic, join as emergency department MO in private hospitals or find another non-medically related job. Secondly, all your ambition to become a specialist will have to disappear unless probably FRACGP organised by Academy of Family Physician of Malaysia, join as a private Master’s candidate at local university(you pay full fee and very limited seats) or probably do some non-clinical, part time courses.

Whatever it is, the government will not be able to absorb everyone. They are not obliged to provide every graduate a job. Many may end up with a license to kill…………. Medicolegal cases are going to increase by leaps and bounds………

 

Finally after settling my tax issues with IRB, I am off again for a long holiday of 3 weeks……… Sayonara to everyone…..