For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)
It has been more than 2 weeks since I last posted on this topic. I have been quite busy lately with increasing workload in my hospital as well as some renovation work going on in my house. In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.
1) Compulsory Service
I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.
2) District/Rural postings
As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!
From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.
The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!
Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.
This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.
I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.
Next: Postgraduate training…………………
Pagalavan's Avatar 
Dr. Pagal, I must congratulate you on this very enlightening article. I am sending this blog to some young doctors who are waiting for their first posting. I know of a few who have already planned to appeal if they are posted to rural areas. It is so sad to note that these people are so ignorant about what it means to be a doctor in a rural setting and the learning experience that they would gain from a rural posting.
i really luv to read ur blogs as it is infomative plus enlightening to every young doctors in msia… currently, im doing my district posting (Klinik kesihatan)… b4 i was send to KK, i was really devastated… was in denial and was trying hard to appeal back to GH…. once i was send down here… i know my rights better… still in the learning process doin admin work and plus … becoming a trainer to all your staffs…. although, life is great, well, im still counting my days to get back to GH… i think 1 year is good enough to be in district … i really cant wait about your articles regarding postgrad!!
Dear Dr Pagal,
Thank you for bringing up the district posting issue. I served in possibly one of the most rural hospitals in Malaysia which is only accessible by river transportation. Like you mentioned, it is the best place to sharpen one’s clinical and surgical skills. However, it is not entirely true that these places have lower workload than general hospitals. When you take into account that basically 3 young doctors are running a whole hospital, from the ED to the wards to the OT, and any ill patients for transfer to referral hospital will further tie up the manpower as the journey takes 3-4 hours on boat. Support from top level is scarce, VIP came once in a while when elections were around the corner, had some dialogue session but never follow up on the issues; but staff support is great, without them it would be unimaginable on how to run a hospital with only 3 doctors. It can be physically tiring and mentally draining, but the things that you see and learn there, make you not only a better doctor, but also a better person.
I have since left the place. Frankly speaking, all the promises on priority for master programme, preferences for your desired specialty/department should not be taken seriously because afterall, we live and work in a system where CONNECTION is everything. Go because you really intend to put into practice what you learn in medical school and sincerely want to serve the people there, because at the end of the day, there is no financial or career renumeration, you will not earn extra allowance (despite what the politicians claim on newspaper) or get into master even though you fulfilled more criteria than others (there is always a ‘quota’ you see), but trust me, if you go with an open mind and do your best, the experience and memory will be priceless.
Thanks for your comment. I do agree that certain districts/rural areas are busier. Furthermore, the ministry has no control over the Master;s selection process. All is done by the Universities. Sadly, most of the academics in our local universtities themselves have NOt served the rural areas!
Hi Dr Pagalavan,
I am one of the government sponsored student in Australasia, and will be graduating next year.
The recent development in the Malaysian medical education seems bleak and with the haphazard postgraduate education, it seems to many of us that returning to Malaysia would be very disadvantageous to our career development and a waste to our training, after working hard to pursue a national scholarship, gaining entry to Western medical schools and undergoing rigorous training.
However, for some of us, returning to Malaysia is still a strong option as our families are based here, being the place of our upbringing, getting married and settling down, and not to mention the legal implications of our contract with the civil service.
As a consolation, what would you comment on the positive aspects working and training in the Malaysian public healthcare system?
How do you foresee working as a trainee and specialist in the public health system? Can local specialists attain the same level of calibre to further develop their disciplines through involvement in their professional bodies, despite being trained in less-than-ideal schemes?
And do you think that there will be something in store for us, who are committed to seeing the public health system work for both the medical fraternity and the public?
What would be the prospect of medical leadership and research, in light of the increased presence of Western medical schools in Malaysia (e.g. John Hopkins, RCSI, Monash etc.)?
Do you think that the Academy of Medicine, MMC and MMA, and the leadership in prestigious public medical schools and research centres, be able to bring the necessary change to our health system and medical education scene?
sorry its supposed to be for the Part 3 blog post. 🙂
[…] https://pagalavan.com/2010/10/10/for-future-doctors-housemanship-medical-officer-and-postgraduate-tra… […]