This is an another article that appeared here http://goodtimes.my/index.php/Education/shortage-of-trainers-of-doctors.html. There are people who still don’t believe that we are going for a glut soon. Well, it is all up to them. I still get a lot of quarries from budding doctors after the recent SPM results. What I can see is that, many of them had already decided to do foundation studies with guaranteed seat for medicine. What they don’t understand is the fact that all these are a money-making business. I pity for these students who are being cheated into doing medicine by an easier route without strict quality control. They don’t seem to know what lies ahead of them.
Shortage of trainers of doctors
There is a scarcity of medical officers to train the glut of house officers (housemen) in local hospitals. The ideal ratio of trainers to housemen is 1:4 but in some cases the ratio is more, thus affecting the quality of training specialists.
Commenting on the issue, the Malaysian Medical Association (MMA) agrees there is a shortage of trainers to housemen.
“The MMA maintains that we do not have sufficient trainers and supervisors and quality teachers and professors or specialists to help train this big number of medical graduates,” MMA president, Dr David Quek, says.
The former Director-General of the Ministry of Health (MOH) Tan Sri Dr Mohamed Ismail Merican also says that while the ideal ratio of specialist to housemen was 1:4, “if all specialists in MOH double up as trainers and are willing to teach avidly, we should be ok. We are allowing 1:7 or 1:8 for clinical teaching.”
Quek feels that many medical schools simply side-step the criteria by employing junior and temporary staff to fill the required quota.
“The Malaysian Medical Council (MMC) and the Malaysian Qualifications Agency (MQA) make periodic visits and review these schools, but we are increasingly concerned as to the quality of the graduates due to the barest minimum quality of the teachers,” Quek says.
The glut of housemen is largely due to the fact that the Government has increased the number of accredited medical schools, both locally and overseas in its efforts to reach developed nation status.
The Deputy Health Minister Datuk Rosnah Abdul Rachid Shirlin had announced last year that Malaysia had not met the minimum doctor-population ratio of 1:600 set by the World Health Organization (WHO).
The MOH had also declared that under the 11th Malaysia Plan, the ministry will move towards achieving a doctor to population ratio of 1:400, on par with most developed nations, by the year 2020.
Quek thinks that the government’s efforts to achieve a doctor-population ratio of 1:400 is happening “too quickly, too soon”.
“We feel the MOH is too focused on an unrealistic bureaucratic target and Key Performance Indicator (KPI) which is not keeping with the best universally accepted standards.
 Houseman at work … there are over 3,000 housemen overpopulating 41 training hospitals in the country. (Picture courtesy of Loo Kar Yee) |
“This sort of 1:400 ratio is only achieved over decades in most advanced countries in the world and never rushed as if these were factory produced merchandise to cater to suddenly thought up demand!” Quek says.
Merican, through an email interview, described some of the steps the MOH had taken to solve the problem of the shortage of trainers in the country.
He said the MOH had brought in 468 foreign doctors and specialists from various countries, appointed on a contractual basis, to serve as trainers as well as to fill in vacancies in several smaller district hospitals.
The number of slots available for the local Master’s programme was also increased to produce more specialists. MOH has also accredited another five hospitals for housemen training in addition to the 41 training hospitals available in the country.
It has also increased the mandatory posting for house-officer training from three disciplines to six in 2008. The six disciplines are Internal Medicine, Pediatric, Surgery, Orthopedic, Obstetrics and Gynaecology and Emergency Medicine
Last year, Anesthesiology was introduced as an alternative posting to Emergency Medicine to ensure a more comprehensive exposure for housemen.
MOH also introduced the “Mentoring Junior Doctors” course which aims at “strengthening the capabilities of housemen trainers”.
However, not all trainers agree that the steps taken by the government has produced the desired results.
A medical officer pursuing his specialist degree in a public hospital, feels that hiring foreign doctors will pose more problems in the long run as it will take away job opportunities for local doctors.
“It is very wrong, to bring in foreigners and forget our own people,” he says.
According to him, the low salary doctors in the public service earn, compared to those in the private sector is also another factor that is driving specialists away from training hospitals.
He added that for every extra shift he does, he gets an extra RM150 and if he has to work on a weekend or a public holiday, he gets an additional RM20.
“That’s about RM6 per hour. One of the reasons why there are so few specialist trainers is because they have either ‘jumped’ to private hospitals or gone overseas where the pay is better.
“My father served the government as an agricultural engineer, but he had to ‘jump’ (move to a private company) to pay for my education.” He says he will do the same should the need arise in his family.
Another consultant in the field of pediatrics from a local hospital believes it is the state of under-equipped medical schools which is a more serious problem than the lack of an adequate number of trainers.
A specialist trainer, herself, she related an incident where a house-officer recommended a patient “traditional treatment”, instead of modern medicine to cure his illness.
She had also encountered many other under-qualified, ill-equipped housemen who “could not even answer the most basic questions about medicine”.
Frustrated with the lack of quality, especially among graduates from newer and smaller medical schools, she feels that the right step is to deregister some of these schools and de-list some of the foreign medical schools that have been producing “half-baked housemen”.
Quek feels the low quality of housemen is due to the fact that medical schools can be set up upon meeting only the minimum of standards.
“Many of the officials argue that the quality of medical schools in this country is inadequate, because all the medical schools so far meet the minimum standards or criteria set out by the MQA,” he explains.
He feels it would be better to cut down on the number of medical schools to ensure producing better quality housemen.
“Australia and the United Kingdom had produced too many doctors in the past decades and has since scaled back by amalgamating or closing down medical schools,” he says.
Perhaps the government should take a note from these “already developed nations” and see that quantity does not ensure quality.
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yup.. i agree with you Dr. Pagalavan.. and the quality of those trainers in teaching hospitals are doubtful as well.. i am so surprised that the house officers in the surgical department of a teaching hospital do not know how to insert a brannula..!!
Dr Merican still giving unconstructive suggestion. That is why the medical system under his hand is worse and now worsening. His way is ‘ideal’ but not practical, he doesn’t know what is the need of the health system.
1. Medical officer (who work in the system and know the need) mentioned above ‘A medical officer pursuing his specialist degree in a public hospital, feels that hiring foreign doctors will pose more problems in the long run as it will take away job opportunities for local doctors.’
2. Dr Merican (who work outside the system) said ‘MOH had brought in 468 foreign doctors and specialists from various countries, appointed on a contractual basis, to serve as trainers as well as to fill in vacancies in several smaller district hospitals’.
Isn’t the Dr Merican suggestion doesn’t meet what the medical officer want?
MOH should listen more to the doctor who see patients and work in the hospital rather than listen to the doctor who only work in the office and seldom see patient.
We learn that to treat a disease is to treat the cause of the disease not symptom. From the information above, the doctors suggestion only treat symptom and not the cause.
In Dr Merican’s defence, his hands are tied. And he does work within the system as a specialist (gastroenterology in selayang if I’m not mistaken).
We are short of specialists in the public sector because people have jumped to private. So, we have to hire specialists have developing countries. What are the other options?:
1. Just leave things as they are – this will overwork the specialists/MOs already in the system and make things worse
2. Train more specialists – we are, but can’t happen overnight (unlike our undergrads, heh heh). Even the quality of this training is at risk cos there’s no qualified people to train them – I don’t consider someone who’s just finished their specialty training via SLAB, with just 6 years working experience, as ‘qualified’. Also, training more doesn’t stop the haemorrhage into private.
3. Address the issues on why people leave public service:
i. pay
ii. discrimination
i. Pay – MOH constrained by the govt pay scale. They should make another scale for doctors, like some other certain govt depts have. Pay can never compete with private though, and there will always be a minority of money-hungry doctors out there.
ii. Discrimination – Certain people getting promoted based on race rather than merit. This will stay as long as racist parties stay in power (and I group MCA and MIC as racist parties as well, in case you were wondering).
Anyway, TSDIM is retiring soon. They’ve already announced the new DG but I don’t know anything about him. I don’t think there will be any significant changes.
Since there are many doctors now and will be more in future soon. One of my odd thinking / suggestion is to start shift work for all departments.
Spread all clinic patient to different hours. Make clinic from 8am to 12am with different shift of doctors.
1. No need to cramp all clinic patients to 8am to 4pm only.
2. Less parking headache, no all patients come together.
3. Less overworked and tired doctors as no need > 6 housemen to work together in a ward. Arrange more doctors for night shift.
4. Doctors more time to rest, no need to work continuously for 36 hours.
5. Government will pay less OT (but will compromise doctors income)
Anyway, just an idea.
Is it not possible to divert more government funds to the public sector to keep them from jumping to the private sector?
Well, we have talking about it over the last 20-30 years but unfortunately, the system just puts us as another public servant with salary scale. We are nothing special for the administrators. So, just flood the market with doctors!
Dear all
What you guys have mentioned are indeed very solid arguments and have sound basis.
I will provide my 2 cents on this issue:
1. I totally agree with the fact that our doctor’s pay in this country is too low. The call claim is pitiful to say the least ( although some senior doctors will come up and tell me that during their time the call claim was RM 25 ! ) A separate pay scale for doctors and careful financial planning to avoid over-spending may call for more dedicated authorities, which we know may never happen. Haha.What a shame.
2. The KKM should provide incentives for doctors/MOs/Specialists who venture into overseas examination/board programmes such as MRCP, MRCOG, MRCS etc… as this bunch of doctors are continually upgrading their knowledge and working hard to earn a foreign qualification.
These people are the ones who usually keep abreast of latest developments, guidelines, advancements in treatments etc. Ask any experienced staff and they will agree. We have too many JUSA C and so called consultants who do not keep themselves updated and instead discriminate against juniors who practise evidence based medicine! EBM is the forefront in many developed countries these days.
Once a MO passes his/her Part 1 board exam (e.g: MRCP, MRCOG etc) or even Masters Part 1 , they should be promoted to UD48 at least. This will encourage our doctors to continue their hard work and studies and in the end you will create less dissatisfaction among new specialists. Most of the specialists were so ill treated during their earlier days ( I have a Pakar who was on UD 41 for 2 years!!!! ) and imagine how can you blame these people for leaving to private practise! Most of them are so phobic of the ill environment that they work in! Please don’t label doctors as money-hungry individuals, most of them served the country better than some politicians have!
Once you have promoted these budding specialists ( i.e those who passed part 1 exams ) you will earn their gratitude and make them wanna stay in public service longer! Do correct me if I am wrong.
3. I can’t agree more with the fact that why bring in foreign individuals when you have so many hardworking local doctors? These local doctors should have their plights looked into instead of doing some “talent” search abroad! Most people abroad won’t be coming back! Forget about the unrealistic ideas of luring them back with so called better pay and etc which will never match their counterparts overseas!
4. Look into the disarray of local masters programmes, most of them are set to discriminate and fail candidates instead of passing them. At the rate that they are failing good candidates and discriminate against our bright young doctors who are eagerly scooped up by UK hospitals… we will never produce enough specialists to cater for our people. We have plenty of Malaysian doctors in UK hospitals who were once discriminated by the local programmes and they are now serving happily with good comments from UK directors! What a joke!
Once upon a time, you worked with Regency Specialist Hospital is it? Are you that Dr. Pagavalan over there?
Yes but no more with Regency