I found this interesting presentation from a blog http://www.tehandassociates.com/2011/07/physician-workforce-planning-in-malaysia-better-coordination-needed/ that belongs to Dr Teh and Associates who runs an international healthcare consultancy firm. He seem to have presented this paper at a recent National Medical Education Conference last week. Almost everything that he had mentioned has been written in my blog. In fact, he has quoted my blog in his writing.
Many still do not believe or understand the situation that I am trying to expose in my blog. I was informed that the entire UK only produces 7000-8000 doctors per year for a population of 62 million despite their medical education being almost 800 years old. But here in Malaysia, we are going to produce almost 8000 doctors annually for a population of 28 million. Malaysia boleh mah……….. We had almost 30 new medical schools in just 15 years, probably the fastest growing medical schools in the world!
I just saw a boy who came to do medical check-up for university entry. He was accepted for medical education at MSU university. It seems that MSU has also started their own 5 year medical programme within Malaysia which will run parallel to their twinning programme. As I said, the moratorium is just an eyewash! This boy’s father got no clue about the situation in the future. In fact, his father still thinks that his son’s job is secured , he can work overseas if no job here or can become a lecturer. When I told him that these are not possible in medicine, he was shocked!! He thought that once you get your MBBS, you can work anywhere like engineers etc!
The article below is an interesting read and those who still doubt what I have been saying over the last 1 year +, please pay attention. Jobless doctor will become a reality and doctor’s income will also drop dramatically.
Physician Workforce Planning in Malaysia: Better Coordination Needed
July 27, 2011
Dr Andy Teh, Principal of Teh & Associates, presented his paper on physician resource planning at the National Conference on Redefining & Reforming Medical Education, held at the Putra World Trade Centre, Kuala Lumpur, on 21 July 2011.
The following is an excerpt of Dr Teh’s paper entitled:
“Eradicating incompetent medical graduates, leveraging oversupply of housemen, avoiding substandard doctors and nurses:- Renegotiating and laying the foundation for national healthcare reform.”
The Problem: An Oversupply of Doctors in Malaysia
More than 6,000 fresh medical graduates enter the Malaysian health workforce annually; about 4,000 from local medical schools and the rest from overseas institutions. This is a remarkably large number for a country with a population of about 28.5 million. In recent years, the alarmingly high rate at which fresh graduates have entered the workforce has caused concern in several quarters (see a list of blogs at the end of this article) because:
- The number of internship positions approved by the Malaysian Medical Council exceeds the capacity for appropriate supervision and training. In other words, there is an insufficient number of qualified senior physicians to oversee the training of housemen (interns)
- Inadequate supervision of housemen, leading to:
- Potentially compromised patient care at the 63 training hospitals approved for houseman training
- Failure to meet the training objectives of housemen, which has negative effects on the health system both in the short- and long-term
An often cited reason for the rapid escalation in physician production is a shortage of doctors in the country’s public sector and target population-to-doctor ratios of 600:1 by 2015 and 400:1 by 2020.
The government has not put forward any other argument that explains the methods used to forecast the country’s requirement for physicians.
Moratorium
Despite the government’s adamance that there is no surplus of doctors in the public sector, it imposed a five-year moratorium on medical programs in December 2010. However, the moratorium does not restrict the number of students that existing medical schools can accept—this seems to defeat the purpose of the moratorium.
Issues
There are several problems with the current approach to physician workforce planning:
- Lack of strategic planning. Health workforce planning should be strategic, i.e. take a long-term view, say, 25 years (as opposed to a 10-year view) and rolling. The use of short-term targets often yield unsatisfactory results, especially when coupled with quick fixes (as appears to be the case).
- Inadequate consideration of factors that influence workforce effectiveness other than physician density. Density, as measured by a population-to-physician ratio is merely one of the determinants of workforce effectiveness. The other main factors that influence effectiveness are: skill mix, distribution, and quality. In other words, a health workforce with the desired population-to-doctor ratio may still fail to deliver the best possible outcomes. Further, if the mix of health workers (doctors, nurses, pharmacists, and other allied health staff) is not optimal, production of health services might be inefficient, i.e. a greater number of health services at the same quality could be achieved for the same cost or the same number of health services at the same quality could be achieved at a lower cost. The relative excess of health workers, especially doctors, in the urban areas and their relative deficit in rural areas are masked by an aggregate population-to-doctor ratio. In fact, the maldistribution of physicians may be exacerbated with the massive influx of doctors. The overall quality of fresh medical graduates may also be compromised due to lack of supervisory capacity during their two years of housemanship/internship.
- Mismatch between the supply of housemen and postgraduate medical education capacity. The critical shortage of qualified senior physicians to oversee the internship of housemen is a serious issue.
A Possible Solution
Any strategy to address the current issues requires a tailored and collaborative approach. Indeed, the World Health Organization (WHO) states that:
A blueprint approach will not work, as effective workforce strategies must be matched to a country’s unique history and situation. Most workforce problems are deeply embedded in changing contexts, and they cannot be easily resolved. These problems can be emotionally charged because of status issues and politically loaded because of divergent interests. That is why workforce solutions require stakeholders to be engaged in both problem diagnosis and problem solving.1
Projecting Future Requirement for Medical Personnel
In addition to density, skill mix, distribution, and quality, other factors should be considered when projecting the future requirement for physicians, including:
- Demographic trends
- Effects of economic development
- Affordability of healthcare services
- Demand for healthcare services
- Regional and international comparisons
- Recommended standards, e.g. WHO, World Bank
- Past trends
- Expert opinion
Working Group
Due to the disparate interests and considerable number of issues at hand, we propose a Working Group, responsible for high-level planning as well as executive oversight, be set up. This Group would consist of at least the following parties:
- Policy makers and health planners from MOH, Ministry of Higher Education, Malaysian Medical Council and National Accreditation Board
- Representatives from the medical schools
- Representatives from the public and private healthcare sector, e.g. Association of Private Hospitals of Malaysia
The implementation of national plans will require sufficient political will.
We suggested several ideas that may form part of the overall strategy to address the issues mentioned above. These may be classified into two major categories:
- Tactics that improve the quality of postgraduate medical and nursing training
- Tactics that control the number of fresh graduates entering the local workforce
Tactics that improve the quality of postgraduate medical and nursing training
According to WHO, “(s)trategies to improve the performance of the health workforce must initially focus on existing staff because of the time lag in training new health workers.”
In brief, we suggested tactics to:
- Build education capacity
- Harness the value of supervision
- Leverage opportunities for “non-clinical” education, for example, in the areas of public health, clinical research, risk management, and also training methods that address the new paradigms of care, e.g. from acute tertiary hospital care to home-based and team-driven care.
Tactics that control the number of fresh graduates entering the local workforce
- Continuous reevaluation of future requirement for health workers.
- Controlling the number of Malaysians being admitted and graduating from medical schools. This can be achieved through:
- Creation of a body to oversee the quality of medical education, the functions of which may be similar to the Council on Medical Education in the United States.
- Introduction of standards to improve the quality of medical education, e.g. requiring a basic university degree before acceptance into a professional degree program (as in some parts of the word), establishing minimum expectations in a medical curriculum, and a minimum number of full-time medical faculty.2 Following the Flexner Report2 which advocated these changes (and more) in similar circumstances to the present in Malaysia, a large proportion of medical schools in the United States merged or closed, and the average physician quality improved significantly.
- A standardized examination for all newly graduated medical practitioners entering the workforce.
- Review of requirements for admission and graduation.
- Review of school recruitment practices.
- Manage student and parent expectations.
Conclusion
The issues related to the oversupply of physicians in recent years can only be overcome by an approach that is more responsive to the health needs of the population, and that incorporates planning with a longer-term focus, appropriate planning methods, data-based decision-making, better coordination among the various stakeholders, and a shared intent to improve the safety and quality of patient care.
References
- World Health Organization. 2006. World Health Report 2006: Working together for health. World Health Organization. Retrieved July 7, 2011 from: http://www.who.int/whr/2006/en/.
- Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation for the Advancement of Teaching, 1910.
Commentary About the Oversupply of Doctors
- A doctor too many!
- Bernama—Health Minister: No Surplus Of Doctors In Public Sector By 2015 (Read the commentary below the newspaper article.)
- Houseman Glut : Why should we be surprised?
- For Future Doctors: Housemanship Glut
Pagalavan's Avatar 
Dr Pagalavan: Thank you for citing my article, which is a synopsis of the paper I prepared for and presented at last week’s National Conference on Redefining & Reforming Medical Education held in KL. The vast majority of conference participants (90-95%) were from MOH; representation from the private sector, especially the medical schools, was unsurprisingly poor but nonetheless disappointing. You might have expected them to show greater interest in helping to develop a viable solution. After all, it’s in their interest! As hinted in the article, the whole problem is complex; there are issues that I have not fully understood, such as: the coordination (or lack of) between the Ministries of Higher Education and Health, apparently misinformed setting of arbitrary targets, and what appears to be decision-making that fails to recognise the local (Malaysia vs USA, UK, Australia, other developed nations) and current context. Despite the challenges, I’d like to think our combined voices will improve the debate on medical education.
The private colleges will not be interested because they are not bothered. They just want to make money as much as possible, as long as possible. They are not interested in quality. Actually most of these medical schools are owned by some connected person and that’s how they get the license so easily from MOHE. If all these colleges are really interested to develop medical education, they would have seeked recognition from other medical councils. However, none of our colleges are recognised elsewhere and thus you do not see any foreign medical students except for Monash.
While I wholeheartedly agree with what you’re trying to say, you have some of your numbers wrong.
The UK has 32 medical schools, which produce 200-300 doctors per school per year. The newer ones have less, under 100. This does not add up to a total of 1000-1200 per year, as cited in your article.
I tried to look for a number, and could only find the following article: http://www.hospitaldr.co.uk/blogs/our-news/uk-medical-graduates-may-be-denied-foundation-year-jobs
It says that 7600 doctors are expected to graduate in 2011, an average of 238 graduates per medical school.
Even with these numbers, the UK has 32 medical schools for a population of 63 million. Compare that with Malaysia’s 33 medical schools for less than half that population! Furthermore, we have Malaysians doing medicine overseas in developing countries and eastern europe, probably close to 2000 each year (1000 from egypt alone) all trying to get houseman positions. That probably equates to 10 more medical schools.
The govt have really got their heads in the sand about this, but I have gotten used to their incompetence. Malaysian parents on the other hand, who dream about their son/daughter becoming doctors “because it will give them a secure future”, they need to be educated about this. There will come a time where these parents will have spent RM100,000-500,000 on their child’s education and end up with an unsatisfying job with low pay, or no job at all.
There is nothing that makes doctors special. Lawyers, pilots and engineers have ended up jobless in Malaysia before. If there are too many doctors and not enough jobs (how many more jobs can Liow Tiong Lai create out of thin air – why not HO’s in GP clinics next?), the same thing will happen here.
Yup, agreed. As I quote “was informed”. Didn’t really check myself. However, UK universities also take in a lot of foreign students and thus the actual local students may very well be much lower.
Uk universities have a quota for foreign students – no more than 10% of each intake. Admittedly, this was 10 years ago, I do not know if this quota is still in place. Anecdotally, most foreign students in UK tend to stay for at least their FY1 and 2 year.
Ireland however, is well know to be a mass producer of doctors – 60% of some uni cohorts, which is why foreign Irish graduates have to sit the PLAB if they want to work in the UK, unlike local Irish grads with the exact same qualification.
Hi, I just graduated from a medical school in UK 2 months ago. As Nav said, the quota for foreign students is still implemented throughout the medical schools in UK. For our batch, my universities only accepted 20+ foreign students per year despite having around 300++ medical students each year.
Regarding the foundation programme application in UK (which is equivalent to the housemanship in Malaysia), the applications are more than the total foundation post available in UK for the first time in the history this year with approximately 10% of applicants not been offered a job (mainly graduates from other countries). Furthermore, the FPUK predicted such trend (applicants more than training post available) will continue to grow in the next few years……
Indeed, there is nothing special about doctors. There has never been any guarantee that having a medical degree assures a career in medicine and a secure living; even if past history would suggest so.
Workforce planning issues aside, I have always maintained that no matter how many doctors a system produces, there has never been (and will never be) an oversupply of excellent doctors. Half of doctors out there were in the bottom half of their class in med school.
Even with all the problems of glut, I would still encourage the right candidates to do medicine/surgery if they have the passion for it, and the potential and drive to excel. These candidates will always find a way to succeed and be good at what they do no matter how inadequate the system they are put through. There is no denying that fierce competition breeds excellence.
What does it matter whether there are 10 vs 1000 candidates for one job? In the end, it only takes one other to beat you out of it if he/she Is the better person for the post!
So by and large, I don’t find the idea of future doctors being unemployed being such a big deal. There are doctors out there who have no business treating patients in the first place. If you’re not good enough, too bad. Find something else to do. That’s the responsible decision anyway. We have all just got to get over the ideal that medical graduates must end up in medical careers.
Unfortunately, the way the f*cktard politicians and greedy academic institutions have turned medical education into a cashcow to be milked for all it’s worth means that thousands of less informed parents will have spent fortunes to put their children through medical school only to see it amount to zilch.
Hopefully websites like this will open the eyes of prospective medical students and their sponsors. No one ever said don’t do medicine… but one needs to make an informed choice.
As far as I know UK/European coutry close down their postgrad training to locals since 3 years ago. As far as I have heard there are really not many that I know of get into real specialty training yet. Unlike in states FY1 and 2 is liek internship – mostly manpower and paperwork and after that they will likely to stop your visa. They are reserving their training seats for locals. After that there is a sudden increase in application for residency in US. Maybe it’s a coincidence. However, its totally different in Malaysia – med schools are promoting that their graduates “can work at alot of places around the world” ending this sentence with a “IF THEY GET ACCEPTED. I still believe doctor is a secured job depending on how you look at it. Can you get rich becoming a doc?unlikely. Can you support your family in Malaysia if you are a doctor?I dont know. But alot of places still need doctor and their graduates are still doing very well with training seats and career after graduation. All I can say is if you want to go do med school think twice and make sure whatever degree you get will be recognized in places you wanna work at. Check certification from those coutry NOT the university information/advisors(its like trusting direct salesman).
Oh and in united states 17k US fresh medical graduate(total applicant 47k) with 22809 training seats available versus 307 million population. Malaysia would be…4k(?) versus 27.5 million population(registered). We are actually producing double the amount of doctor:patient ratio lol.
Read page 13 for summary for NRMP match – for those who still has high hopes for coming to states look at IMG matching rate – img include those who has had 5-10 years experience with tons of research background (esp those who cannot proceed in UK). Can Malaysian fresh grad without clinical and research experience compete?
Oh and I have to emphasize again – please check if your med school is eligible to take USMLE if they tell you that you can go to the states. iI have had lots of people that ask me that questions but their med school is not included under ECFMG accredidation.
http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8
http://www.aafp.org/online/en/home/residents/match/summary.html
A graduate student can only take USMLE only if their school is ECFMG accredited. To know whether your country’s medical school is ECFMG accredited, please access https://imed.faimer.org/ and key in your country. FYI, malaysia only has 13 schools (6 private and 7 local) which are accredited.. the rest… hmmmm
Well, do take note that you can still take the USMLE even if your school is not accredited. You just have to fill up some extra forms, ask your school fill some extra forms etc, and hopefully all goes through.
A very alarming article with an equally alarming statistic, I’d say. As an aspiring Doctor, it only motivates me to study harder and work even harder. I did plan to take up medicine at an IPTS and then sit for USMLE to become an IMG with migration to USA in mind. I have few questions to ask regarding USMLE. Unfortunately, the IPTS medical school that I’m suppose to enroll is not listed under IMED. I have emailed IMED concerning this and received a reply :
______________________________________________________________
It is required that an applicant’s medical school and year of graduation be listed in IMED for eligibility for the USMLE. If your school is not listed, it is most likely that FAIMER never received a request from the government to do so.
To be listed in the International Medical Education Directory (IMED), the Ministry of Health, Ministry of Education or other authorized agency in the country where the school is located must write to FAIMER to request the school be added to IMED, and to provide the following information:
· That the medical school is recognized by the government of the country for award of the Doctor of Medicine (or equivalent) medical degree that allows the practice of medicine in that country by graduates of the medical school,
· The date on which recognition was granted and whether the recognition is indefinite or time-limited. If recognition is time-limited, for how long a time period the recognition valid,
· The date on which graduates of the school became, or will become eligible for medical licensure in that country,
· The duration of the medical school curriculum, the language of instruction and the title of the medical degree awarded,
· Whether the school has a physical campus in that country and the location (address) of the campus,
· Whether instruction has begun at the school and, if so, on what date. If instruction has not yet begun, the date when classes expected to begin, and
· Whether the school has a campus in any other location. If so, to specify the location.
Documentation must be sent on letterhead stationery, with the name, title and signature of the authorized official, sent directly to FAIMER from the government or agency office.
Carole Bede
Chief Librarian
FAIMER
3624 Market Street
Philadelphia PA 19104
USA
email: imed@faimer.org
fax: +215-386-9767
FAIMER is not an accrediting body and listing of a medical school in IMED does not denote accreditation, recognition or endorsement by FAIMER.
_____________________________________________________________
After Googling around, I’m aware that a graduate from a non IMED medical school could still sit for USMLE but, will be placed at the bottom rung of the matching hierarchy. However, pgy1’s comments landed a blow to my hopes of becoming an IMG.
My questions are:
(1). Is it even practical for a Malaysian IPTS medical school graduate to sit for USMLE with a hope to migrate to the States as an IMG? What are the odds?
(2). Is it advisable for a 3rd year medical student to sit for Step 1 of USMLE?
What would be the ideal time to take Step 1 of USMLE?
(3). How to enhance the the chances of getting matched in the States as an IMG?
Kindly advice.
Hey,
I hope I did not cause negative impact to your ambition. I would say that since you did bothered to look at the statistic you will study harder and get more prepared comparing to those that just get into med school and say that they wanna get to US or other countries, and doesn’t even have a clue about USMLE.
1) Depending on which med school you are in Malaysia, from your name I guess Monash? – try searching and asking if you are considered same as Monash in Aus because you guys get the same degree/cert. However, for other med school I would say its still practical to do it. Hope is always there, what increases the chances though are how much hard work you put in. I am working with bunch of colleagues with some who has decade of experience, some tons of research, and when you look at bigger centers they actually tend to reserve 1-2 seats for these “overqualified” doctors to boost the board exam score and status of their university.
2) Yeah it is good to take it make sure you know the syllabus and do questions online. I did it after finishing basic sciences.
3) as aboved, As med student getting good usmle score is main thing. then get good Letter of reccomendations from CLINICAL lecturer(best from department of interest and hopefully from US). Doing elective/sub-internship in states would greatly boost your chance – but you need to make sure the program recognize and accept your school’s accredidation(I think Monash will be fine?). Spending 6mth to 1 year in research in US is a great idea too – it takes pretty quick to complete a good retrospective studies or literature review but you need good mentor/advisor.
Always remember timeline for US grad residency application is VERY different from other countries – application starts July, interview starts about september and match at March starting work at July. Thats the brief timeline and let me know if you have further question.
In my humble opinion, the fact that the ministry is pushing for the adequate ratio of doctor to population, 1:400 failed to address an area of big concern. They are merely oversupplying HO/MO but nothing is aggressively done to retain specialists and subspecialists who are badly needed to manage difficult cases as well as to train juniors. In the end, the system will be flooded with HO/MO but the few remaining seniors will be overworked. This certainly doesn’t augur well for the system. Aggressive measures need to be placed out to retain these senior doctors who are very valuable.
When I was in SCHOMOS almost 10 years ago, these issues were discussed numerous times with MOH and JPA but they were not bothered! These monkeys in JPA do not care what happens to medical sector as they just consider it as just another civil sector!
I think there are three trends which will intersect in the next few years
1. The effort to make the 1:400 ratio, without giving a damn about the quality
2. The shift of our current health system to a NHS-base socialized care model
3. The fact that primary care will become very routine and simplified.. and the more complex part of family medicine will be taken care by family physicians
Hi there. Can you please comment on the latest MOH move to abolish calls and change to the shift system? Limiting HOs to working 60 hours a week? Thank you.
I had already commented about it about 2 months ago when it started in Temerloh. Pls read my earlier blog postings.
Ian Tan, I assume that you can read chinese. Pls refer to this http://www.chinapress.com.my/node/239414
Our DG mentioned to the press that houseman will work 54 hours per week, from previously 90 hours. So there is a shift system there.
lol omg 54hrs per week thats so…lame? lol.Sorry to say that but that will reduce clinical experience and procedure by about 50%. So future houseman in next years will be…50% more incompetent?Hopefully they will have bedside teaching more so at least houseman know how a patient look like. Hopefully things will get better.
i dont think 54hrs/week is lame. It is the 90 hours that makes medicine dangerous
I absolutely agree. I have seen mistakes been made by doctors working long hours. I know surgical registrars who have had microsleeps while operating because they have been working 24 hours straight. I know doctors who have crashed their cars on the way home after working >24 hour shifts. Even truck drivers have restrictions on how many hours they can drive each day, but there is still the mentality among many senior doctors that 36 hour shifts are good.
However, I don’t agree with an 8-hour shift system, because it devalues the job and takes away much of the learning experience. You can easily make a balance. One person on nights, split into 4 and 3 nights (e.g. 10pm to 8am). One person does a long day each day (7.30 am to 10.30 pm) and the weekend person works long days. An example of a roster which needs 6 people to run:
M Tu W Th F Sa Su
1 N N N N – – –
2 L D D – N N N
3 – – L D L – –
4 D L D L D – –
5 D D D D D L L
6 D D D D D – –
N = 2200-0800; D = 0730-1630; L = 0730-2230
This is just an example. More people in the dept/ward will make roster writing easier. Busier departments may need 2 people on a long day, which can be achieved with more people in the dept. 30 mins is allocated for handover between shifts. The roster above results in a average of 53.17 hours/week over a 6 week period.
As for people doing not doing handovers properly, I don’t think that is a good enough excuse to make people work unsafe hours. HO/MOs can be taught how to give a proper handover, if they haven’t learnt this already. A department can easily draw up guidelines on what and how information should be passed on. If they don’t do their job properly, they should be taken to task by their supervisor – I suspect this last bit is where the major problem lies, and that includes everything, not just handovers.
Formatting didn’t turn out right for the roster above. The 7 characters after each number correspond to the day of the week.
Just leaving what nytimes lately published. You can read the research mentioned in the news as well.
http://www.nytimes.com/2011/08/07/magazine/the-phantom-menace-of-sleep-deprived-doctors.html?pagewanted=all
It’s true that sleep deprivation may cause harm-but historically it was never the major cause of medical error. I am not supporting 36hour call but I do think that 30hr call every 3rd to 4th night is reasonable. Any doctor should be trained to have the appropriate response to different situations esp during on-call. That is the main purpose of call – to build in a reflex(safe decision) towards different situations, and to learn to work under stress.
Shift work will be slightly unrealistic. Excluding the fact that we are reducing the experience to half of what it used to be, and yet paying double the amount of doctors that is available. If there is 2 shifts per day, and you are suppose to hand over 20 patients, how long would it take for the hand over process?
Bringing up that doctors get into car accident after call or long working hours – Is it really the work hours that lead to car accident or one’s own ability to judge if you are in right state to perform a task. What if the doctor decide just to take a 1 hr break prior to driving home?
Think about it- we ASSUME that most medical error is made by fatigue, but at the same time, there are much more medical errors made due to incapability, poor knowledge, failure to identify sick patient, negligence, and miscommunication(healthcare-healthcare and healthcare-patient).
It’s extremely hard to determine the exact cause of any medical error. Was someone incompetent because they were tired or was it because they were a lousy doctor or was it a single moment of inattention because they were worried about their sick child at home or ___? We can however safely say that higher fatigue levels and sleep-deprivation increases the risk of medical errors occuring.
To imply that a 30 hr call is ok because builds character is irresponsible. Why do we not let sleep-deprived pilots fly airplanes then?
Handing over 20 patients is not a problem. Make a handover sheet with the all the patients’ names, working diagnosis and past medical history. Have a column for each daily update, including tasks to handover. This can even be updated on a PC so the file never gets lost. Once a proforma is there, it would takes 15 mins to do and 10 mins to perform an actual handover by mentioning the essential issues (everything else is written down). It may be longer if some patients are complicated but that comes with the territory. Junior doctors elsewhere have been doing this for years so I can’t see why Malaysian doctors shouldn’t be able to as well.
If we are reducing the experience to half of what it used to be, then we should be increasing the length of training. That has already been done with housemanship, maybe it’s time to do that for the Masters programmes as well. Most commonwealth countries have 5-6 year postgrad programmes, instead of 4 years like our Masters.
I feel the main stumbling block will be a potential decrease in pay. Money is a strong motivating factor, more so when pay in the govt sector is already low.
And so 20 patient = 25 minutes of hand over process(update list and hand over process) and I am pretty sure in most hospital 20 is low census. What if we are in icu where at least half of the patients are complicated? Again reduction of duty hour from 100s to 80 in united state did not improve medical error and lately there is a change to shiftwork. I am interested to see new data that will be presented in next few years if there will be decreased in medical error.
There are different professional in hospital. even if a doctor made mistake there willbe someone else catching it before reaching the patient eg attending, senior nurses, pharmacist. How many times senior nurses or phamatcist had warn the doctor that the prescription is wrong and they were just ignored. That response may be due to fatigue but still it comes down to attitude again. And that is The reason I emphasize removing fatigue will not improve overall medically error
Yeah if you assume that hand over of patient is done perfectly. Biggest mistake made durig patient care is never fatigue/overwork. Infact it is miscommunication especially during handover. The lesser hour work meanig more shift changes which gives more handover. This will have more room for mistake and especially if there is no good supervision.
lets just watch and see… back down the dogs a bit… i quite agree with a bit of both: implying 30 hr calls builds character AND banking on it isn’t safe. (i’ve driven thru a wall before, i assure you its fatigue more than it is poor judgement), on the other hand passing over is always the most dangerous time. patient collapses unnoticed etc etc usually when the nurses pass over, i hate to think what happens when doctors start passing over… whatever it is, for me, any change is better than the past working conditions in terms of hours… sure we learnt better with our longer hrs and more frequent calls once upon a time, but patient load nowadays is horrendous! we can’t stay in the same system as the past if we wanna start improving… GA is working shifts, so is A+E, some place paeds MOs are also working shifts wen they have enough people. and i’ve seen its better… ii still think instilling good conscience is the utmost important thing a superior can impart on the HOs. bad them reflects our teaching too to a certain degree, no? its an apprenticeship form of training,we have to start loving each other to strengthen this.
Hi doctor:) I have just completed my A-Level and got my results already recently. My results are AAC-the c for chemistry. I have checked at the MMC’s website on the minimum requirement to study medicine in this country and it’s stated at least all Bs. The thing is I have been admitted to study in Melaka Manipal Medical College which minimum requirement is CCC. Now I would like to ask whether can I register under MMC after i graduated from medical school? I am very worried of this issue and am really interested in being a doctor.
The MMC guideline is for the university to follow. If the College does not comply with the guideline, MMC can derecognise the college and all graduates need to sit for the medical licensing exam before being able to practise in Malaysia. So, if it is true that Melaka Manipal is doing this, they may get into trouble soon.
i heard tat there is too many doctors in Malaysia and there will be a surplus of doctors in the future. I juz finish my SPM and i am planning to join the medicine program but i am vqry worried about tis issue. So actually should i become a doctor?
Dear sir, I’m thinking of pursuing medicine in the near future. Does this mean that the future isn’t really bright for me? The overflowing production of doctors in Malaysia has caught my attention. However, medicine is my passion and my dream. Is there anyway around it?
There is no way around it unless your degree is recognised world wide. You just have to put up with all the frustration that will be coming along your way. Getting a job itself may be a privilege, what more postgraduate studies.
Your post are informative ,albeit very depressing !Your prediction on jobless doctor really scares the crap out of me.I never thought pursuing my lifelong dream would become a nightmare right after i finish reading this post.Anyway,i’m really glad that i stumble upon this post,it somehow prepares me mentally of what to come.I also have read your other post,i might say ,it is rare to find such detailed explanation on basics of this career.Kudos,i guess.
Just one question though,you mention that taking mrcp would hasten specialty program by one year, and it is a sure-fire way ,without waiting indefinitely for the 10% quota.Is this true,or am i reading it wrong?
If you are a 4th year student, you may just escape the jobless scenario! Yes, taking MRCP is a shorter route but situation may change as I heard our DG is trying to make MRCP equivalent to Masters by imposing a minimum 4 years training in Medicine before being gazetted as a specialist. However, it is an open system which enables you to sit for the exams freely. You must also understand that it cost a lot of money and the passing rate is usually < 50% worldwide.
less than 50%! is it because they impose some sort of passing quota or is it that hard to pass the test? Ohh,i’m already imagining myself being a chronic MO for the rest of my life.And what is with the delay for the specialist program? i thought that our country is in dire need of specialist!
Anyway,i’m trying to shed some light here about my career path.After 1 year of HO,i’m applicable for MRCP with or without HOD recommendation.Once i passed all 3 part in 5 year period,more or less ,only then can i be definitely absorbed into the specialty/sub-specialty.Correct me if i’m wrong ,kind sir.
MRCP is an internationally conducted exam which had to maintain certain standards, unlike our SPM results!
Being a specialist is not like producing a factory product. You need enough trainers and proper training system with strict monitoring of standards. A specialist got no one to consult!
After you pass all 3 parts of MRCP, you need to undergo 18 months gazettement process before being gazetted as a specialist, After that you need to wait 2 years before applying for a subspeciality training programme, which is another 3 years.
Dear 4th_yr_med,
<50% pass rate for the MRCP is because you have many many doctors from developing countries (including Malaysia) sitting the exam who do not pass. The pass rate for UK-trained doctors is much much higher.
Just because the country needs specialists does not mean we need to have shortcuts to specialisation. All parts of the MRCP can be completed within 3 years of graduation if taken as early as allowed – this does not mean you are a 'specialist'. In the UK, you would need 4 more years of specialist training after the MRCP to be registered as a specialist. In Malaysia, they let you get away with gazettement for a shorter period – although Dr P says this might change in the future.
To become a competent specialist, you need to pass the required assessments to demonstrate your knowledge AND have adequate clinical experience. One without the other is useless.