It has been 3 months since I wrote my Part 2 of this topic where I discussed about the public healthcare system of this country. Now, I will move to the private healthcare system.
One of the first component of the private healthcare system of this country are the General Practitioners or simply known as GPs. The private hospitals started to appear in the 1980s. Thus, I will divide this topic into 2 parts: GPs and private hospitals.
General Practitioners (GPs)
In Malaysia, anyone can become a GP after completing 4 years of compulsory service with the government. GPs were the first private healthcare service providers in this country. They were highly respected by the community as almost equivalent to a specialist. In 1970s and even 1980s, specialists in various disciplines were a rare species in our healthcare system and thus the community considers GPs as their family specialist. In fact GPs did a wonderful job in providing simple primary care services to the general public as they were open till at least 10pm daily and there were not many government polyclinics then. When I was small, I still remember my father bringing me to see a GP for simple upper respiratory tract infections. Consultation and medications will just come to about RM7-10, which is quite a big amount those days!
It was quite a profitable business for doctors to become a GP then. Whatever people say about being a GP, it is still a business to earn money and a living. Almost all GPs in 1970s up to 1990s were doing very well and were earning quite a big sum of money. There were no regulations to monitor them except for professional conduct which was monitored by Malaysian Medical Council. They were also allowed to store and dispense medications without a pharmacist and trained nurses. This situation is still the same up to today. However, when more and more doctors started to open clinics in a town, competition began to set in and this has changed the scenario of GPs currently.
The competitions for GPs are not just from their fellow GPs and private hospitals but also from the government polyclinics and recently, the 1Malaysia clinics. At one point of time many doctors were leaving the civil service to start their clinic immediately after completing their 4 years compulsory service but the situation is slowing down gradually. Why is it so? Firstly, the government has come up with the Private Healthcare and Facilities Act 1998 which was implemented from 2006. This act makes sure that every private facility is built based on certain requirements, like the size of the door, toilet, consultation room etc etc. Before you can even start the clinic, you need to submit the floor plan to MOH for approval. You can only start your renovation after they had given the approval. After completing your renovation, the ministry’s unit(UKAPS) will come down to inspect your clinic to make sure that you comply with the act. Any non-compliance is punishable under the law. Only then you will be given the permit to start your practise.
Secondly, the income of many GPs is gradually dropping due to severe competitions. I know of some GPs who had closed down their clinic and doing locums instead, both privately and in government clinics. Some GPs are only earning a net profit of less than 10K per month. Remember, an income like this by working from 9am till 10pm daily is pathetic to say the least. There are many factors that will decide on whether you will be successful or not. Your location of the clinic is one of the factors. Many town areas are quite saturated. The best option will still be rural and semirural areas. Most successful GPs are from these areas as well as in housing areas which are far from government polyclinics/private hospitals. Your communication and clinical skills is the next factor.
Unfortunately, due to severe competition, some black sheep’s began to appear in this system. Many of these GPs were just interested in making money and nothing more. They refuse to upgrade their knowledge and manage their patients accordingly. In Malaysia, unlike other countries, you can renew your Annual Practising License (APC) without needing any CME points. In many other countries, you need a certain minimal number of CME points before your APC is renewed. Even Dr Mahathir and Dr Chua Soi Lek can still get their APC despite not practising as a doctor for so many years. As long as you are a doctor, you will get your APC!
I had seen many GPs mismanage common medical conditions like asthma, diabetes and hypertension. Even when they know that they can’t do anything much, no referral is made to a specialist in either public or private sector. This is because they do not want to lose the patient to another physician and thus reducing their income. I had seen patient who are diabetics for many years but not a single blood test was done for renal function, fasting blood sugar, HBA1c etc etc. Only glucometer readings are done. Many will turn out to have renal impairment. Many at times, even a diagnosis of hypertension and diabetes is not properly made. I had seen many patients presenting with hypoglycemia with treatment started by GPs and turn out to be non-diabetics. I still see obese diabetic patients being started on sulphanylureas when the standard guideline says that Metformin should the first line treatment. These are bread and butter diseases that should be managed properly by GPs but not so in this country due to poor continuous medical education and the non-existence of compulsory CME points for renewal of license. I know GPs who are selling medications including sleeping tablets over the counter, asthmatics still being managed with tablets and daily steroids etc etc.
Many years ago, I did locum in a GP clinic. For every patient, irrespective what is the complaint, 3 medications must be given including 1 antibiotic!! Even if the patient complain of headache or bodyache! If you don’t do it, the staffs in the clinic has been ordered to add the medications! How unethical! This was one of the reasons why I never did locum after that! I had only done a total of less than 30 GP locum sessions in my entire medical practise so far. It is becoming increasingly difficult to see GPs who really cares for a patient.
Future Direction
When the national health care financing system is introduced in the future, GPs will be forced to do postgraduate degree in family medicine like in many other developed countries. As you may be aware that in many other countries, you can’t become a GP without a postgraduate degree or proper training. Being a GP itself is a specialist.
Soon, GPs will also lose the right to dispense medications. This is already in the pipeline with full support from the Malaysian Pharmacist Association. Only MMA is still fighting against it to safeguard the lifeline of many GPs. Selling medications really brings a lot of profit for these GPs.
MOH is encouraging GPs and soon to be GPs to do Diploma in Family Medicine for a start. Academy of Family Physicians of Malaysia has started this programme since 2009 and the first batch has graduated. It is an online course. They can go on to do FRACGP for another 2 years after that.
I got nothing against GPs but many black sheep are destroying the reputation and status that these doctors had once upon a time. Once respected doctors are now going down the drain. Many, finding it difficult to survive. That’s the reason why you don’t see many new clinics opening recently or doctors leaving civil service to open GP clinics……………… Frankly speaking, government polyclinics have better facilities to manage chronic diseases then GPs but the doctors got not much time to spend with the patients and there are no proper supervision of junior doctors.
Next: Private Hospitals……………..
Can government doctors do part time work with other companies/MNC’s on their off days? Not necessarily locum, but management stuff, etc.. do they need to declare to their hospital?
As a goverment servant, any job outside need to get permission from the government.
Hi,dr pagalavan, may I know more about the research field in Malaysia? How about to be a medical officer in CRC or IMR centre?
Btw, Dr Paga, good overview for the future of GP’s. Don’t forget, a lot of ppl also do the Occupational Health Doctor course in NIOSH, and that is not equivalent to a postgrad qualification for fam med.
Good article as always from Dr Paga, especially the bit about GP’s in Bolehland
It is getting increasingly difficult to find a good GP and everyone has their own favourite “GP bashing” story to tell. I feel sorry for the good GP’s who unfortunately get tarred with the same brush due to the real or perceived rising incompetence amongst GP’s.
To be fair, I think trying to make a living as a GP is rather challenging. For starters, the public sees them as non-specialists and therefore at the bottom of the medical totem pole. Then there’s the public perception that GP’s should serve their local community. So the public expects that GP’s should charge only minimum fees and be available for consultation at any time of day. I have friends in places like Klang and Ipoh who still firmly believe that a GP consultation fee should be RM7-10 at most!!! WTF???
If this is the public expectation, then there is no surprise that GP’s will make up their living by increasing volume/throughput (ie: shorten consultation times to the bare minimum in order to maximise the number of patients. Quick fixes will be the order of the day rather than a considered and detailed diagnosis followed by appropriate treatment). Then there is the escalation of prescribed medications in order to maximise profits from dispensing.
Funny how some people who moan about the RM30 they paid their GP (for consult and medicines) can happily shell out RM200 for some fancy designer “night cream” that will rejuvenate their wrinkles. As ever, one can make a lot more $$$ selling dreams and desires (“night cream”) rather than harsh realities (“your skin is awful because of your smoking”). Maybe that’s why more and more GP’s are turning to non-surgical aesthetics like botox, fillers and lasers.. but that’s another topic for another discussion..
I have to say that I still side with the GPs as far as dispensing rights goes. I’m not convinced that the pharmacists are necessarily better suited for this given all the poor regulation that goes on in Bolehland.
Last July, I had a bad case of gastritis whilst on holiday in KL and popped into one of the pharmacies in MidValley. I introduced myself as a doctor and asked the pharmacist for ranitidine. She handed me a box of Zantac to which I replied, “No thanks. Generic ranitidine, please. It’s a lot cheaper and works just fine.”
She says, “Actually it’s better to take Zantac. It works faster than generic”. I looked her sharply in the eye and said, “As a qualified pharmacist, you might want to think of the ethics and pride in your profession before you make unfounded statements such as that. Generic, please”.
Hey, look at that! I managed to avoid a GP bashing story and gave a pharmacist bashing one instead!! 🙂
Another reason why it’s become a dog-eat-dog world in GP land:
Most banks and companies are nowadays instructed to give panel contracts to only Bumi-owned practices. All the traditional solo-GP practices (vast majority non-Bumi, 20-30 year old practices) therefore have had a good secure source of income disappear. Add this to the sheer increase in number of GPs out there (any joker can become a GP after their govt service), and you have people resorting to all sorts of unsavoury practices to maintain their income.
>> any joker can become a GP after their govt service >>
In fact, the jokers often do! This is why General Practice contains a disproportionate representation of incompetents who have no business practicing medicine in the first place.
Not all GP’s are bad and I do know quite a few good ones. But unlike the larger structure of hospital medicine where if one is incompetent it gets exposed much more readily, the typically solo nature and “cold cases” patient demographic of general practice means that errors and poor performance are less easily noticed until a major disaster occurs.
On another note, those major company panel contracts aren’t necessarily such a good thing. Just ask any doctor who has ever had to chase these major companies for monies owed!
Yes. Chain clinic is the worst. Imagine they charged UPT test only for RM60 daytime and nebulization for RM120. Some more I got a case that the chain clinic gave NSAID for moderate gastritis pain patient. Luckily didn’t end up as UGIB.
Some stupid rich pt (driving mercedez) use to go to these clinics for IV medication for hypertension, cost is RM150/treatment. I dun know why? If you can get a good GP, it is much cheaper than go to specialist clinic for treatment.
I would advise not to visit chain clinic especially at night as I suspect most of the 24H clinic hire non-qualified doctor. You are taking your own risk.
Now, the chain clinic boss just set up a clinic and sell it to a new GP with condition monthly RM1500 royalty. But the clinic still under the clinic group name. Imagine they set up 10 clinics and sell it, so RM15K per month and this was 5 to 6 years ago situation. I used to call one of them, usually the one they are willing to sell mostly no business one. They just want to recover their cost of setting up and the taker will take all the risk.
Dear Private,
You are doing the same as when the public generalizes the GP population as incompetent because of SOME black sheep without giving due credit to those genuine competent individuals. Not all chain clinics are as you say. I work with one, and i can tell you that we are all qualified drs who frequently have to deal with pts dissatisfied with services from not only other chain clinics, but also as frequently from solo practices. Please do not generalize. It is unbecoming from someone in the same profession.
In Canada, it takes 2 formal years of family medicine training to be a family doctor (or GP) after medical schools, and there are subspecialty in family medicine too such as emergency field, palliative care, anesthesia, etc. It is recognized as a specialty here, unfortunately most patients do not know about it and consider GP as a refer station. Patients need a formal referral from GP before an appointment with specialists could be arranged.
I know a lot of house officers doing locum at private GP clinics. So scary…………………….
Houseman should not be doing locum. You can report to MMC or local UKAPS unit if you know of any.
Report also what will they do?
So many people simply swap universities from recognised to unrecognised and MMC tutup mata (buat tak tau!)
U think they’re gonna go after HO’s who do locum? The clinic owners (Doctors themselves will pay duit kopi and MMC will happily go for McD’s breakfast!)
During my induksi course, one of the session was lecture by MACC. The stupid MACC personal told us how intelligent they are to catch the houseman who do locum outside. Most of us were stunned by his statement. Since when the MACC start catching locum houseman who is earning RM25 to 40/hour?
Housemen are not suppose to do locum! However, it is not MACC who goes around but the UKAPS unit of MOH.
Dear Dr Pagalavan,
i support GP hold the dispensing right,not only GP but for all doctors i think we have the right to dipense medications .
In this Bolehland,anything can happen despite the law and restriction.For example,there are a lot of community pharmacists sell drugs overcounter wihout doctors’ prescription as they are acting like GP doctors in their shops,they can check patient blood pressure and blood glucose and simply sell the antihypertensive and diabetic medicines to their customers without asking / refer them to Doctors.
With ours health minister announcing the possibility of shorterning the compulsary pharmacist training from 3 years to 1 year. The reason is to accomodate the private sector pharmacist demand. I think this decision is crazy. Mr Liow is destroying not only doctor but pharmacist as well. He is insane.
It use to be 1 year before and I don’t think it is due to shortage of pharmacist in private sector. There seem to be an overload of new pharmacists in gov hospitals now and I don’t think the gov can support anymore. If I am not mistaken, their critical allowance has been removed already.
Doctors may be next in line!!
Even in the US, a country which awards dispensing right to the pharmacists, the problems of wrong prescriptions and medications are rampant. So what’s the point of giving the pharmacists such right?
Many patients in malaysia ,they probably think the community pharmacists are same as those GPs in the clinics or maybe they just want to save their money from the consultation fees charged by GPs therefore they decided to forgo doctors’ opinion altogether and decided to self-medicate simply by collecting all her medications from the pharmacist who supplied them indiscriminately.
This situation is happening everywhere in the malaysia!
the dispensing rights to pharmacists just uprooted the whole GP practice in India…you just cant find GP’s around as most of the patients tend to skip them and take prescription medications over the pharamicists/druggists…this will inevitably extinguish GP practice here too one day…equitable and accessible primary healthcare will be a myth soon with 1care coming into place….
Dear Dr Paga,
A very good article. I dont expect the GPs in Malaysia to have this kind of scenario before. Personally, i had good and bad experience with GPs too. We can tell whether they are genuine from the way they ask history,did PE & consult.
Actually, im a vet. The vet situation is worst. We are not required to do houseman or anything like that. Its up to the fresh vet grad to choose from where one can be well-trained. I own a vet practice together with my husband (a vet) & had experienced working with some vets before we have the confidence to open up our own practice. And thats make we aware that in vets practice, there so many black sheep as well. And worst there are so many bogus vets in Malaysia.
The authorities are not doing their best in this issue. We dont have strict regulations like GPs to open up a clinic. Thats why anyone can open up a vet practice. Even we can find pet shops giving treatment to pets or selling drugs. To renew APC are also the same, no need to collect points or whatsoever, just pay the fee.
But, recently i heard the MSAVA( Malaysian Small Animal Veterinary Association) are working hand in hand with MVC (Malaysian Veterinary Council) to makes things better for us, Small Animal Practitioner.
About few months ago, we heard that the pharmacist board proposing to have the right to sell the veterinary drugs as OTC to DVS. But, we dont allow it. Its so dangerous to allow it to happen. Even the pet shops now is freely selling controlled drugs & no action been made. Pity..
So, together we hope the medical (human n vet) field in Malaysia will be up to a standard where it should be soon.
URGENT NOTES TO Dr PAGALAVAN,
Dearest Dr,
I suddenly realised that in Avicennia Directory for Medicine, MSU off shore campus, Bangalore a.k.a International Medical School, Bangalore is not yet in the list.. This might implied that MSU degree is not yet recognised by United Nation.. But, MARA and JPA has continously sent their student for at least 4 batches.. Im afraid that this student cant work elsewhere except Malaysia.. As a father, I really interested if my son could do their housemanship training in UK and further take postgraduate there.. But General Medical Council (GMC-UK), has clearly stated the criteria to work there, must have primary medical degree which is listed in Avicennia Directory..
So what is your comment and advice to my son???
Really appreciate your comment..
Thanks.
Amir
Amir,
Sorry to hear about your predicament. IMS-MSU is not currently on the Avicenna Medical Directory (formerly the WHO Med Directory) because it has not yet been recognised by the Malaysian Medical Council (MMC). Once MMC recognises it, a submission can be made to Avicenna. MMC usually recognises a medical school only when the first cohort are in their final year. Of course, there is no guarantee MMC will recognise IMS-MSU (read about what happened to Cyberjaya) but it is highly likely they will because of the MARA and JPA scholars.
You should know this: Once on the Avicenna directory, your son has to sit the PLAB exam to be allowed registration in the UK. To be allowed to work, he must get a work permit and the UK are now very strict about this – giving preference to their own (as they should) and EU residents. Malaysians will be competeing with doctors from Indian, Pakistan, Bangladesh, Sri Lanka, Arab countries etc who are all trying to get into the UK via the same route. Truthfully speaking, it is highly unlikely that your son could get a job in the UK via this route.
Even MMC has NOT accreditated MSU yet. They usually do this when the first batch of students are in final year. It is rather ironic to see JPA and MARA sending students to this private colleges before it is not even accreditated by MMC. Only in Malaysia, this can happen!! In other countries, the medical council need to accreditate the course first before the first batch is taken in. MOHE gives the license and expect MMC to accreditate it by hook or crook!! That’s Malaysian style. That the reason you see 30 medical schools appearing in just 15 years, the fastest growing medical schools in the world and the highest per population ratio.
Having your college listed in WHO is not really that difficult. What you need is for the degree to be recognside by the country where it is being issued. This directory DOES NOT give any international recognition.
You still need to sit and pass the PLAB entrance exam before getting a job in UK. It also DO NOT guaranteee a job in UK, preference is given to UK citizens and EU citizens.
Forget about UK, virtually no chance. A lot of people make the wrong assumption that as long as you have PLAB, you can work in UK. Having PLAB only gives you the right to be considered for GMC registration and having GMC registration is no guarantee of a place for housemanship. For further information about housemanship and how to get in, go to UKFPO website, bearing in mind your son is listed in the final category of candidates.
The likelihood for non-EC candidates getting into postgraduate medical training in the UK is going to be extremely slim from 2012 onwards. This is due to progressive increase in UK medical graduates over the last 15 years (though not anywhere to the same extent as in Bolehland) and the open border policy across EC countries for employment.
It is likely that from 2012 onwards, non-EC candidates will require a Tier 4 visa (ie: work permit) to undertake postgraduate medical training. A work permit will only be granted if the employer can give evidence that there is no EC candidate suitable to take up the position. This can be a rather involved process.
I have personally been through this a decade ago when undertaking my postgrad surgical research in the UK. Whilst permit-free training existed in those days, research posts were not regarded as training posts by the UK Border Agency. In order to appoint me (being M’sian), the interview committee had to apply for a work permit. This entailed not only writing a summary for each of the other seven EC candidates who were shortlisted and interviewed, to show that they were not suitable for the post. They also had to do the same for the other 85 EC candidates who had applied for the post, even though they had not been shortlisted!
When this much effort and paperwork is required, one can imagine why it’s much easier for an appointments committee to simply pick the best available EC candidate for any post, rather than to go through the work permit mill.
Hello boss if u want ur son to work in UK why u send him to an unrecognised new uni? Why didn’t you at least send him to IMU PMS programme? Now nasi sudah menjabi bubur. at least send him to Australia la ……. U think by jimat in MSU u can harbour hopes for the UK ah? Please la bang…..
IMU PMS programme also wont bring you to UK. LOL
The reason why many people enrol in local med schools is because they CANNOT get a place in UK or Australia. Because of the oversupply of medical schools in Malaysia, it is very easy to enter, so many people assume it is the same elsewhere. Only when they try, do they realise how difficult it is to enter med school in the developed countries. It is particularly difficult now in Australia as only a minority of their med schools are undergraduate entry.
Dear Dr P
What is the medical doctor future and the training for new doctor situation in australia? Presumably the student has PR Status?
PRs generally have nothing to worry about in Australia – the ONLY problem is getting into medical school as a PR. You’d have to compete with other Australian citizens and PRs; and don’t even think about the IMU backdoor entry – PRs and citizens are not allowed to be matched with medical programmes from their respective countries. So good luck with that 🙂
I don’t see the competition issue as a problem, and luck should have no more than a minor role to play in such matters. No quality candidate should ever worry about getting into their course of choice at university. Competition breeds excellence and a merit based system gets the best and most motivated brains to excel.
you must also understand that there is no guarantee that you wil get a job in Australia after graduating. I was told that some of the states in Australia got no more vacancy for internship.
As far as i am aware, all Australian states guarantee internship positions for their local (read: PR and citizen) graduates – thanks to the student/medical unions. You may not get your first few preferences though.
There are too few vacancies for non-locals in Australia. Ie. international students who graduate struggle to find a job, with roughly one spot available for every 3-5 non local applicants.
What I meant if for foreign students. Citizens and PRs will be given preference.
Dr. Pagalavan , i for one support the dispensing rights of the Gps. and hopefully it will be supported by the MOH with the help of MMA. i’m irked of the unethical practice of pharmacies dispensing medication without the doctor’s prescription.basically i feel that they have insulted the doctor’s status in the community in looking after the health of the patients in the community simply because it is cheaper because there is no consultation fees. thats why i call them ” MEDICAL FRAUDS”. more so is more prominent among the chinese pharmacist where they have the advantage of the lingo to convince customers to believe of their dispensary.
so in view of the upcoming health financing scheme , does his mean will they totally terminate the dispensing rights?… what about the 24hours clinic?.. and what about the location of the pharmacist where it is situated miles away from a particular in that area , wouldn’t it be inconveninet ofr patient to take the hassle to drive to 2 cormers merely to take medication……. another thing i would like to highlight here , since they are enforcing primary care practitioners in pursuing specialist course , are we able to dispense high end medication for instance JANUVIA , or GLUCOVANCE ,or antibiotics like CIPROFLOXACIN / AUGMENTIN since it is goin to be a CONTROLLED ITEM hat is oin to be regulated by the ministry?………. and are they goin to apprehend these unethical pharmacist if they dispense THESE HIGH END medication?
FRANKLY speaking what is the MOH doing about this particular matter?………. So with this notification and via MMA , i hope that this matter will be highlighted to the cabinet.
for those who have forked out their money to set up the clinic , don’t u think that they are running at a lost now for the CURRENT LOOPHOLES running in the system……..
Dr. Pagavalan , please reply to this matter . thank you
If you read today’s Berita Harian, there is a whole page article on pharmacist and interestingly the pharmacist they interviewed seem to be acting like a doctor! She seem to be saying that she can reduce patient’s cost by introducing generic drugs and giving patients more options! Where is our MOH’s bahagian pharmacy? sleeping I guess.
Yes, I know what the pharmacist are doing out there. There are not many ethical left. It is a business and profit counts.
At the moment, even when the 1Care system is introduced, I don’t think they will remove the dispensing rights of GP. It is just too early to do it but the time will come when the national healthcare system is completely revamped. Zoning and GP/Pharmacy registration will become mandatory. The NHS may take over pharmacy dispensing. However, I don’t expect this to happen in the next 15-20 years.
Actually, even now, no one is stopping you from prescribing high end products outside of MOH. Only in government hospitals there is restriction on prescription. I know of GPs who are prescribing Jenuvia etc.
Yes, the enforcement unit in Malaysia is screwed! Right from MMC, MOH etc , there is basically no enforcement at all. MOH should make the enforcement better but the doctors themselves are against it . If a doctor hires a houseman for locum, he should be penalised but when that happens, everyone makes noise.
Dispensing Separation most likely will be implemented any time soon, not in the next 15 or 20 yrs, but within this year or next.. the heavy campaign on DS by the MPS is too obvious across all the mainstream media..
Dr,
if I finish my undergraduate medical studies in somewhere overseas and directly apply for GP specialty (for 2 years right?) without housemanship there as well just to get the degree from overseas. do I still need to do housemanship and compulsory service if I come back?
is holding a GP specialty degree good for work in malaysia? with reasonable working hours? what are the other options I can look into?
At the moment, it does not matter whether you have GP speciality or just MBBS in Malaysia. Your patient charges are still the same. As a GP, when you open a clinic, you need to work from 9am to 10pm everyday to earn a living!
Even overseas you can’t do GP immediately after graduation. You still need to do housemanship and rotation as medical officer before becoming a GP. I think you don;t understand what GP is all about and the career propect of a doctor. Pls read all my articles.
I’d like to relate my experience…had a young taxi driver with bilat cataract,op done in one eye and next one due soon.Digging into history,he uses steriod eye drops (the famous one) for every eye itch he had for 15 years almost.Where did he get it? pharmacy of course.In our world its iatrogenic,negligence and of course litigation at worst.In pharmacist world …what is it ? Cash in and what happen to u next is your problem.
Sir , thank you for all the knowledge you shared here. you mention bout Diploma in Family Medicine . can you tell me more bout this.
please go to Academy of Family Physicians of Malaysia website.
Hi
I am a graduate from overseas in recognised college in Ireland. I would like to return home to become a GP. Will I need to still do compulsory government service before opening a practice? If so, are MOH polyclinics considered as government service? Thanks
If you have served more than 10yrs overseas then no need compulsory service. Yes, MOH polyclinics can be used for compulsory service.
I’ve completed internship, a year of SHO in medicine … would that be sufficient? Thanks
That won’t be enough. What runs did you do in your intern year? If you’ve only done medicine and surgery (6 months each) during your intern year, you still need to do orthopaedics, O&G, Paeds and probably ED in Malaysia before you get general registration because those are the requirements for internship here.
And yes, once you have done these, MOH klinik kesihatan counts as part of govt service.
Depends on MMC
Most likely MOH will ask you to complete few more HO postings in Malaysia before getting full MMC registrationM
So if I get full registration, I can work in polyclinic for 4 years to complete compulsory govt service before free to do GP? thanks
Yup
Once you get full registration with MMC, you only need 2 years govt service. The 4 years refers to 2 years internship and a further 2 years after that. However, best to check with MMC – those buggers might make you do 4 years for fun
Also how does one look for the MOH polyclinic jobs? where are they advertised?
There is no such thing as advertisement. After housemanship you can apply to MOH or Jabatan Kesihatan for a transfer to goverment polyclinics. Whether you get the post or not and where you will get the post depends on availability of post
I am coming home from overseas…as far as I can see on the criteria, I will qualify for full registration. Who do I contact in the MOH ? Thanks
Pls contact MMC
Hi dr paga,
im currenty working as mo in gov. My contract w finish this feb. Do u think further study( get speacilist 1st) or staight away open GP is the best option.?
thank you
Up to you. In the future, all GP may need to have at least a Diploma in primary care. You can still do this after becoming a GP
What is your criteria of a good General Practitioner ? (besides mentioning about how caring the GP is)
How much interaction do you, as a specialist, have with GPs ?
MH
A good GP is a person who cares for the patient and not about money. He should also keep his knowledge up to date. Patients that they can’t manage to the best interest of the patient should be referred for specialist care.
I always keep a good relationship with GPs. Every single referral to me will be replied and most of the time I send back the patient to the GP unless the patient refuse.
“A good GP is a person who cares for the patient and not about money.” These qualities also applies to specialists.
What, gathered from your good relationships with GPs, are the changes in GPs over the past decade ? What are the common mistakes of GPs when they deal with ENT cases ? Are GPs or specialists more prone to be out of date ? Just how up to date is an average specialist ?
The answers are all available in this blog. Care to read more. How many GPs attend CME and conferences? I can assure you I see more specialist attending conferences to update their knowledge.
A reason for the low GP turn out is the irrelevance of many of the conferences (for GPs). True, apathy among GPs (and specialists, esp those in the private sector) is a contributing factor.
B4 you decide on GP, u might wish to do an attachment with an experience / good GP. GP is demanding but completely satisfying.
What are the common mistakes which GPs make in ENT cases ? How could GPs have avoided these mistakes ? Are these mistakes due mainly to lack of updating ? Or are they due to an outdated undergraduate syllabus ? My impression is that for most ENT diagnosis, GPs ought to be as capable as an ENT registrar in an institution. The GP could then leave the detail staging, biopsies and surgical intervention to the ENT surgeons.
they should know their limitations and know when to refer to a specialist
The Academy of Family Medicine does not explain enough the work of GPs. Hence the perception that GP is mainly about cough & cold, panel doctoring and issuing of medical leave.
Q: “What are the common mistakes which GPs make in ENT cases ?”
Ans: “they (GPs) should know their limitations and know when to refer to a specialist”
And a specialist should also know his limitations and refer to a more capable person with more facilities. Alas, this is not always speedily done.
I asked about changes in GP over the past 1-2 decades….With cheaper and better instruments, GPs are gradually able to use them at the point of care (POC) – e.g hemoglobin meters, rigid endoscopes, oximeters and short flexible endoscopes. Ironically, an impediment is the lack of teachers to promote these instruments to GPs.
the problem is , most of the GPs in malaysia at the moment are MO of 4 years of service. That’s why the government should make it compulsory for GPs to have a postgraduate degree like FRACGP or Masters. Atleast a Diploma in family Medicine. Few bad apples will destroy everyone. Goes to the specialist as well.
A committee member (Mr SS) of the Academy of Family Medicine (MAFM) complained that ‘there is no feedback from the institutions’ to GPs’ referrals.
But Ms SS were to read MOST of the referral letters by GPs, then he would admit that the referrals were not worth replying to.
well, I reply every letter from GPs
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Get your spamming crap off this blog. It’s not welcome here.
hi dr pagalavan,
i have 2 questions here.
1. I know a doctor who pass the FRACGP have to be gazzetted for 18 month in govt. But what about the compulsory service after becoming a specialist if the doctor is already in private practice?
2. can a doctor with FRACGP pursue subspecialialization in Dermatology in public university or any private institutions? in other words, can a FMS be a dermatologist?
You only have to do the gazettement in government sector.
2) he can sub specialise in dermatology BUT CANNOT call himself as a Dermatologist. It should be Family Medicine specialist with special interest in Dermatology.
hi dr pagalavan,
Is there a way of how I check transfer application status to any government KK? – The KK applied is somehow full and still awaiting for opening, need to know when to pursue as soon as there’s an opening. And aside from waiting for an opening, wonder if you can advise on how to check if other KKs has opening a GP to transfer from GH.
Check with your JKN
Hello and and a very good day Dr.
I am a certified medical officer working in government hospital in kl.
I am planning to open a clinic in Malaysia and currently I am on unpaid leave following my husband in uk..
Could u please suggest what diploma that would benefit me to open a clinic in Malaysia..Since I am not working here in
Uk I planned to take short courses.
You can do any diploma like primary care, skin etc
You could and should continue to pursue diplomas (and degrees) while working as a GP. Are there proven advantages for getting a diploma BEFORE starting GP ?
depends what type of training you had done before leaving government service
Hi dr..I read your post saying that anyone who completed 4 years compulsory service can become a GP in Malaysia. I have completed 3 years of compulsory service and plan to apply to kkm as an administrative post for a year before deciding to open my own clinic. Will working as administrative post in kkm counted as compulsory government service?
As long as it is government service
Hw much will u earn as GP?
That depends on your luck. Generally an average from 5-20K/month.This is by working 9-10pm everyday.
What should GPs do to increase their income ?
get more panels
Dr Pagalavan replies to all GPs’ referrals. That is commendable. What is the reply rate to GPs’ referrals in the government hospitals ?
None as far as I know
What are the main grouses of Malaysian GPs ?
rules and regulations
With better instruments at the point of care and affordable imaging in the private sectors, GPs can improve on their ENT & rheumatology diagnosis.
With more panels, a GP’s income might increase. However, improvement in the quality of practice (in terms of rapport, monitoring, better referrals, recalls, co management with specialists and counselling) might be hampered.
A surer way of increasing a GP’s income would be to invest in the practice – e.g knowhow, instrumentations and softwares.
MH
Of the bigger equipments avail to GPs, the most useful (besides the Xray and the PC-based ECG) is the ultrasound machine – for abdominal US, echocardiography and MSK sonography. Of the smaller equipments, the useful ones in GP are the microscope, the cautery, the oximeter and the rigid endoscopes. And a good Hb meter is an absolute must.
Any advice on what is a suitable Hb meter for point of care use ?
Hi Dr. Paga,
Currently I am GP trainee in the UK at the moment and hoping to go back to malaysia to open a clinic, is that possible? does malaysia recognise MRCGP? if there any additional exam or work i need to do?
Looking forward to hearing from you.
Confused GP trainee
You need to do 2 years compulsory service in government service before you are allowed to open your own clinic. MRCGP is recognised but you need to undergo 18 months of gazettement process under supervision
You would have done your Housemanship in UK, and that will be recognised.
You will need to complete 2 years compulsory service.
Anyone can be a GP in Malaysia, you do NOT need any additional qualification. So after completing your 2 years compulsory service, you will be free to do whatever you want.
There is however, a speciality of Family Medicine in Malaysia, but under the NSR rule, only one of the Masters of FM, or the MAFP/FRACGP are recognised. The UK MRCGP is not recognised, but can be assessed as equivalent under NSR.
There is little difference at the moment in Malaysia between a normal GP, and a “Family Medicine Specialist” in private practice.
hi, i hope you can read this reply as the last replied was a year ago.
i am a malaysian and currently working as a MO in singapore (underwent HO ship in Sg too), in the future I would like to go back and serve the country. I am interested in GP or primary care(even if it is under government sector), may i know if i need to repeat HO ship again? thank you.
blur blur junior MO
As long as you have completed all the postings needed, no need to do HO again. However, still need to do 2 years compulsory service with the government .