Didn’t I say , it is coming. It is official that the compulsory service for Pharmacist will be reduced from 4 years to 2 years ( including housemanship). This was announced today by MOH. If I am not mistaken, the compulsory service for pharmacist was introduced in 2004 due to shortage of pharmacist in the government sector. In just 6 years, they have reduced it back. It was reported in Bernama that 90% of the post in government sector has been filled!! I know pharmacist are now functioning as dispensers in many government hospitals and some klinik kesihatans have 2 pharmacist!
So, the government is now allowing them to resign earlier to enter private market. Another knee jerk reaction for poor planning! Unfortunately the private market is not that great either. Most private hospitals only need 1-2 pharmacist to run the show. Same goes to the retail outlets. So where are these pharmacist going to go? Is this the prelude to stopping dispensing rights to GPs? Once there are a lot of jobless pharmacist out there, the government may just stop allowing doctors to dispense medications and insist on GP clinics to hire pharmacist. Well, doctors are next in line……….. I am already hearing rumours of compulsory service being scraped for doctors.
http://www.bernama.com.my/bernama/v5/newsindex.php?id=618149
Pharmacists’ three-year stint with Govt reduced to one
KUALA LUMPUR: The requirement for pharmacists to serve a mandatory three years with government hospitals after they graduate has been reduced to a year.
Health Minister Datuk Seri Liow Tiong Lai said the cabinet had approved the decision in early September. It will take effect immediately.
However, he said, the one-year training before the compulsory service would still be maintained.
Pagalavan's Avatar 
I hope next new from Health Minister Datuk Seri Liow Tiong Lai is that start next month that’s November 2011 all new HO will be 1 year and it will take effect immediately! due to overload of HOs. oh yeah!
Legally, housemanship is still 1 year!!
Dear Dr Paga,
What do you mean legally housemanship in Malaysia is still 1 year? Isn’t housemanship is compulsory for 2 years before full registration is given out?
The medical act has not been amended yet. Thus, legally it is still 1 year, the 2nd year is known as junior MOship.
seriously???? why HOship consists 4 months posting in Surgery, orthopaedics, medicine, paediatrics, obstetrics & gynaecology and A&E which sum up will be 2 years???
and after completed 2 years only will be eligible for full registration i.e MO???? so, whats the definition of ur legally junior MOship????haha.
PLease read the Medical Act 1971 and you will know what I am talking about
I hope next news from Health Minister Datuk Seri Liow Tiong Lai is that next new doctors will be one-year housemanship start next month Nov2011and it will take effect immediately! due to overload HOs… OHh yeah! 🙂
and soon, hopefully Malaysia switches from the UK/Russian system to the US system of medical training though. Great!
and soon, hopefully Malaysia switches from the UK/Russian system to the US system of medical training though. Great!
Why would that be great? Each system has its strengths and weaknesses, and I’d be interested to know why you think the US system would be so beneficial for medical training in M’sia. (Yes, the current UK-based system is crumbling but that’s a problem with implementation than the method itself).
so that we can choose on the specialties that we like and we dont have to waste time on other specialities. the best part is we can choose specialties right away after medical school. main point is HOship should be 1 year like old days.
Malaysian healthcare system is not ready for system like US. No matter what subspecialist that you become, you still need to know general surgical/medical knowledge. You don’t have all subspecialist in all hospitals!
I’m not sure how well the US system would work in M’sia. In the US, medicine is a graduate course and so they are older by the time they obtain their medical degrees. There’s no choice but to streamline their careers at an earlier stage.
In the UK, some of our graduates are 21 or 22 years of age. It can be quite difficult for some to be forced into making a specialty career decision at that stage.
Within reason, time spent in any specialty in medicine/surgery is never really wasted. It just helps to make one a more complete physician/surgeon. The problem with early immersion into specialty training is the loss of general experience.
In continental Europe (eg: Belgium), surgery trainees can sometimes have completed specialist training by the age of 28-30. I’ve worked alongside some of them. They can do microsurgery with complete proficiency, but are rubbish at dealing with the patient as a whole, such as a case of post-op pneumonia or pyrexia of unknown cause. So yes, they are very good technically but their lack of ward time in general patient management shows.
Particularly in surgery, you can’t cheat the system. Time is needed to gain the required skills, experience and maturity. This does not change even if one can get the paper qualifications sooner.
There is a tendency in this materialistic goal-driven world for everyone to be in a hurry to get somewhere. Don’t forget that in medicine and surgery, the journey is just as important, and can be just as enjoyable as the eventual goal.
I absolutely agree with Jon J. This perception that working in a broad range of specialities during prevocational is “wasting time” needs to be corrected. There is much to be gained from working in the general specialties before embarking on a vocational career of your choice. The Americans get away with it for 2 reasons:
1. Any patient with a medical problem affecting more than one body system gets referred to multiple specialists – even the very simple stuff that a (competent) house officer can handle. This adds layers of cost to the system.
2. Every centre has subspecialists to see all these referrals. Compare this to Malaysia where the smaller hospitals have general specialists.
i believe soon our beloved government will reduce the compulsory service of doctors from 4 years to 3 or even 2 years.
but i dun think government will going to change the uk system to us system .
There is no point for them to do so.All they want to do is to solve the problem of oversupply of doctors in the government sector by encouraging them or push them into private sector (real world)
but remember that once the private sector posts are not available .There will be lots of jobless doctors out there.
i dun think this kind of future will make all of us to feel happy and great!!!
dont think reduce the compulsory service of doctors from 4 years to 3-2 years. there will be not enough MOs,reg. &/or specialists to train those over supply HOs. best thing is immediately reduce duration of HOship training to 1 year! haha!!
How is it possible to reduce housemanship training when you guys already started a shift system, where exposure and experience will be reduced at least by half, and you think they gonna reduce the housemanship duration further??That doesn’t make sense(but somehow sounds like government). And I dont think reducing houseman training to 1 year will be good for anyone especially patients. This will only lead to production of more GPs that are…likely unsafe.
Malaysia will not be able to follow US system unless there is enough training post med school.
If we dont deal with the main problem of overproduction of doctors/quality of medical students, then more problem will arise.
u know something in malaysia, its everything “boleh”
Do you think the government will make it that only people who are family medicine specialist can open private clinics?
Yes, the day will come.
malaysian government should make it compulsory for GP to have family practitioners’ certification before opening a private clinic……..BUT i don’t think they will enforce it!
It will in the future but long way to go…………..
One day all private clinics may be required to have pharmacists to dispense drugs.
GP may have a headache soon.
Seems like government is killing us (the medical profession), not helping us.
http://www.themalaysianinsider.com/malaysia/article/mma-putrajaya-gambling-with-nations-health-by-liberalising-medical-sector/
if you ask me, having a pharmacist dispense medication in all gp’s is probably a really good thing. With the increasing amount of medications at a g.p’s disposal, its always necessary to have a safety checkpoint at the point of dispensing and the pharmacist can also improve customer service.
Profits is not just about the balance sheet, it’s also about increasing trust and happiness; its about promoting the clinic’s performance. With an in-house pharmacist, I can push supplements and multivits ethically, again increasing revenues. With an in house pharmacist, I can also safely treat chronic conditions more effectively, including diabetes, hypertension and hyperlipidemia as it frees my time to give advice/tips/tricks on how to take the medications etc. You guys need to look at the big picture.
With the looming possibility of super-group practices, hiring pharmacists is not going to be a big problem for GP’s.
I agree with you in principle because it is best practice to separate dispensing from medical consultation. However, there are real barriers to implementing this in Malaysia:
1. Smaller centres lack easy access to pharmacies.
2. GPs will have to raise their consultation fees because they can no longer make profits from dispensing. While they charge RM15-20 now, they will have to charge RM40-50 in the future to make ends meet.
3. Patients will have to make two stops instead of just one
4. Items 1-3 will have the public in uproar. Changes which makes things more expensive and inconvenient will not go down well.
5. There’s nothing to stop pharmacists trying to ‘consult’ as well as dispense, because of poor enforcement – patients will actually accept this because it is cheaper for them (although inherently unsafe)
Ur right boss… thats why I argue that its always a win-win situation for battle-hardened GP’s..
if regulators get harsh, the public will suffer, GP’s win the moral battle and patient volume returns to them once the regulators roll back (in practice, the regulator just can’t get harsh, and this is evident from the very slow implementation of the National Health Financing Scheme). Further, regulations are usually top-down, in multi-tiered levels, meaning, most GP’s have about 5-10 years to respond to drastic regulatory changes.
Now, if regulators are slack, GP’s still win the financial battle, as the financially savvy ones will re-invest their earnings into a growth model, establishing more clinics in the rural areas. And GP’s don’t really earn from ur average people, their bread and butter are factory and insurance panels. And with malaysia becoming a mid-level industrialized nation, theres a lot of pie to distribute among GP’s.
To quote a clinic owner in Klang Valley – “national insurance? there is simply no political will for it to actually happen’
And about the issue of having a post-graduate qualification to open a clinic, its going to be a long time before they make it absolutely mandatory. Market forces just does not deem it possible. What the regulatory bodies are trying to do will be to rate clinics via the Quality in Practice accreditation, at level 1, 2 and 3. Thus, a QIP level 3 would be a clinic with a FMS and of the highest quality in the eyes of the AFPM while QIP level 1 would prob have a basic GP instead.
The consumer who is very particular about rating/quality, insurance companies who are pushing quality as their main focus or even the upcoming NHCS financing may only decide to use QIP level 3 clinics as their panels. The general public may still have access to their ‘family doctor’ who may even be QIP level 1. Anyway, this may take a decade or so before it becomes reality.
On a final note, again, it’s not about the money (purely). It’s about the lifestyle also. The British GP’s (who’s system we are trying to emulate) are the most chilled out bunch of guys (along with psychiatrists and dermatologists). And in the NHS, most specialties have a pay difference of about 10-20% only. Thats socialist medicine in a nutshell.
Sorry, my third post in a row. But I just have to add.
Malaysia being an ‘industrial’ country, has tons of factories who cover their workers for basic medical benefits. To be a factory panel, all you need is to be a NiOSH certified OHD. So, again, even if you are not a FMS, you can be a OHD and survive handsomely.
I apologise for only talking about the financial aspects of it, but it seems to be the only problem for most ‘altruistic’ doctors these days eh?
I apologise for only talking about the financial aspects of it, but it seems to be the only problem for most ‘altruistic’ doctors these days eh?
Chill, that’s a little unfair.
Given that the fees of a private medical degree these days is upwards of RM700k, it’s entirely appropriate if students thinking of a medical career ask the question of likely pay once they hit the workforce.
In business, you wouldn’t invest 3/4 million on anything without first finding out the prospective return. It’s just good sense, and I have never had a problem speaking freely with prospective medical students about potential future renumeration. Most just want some reassurance that they will earn a reasonable living. Also, have you cosidered that it is not easy to remain idealistic and altruistic if one is continually struggling to earn enough to look after one’s own family?
Here’s another perspective to think of – does it really matter what drives a doctor to excellence, even if the main aim is financial? I have a few senior colleagues with large private practices who are primarily driven by lust for money. They are excellent surgeons and the ethics of their practice are beyond reproach. Many patients have been helped greatly by their expertise. Is there anything wrong with that?
Does it really matter what drives a doctor to excellence – whether it is altruism, academic ambition, intrinsic calling, ego or financial lust? So long as none of these goals exceeds ethical virtue, then ultimately patients still benefit.
Jon, nicely argued. I certainly agree with that.. Maybe what irks me are the opposite bunch of doctors.. those who can barely practice ‘safe medicine’, and are thinking of ways to milk the money-cow, and further accelerating the demise of any market-driven excellence in the health care industry.
I think Jon and Nav have really hit on something a few posts above.. and that is the driven ambition to be a “somebody in a field”. Consultant Gastro Hepato Neuro Yada Yada Mada Mada.. as my prof once joked “The patient with a right ear otitis media wasn’t treated by the right handed ENT specialist”
We have to blame the American system for this. In Australia, some of their most dedicated (and most renumerated) doctors are very very seasoned rural practitioners… yes the type who carry im adrenaline injections in their pocket and walk around with aborigines. no kidding.
Funny how sometimes we when we look from a 3rd person perspective, we look at all the irony of things, where the quote often goes as : “To be a specialist is to become more knowledgeable in less and less areas”.
But I wonder if one would have a pancreatic cancer, would one want his/her op to be done by a general surgeon, or a surgeon who sub-specialize in hepatobiliarypancreas -the HBP surgeon?
I would definitely op for the latter. You?
Nav, GP in Malaysia don’t charge RM15 to RM20 any more. A visit to a GP with cough and cold ( with a few medicines) cost RM70.00 A child with fever to a GP was charged RM50.
Is it chain clinic? then it is common for it. with nebulisation it can reach rm120 for that. My pt also complained that, with 3 medicine and less than 20 tabs in total. They charged her RM50. UPT alone is RM60. Worse still, no medicine name written on the medicine packet. So, I couldn’t trace what medicine is taken.
Heh heh … my parents are GPs but they work in a small town. They still charge that much – but I can understand that KL prices would’ve gone thru the roof for various reasons.
An example of competition and saturation: When my mum opened her practice in 1982, there were 8 GPs in this town – now there are more than 30. This town’s population is actually lower now compared to 1982, though admittedly it has increased a bit in the last 10 years.
there is definitely a tough competition not just between the GP but also with pharmacists nowaday.
hi dr. I am currently studying international baccalaureate and sponsored to pursue study in UK for medicine course. Reading ur posts enlighten me on increasing numbers of doctors by the time I graduated. Since I can still apply for one non- medic course, could you suggest courses (related to science), which I can apply? At first, I am thinking of pharmacy and bio medical but since job prospects in M’sia is not so good, I changed my mind.
ur reply is highly appreaciated. Thank you.
If you have a scholarship to study medicine in the UK …. by all means, go. Make sure you stay there as long as you can (i.e. try and specialise there) before you think about coming home. If the job situation is good at home by that time, then great. If working as a doctor in Malaysia by then is even worse than it is now, at least your qualification is recognised elsewhere and you can reconsider your options.
thanks for the advice. For UK, I can only apply for 5 choices only. 4 for medicine course and one for non-medic course. Do you any suggestion on which course I should apply?
If you are going under JPA scholarship and you are REALLY interested in medicine, then go ahead as the government have to give you a job.
Appetizer for u all…..
http://www.thesundaily.my/news/167606
http://www.thesundaily.my/news/175519
[…] Remember what I wrote on 6/10/2011 https://pagalavan.com/2011/10/06/i-told-you-so/ that there will come a time when doctors will not be allowed to dispense medicines ? Well, it is […]
[…] year in October 2011, the government reduced pharmacist compulsory service from 4 years to 2 years https://pagalavan.com/2011/10/06/i-told-you-so/. It was reported that almost 90% of the post in government sector has been filled. Subsequently, […]
[…] 6800) and pharmacists (1: 3355) despite the post in civil service being almost full as mentioned here and here. Once the 1Care system is implemented and the dispensing rights are given to the […]
[…] back in October 2011, I wrote this. In just 6 years, the government reversed their decision from a 4 year compulsory service for […]