2:42PM Dec 13, 2011
The 1 Care health system transformation plan for Malaysia is now in the process of being sold to the public.
To our knowledge, the development of the blueprint is being fast-tracked and that the detailed plan to implement 1 Care will be ready as early as 2012.
Technical working groups are already hard at work on this. As the term technical working group implies, it is the technical details are being worked out – not the decision for plan for a new health system. Thus, we are way past the “still in planning process” (The Star, May 13, 2011).
We must address certain issues that are raised before implementation.
We are told that the new health system will be in the substance and form of the NHS of the UK. We strongly urge for a critical rethinking of this for the following reasons:
1. Existing Primary Care Provides Better Accessibility and Choice
The primary care model of the NHS has many failings. The picture from the NHS shows that it is not the proven mechanism to facilitate appropriate access to higher level of care. In the UK, this system requires patients to make appointments with the GP, even for acute conditions. As a result, the A&E Departments of hospitals are jammed with patients and waiting lists for cold cases to see the doctor or undergo surgery is long.
On the other hand, Malaysia has a better healthcare system. We had good KPIs reported in the latest National Health Accounts Report. Our health system has been praised in many international reviews and articles published in journals.
In Malaysia, government health facilities have a good system of referral and provide the safety net for the poor. Those who can afford to pay out-of-pocket consult private doctors. This is a good balance of those seeking private and public healthcare.
What the government really needs to do is protect those using private care from exorbitant charges and being over serviced. This can be handled by strict enforcement of the relevant provisions in the existing Private Healthcare Facilities and Services Act1998/Regulations 2006.
There is choice with the present system. With 1-Care this choice will not be there. The patient and public pay upfront in the form of insurance or taxes. If they do not want the doctors or the service that is allocated, they will have to pay again for what they choose.
2. 1 Care will cost more
Worldwide it is recognised that a system based on general taxation is the most efficient and equitable.
Experiences from many countries have shown that the rise of healthcare cost is higher when other forms of healthcare financing are introduced.
Instead of finding another method of financing, including social health insurance, to improve efficiency through provision of greater choice and better control on cost of health care delivery, the MOH should look internally on wastage and efficiency and improve the government system to be better than the private sector as shown by experiences in Singapore and Hong Kong where the public prefers the public system.
The 2002 Report of the Study on “ Healthcare Reform Initiatives in Malaysia” by three Health Ministry-appointed consultants led by Donald S Shepard have clearly diagnosed the important issues of healthcare delivery in Malaysia and proposed solutions.
Cost-wise, the consultants “calculated that in the year 2000, the average ambulatory consultation (public facility) outside of a specialised hospital (including average prescriptions and laboratory services associated with that visit) costs RM91, while the average inpatients stay cost RM1,091 (or RM286 per day).
In contrast, the fee for an amublatory visit, RM1, has not increased in years and covers only one percent of the economic cost of an average visit”. This does not include the economic cost of long waiting time and time off work.
We know that the average cost for a GP outpatient consultation including prescriptions would only be between RM30 to RM50. Waiting time is shorter. Thus it is clearly cheaper and more efficent to just outsource this ambulatory outpatients to the existing robust GP system thereby releasing the public system to concentrate on secondary and tertiary care. The recovery economic cost of a shorter waiting time will also benefit the patient and the community.
3. Transformation versus Evolution
The overall recommendation of this extensive study based on the diagnosis of our healthcare system was for the country to proceed with “limited reform”.
This reform “should improve the management of the public healthcare services so that they can provide better working conditions for their staff,fill critical vacancies,enhance responsiveness to population’s needs and wants, and maintain an equitable basis for financing healthcare services”.
4. Improving stakeholders’ feedback for 1-Care Consultation
The cost and implications of 1-Care affects all. Judging from the concerns expressed by many doctors and the public in the media, it is clear that those so called stakeholders that are invited for discussion are:
1. Either not real representative of the profession
2. Or the stakeholders are not providing feedback
3. Or the stakeholders are some favoured few
It will be good governance to inform the public who the stakeholders are (in name and organisation) to ensure that they are truly representative and to include more public representation like patient groups, consumers, employer representatives and more NGOs.
5. Corporatisation of Public Hospitals.
The 1 Care systems requires corporatisation of public hospitals – the establishment of administratively autonomous hospitals through devolution of authority from federal control, a variant of corporatisation ala IJN. This will be in line with the seamless integration of private and public healthcare facilities.
This is clearly not possible as private facilities are profit-driven as compare to public facilities which is socially-driven. Furthermore this is contradictory to that reassurance given by the health minister in 1998 that the government will not corporatise public hospitals.
At the end of the day one would create a huge profit-driven monster that will be impossible to control as the regulator (i.e. the government) will also be an operator of the industry via its GLCs.
DR STEVEN KW CHOW is president of the Federation of Private Medical Practitioners’ Associations Malaysia.
Pagalavan's Avatar 
If you have read the book by Robert Kyosaki. You will know that the different between KWSP vs. Pension scheme. KWSP is you are responsible for your own where under pension scheme, the government is responsible for your living.
With the emerging of NHFS, it appears that the government is passing ‘his’ responsibility to your hand. Your are going to responsible everything after your retirement. So, dun put high hope on the government.
I knew it since I first worked in the government and ‘they’ are trying hard to get rid of pension system. To be prepare for high cost medical treatment soon.
This system also sounds like the one used in Singapore and Australia called Medicaid/Medicare (A bit fuzzy on this one). Every citizen is required to contribute to their own medicare funds and if it’s not enough, top up using their own private medical insurance.
What does it mean for us? Is it a fairer system? An autonomous run hospital could be a better hospital? Or worse?
this is another way of our 1my government to make money out of the citizens pockets.i believe there will be a so called” non profit” organization to control the GP or doctors through the 1 care med scheme.Under such scheme, Gp are” employed “by this organization.GP are not longer the bosses.The organization or corporation will monopolies the healthcare system of Malaysia.
I think it is a fantastic plan.
Why?
Stand on your own feet.
Once patients start paying for their own bills, they will realize how important it is to comply. We see many patients in government sector not complying discharge. Government spends thousands of ringgit on these individuals who in the end actually waste the funds. Thus, in a whole, this idea is beneficial to the government
How about the patients? Having to bear additional salary deduction per month may not be a good thing. But this is just like an insurance. Insurance in my belief is something very important. Many malaysians, do not believe in having insurance thus, causing a burden to the gov in times of crisis. Thus, indirectly, having security in terms of health is a fantastic news.
Now how about the doctors?
In my opinion, WE BENEFIT THE MOST. Why?
Have you had this thought about a colleague? “How the hell did he become a doctor??” the exit policy is fantastic to rid these incompetent staff. Once hospitals operate as private, they would have to care for the patient much much more. Hence, useless doctors and nurses would have to be useful or they may just end up by the road side,sweeping rubbish.
HOWEVER,
In malaysia, if an idiot is to be appointed as the CEO of the hospital, then, the whole hospital will collapse together as well.
In malaysia, there is no transparency, even the complaint boxes are not transparent. Thus, exit policies would be in favor to certain races and blah blah blah.
In the end, it all boils down to your own self work. Work hard and be the best. Hence, doctors, step up your game. If u are useless, become better. And medical students, choose the proper university, not some cheap useless international universities. And if you are alr a medical student, you better not having mediocre grades. Do well in medical school and be enthusiastic to learn untill you die or end up out of the service.
To be fair, the idea or concept is a noble one. But the implementation or policies governing it may leave much to be desired as seen in various brilliant ideas put forward. Unless and until a truly non-profit body/regulator runs the system, it is difficult to be certain on the practicality of this system.
Having said that, I do agree that with patients being made to pay for their healthcare, they will value medications and appt given more than before. But please think again, who is going to contribute to the national insurance scheme? The rich guys? or the middle income group who is struggling to live each day? or the rural folks who is contended having 3 meals a day to feed whole family?
Out of all of our citizens, only 10% are paying income tax, as they fall into this bracket of so called earning sufficiently to pay back to the community (which may not be true). So now the burden again is placed on this cohort of tax payers to subsidised the healthcare system. It is bound to fail, and middle income or tax payers will be severely burdened and breakdown.
POlicy makers need to be clinician with forsight, not administrator who knows nothing bout medicine. Increasing the minimal or nominal payment public paid to see doctors in govt sector, cutting budget for unnecessary idealistic projects, will generate more savings for the govt to continue to subsidise the public healthcare.
Well,….don;t disturb the balance that is already in place, otherwise things may turn out bad.
Reading an article like this gives you the warm and fuzzy feeling, that everything will turn out just fine 🙂
http://thestar.com.my/lifestyle/story.asp?file=/2011/12/14/lifefocus/10082004&sec=lifefocus
Excerpts:
“I admired the doctors, from the anxious housemen to the serious MOs, the more assertive MOs, the confident ones with master’s degrees, and the benevolent specialists. They are a dedicated lot of busy, busy people. They worked non-stop, especially during the eve of public holidays”
“I believe there are more teams of doctors in other hospitals who are developing along the same lines to raise the standards in our medical service. Malaysian hospitals boleh.”
Anyone here care to share his or her experience in government hospitals, recent ones maybe?
It depends on which hospital you go. Some of the newer hospitals are well eqiuiped and has limited number of beds. Thus the service will be better compared to the older hospitals.
The thing is, Medicare in Australia allows you to choose your GP, and basically depending on your GP (bulk-bill or not), it’s either totally free or you have to pay additional gap fees. Medications listed under the PBS are heavily subsidised while those that aren’t listed are fully paid by the patients themselves. Plus, whether or not you work in the public sector, everyone contributes, as the funding comes from money collected via general taxation.
Seems like this NHFS do not allow patient to have any sort of autonomy (you don’t get to choose your own doctor). Plus what happens if you are out of town and need medical care somewhere else in Malaysia? Then you have to pay everything yourself again despite contribution to the NHFS?
…and let’s not forget that a majority of the population pays close to 30% income tax… and the rich have tax brackets that approach 49%.
This is basically the British NHS being implemented in Msia. Except that there is no cap in visits or ‘allocated’ funds per patient in NHS. There is however, a cap in the allocation for the list, and if the doctor manages his list well (ie keep patients well and reduce visit demands), he will earn more (surplus), and vice versa. The British GP’s complains no end about this system, but most make decent living.
I am not sure if it will work in the Msian context. A big problem is funding, the vast majority of people in Msia (unlike UK and Australia) do NOT pay tax (or even have tax files). And based on the usual Msian bad implementation, I foresee failure.
yup….i agree that source of income for doctors may be affected through the implementation of this system….but at the same time i have to admit that it may have a positive effect to the country’s mortality and morbidity statistics. its crucial to impose the sense of responsibility in patients….in general most of the malaysian patients take their diseases for granted because they lack the sense of belonging towards their illnesses….they feel its the doctor’s job to handle it…one of the sad reason is because they get their med’s for as low as rm1 in govt clincs…they are being saved by the govt from seeing the complications of their diseases….hence the general human mindset plays its part….cheap things are usually poor in quality…..they dont deserve to be appreciated.people default their apppointments, take the medications as they wishes, insist on getting extra stock, insist on m.c, look down upon govt staff…its time they feel the pinch for a good cause.hopefully the system is improvised further so that the negative effects to the GP will be minimalized so they too cn show some passion towards this system!!
What if I get a GP who doesn’t know how to recognize
symptoms correctly? Or worse cannot perform a
proper physical e.g missing a murmur or if I come
in with bleeding PR- just give me Dafilon and Preparation H
without a DRE missing a rectal growth.
Or what if I come in with an MI- and he/she doesnt read ECGs and
chuck me some antacids.
Or I come in with a laceration and he doesnt even know how to hold
a needle holder?
Malaysia should never have managed care.
Alot of our doctors TODAY are poorly educated(read- substandard medical school)
and poorly trained( substandard Masters program).
Not to detract from the excellent doctors that were and are around.
I am talking about the scenario today
I seldom encountered the above mentioned senario. The worst senario for me was the GP gave NSAID for moderate gastritis pt and missed the fetal beating heart and advised her to do D&C. Most probably they are doctor with no licence. Some clinic did employ such doctor for locum because hard to find the proper one.
For a NHS-type system to work, the country should have a good track record in the following
1. Highly accountable in the implementation of socially good, non-profitable entities – typical of OECD countries
2. Predictability of outcomes in the provision of clinical services i.e if i randomly select ten doctors, all would be able to provide the same outcomes
3. Good track record in preventing social inequality – again typical of OECD countries
You be the judge about what Malaysia is capable of.
The problem with 1Care is it rests on the need to sustain “developed country” level of mortality and morbidity without causing cost inflation ala US healthcare, since we are so bloody sure of becoming developed by 2020.
So, assuming we have not achieved developed status by 2020 (surprise, surprise), what we have is a dysfunctional health system, trying to “look and smell” like the NHS, serving a country that is probably descending to the likes of Nigeria or Saudi Arabia.
Don’t be surprised if the biggest winners are GPs. Not 1Care panels, but pure cash-for-service doctors who seem to provide better care for a marginal cost. People WILL pay 70-80 bucks for their regular doses of quality antibiotics. Its after all, the same shade of perception that has driven ‘locally’ made Proton cars out of business, eh?
currently, i’m doing ho. i would like to be a cardiac surgeon, so could you please pave me the best way to further on this field…..in malaysia and possibly in united kingdom as i got offer from MARA to get the sponsorship to specialise in this field oversea.
warmest regard,
Mearz
To become a cardiothoracic surgeon: complete 2 years of Houemanship, 2 years of medical officer, complete 4 years of Master’s in Surgery, 6 months of gazettement, 1-2 years of waiting to get subspeciality training , 4 years of Cardiothoracic training. All this assuming you get your Master’s seat on first try and you pass on first try. Even after all these, you are not necessarily competent to perform a cardiac surgery on your own. It will take another few more years to be competent.
I don’t think MARA knows anything about speciality training in medicine. Is your degree recognised in UK? In UK you need to pass MRCP and get into cardiothoracic surgery training for another 4 years.
dr. mearz enquired about cardiac surgery training: …possibly in united kingdom as i got offer from MARA to get the sponsorship to specialise in this field oversea.
I’m afraid this statement reflects that MARA does not really understand postgraduate surgical training particularly in the UK.
The shortest pathway to cardiac surgery training in the UK follows:
1) Foundation Training (“FY1/FY2” – 2 years). HO post basically.
2) Core Surgical Training (“CT1/CT2” – 2 years; to pass MRCS exam by end of CT2). This is like an MO post with little cutting opportunities.
3) Specialist Surgical Training (“ST3-ST8” – 6 years; to pass Intercollegiate FRCS exam usually during ST6-ST8). This is the stage where the actual cutting experience is accrued.
Successful completion of programme with sign-off of competencies by training programme committee and passing of Intercollegiate FRCS leads to award of Certificate of Completion of Training (CCT) and entry to UK GMC Specialist Register. Candidate awarded title of FRCS(C-Th).
So the minimum is 10 years after graduation in the UK. Needless to say, no one has ever done it in the minimum time. Average is 14 years. All posts at every stage are applied for in open competition (extremely fierce at the CT to ST stage) with interviews and appointments by committee. No cables, backdoors or quotas. The job goes to the most deserving candidate; and the CVs of successful candidates are stacked to the hilt with things like a higher research degree, publications and presentations.
Being Malaysian, I get a lot of enquiries from Malaysian medical students asking about the quickest route to an FRCS. At that stage, their main focus is to get the qualification and return home as quickly as possible. They seem to think that the postgrad degree is all that is needed to be a specialist surgeon. Those who successfully enter specialist training later come back and tell me that their main worry is no longer time but to ensure being surgically competent by the end of their training. The qualification is meaningless without the ability.
If you successfully secure a training post, you are employed with a decent salary and you will not require MARA sponsorship. Even if MARA was prepared to pay your salary, you will not be able to stroll into a 6 year training programme as a “visiting” specialist trainee.
The most time that any UK training programme committee will allow to a self funded overseas visiting trainee is 2 years. This is normally granted to trainees who are at the end of their training in their home countries and are visiting the UK for overseas experience. This means that you will need to go through Masters in Malaysia. Then find a training region willing to take you on for 1-2 years in the UK. Having contacts with UK consultants at this final stage does help a lot.
Numbers of specialist surgical trainees in UK is tightly regulated to ensure quality of the training. So having your own funding doesn’t mean a thing since the training programme committee will only allow a visiting trainee if there is enough operating opportunity that an extra visiting trainee will not dilute the experience of the national trainees.
It is difficult but not impossible for a non-EU candidate to secure a specialist surgical training post in the UK. The question is how much you want it and how much extra you are prepared to do to make your CV competitive.
Good luck if you choose to pursue it. Remember that if you do not dare to dream and make the attempt, you will never achieve your goal. You cannot get a job you do not apply for.
forget to say, i graduated from university of manchester, uk and i back home to complete my ho first. The aforementioned pathway is for malaysian or uk…which one is shorter and more ease?
Can u explain about MRCP?
sincerely,
Mearz
Your problem would be getting registration in the UK now that you have done your housemanship in malaysia…
The above mentioned pathway is for Malaysian. However, the parthway is also almost the same in UK. You need to do MRCS and then subspecialise in cardiothoracic. MRCS can be done as an open exam unlike Master’s BUT the competition to get into cardiothoracic training programme in UK is great. The chances for a foreigner and non-EU citizen is very slim.
As for MRCP, please fo to my future doctor page and look under ” step by step approach in doing internal medicine speciality.
1000 ppl climb to the top of the “cardiac surgeon” pyramid, only 1 makes it. Go figure ur chances.
Difficult but not impossible. But fair to say that persistence and determination are as important as intelligence and ability in highly competitive specialties.
Small specialities like Cardiac surgery (include in this Neuro, Plastic and Paediatric surgery) are typically harder to get into than General or Ortho. The limited number of specialists means that there are also limited numbers of training places.
Consultant Surgeons in England, 2007*:
Paediatric surgery 121
Neurosurgery 220
Cardiothoracic surgery 287
Plastic surgery 308
Oral & maxillo facial surgery 345
Otolaryngology 559
General surgery 1,841
Trauma and orthopaedic surgery 1,872
*(source: http://www.rcseng.ac.uk/service_delivery/workforce/statistics)
Update….
http://www.malaysiakini.com/letters/184923
Another way is to do the USMLE and obtain ECFMG certification.
The next step is to secure a spot in a Surgical Residency-either a stand alone independant program in General Surgery lasting 5 years and of which you will later apply for a CardioThoracic Surgery Fellowship lasting 2-3 years.
If you are lucky enough,you may obtain an Integrated residency which is 5 years tailored training in CardioThoracic Surgery-you will be “loaned” to the General Surgery Department for the first two years for generic surgical training.
At the conclusion of training, you will be BE(board eligible) and can be BC(Board certtified) by a comprehensive examination to be designated by the American Board Of CardioThoracic Surgery.
In short
-you need good scores in the USMLE
-you may need to do a clinical observership/externship in the US
-experience in research/audit helps a lot
During training
-you need a cast iron stomach and ability to juggle life with little sleep and a lot of study
-you will begin “cutting” during PGY2 ,second year of residency
-you have to do a lot of scut work during PGY1 and PGY2
I somehow believe that Americans are the best teachers in Surgery.
And the often busy stressful environment at my residency is balanced
by supportive and willing teachers.
I had experience working in Malaysia in Surgery and hence,I am not offering a biased view.
Dear MalaysianMD,
Thanks for your information. But from what I heard it is really difficult to get into US surgical residency unless one has the green card or citizenship, in fact only about 50 IMGs were matched into the categorical surgical residency last year.
Having met the adviser for US Residency in my college has discouraged me further. She told me that there were seniors who scored 99 in both steps, with a few publications in hand and few months of USCE could not get into surgery. She actually advised us to apply for both primary care specialty and surgery together, to avoid being unmatched in the end. And we can try to switch into surgical residency once we get into the system, as we would have developed some connections that time. But it takes double the effort if I follow this, as I will have to go for electives for both specialties, preparing two different personal statements and of course lying to the program director during the interview.
I am planning to start preparing for USMLE after a few months during my compulsory internship in India and I would really appreciate if you could advise me on what to do to improve my CV so that I would stand a better chance of getting into surgical residency.
Except USCE in surgical specialties, would you advise me to work as a research fellow voluntarily in US? As I heard someone got into surgery after working for a research project for a year, and my friend’s uncle got into Radiology after working in this way for three years.
Thanks in advance.
Hi MalaysianMD,
Can you tell us your story of how you got into surgery in the US?
Dear MalaysianMD,
I am currently a final year medical student from University of Newcastle, UK and just finished my intercalation in Master in Research. I have done a research in Stem Cells and Regenerative Medicine and have the paper published at the end of the intercalation. I am actually planning to sit for USMLE (in my final year) and hope to be matched to internal medicine in US, before I can proceed to medical oncology residency. If you don’t mind me asking, what is my chance of getting a residency in int med in US? Being an IMG from UK, I do understand that getting a job in US is definitely not an easy task, but just asking, do my research during my intercalation increase my chance? What else do I need besides having a high score in USMLE?
Dear Soulmate
It is indeed hard,very hard but nonetheless not impossible for an IMG(international medical graduate) to obtain a surgical residency in the US.
If you are lucky(or shall I say unlucky),you can obtain a Non categorical Surgical Post for PGY1 with no guarantee that you will progress to PGY2.
Many IMGs have lamented that after one year of scut duties,they are left without a job/residency and go back to square one.
The Non categorical year is the year whereby you will be assessed -on your ability to assimilate clinical knowledge,be a superb surgical assistant and take no prisoners attitude to patient care.You will be lucky to get 3 hours sleep a day.(the situation is changing now with the implementation of controlled hours but many US hospitals continue on with old school methods)
If you do apply and match for Primary Care.Internal Medicine which are easier to secure-you are more or less “obliged” to complete the residency.Program Directors do not take kindly to candidates who use residency opportunities as stepping stones to jump off to another residency.And that would also not be viewed in a positive manner by Surgical Program Directors.
My advice is to ask yourself-if you really want it(CardioThoracics) you have to go for broke-try and try again.If you don’t match-you may can do a year or two of research(mostly unpaid) and you will have a second shot at the coveted residency.Almost all IMGs who are in CTS are either trained cardiothoracic surgeons from their homecountry who came for a fellowship and then decide to redo their whole residency again.Other IMGs are those with excellent USMLE scores and had extensive research experience and publications in the US.
If you can entertain the thought of doing Primary Care or other specialties, more than likely you will get a residency spot and can be trained in the US and possibly make a decent living in the US thereafter.
The question is what do you want?(This of course has to be balanced by your USMLE scores and what are you willing to undergo in order to do CTS)
Dear MalaysianMD,
Thank you so much for your prompt reply and valuable advice.
Whether to go for internal medicine or stick to my dream of becoming a surgeon is the toughest decision to make. If you ask me to follow my heart then I would say surgery, but sometimes dream has to be balanced with reality, and this is the saddest part of life.
Anyway I will apply for electives in US first, as this has to be done before the end of my internship when I am still considered as a medical student.
Thanks again!
To MalaysianMD….
Are you a graduate from anywhere else and then do your surgical training in US?
Do you know how to go for surgical training programme in Ireland,Australia and New Zealand?
You have to be allowed to work in those countries first – check the requirements of the respective medical councils but usually you need your basic medical degree to be recognised OR sit entrance exams (after which you usually start again as a houseman).
Once you have been thru all that (will take 2-3 years) you can start applying for surgical training – this is another hurdle because places are very competitive AND you are at a further disadvantage because you’ll be from overseas.
Sorry, no shortcut.
The NHFS will not work!
First, I and perhaps many other Malaysians will not want to be restricted to a particular GP come thick or thin.
Why should I do so, especially if this GP may be a dumb-dumb.
Would any of our Government ministers do that?
Also, this scheme is like the horrible FOMENA which is a licence to enrich certain parties at the expense of the patients.
And its propensity to cut costs by restricting treatment or effective medicines to their patients are definitely contradictory to in the field of medicine.
Haven’t our government said very often that nobody, no matter how poor, should die from lack of medical treatment?
Well, having the NHFS will probably be it!
All in all, it must be vehemently objected to by everybody, especially doctors!!!!!!!
This will only work out in urban area. How about those in the rural area? Low socioeconomic status, poor education level, logistic issues, illegal imigrants. How can this system incorporate to that extend?Going out just to see a doctor requires an hour of walking journey and another hour of car journey/boat journey, not to mention about bad weather, total cut off from the accessible roads. This will further widen the gap between the urban and rural. For those who can’t afford to pay, how will their future behold? worse health care, more debts, more ill cases? The condition in rural area has not been improved and yet we try to standardize the health care system to developed country level, How can we cope with that? We as health care workers in rural areas are still struggling to cope with that higher standards of health care with limited resources and poor accessibility… and kpi target is increasing at par with the developing/developed country level, making it even more difficult to achieve for a forgotten place like here in east malaysia. Gos bless the poor and those suffering!!!
I was informed that the 1care system may only apply for the urban areas first and the rural areas may stil be fully government funded.
Hi Soulmate,
I ‘m a Malaysian graduated in India too and I have done my step 1 and step 2ck exam.I got 99 for my first step and 82 for my CK(suppose to be 99 too in old grading system, but ECFMG have recently revamp it and abolish the 2 digit score.Thus,the two digit are only for your viewing.Now they’re into 3 digits)
Which university are you from?Let me know you email ID, we can have a chat 🙂
Hi Henry,
Nice to meet you here! And congrats for your great step scores!
I am from KMC, Manipal.
Email: heekong@gmail.com
Hi Soulmate,
Glad to see your letter this soon.I know the college really well.
Thanks for the complement.I like to put my thought on this residency issue.
Even with such score like mine, my chances of getting Internal medicine are slim.how do I know that? I am following a few of my friend that have similar score in their persue of IM.As of now, there’s no news on their matching for residency.
well that’s for IM.I don’t know the detail for surgery or other highly sought after specialty but it’s extremely tough for outsider that schooled in non-American medical school.The only possibility I can think of getting surgery(yes, even Neurosurgery or cardiothoracic surgeon) is by doing the twinning program of IMU, that is with Jefferson medical school.As per my knowledge.Malaysian grad from that school are on par with American from local school there.Hearsay there is a Malaysian cardiothoracic surgeon in America.For people like you and me, an International medical graduate(IMG), our only hope is to fill vacant/tough post that are discarded by local American.
I recently met a super senior of yours, he is doing his pulmonary fellowship in Texas university.I’m really glad I could met him over lunch during his sojourn in Malaysia in between his residency and fellowship.He took up residency in one of the community hospital in NY.I heard a lot of stuff from him.
Anyway, cut the digression short.Going to America to work is a possiblity but that’s only in certain specialty and I’m not going to discourage you on surgery. As I have heard from that senior that his classmate got surgery after his distraughtful probation period for surgery.Then again, that’s like 4 yrs old news and I don’t know how is it now in America.There, try for surgey if you really are passionate about it and you’re the sort with no string attached, as it might take years.
Alright then, I am going now and sorry for being anonymous as I am secretive sort.
Cheers,
Hi Henry,
Yea i do agree with you that the IMU-JMS/Canadian Med schools is the best possible route for malaysians to get into any highly sought after residencies. In fact it raises the matching rate from 40%(for IMG) to around 70%. There was even a malaysian getting into surgical residency of Johns Hopkins and now working as a vascular surgeon in the same institution.
From what I heard getting matched into IM/FM/Paeds would not be a problem if you have a double 99 score. But of course this does not apply to those top university programs which usually only take in american seniors. IMGs like us should not be too choosy and we always need a few community programs for back up. If you have a few months of USCE with great letters of recommendation (only from american physicians), and some research experience then your chances will be high.
A senior told me that 99 scores only opens a door for you to get the residency interview, all these factors like USCE, research experience and of course performance during the interview are important on how you will be ranked by the program directors. He was offered a prematch for a university program in Washington and the program director even praised him for his extensive research experience in med school and great presentation skills.
Do you mind giving me your email id? I would really appreciate if you could provide me some information on clearing the steps.
Thanks
[…] first part of this topic was written by me on 15/12/2011 https://pagalavan.com/2011/12/15/for-future-doctors-the-change-is-coming/. Since then I witnessed that 1Care issue is being discussed in various blogs, online news and even […]
[…] appoint GPs as one of the primary care providers to the public. I have mentioned about this over here and here. There is a high possibility that dispensing rights of GPs will be taken away and given […]