Will this situation appear in Malaysia soon? I am afraid the time will come. In fact it has already started to happen. I am beginning to see doctors closing shop and jumping from one hospital to another for survival. With the glut that is coming, the situation will only get worst. This article appeared in CNNMoney and below this I have attached some info regarding 1Care system.
Small Business: Doctors going broke
By Parija Kavilanz | CNNMoney.com – Thu, Jan 5, 2012 12:37 PM EST
Doctors in America are harboring an embarrassing secret: Many of them are going broke.
This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.
Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.
“A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.
Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.
Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. “And we still barely made payroll last paycheck,” he said. “Many of us are also skimping on our own pay.”
Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. “Our total revenue was down about 9% last year compared to 2010,” he said.
“These cuts have destabilized private cardiology practices,” he said. “A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well.”
12 entrepreneurs reinventing health care
Pentz is thinking about an out. “If this continues, I might seriously consider leaving medicine,” he said. “I can’t keep working this way.”
Also on his mind, the impending 27.4% Medicare pay cut for doctors. “If that goes through, it will put us under,” he said.
Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.
Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary “patch,” this dilemma continues to haunt doctors every year.
Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians’ financial woes.
“Many are too proud to admit that they are on the verge of bankruptcy,” she said. “These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them.”
Donegan knows an oncologist “with a stellar reputation in the community” who hasn’t taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn’t reimbursed for.
Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors’ ranking. Still, he is contemplating personal bankruptcy.
That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.
Changes in drug reimbursements have hurt him badly. Until the mid-2000’s, drugs sales were big profit generators for oncologists.
In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.
“I grew up in that system. I was spending $1.5 million a month on buying treatment drugs,” he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.
“Our reimbursements plummeted,” Barth said.
Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.
“I was $3.2 million in debt by mid 2010,” said Barth. “It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first.”
He’s since halved his debt and taken on a second job as a consultant to hospitals. But he’s still struggling and considering closing his practice in the next six months.
“The economics of providing health care in this country need to change. It’s too expensive for doctors,” he said. “I love medicine. I will find a way to refinance my debt and not lose my home or my practice.”
If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he’s turning away new patients whose care he can no longer subsidize.
“I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer,” he said. “The moment has come to this that you now say, ‘sorry, we don’t have the capacity to care for you.’ ”
Small business 101: A private practice is like a small business. “The only thing different is that a third party, and not the customer, is paying for the service,” said Lion.
“Many times I shake my head,” he said. “Doctors are trained in medicine but not how to run a business.” His biggest challenge is getting doctors to realize where and how their profits are leaking.
“On average, there’s a 10% to 15% profit leak in a private practice,” he said. Much of that is tied to money owed to the practice by patients or insurers. “This is also why they are seeing a cash crunch.”
My biggest tax nightmare!
Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.
“It is embarrassing,” he said. “Doctors don’t want to talk about being in debt.” But he’s planning a new strategy to deal with his rising business expenses and falling reimbursements.
“I will see more patients, but I won’t check all of their complaints at one time,” he explained. “If I do, insurance will bundle my reimbursement into one payment.” Patients will have to make repeat visits — an arrangement that he acknowledges is “inconvenient.”
“This system pits doctor against patient,” he said. “But it’s the only way to beat the system and get paid.”
— Are you a doctor who has made financial decisions you came to regret? E-mail Parija Kavilanzand you could be part of an upcoming article. Click here for CNNMoney.com comment policy.
1. The government plans to introduce a new healthcare system called 1-Care. It includes an insurance system to fund for healthcare.
2. The National Healthcare Financing Authority will be in charge of 1Care – and …it is likely to be turned into a GLC.
3. Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out)
4. There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before- service.
5. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
6. The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependants.
7. But the problem is: 1Care does not cover all your medical expenses. Only for a prescribed basic list of what “you can have” healthcare items. Anything more than basic you will have to pay your own.
8. Your long-serving independent family doctor will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost- effective independent clinics serving the country will be replaced by 1Care clinics.
9. You cannot pick your own doctor. 1Care will allocate a doctor to you.
10. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping).
12. You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket.
13. Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not.
You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.
14. You will be prescribed only medicines from a standardised list of not-the- original medicines in keeping with WHO List of essential Medications.. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have major say in the price and the range of this standardise medicine list. It will likely to be the cheapest medicine.
15. The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy.
16. If you do not like what is given to you, you can get alternative care by paying out of your own pocket.
The Big Picture
Each year, we all pay a total of RM44.24 billion a year for healthcare – now called National Healthcare Hospitals and clinics ( an integration of public hospitals and clinics, private hospitals and private GPs. which in essence is a privatisation of public and nationalisation of private healthcare facilities)
All this will now go under 1Care.
This means 1Care will get almost RM45 billion a year.
The administrative cost is likely to be 10% or about RM 4.5 billion
The poor
Who will then care for the poor and the marginalised population when the private and public healthcare corporatize and turned into independent commercial entities each competing with the other for business and profits?
Public hospitals and clinics are service-driven will become corporatize/privatise and have to be profit-driven
So who will serve the people in remote places?
Who will serve the very poor people?
Situations
What happens when the government introduces 1Care?
The whole system of independent one-stop GPs will be restructured and converted into 1Care clinics like the UK NHS general practitioner system.
Before:
Ali has always having skin rashes for many years. He has to see his doctor once a month to get treatment. That would mean he will have to see his doctor 12 times a year just for this illness. What if he has other illnesses?
Now:
But now, Ali’s doctor has allocated only a budget equivalent to six visits a year. Regardless of how many time Ali would need for his yearly treatment. What happens then? A rationing system will kick in. If the doctor sees Ali too many time, his “P4P” (Pay for Performance) profile will be poor and he will be paid less.
To start with, Ali will probably cannot just walk in and expect to be treated. He will have to make an appointment. There will be a long waiting list. What if Ali needs to be treated for fever or some painful joints? He will also have to wait for his appointment. If he cannot wait and wants immediate treatment from another doctor he will have to pay on his own. This is what the NHS UK system is offering its patients.
Lim has an appointment to see his doctor over a knee ache. Just before his appointment, he has an ingrown toe nail that has become painful. At the clinic, after his doctor treats him for his knee ache, he asks his doctor if he could look into his ingrown nail. His doctor says “No, the system does not allow me to do that. You must make another appointment. This visit I can only treat and bill for your knee ache. 1Care will accuse me of over-servicing my patients. I have no discretion here, all is by SOPs” This is what the NHS UK system is like today.
Mutu lives in a remote rubber estate. One day he had chest pain and went to the nearby 1Care clinic..He has blood pressure problems since young and has had fits. A hospital assistant saw him. Because of a change of his medications to the cheapest not-the-original medications, his blood pressure went out of control and his seizures returned. He developed a fatal stroke and died This is already what is happening when essential original medications are replaced with the cheapest .The cheapest medications is not necessarily the best for the patient and certainly not the safest.See More
I have mentioned before. The actual objective of the 1Care is not to protect the rakyat but to protect the ‘government’s wallet’. The current DG is keep misleading us in these.
Let see the news from Malaysian Insider today :
http://www.themalaysianinsider.com/malaysia/article/national-debt-to-equal-gdp-by-2019-if-putrajaya-remains-spendthrift-say-economists/
Actual situation is the government no more willing to perform its responsibility anymore. The government is passing its responsibility to the rakyat. So if the 1Care is kicked started. We actually are taking care among ourselves.
Imagine consultation alone is RM60 (without medication). Won’t you think it already increase the overall of the healthcare cost. This is the government another move to squeeze money from all sources.
Later when GST taxes is implemented. All the money used for salary increment, RM500 incentive for poor and others will be taken back by the government.
So, I would suggest not to put high hope on the DG and Health Minister, they are not here to protect healthcare but to ruin it.
I came across an article under the tindak Malaysia with article name The Die is Cast. I don’t know how true is the situation, but no harm and have a read in it. Just go to the google and search with keyword : Tindak Malaysia The Die is Cast, download and read about the powerpoint file. You will be amazed how bad is ours current situation.
UK NHS general practitioner system is not a perfect system.
Dr Paga this is your call to join politics for a good cause. Write into Malaysiakini and Malaysia Insider. It can be the next NFC cow and cattle issue which can permeate the suburban + rural mindset. The last thing they need is to make appointments and wait for a week before they see the doctor. As it is these ppl visit the Emergency department at 1 a.m with their 4-5 children “Sebab tak mau tunggu lama lama”
Let me make some corrections. In the UK, there is no limit to the number of times you are allowed to visit your doctor. True, often there is a waiting list when you make an appointment, which is usually 1-2 weeks. However, if it is an urgent problem (for example, a child with fever) there is usually 3-4 appointment slots daily on each doctor’s list reserved for such urgent cases and they will be able to see them on that day itself. WIth regards to dealing with multiple problems in one visit, of course any reasonable person would understand that we cannot deal with 10 problems in one 10 minute consultant. But, a while ago, I made an appointment 2 weeks ahead for some bowel irregularities and in the mean time developed a URTI – the GP treated me for both of them. Having the GP as gatekeeper is not such a bad idea – I’m sure doctor would still refer whoever they think need opinion at a secondary or tertiary centre .
I was a medical student in the UK and I know how the NHS GP works. I’ve been at placement with at least 5 different GPs and I think it’s much better than the Malaysian system here. Ask any UK grad, I think they would agree. In Malaysia, unless they are under government KK follow up, chronic illnesses tend to be neglected just because people thinks that taking antihypertensive or OHA are just a once off thing, and it is simply costly to follow up at private clinic (with them using branded medication and what not), and they hop from one clinic to another whichever is convenient for them. In the UK, GP really serves as the family doctor, understanding not only the patient’s medical history, but also that of the whole family and the social network, from birth to death, sometimes spanning through several generations. I still remember accompanying my GP on a home visit to a dying cancer patient’s home to see to his pain control, for 7 days, right until his death.
Making profit or not, I am not sure but I have not heard of any GP in the UK who had to close down for making loses. Good for the patient? Definitely, at least better than the private GP system that we are having here.
I agree.
GP in Uk can earn at least 100k a year. Less work load compared to hospital consultants and a good family life.
Final year med student
One of the main concerns for me is the standard of GP in Malaysia. In UK, all their GP are well-trained with MRCGP/FRCGP. Most of our GP here in Malaysia are doctors with a medical degree and a few years of experiences in government hospitals. If the idea of random allocation of family doctors is true, one can only pray and hope to get a safe and good family doctor. Furthermore, in UK, patients are allowed to choose which GP Surgery (clinics) to register with; the only limitation is you can only register with one GP.
I would disagree about uk GPs being well trained. Nowadays they only spend 4 years in hospital at house officer (FY) or senior house officer (ST) grades, and doing shorter European shift hours. They also only spend 6 months in various specialities which is not enough time to know the subjects well. And the MRCGP isn’t that difficult compare to the other hospital specialties’ exams. As a result, we are seeing more GPs who are often very inexperienced due to their short time in hospital training. And many go into GP careers because they want to avoid working in the evenings/nights and weekends, and they can earn more than hospital specialists by taking this route after only 4 years from graduation (only in the UK are hospital consultants in the NHS paid less than their GP counterparts even though they’ve been through more rigorous training)
from the briefing kkm gave us, all the KK doctors will have masters in Family medicine (the ideal situation), all MOs in KK will be given opportunity to undergo training to become FMS or FMS-equivalent ie they are trained to handle special clinics eg STD / Methadone clinic etc
if any MO could not complete the training they will be given extended time but eventually if they still could not perform they will lose their job with the NHFA
i think it’s the best for the poeple
YUp, that will the scenario in near future
precisely. secondly.. the “well trained British GP” is definitely better than the “Malaysian GP” is bollocks and typical of this mentality that aggrandizes anything from the West. It’s as weak as saying that the Bentley is a better transport solution than the Honda simply because Bentley cars are better/greater.
The cost of keeping society as healthy as possible is NOT the same as the cost of keeping society as “not sick” as possible.
So while highly trained GPs with all their FRs at the back of their name may be good at solving problems, what we need are actually “players within an effective, equitable and efficient health system”. And somehow, I suspect, having more qualifications behind your name does not help.
What helps is a performance management system that is blind to demographics or ethnographics that binds together this 1Care system. Is that possible? Lets see.
I agreed with you, Chillax.
For Weng. Some how, placement at different GPs clinic doesn’t mean you know the entire system unless you are GP there. Weng’s comment only valid if he works as GP in UK and Malaysia before.
and Weng’s another statement
“In Malaysia, unless they are under government KK follow up, chronic illnesses tend to be neglected just because people thinks that taking antihypertensive or OHA are just a once off thing, and it is simply costly to follow up at private clinic”
is totally wrong and it reflect that he has no clue or knowledge about chronic illnesses management in Malaysia.
I think most of his info were ‘heard’ from somebody.
come on gentlemen! lets face the reality and please don’t compare malaysia to UK. I learned that few of you has much experiences of being in foreign country and know much about their health system but we are now in malaysia and being a malaysian lets only focus the current problem that the health system facing of…
Dr paga, has stated lots of issues about our health system. So what we are going to do about that ?
I am only a medical student and i really hoping that doctors like you all will bring some changes to the health care. Every moment i’m waiting for the good news from this blog but only ended up in hearing complaints and arguments.
Let put the ideas and thoughts all into the action….
Please don’t mind me and im sorry if i bothered ur emotion 😦
what we need is an extra module on business, economics and management (BEM) for medical students during their undergraduate days.
and doctors need to be exposed to basic BEM knowledge.
Most have no clue that their money is being stolen from them right under their noses. When remuneration is poor, effort is under optimized. This mismatch balloons and we have a generation of doctors who are wondering why did they put all the “effort” and “money” into pursuing a line of work where the only reward is to convince yourself that the patient has a better life thanks to you.
You see, most private GPs who are doing well are businessmen who happen to be doctors. Most gov specialists who are pissed off are doctors with no business acumen. Im not happy with this either, but its the reality.
And frankly, I smell a conspiracy that MMA is deregistered and toothless the year elections is going to take place. 1Care just cannot be used as platform against BN.
The average malaysian GP today cannot pass the MRCP let alone the MRCGP.
Heck, they may not even pass the final MBBS of say Cambridge or Oxford.
Their idea of a physical examination will definitely place alot of British MRCP examiners in a gaggle.
Let´s stop kidding ourseves- some doctors doctor are even grappling with proper terminology and English.
Well, lets not romanticise about the “old school physicians”.
Lets embrace mediocrity or worse.
so whats your point?
the average british GP cant speak the malay language.
the average british GP will never understand why some rural malaysians choose to die rather than amputate a gangrenous leg
the average british GP doesnt care about Malaysian problems, culturally, socially and economically as much as we dont care how fresh their guiness draft is on a Friday night.
if you’re trying to convince us that UK, US and Australia are fantastic and have better doctors than Malaysia, wow I must applaud your creativity.
Countries who are developed and economically advanced certainly have more resources to POUR into their training and development program. And to add salt to the wound, we have our own doctors who leave the country to greener pastures.
We are concerned with 1Care and whether it will succeed in keeping Malaysians healthy at an economically justified cost.
I have to disagree with Chillax.
I do not think that Sarcastic doc was trying to “convince that UK, US and Australia are fantastic and have better doctors than Malaysia”
Do take note- in order to better ourselves -taking overseas membership exams that emphasize thorough clinical examination in a systematic manner and elegant presentation and professional manner of answering questions is indeed useful.Of course, many of our Malaysian doctors have problems with these membership/fellowship exams.
It was not uncommon to hear of doctors taking up to ten years to pass some of these exams.To paraphrase that “the average british GP cant speak the malay language.
the average british GP will never understand why some rural malaysians choose to die rather than amputate a gangrenous leg
the average british GP doesnt care about Malaysian problems, culturally, socially and economically as much as we dont care how fresh their guiness draft is on a Friday night”-I think we are missing the pointing finger here.
If the average Malaysian GP cannot pass these exams, surely this must point to some deficiency in our graduates or in the training system.Of course the British GPs cannot speak Malay or etc.But learning the proper facets of medicine-the proper way to present findings and examine patients and to store a large bank of theoretical knowledge is a vital asset also.
And we show that we here in Malaysia are able to achieve an on-par level with our conuterparts overseas.Like one of our FRCS guys in the 80s winning the MacGregor medal in the exam.
If our GPs/medics cannot even pass these “exams” it leaves me wondering how can they teach the next generation of doctors to pass these exams or achieve a benchmark standard internationally.
One thing I can tell you- and this is based on my observation- many of our MMed(Int med) holders will not pass the MRCP.Yes,they have a reasonably good volume of knowledge and yes,they can treat patients again reasonably sound.But their method of case presentation and clinical examination is not up to par.Will they make the best teachers for medical school or for aspiring postgraduate trainees? I doubt it.
We are heading off the track of this discussion no doubt.
But just focuding on the symptoms will not solve or alleviate the problem.We have to get to the source.
Now if you will excuse me, I would like to suggest some of our medics to have a threesome with Kumar and Clark.
Dr Who,
I admire your dedication to passing exams. Only one problem with that.
What “knowledge” is your MCQ/SAQ/OSCE/OSPE/clinicals etc etc based on?
Are you really suggesting that medicine is a discipline with unassailable “facts”? Are you suggesting that Textbooks are “authoritative” ? Are you suggesting that we trust “the best teachers” without evaluating the original evidence ourselves?
As far as I know Dr, we have changed our “facts” and “theories” so many times in the history of medicine that politicians seem more consistent than us!
Our idea of “science based medicine” is so appalling that I would hesitate recommending medicine as a career to a seriously intelligent young person.
Most of our “factual” information is based on “research”- whose quality is suspect. Altman felt compelled to write an editorial about it in BMJ as far back as 1994.
The scandal of poor medical research
http://www.bmj.com/content/308/6924/283.full
Further, I am not at all convinced that most academicians really know how to evaluate an orginal research article let alone produce good research themselves. Please look at the 2011 UK Commons Parlimentary Select Committee report on Scientific Peer Review. It is very revealing.
Warm Rgds
WarmRgds
Really, have a threesome with Kumar and Clark? I hope ur not serious because it certainly didnt sound like a joke.
“One thing I can tell you- and this is based on my observation- many of our MMed(Int med) holders will not pass the MRCP”
I appreciate your point, but I think you are missing the trees for the forest. Again, back to my car analogy, you are saying that our smaller Hondas and Toyotas (notice how im avoiding the use of protons) cannot match a Bentley.
So, based on ur reply, we should now upgrade all our doctors to pass the MRCP and further obtain their FRCPs. Good luck. Whats going to happen is “brain drain maximus”. All the God-fearing and Nation-loving FRCPs are just going to migrate instead of serving rural Malaysia. Why? Because they can.
I know this mindset and I recognize it from a distance. American and British grads are world-class because their unis are the top in the world and their healthcare systems are the most modern in the world. So everyone wants to be an American fellow or a British royal member. Good for you, and yes, we all must compete and be as good as it gets.
Yet, they (some private consultants with all their FR’s and MR’s) want to ‘rape’ Malaysian patients of their insurance with their typical unethical practices (waiting from u Dr Paga about that one). You look into your selves and tell me I dont have an ounce of truth in that allegation. Sure some of you use the age old retort “but i spent a fortune on my education”.
Health Care Quality and Health Systems Outcomes are complete different.
http://www.photius.com/rankings/healthranks.html
The French have the best Neurologists in the world, and the best health system in the world.
See, all you selfish people only think of how much money you can make and thus turn towards the most capitalistic nations in the world for inspiration. I dont think we should give a crap about you.
1Care, if properly executed, will restructure our health system to one that can provide top notch outcomes for our nation. The question is not how many MRCPs you can train in the next ten year.s The question is, how much corruption will exist in the new body designed to oversee the delivery of 1Care?
I’m sorry to say that NONE of my friends who got MRCP choose to stay in the government. They are leaving for UK / US (probably not coming back) or private. The rest who stay will aim for sub-specialization. But NONE of them stay after they sub-specialized.
I will think passing many exams are not the first priority. The first priority must be a safe doctor (in treating patient’s condition as well as patient’s wallet). If fact for the MMed holders (some of them) will become a lecturer and doing research. I seldom see MRCP holder doing research and teach. To them, it is the fastest way to get out from the system and go private or overseas.
To me, the most important one is the first liner like Emergency Physician/MO and Outpatient Specialist / MO and GP (private). They are actually the backbone of the health system and treating the most patients. I hope Dr Who NOT to look down on them just because they are not ‘passing’ your mentioned exams.
Chillax – seems like anyone mentioning the UK system and comparing it to the Bolehland system touches a raw nerve with you. Yet to be fair, Dr Paga initiated it by his posting in the first place comparing 1-Care to the UK NHS. And 1-Care does have fundamental elements similar to the NHS. So it’s only understandable if others followed on with more comparisons in their comments.
There are numerous errors in Dr Paga’s post regarding the UK GP system. Weng’s points in rebuttal about the NHS GP system are entirely correct.
Like Chill, I’d rather not get into yet another *insert OECD country* vs Bolehland debate here. I’d prefer to keep the discussion closer to home.
The NHFS/1-Care plan as it stands has a lot of worrying lubang’s well pointed out by Dr Paga. But with further careful planning and good implementation, it has the potential to change healthcare in Malaysia for the better. The major worry is that no matter how good the plan, implementation never seems to be effective in Bolehland and there always appears to be a suspicious degree of unaccounted for cashflow leaks in any national grand plan.
As doctors, we are trained to put our patients first. So all efforts (and resources) go towards the patient directly in front of us. Which tends to lead to the idea that “if only I had more funding, I could do so much better for the patient”. But Chill has pointed out so often and correctly that more $$$ only improves things to a point. Healthcare is a bottomless pit, so ultimately, the key is better business management of available healthcare funds. Not a strong point for most doctors sadly.
Closer to the service delivery end of the 1-Care plan (ie: GP’s), there is a fundamental worry over the variable quality of GP’s across the board in Malaysia. For 1-Care to work at this level, there has to be reasonable assurance of minimum ability and competence or every GP so that the people do not suffer from a postcode lottery. ie: if everyone is paying into the NHFS, why should you suffer just because the GP designated to your area is crap?
And what of accountability, transparency and quality assurance? No grand plan such as this could succeed without these elements at all levels. But of course in Bolehland, you can forget about these because the first two would spoil the corruption party. And the last element will always be hindered by cables, political fingers and racial supremescist ideology.
We live in hope.
Dear Dr.Who, Dr.Pagalan and msn,
I agree with the comments by all of you.
As a soon to graduate general surgeon who is completing my training oversea, I understand the concerns stated. I know I am deviating off the 1care issue in my comments
I do agree that I cannot understand how Malaysian medical universities can provide good training to their current crop of medical students with the lack of clinical exposure (one medical to one hospital and a few community clinics? the teaching ratio is way too high for any good education)
I agree with passing the UK exams comment. I think the problem lies with the our Malaysian master degree program exam. It’s the same like SPM and STPM (more and more students get As compared to the yesteryears). It’s the QC and the standardization of the exam. Foreign medical professional body held their membership examination in high esteem because of the professional standard that they are maintaining. I sure do not hope to hear that some “shocking news” that those who passed our Malaysian master degree program exam actually passed with a low mark (to sound extreme, passing mark of 30??) or some selected candidates actually passed their exam because of the connections that they have. I am sorry that I sound cynical but I have heard many horror stories of the ability of some of our local doctors (stories shared by my friends who are practising in various local hospitals). And i sure do also acknowledge that we have specialists who passed the master programs due to merit and not as mentioned above.
mcfan
Dear Dr Pagalavan,
I am a medical lecturer. I am impressed with all the counselling you are giving these young people. That’s being of real service. Just to add a little to what you have been saying.
First problem:-After many years of practise I am not so sure I agree that an academically good student= good doctor. I would give my vote to a mature, astute student, a good critical thinker with reasonably good exam results- only problem is how do we locate and identify such students?
Medicine is too important for us to use “A’s in exams” as a surrogate marker for real intellectual ability.
Second problem:- After having taken in good students, what are we teaching them? I am sure you are aware of the unhealthy state of medical research-the foundation of clinical medicine. Small, biased, poorly designed clinical studies predominate. Headlines grabbing basic science research which later turn out to be duds or fabricated. Medical researchers frequently in the news for research misconduct. Research papers being retracted for incompetent research. And the list goes on……… Our “evidence based medicine” does not seem to be very reliable evidence does it !!
Medical education needs a serious reworking.
Rgds
Please keep up the good work
Look what made the news today:
University Suspects Fraud by a Researcher Who Studied Red Wine
http://www.nytimes.com/2012/01/12/science/fraud-charges-for-dipak-k-das-a-university-of-connecticut-researcher.html
Thanks for your comment. I do agree with what you have said.
Oh by the way, according to some sources from my university the new “on-call” allowance cut is due to the elections coming up, and plenty of the government sectors and department’s budgets are on hold until the elections are over and being channeled back
So is the RM2700/mth for future doctor fiasco hitting in? Some of my seniors who are in their H/O are still being paid of Rm4-5K, which is quite well for now? How exactly does the payment system goes upon medical student’s graduation anyway?
The “on call” allowance is no more since the introduction of shift system. It has been replaced by “shift allowance” of RM 600 which is a 50% paycut actually. The total salary for HOs at this moment with the addition of RM 600 is about RM 3945 after EPF and PCB deduction. The JPA has announced that after the introduction of the new salary scheme SBPA this year, all allowances will be reviewed. I will expect some allowances to be removed and some reduced as the basic pay will increase under SBPA. If they do remove the critical allowance, there will be another RM 750 paycut. It was announced earlier last year that critical allowance will be cut by 50% but denied by the MOH. I am sure it is coming sooner or later.
After this U41 salary of HO, it will take years before you even touch RM 7000. As a MO , you will hit about RM 7800(net salary) after 12 years of service. As a specialist, you will hit about RM 10000 after 9 years of service.
if ur a 30 year old doctor, earning 5-6 k a month, just be happy with what you have. Earning anymore than that for the experience you have is a farce.
If ur a 50 year old doctor, complaining about earning 5-6 k a month, i think you must have set on ur laurels the past 20 year, or heavily invested based on short-term returns.
Ok, so you’ve obviously got some opinion on what you think a doctor at age 30 (and 50) is worth based on experience.
So we(I?) can better understand the position you’re expounding from, care to enlighten us(me?) on what your specialty is and level of experience? Enquiring minds want to know.
Just take the statement for what it is. If you disagree, good for you. Read my sentence again, clearly, slowly.
Either you made it big, or you made it small. If you get paid little for making it small, and you dont like it, then theres nothing society can do about.
Besides, whats your point of wanting me to clarify my opinion? Words that are presented well in a sentence SOMETIMES cannot hide the fact that it has no substance.
Just curious, You’ve got a grasp of health economics better than the usual doctor (This would include me!). Most doctors only learn aspects of health economics as part of Public Health in medical school and their eyes probably glazed over in 5 minutes of the lecture starting!
It provides for a somewhat different opinion to the norm, which in these discussions is no bad thing..
haha.. Jon.. u and i have had many arguments on this board… starting to feel like old friends already 🙂
father is an MBA .. too many economics related arguments with him over the years also
Now nurse, doctor to follow
http://www.themalaysianinsider.com/sideviews/article/thousands-of-private-college-nursing-grads-jobless-jeyakumar-devaraj/
Well, well, well!
Haven’t our government said often enough that healthcare in this country will not be privatised?
Now, that’s exactly what’s happening!
Isn’t it!
And it is creating some cash cows for the those in the healthcare industry!
Also, the government’s allocation for healthcare all these decades had been low compared to other countries in this region.
And there is no reason for this to be so when it can spend billions on all sorts of items which are of little or on use in upgrading the living standard, including the health, of its citizens.
Don’t you agree?
Vong, the term CASH COW has been redefined in our country. Nowadays, when you say CASH COW, we have to be very specific as there are some CASH COWS which are totally epic.
[…] Read more case scenarios here. […]
Extra updated tidbit;
http://www.bernama.com.my/bernama/v6/newsgeneral.php?id=645018
“If the people don’t like it, we can scrap it”.
Right.
election coming mah…………….
Reblogged this on alice's space.
[…] January 2012, I wrote an article on how doctors in US are going broke. Well, the situation has not changed much. The latest news from US says that many private practices […]