Yesterday (18/03/2012), the Malaysian Medical Association Johor Branch had its AGM for 2012. It was a special occasion as the President of MMA and the SCHOMOS Chairperson were present to have a dialogue session with all the members. It was a fruitful meeting and many issues concerning the medical fraternity were discussed. We also got to know the latest happening that will change the future of medical profession in this country.
1) Housemanship
The declining standards of medical education and oversupply of doctors were discussed. It is indeed true that the number of housemen is reaching an unimaginable level and MOH is very much aware of this. To cover this up, MOH has come up with the shift duty system and to allocate more district hospitals for training. Most hospital’s housemanship post is fully occupied. The ratio of housemen to specialist supposed to be 5: 1. Unfortunately, the way MOH calculates this figure is rather odd as they include all specialists in the hospital including radiologists, pathologist, ophthalmologist, ENT surgeons etc where housemen are never placed. So, in reality there are not enough trainers for all the housemen who are currently in the system.
The oversupply of doctors is a harsh reality which is going to happen anytime soon. MMA has discussed this issue with MOH but unfortunately MOH puts the blame on MOHE. The moratorium is just eyewash. It is very clear that it is all about money and the only people who can stop this rot will be the general public and not MMA. Whenever MMA brings up this issue to MOH or MOHE, they are accused of being selfish and avoiding competition! Thus, it is very clear that they want to flood the market with doctors and no one is going to guarantee you a job.
The maximum period to complete your housemanship is 3 years. Anyone who does not complete the housemanship in 3 years will be automatically terminated. Any houseman who is caught doing “locum” will be automatically terminated.
It is indeed true that MMC may soon remove the 4 years compulsory service under pressure. It is no more a rumour as I have mentioned before. It basically means that after 2 years of housemanship which is given on contract basis, there is no guarantee that you will get a job. You will have to apply to get a job in civil service or open a clinic (with license to kill). You can also forget about postgraduate education if you do not get a job in public sector.
2) Postgraduate education
It is also true that you are only eligible to apply for Master’s programme on 5th year of service (2+3 years). The number of Master’s post is gradually being increased due to political pressure. It is way too many compared to what the universities can really handle. The quality of Master’s graduates is slowly dropping and many consultants in hospitals have voiced out their concern. We are now seeing Master’s graduates who can’t do simple surgeries. Fresh Master’s graduates are teaching Master’s students in the universities!
Those who quit Master’s programme or who failed 4 times (meaning disqualified) will still need to serve their bond with the government and repay the JPA scholarship.
3) Insurance companies
One of the GPs brought up the issue about insurance companies cutting the consultation fees and threatening doctors. It seems that many of these insurance companies and MCOs are requesting doctors to reduce their fee if their contract is going to be renewed. If you refuse they will find another GP who is willing. The situation has reached a critical stage to the extent that some newly opened GP clinics are willing to be paid only RM5 per consultation!! How desperate the situation has made of some doctors!
With the removal of compulsory service, many of these unemployed doctors will end up opening a clinic to survive. These doctors would probably even accept RM1 per consultation! Someone in this blog commented about competition some time ago, so here you are………..
It basically means that doctor’s income will gradually reduce and many may just earn enough to survive. It is also unavoidable that the dispensing rights of doctors will eventually be removed.
The 1Care system is still in planning stages and nothing has been finalised. So, we just have to wait and see.
4) Liberalisation of Health Sector
In Budget 2012, our PM has announced the liberalisation of many subsectors which includes health sector. The MMA has voiced out its concern regarding this matter as proper monitoring mechanism is not in place yet http://www.themalaysianinsider.com/litee/malaysia/article/mma-putrajaya-gambling-with-nations-health-by-liberalising-medical-sector/. Unfortunately, it is unavoidable once again. Since February 2012, the government has allowed private hospital of 100% foreign equity to be set up in Malaysia. They are also allowed to hire foreign consultants as long as their degree is recognised by MMC/NSR. By September 2012, foreign specialist/doctors will be able to set up their clinics in Malaysia!!
Unfortunately, the amended Medical Act 1971 is yet to be tabled in Parliament. Thus, the National Specialist Register (NSR) is not compulsory at this point in time. So, where is the monitoring system to make sure that these “so-called” specialists are indeed what they claim to be? Someone can set up a “proctologist” clinic beside yours and earn a decent living! Even now, there are some private hospitals which are hiring “so-called” specialist “trained” in some other country without NSR registration. Private hospitals are profit driven and what they are interested is only money and not quality. With the poor monitoring system, these doctors can easily get away with whatever they are doing and the rakyat will eventually be the victim.
Over the last 24 months since I started blogging I have been constantly saying that the future is bleak for doctors. Guaranteed job, good money and life are the reasons why many choose medicine. That is the fact! Forget about helping people, curing the sick etc which is actually the minority. Whatever said, at the end of the day, it is a profession to earn a living. Unfortunately, many people believe that just because they spend RM 500 000 to RM 1 million to do medicine, the return of investment is high!! It is a total misconception that the public is totally unaware. Our society is just obsessed in getting their children to become a doctor for glamour and social status. That must change!
Secondly, doctors are so disunited that the government can just do what they want. The only organisation that we have is MMA but unfortunately how many of you guys who are reading this are even members of MMA? How many of you are even interested to fight for the betterment of future doctors? I have done my part and still contributing to the betterment of doctors in this country. I created this blog to educate the public/future doctors as I realised that many are not aware the mess that they are getting into. MMA received a lot of bad publicity recently but it is still the only organisation to fight for doctors.
The future is indeed bleak……………………….
Pagalavan's Avatar 
That’s just too bad. It’s sad to see all these going behind our backs, and yet everyone is still thinking of the sweet stuffs of venturing into the medical profession. Heel howl, if you have the passion for it go go go. But this really just makes me even more sure that I’d not wish to be part of the Malaysian healthcare system.
Why is this happening again? Who cares.
Call me ignorant and all, but we are just budding graduates. By the time I do complete med school, I’m probably in hot waters, close to steam immersion. Why should I jeopardize my future with something I can’t grasp at all? People can say all they want for us to venture into other countries but they just never know how hard and different the systems are. Easy to be said than done, cliche magnified by 1000 times.
Bystanders, why don’t you accept the fact that our government has screwed up one of the core profession in our country? Please just knock yourself in the head, and wake up.
And in another ten years time, people will start telling me, why have you not taken medicine? We are short of doctors now because of the sudden drop in med school grad.
Puhlease, did law graduates ever decline in their number?
Robinn,
There has been an oversupply of law degree holders in the past. Unlike medicine though, law degree holders can go into various fields with their law degree. Not everyone needs to sit the CLP/Bar exam and become a lawyer.
Malaysia has experienced a glut of engineers in the past – about 10 years ago. There is currently a glut of pilots now – new grads are still waiting for a job after over a year. What I’m trying to say is no profession is immune from this.
Medical degree holders are limited as to what they can do, especially if they are not registered and do not have any prior experience practicing as a doctor. And to get that experience to practice as a doctor and general registration, they have to start off by doing their housemanship. There are those that have done well working for pharmaceutical companies – but how many of these joined straight after medical school? It would’ve been cheaper, easier and quicker to do a bioscience degree if you wanted to join big pharma straight after med school.
The numbers will never decline but jobless numbers will increase for sure.
Very sad (or depressing scenario)…
I see the problem now is TOOOO many house men, toooo few specialists to train them….
In a nutshell, why can’t MOH or MMC recognise more post-grad courses overseas, or allow students to pursue Masters or specialist course (in well-renown countries e.g UK, US, Australia, Ireland, India…) and then ask them to serve in Malaysian hospitals (or maybe Klinik Kesihatan) upon completion…
The MOH already is doing that. As long as you got the necessary qualification, you will be recognized BUT how many of them are willing to come to serve. Most want to practice in UK, US ad Australia or even Singapore. Only when they have no option, they might come to Malaysia. Those who came (especially those from India, Middle East etc) are all with dubious quality. Most likely they are already not dong well in their home country and wish to have an easy life here killing our patients. Malaysia should not be the dumping group fir such specialists.
Yes, I wrote about this in 2004 ( read my MMA article written in 2004!).
people who do that will never return to Malaysia! Even if they return they will not serve the public hospital.
A very2 good article BUT sad to say it is the doctors that are to be blamed for the mess that we see now.
If you see Doc the only profession that was looked upon was the medical profession but sad to say when we go out in the open what we see is dog eat dog,with this attitude of the doctors in the 70s 80s today we are in this shit what you sow is what u harvest.
For the budding doctors do not worry we are in a border-less world so please study hard & move out of this place for very soon the public is going to come to get his pound of flesh from you as today I have more faith with A senior HA than a junior doctor as today education is big time business u enter a college & you are in auto drive to final,maybe the docs should demonstrate in the streets like the lawyers in Pakistan did.
Very well written. It feels like there is no light at the end of the tunnel.
Dr.Paga, coming from my training system, for you to write this statement: Fresh Master’s graduates are teaching Master’s students in the universities! It must mean that the fresh graduates standard is bad and probably shouldn’t even have been allowed to have graduated. In North America, there is no problem of a fresh graduate teaching residents, surgical residents love fresh graduates because they are the one who is most in touch with the recent evidence based medicine and well trained fresh graduates (with fellowship) should be able to do and teach surgery as well.
Unfortunately in Malaysia, there are not enough trainers to even train the juniors. It is a vicious cycle like blind leading the blind.
I know HOs doing locum…ahh this country is going to the dogs. They should send a circular or notify all doctors running a private clinic not to engage a HO for locum.That is the only way….What to do HOs these days want to drive expensive cars as soon as they graduate, so have to force themselves to look for ways to earn more money…what a bloody money-minded attitude. MORONS!!!
Actually GPs have been told many times by MOH not to hire HOs.
problem is the private GP clinics are finding it hard to employ registered MOs for their locums: Possibly due to:
1. A+E in general hospitals are still offering RM80 per hour locum rates( which is usually scooped up by some greedy consultants/specialists/hospital directors and mind you these directors have not practised medicine for years! It makes us wonder how they can secure the slot at the 1st place… and of course there is the outcry of other departments such as medical,surgical, OBG etc where they get RM200 for 24 hour – 36 hour call even though many at times they have to do alot of procedures and surgeries and the remuneration pales in comparison to the A+E locums!)
2. Alot of MOs are finding it hard to do locum when they have family, on calls, HO duties to cover, CMEs to run and of course the constant bombardment of exams if they are the hardworking sort. Basically after deducting all these time spent, there is little time to do locum unless you dun wanna sleep.
3.MOs generally are aware that scams are running in alot of clinics, i.e. unregistered staf, poor practise environment, medication problems and referral problems, so most of them think hard before going to do locum in these places for fear of medico legal issues
I can confirm what falcoblitz has said above. My sources at MOH hospitals tell me that the $80/hr locum jobs are pretty much taken by those in charge or those who are kamching with those in charge before they are even ‘advertised’ to other staff.
And some clinics are run like a business: There is a list of symptoms and drugs to prescribe given to these locums. Patient tell you they have a symptom (cough, runny nose, tummy pain, headache … etc) and you match the drug to that symptom. That’s it. No need to use your clinical acumen to find out what is really going on with that patient. Your job as a locum is to make sure the clinic continues to make money – don’t spend too much time on one patient trying to sort out their medical problem. Just charge them money for drugs they probably don’t need and see the next patient. Better yet, order some unnecessary investigation and get kickbacks from the person doing the investigation for the referral.
The reason why I almost never liked doing locum is because of this. When I was an MO in a district, I did locum once a week in a clinic. You are just a dummy sitting there. The staffs will decide what medicine need to be given. There must be atleast 3 meds for each patient and one of it must be an antibiotic!! Even if the patient’s complain is headache!! No matter what you order, the staffs will add an antibiotic! After 3 months , I left and never really did locum after that.
Surprisingly, I just saw a patient in my hospital who was seen at this same clinic for backache(PID). He was given: Augmentin, Ibuprofen, Piroxicam and Indomethacin!! What a joke, despite all these, the clinic is still running!
Soon, this RM80/hour locum will be terminated as there will be enough doctors to do shift duties in OPD and A&E.
The whole civil service need to be reset but I’m afraid that will only happen when the country has gone bankrupt.
As long as the educated lot and the professionals just sit here and comment like armchair critic..the nincompoops and the dogs will continue to run the country.
The grave will supply plenty of time for silence.
I agreed that the future for doctors is indeed very bleak. One of the main problem I see is that the current system does not produce the quality doctors’ base on the merit because the system is being overwhelmed by doctors with unsure quality especially those who got admitted to medical school solely due to financial factor. The overwhelmed system destroy the potential even for houseman with good potential because so much time and resources have to be wasted on such a big number of HOs.
The universities (the BIG 3) must ensure that this last defense (Master program) will not be fallen to the politician and businessman in order for them to make money. I believe that with controlled increase number of Master candidates, the quality can still be maintained although the candidates may take a longer time for training or to gain experience. I see the greater factor for the deterioration of Master graduates quality is due to the exodus of senior experienced consultants mainly due to the mushrooming of private hospitals. Even those newly graduated specialists are being lured away once they completed their gazattement or subspecialist training. The private wing of public hospitals are no good at all as the consultants had been spending too much time there rather than teaching hence the fresh Master graduates teaching the new Master trainee. I can’t imagine who are actually teaching the medical students if all the consultants are busy in private wing? HOs or new MOs?. Something must be done to retain these consultants and subspecialists otherwise our training system will eventually collapse.
The doctors must be united and brave enough to voice their concern. MMA is just a social club and they have no say at all in any of the policies implemented. I am worried that in the near future, new doctors may even have to work WITHOUT salary or minimal salary (like the law apprentices) just for the opportunity of housemanship.
I do agree that the MOHE is the culprit which causes the current dire situation. They had been given too much power to allow the setting up of medical schools WITHOUT consultation or input from the professionals. The MMC seems to take order from MOHE just to rubber stamp the medical schools so that their graduate can practice in Malaysia. National Specialists Registry is a joke. Anyone can just fill a form and pay 2k for listing of your name in the registry. The money goes to another social club, Malaysian Medical Academy with no legislation power to stop any specialist practice. MMC is partly to be blamed as well as ourselves, the doctors in particular our DG (MMC chairman). MMC must regain the dignity by getting back the power to approve any medical schools due to merit and not kowtow to businessman or politician. Unfortunately based on past record, some past DGs are businessman as well.
I think it is very dangerous for a houseman completed 2 years training to open a clinic. They have not seen enough cases in order to practise in solo. At least 5 to 7 years is needed to gather experience.
Yup but you think the politicians give a damn! they go overseas for their treatment!
Primary healthcare is distinct from hospital based care and should be treated as such. Depending on where one is trained, the doc with 5 years of experience in the wards may not have the savvy of someone trained in the longitudinal care of patients. ie. primary health (GP) is quite a focused area of medicine.
Thank you for the detailed discussion. Any suggestion for the solution(s)?
I have given the solution right at the end!
very saddening.. why does MOHE approved many private agents to recruit students to medical schools in countries like russia and others… these selfish agents has made so called merit related medical education as it is a business course over the years..those days, abt 10 years ago..we could only see many advertisemnts advertising business related courses like human resource course, marketing and etc,, where they demand easier entry to those courses..but sadly ..nowdays i could only see advertisemnts on medical degree being offered in russia and etc and they even have highlighted that its an easy entry.. really frustrating…so it shows that teh quality of this so called noble profession has deteriorated drastically due to uncontrolled and poor and inefficient management frm MOHE… MOHE should take these things into consideration as the more new med school they gonna approve they poor the quality gona be.. i feel very bad for my fellow malaysians who will have to go through many unqualified doctors in the near future in this country…. oh god.. pls show us a good way
Come on people…bring this matter to the main stream media…bring it to the main newspaper..bring it to the mass public effectively
Enough with just talking and talking and talking and criticizing HERE in this blog without any EFFECTIVE ACTION taken!!!!
Come on people…we are doctors of the present and the future..
Main stream media? are you joking? Even when MMA issues press statement, most of it never appears in the newspaper!This blog is all about action: by informing the public who are internet savvy to know the reality. Have you seen anything in the main stream newspaper talking negative about the government?
The current junior doctors have too much of an expectation. Even in foreign countries having an mbbs degree does not guarantee career progression. The question that needs to be asked is what other qualifications do they have to offer. How many clinical research, audit, presentation and abstracts have they done? What courses have they attended to show their commitments? How can they expect to be spoilt into being given a specialist training when their mentality is still at that junior doctor level without any interest in continuous professional development.
“Guaranteed job, good money and life are the reasons why many choose medicine. That is the fact!”
This is the sad reality of it. The number of people going into medicine for the wrong reasons. The quality of doctors are declining because doctors no longer care about the patients and know the satisfaction of a days work. Pitiful. Undergraduates were told before they came to medical school that life is not going to be smooth sailing nor will it be easy as they imagine. And at that moment, everyone was desperate enough to get into medical school just to get that glamour factor of adding DR in front of their names. Next time be a little bit more mature and take a second to think instead of pointing fingers at others when things don’t get their way. If you want money then get into politics.
dear dr.pagalavan.. what is your opinion about MOHE approving more agencies to recruit students to medical school in overseas?? and these agents simply recruiting unqualified students .. medical has become like business related courses..
That is what I have been saying all this while. It is a money making business. It is the public who should be educated. Unfortunately the main stream media is more interested in politics then the welfare of the public.
I’m a Malaysian student studying overseas in Australia. It really saddens me to read about the Malaysian healthcare system, and it’s even more awkward when I compare it to the Australian system.
Personally, I would like to return to Malaysia to practice after my degree, but as it stands, there isn’t an awful lot going for it.
To those UK/Australian medical students who are contemplating on whether to come back home, here is my thought. I graduated from the UK two years ago and now am on my fifth posting in a teaching hospital in KL. I asked myself the same question during my final year as a medical student: to stay or to come back, even I was actually obliged to return because of the scholarship. Scholars or not, all oversea students have second thoughts. Both options have the advantage and disadvantage. I would say think hard about what’s MOST important to YOU. Your career? Perceived to have a better reputation having completed your specialist training oversea? You being near your family? Even having nasi lemak and laksa easily accessible all the time? No one can give you the answer except for yourself. Once you make up your mind, just follow your heart.
I find working in Malaysia not bad at all. Not all boss are stuck up and bully. The new generation of specialists are open minded and considerate to the juniors. The older generations of consultant may be a bit naggy, but rarely do anyone gets shouted or be publicly ridiculed unreasonably. MOs, like anywhere else, comprise of mixed personalities, but most that I am working with are hard working, reasonable and appreciate the HOs.
The HOs, myself and my colleagues, which apparently Dr Pagalavan are so disappointed with, in actual fact, I think, are not bad. And coming back home to join us would not degrade your standard. I certainly hope my friends in the UK would not think less of me for continuing my training in Malaysia rather than staying in the UK. Like everywhere else, there may be one or two HOs who are true slackers who simply cannot perform. But overall, we work hard just like our predecessors. We make mistakes once in a while and may get a good scolding but quickly.learn from it. I have no complain at all about my present HO colleagues. Yes, some of my friends have thought about just getting over with housemanship and opening a clinic, just because they feel that hospital medicine is not for them. But when they are at work, they take their job seriously. My colleagues do not pass over unfinished job for me to do during oncall time, and would help me out while they are free if I am busy and overwhelmed. You will be expected to be such willing team player if you do join us in the future. Here, one specialist gets one or two HO at a time, so he/ she do get to know us.
The overcrowded HO situation doesn’t apply in my hospital. The shift system still is still not yet happening in my hospital. At least in the place I work, most of us are genuinely interested to do medicine and as tiring and stressful as the job is, we remain professional and work our arses off for our patients. The truly disinterested ones will drop out sometime in the first posting (usually getting extended to the point they cannot stand it and quit). True, there are 1001 problems currently regarding housemanship, and even more to look forward to with the mushrooming of medical schools and what not. The politics in this country is a mess. That doesn’t mean that we write ourselves off straightaway. The blog is rather all about negativity and lots of supporters going ‘yeah yeah that’s right, everything going down the drain nowadays’. Things are never perfect wherever we are. Can you tell me that in UK/US/Australia there is no problem at all? I know some of my British friends have left the UK, or indeed had left medicine all together as they were fed up with problems in the NHS. Honestly, there are still many positive things to look forward here. So don’t let the issues discussed in this blog put you off coming back home to work. We can and will work something out when situation becomes desperate.
The very fact that you are in a teaching hospital in KL(presume UH or UKM) is what makes you oblivious of the situation in MOH hospitals. You notice that I never talk about teaching hospitals? It is because they have a completely different hierarchy and lots of specialist and MOs.
If you want to know the real situation, you need to work in hardcore MOH hospitals. However, I admire your courage and positivity. I have been in this system long enough to know what I am talking about. I am talking about the reality that will hit you soon.
I think that working in teaching hospital is different and not exposing you to the real situation because you always have senior to rely on. However, I am pretty sure you are not going to stay there forever and you are definitely going to the rural area (unless you have cable).
You maybe superpositive now but I have seen some ultrapositive houseman as well during my housemanship. I met him (Malay college) in one of the cardiology conference and knew that he quitted government after 6-7 years, he was disappointed with the system. You are considered ‘lucky’ as houseman in the teaching hospital but when out from the city and work alone. Are you still that superpositive……I’m doubt about it…
My friend did clerked patient during on-call until he slept in the middle of the clerking process. Just let you know that he had 25 admissions for that night. For me during my surgical posting, it was common for me to take my dinner at 11:30pm because so many work need to be done.
Teaching hospital normally has better emergency department management. They will settle the case before admit into the ward so you just accept the case in the ward only. But other MOH hospital seldom do this. They admitted the patient first (because too many patient in ED (1 night shift can reach 100-120 patients), so you have to do the diagnosis and procedure in the ward e.g history taking, blood taking, provisional diagnosis & etc. Some ED doctor (bad one) just admit unstable patient into the ward and you no need to sleep that night already.
UM and UKM control the number of houseman they take per intake. in fact it has one of the lowest numbers of houseman intake relatively to other general hospitals like Sultanah Aminah or HTAR which why overcrowding is not an issue.
I assume when u say teaching hospital you are saying university hospital because HTAR and the like are also teaching hospitals albeit most of time they function like bashing hospitals. Bashing house officers.
If you look at the current house officers at university hospitals their “demographics” are a bit skewed. Most of em are JPA/MARA scholars from UK/IRE/Australia/UM/UKM and not from ex-ussr/indonesia/india/egypt. There will be some from those places but in general they are from UK/OZ/IRE. Correct me if I’m wrong but there is my general impression from my colleagues who are working there currently.
Again correct me if I’m wrong but your views is skewed and does not apply to general hospitals elsewhere where doc overcrowding is an issue and vodka-bribing docs are plenty.
I realise that you are only telling the truth, desperately trying create awareness of things that the mainstream media is not addressing. But it feels like EVERYTHING in this blog is just so negative, so depressing, so hopeless. And in reality things are not all that bad (for example, efforts by the teaching hospitals). I would have liked to work under you, and I would have liked you to find me committed worker, a quick learner and had studied medicine because I genuinely want to help people. From my observation, people like myself majority forms the house officers currently. I know this blog aims to expose the issues that we may be oblivious to. I just beg that you occasionally inject something positive, perhaps an experience with an especially keen young doctor that you have worked with. And perhaps some solutions sometimes, some suggestion on what action should be taken by both the older and younger generations of doctors. So that inexperienced medical student would not feel so depressed and dejected before they even start working.
Actually, if you read all my post since the last 2 years and my MMA articles that I have written since 2004, you will see plenty of suggestions and ideas. Unfortunately, no one listens. I have been active in MMA and have worked “free of charge” for the betterment of doctors in this country but the system is just too complex and screwed to change for the better!, for worst probably….
Now, talking about “afforts” by university hospitals. I hope you are aware of these things:
1) University hospitals are not bound by rules and regulation of MOH. They come under MOHE. That’s the reason why they can limit the number of HOs they take and not to implement the shift duties. That’s the reason you do not see the “oversupply” of housemen in these hospitals. They cam also select their own HOs. Previously I use to hear how VIP’s children are more preferred to be taken as housemen in university hospitals. People with cables are more likely to be accepted by them. Underperforming housemen are kicked out to MOH hospitals. Most of the specialists in these hospitals have never worked in MOH hospitals. They are people who return from overseas and join these hospitals so that they don’t get sent away from Klang Valley (e.g do not want to seve rural people etc). Subsequently they wil resign and go private. Since I was a student in UH til now, they will always have enough staffs as most MOs are Master’s students and they have lecturers, senior lecturers, associate Profs and Profs in their heirachy.
2) Do you know that these hospitals can reject patients? Once their beds are full, they will ask the patients to go to the nearest MOH hospital. They also do not take low risk patients for delivery etc most of the time. That’s why you see lower delivery rates in these hospitals. Try comparing with HSAJB with 50-60 babies delivered per day!
3) Working “your ass off” in these hospitals are totally different then MOH hospitals. Try telling this to your colloegues in Hospital Klang and see their reaction. Most HOs who do housemanship here will never go back to MOH hospitals as mostly can’t cope. I have seen a few who immediately resigned and left back to university hospitals and joined their PLAB programmes. It could be the fact that they prefer the environment there but I will tell you 1 thing for sure: the workload is definately much lower in university hospitals because of the reasons mentioned above.
I have always encouraged people to come back and work in Malaysia but they must be willing to put up with the workload and environment. However, if you are self sponsored student and manage to get a training post overseas, pls finish it before coming back. You said, people should not listen to what I say in my blog which is the harsh reality, I can also say that please do not compare university hospitals ( only 3 in the country) with MOH hospitals. The real healthcare in this country is provided by MOH and most of the issues I am talking about is MOH issues. That’s the reason I never talked about university hospitals. I can tell stories about them and their politics but I am not keen as they are not my priority. That was 1 of the reason why the government refuse to allow any university hospitals to be set up after HUKM. The newer GH like Selayanf, Sg Buloh, Ampang etc have similar issues like uni hospitals in terms of bed limitations but NOT HO limitations as they have to follow the rules of MOH.
Dr,
I just got my A Level result and got a B for chemistry. I was the top student in my secondary sch and scored full A including A+ for chemistry but I failed to get any scholarship. After getting the A Level result and I was so shocked that I got a B for chemistry. I actually want to go for medicine but due to financial problem I can just go for pharmacy. I’m scared of doing pharmacy because of the B in chemistry where pharmacy course actually focus on chemistry more. I want to become a doctor because doctor treats patients in a much different way than a pharmacist does. I mean, when a patient goes to see a pharmacist, pharmacist only dispense medicine, however, a doctor goes more details. (I cant really express in words hope u get what I mean) I can just say Im looking for the way of working like a doctor does.
Although PPTN is provided, but the tuition fees for medicine course is really expensive nowadays. For eg, IMU MBBS costs 390k! Beside PTPTN I can still get another educational assistance but to be frank, sometimes we would need to see our ability to pay back the debts. Yes, by getting all the loans I can definitely go for medicine but I will have to pay for rm1700 per month for at least 10 years or 20 years in the future. Due to this, I think pharmacy will be a wise decision as I am not going to burden my family. Doctor, do u think me decision is wise? Im not affordable to take loans for the sake of medicine as I don’t think I’m able to pay back in the future since the job is not guaranteed.
Taking huge loans to do medicine is a big mistake. What about dentistry, psychology?
Is dentistry good? If dentistry, which local university is good? However. definetely not IMU coz the dentistry local programme costs 450k! :S
UM, USM
radiology??
what do you think??
the number of Master’s post is quite limited with only 3 universities offering the degree. FRCR is another option
pharmacy is okay right??
Still OK eventhough the gov sector is almost full. The private market is still open. When 1Care system is implemented, the scheme may need more pharmacist for community pharmacy services.
Agreed…The Ministry should employ a more stringent method, not only during houseman period but also during the application period. If it is possible, a final practical paper should be made compulsory at the term end of housemanship. Something similar to the CLP or the Bar as I believe is required in the law profession. As more and more doctors are being churned out, some with standards that fall way below what is required for doctors in other nations, I believe that help weed out those who are unfit to practice.
2 years ho is actually a ploy employed by both the NHS and moh to circumvent the oversupply of medical graduates. in fact even the antiquated post graduate training programme(mrcp/frcs etc-entry exams for ‘real’ postgraduate training ) which is now replaced by the certificate of training in UK are measures to contain the number of specialists(oversupply of specialists as well) which may not even have a job after they completed their training in uk
in Uk the most coveted PG is not the hospital based specialties but the neglected and often look down upon GP scheme in malaysia.in the early 80s most potential Gp trainees will have completed their mrcp/mrcog in hospitals while still waiting for their postings in GP – diametrically opposite to the situation here.
in fact most PG training in the world are managed by colleges of specialists which enforces stringent requirement for their training pregramme, as mentioned,not all hospitals can and will be allowed to conduct those training activities unless there are adequate consultants to supervise the trainees and the hospital is equipped to be listed a s a training centre
fact of the matter -theres difinitely an oversupply of medical graduates in malaysia.unemployment will be an issue soon.The oft discussed PG /GP divide and training,quality of doctors etc is secondary to the blatant violation of this basic economic principle- supply vs demand
parents/potential doctors need to understand that like any university graduate in other discipline ,jobs are determined by supply vs demand- not having a job after graduating is not unexpected given the torrent/avalanche of supply in the foreseeable future.
kudos to the super positive houseman!
I have worked in a district hospital (I understand the bloggers frustration) and I am currently pursuing my masters at a local teaching hospital ( I understand the positivity and “fresshess” of the H.O) .I actually think its the survival of the fittest.
There are some low quality slackers in the hospitals (so let them rot), the good ones are the the proactive ones-trying to make the most of their professions.
There are other posts to be filled-LPPKN, MOHE, District hospitals, KKs, heck some of my friends work for the UN/UNICEF.
We still don’t have enough specialists-so we need more doctors, its just that the bottom of the pyramid is ‘filled to the brim’ -shall we say? If my theory rings true, then the ones that “rot” wont become a specialist.
Bottom line; lets be a bit more positive here. There are plenty of other options available and we do need more doctors to fill in jobs and fit the ratios of doctor: patient.
The ratio of 1: 600 will be achieved by 2016 based on data from MOH themselves. In Johor, all district hospital’s MO post are full. In Selangor, N Sembilan and Melaka, even KKs are almost full. So, once everything is filled up, jobless scenario is a reality.
I do agree that the ones that “rot” won’t become a specialist BUT there will also be many who will never get the oppurtunity to become a specialist due to our limited number of post. The quality will be a different issue all together.
There are other options right? Private hospitals, university hospitals (including pre clinicals and reaearch) , working overseas and the rest that i mentioned earlier?
Specialist training can be done overseas also, no? Masters program used to be hard to get into, because of the competition. The time based promotion in KKM seems to have elimated a large portion of that. Most of my friends that applied, especially the junior ones get to pursue their training now compared to a few years back. Then their MO post can be filled up by the new UD 44s( always an issue before as some hospitals wont allow their MOs go for training due to lack of staff). Ok, so I may not have data such as ratios etc but im just pointing out that maybe that there are some things that may gave been overlooked in the ratios.
Nope. Private hospitals DO NOT employ MOs except for emergency department. Each hospital probably needs only 4-6 MOS at the most. Consultant are NEVER employed by private hospitals. There are only 3 university hospitals in the country. How many can they absorb? They don’t need to employ many MOs as they can depend on the Master’s student to do the work. You can’t work overseas if your degree is not recognised there unless you sit and pass their entrance exam ( with no guarantee that you will get a job).
Specialist training cannot be done overseas unless your degree is recognised as mentioned above. NONE of our 36 medicals schools are recognised overseas except UM/UKM in Singapore and MNonash in Aus/NZ. So, most will be stuck in this bolehland.
The time based promotion DID NOT change anything. It did not create any new post.It’s just that the post follows the body. The U41 will be coverted to U44 but no new U41 will be created. The total number of post is still the same throughout KKM. The reason why you see the post being filled up fast is because there are so many HOs finishing housemanship now and being sent to districts and KKs.
The number of HOs have reached 5000+ last year. The number of Master’s post is only 800 this year with 1000 by 2015. By then we will have 7000 MOs applying for Master’. So, as the time pass by, only 10% will be able to get the post. That’s the reason why MOH is implementing 2+3 years for Masters.
However there is a catch. The MOH or rather JPA has no clear policy on how to boot out these low quality doctors. In fact the process to fire a doctor is very tedious and difficult to be carried out so most pengarah hospital and consultants will take the easy way out by transferring them out from their eye sight. Worst they may end up in the MOH admin and forming policies that affect us the clinician who are actually doing the work and of cause the patient.
I do agree with this. I have seen one or two doctors who don’t really care what happens to their patients because they know that they likelihood of not getting their pay cheque is non existent. This is a flaw, I guess this can be an issue we can address as doctors. Personally, I see it as a responsibility to make official complaints about these ‘dangerous’ doctors.
try making a complain to MMC. You will never make another complain after that! The process is very tedious to go throu for any one who makes the complain. And after all the effort, the doctor involved will be issued 6 month’s suspension!
Had a thought. If they make the 2 years housemaship as contract, I guess this could happen. I mean- they could refrain from hiring certain doctors. However I hope this system wont be abused. ( prefering to hire some over others for the wrong reason)
Yup, no guarantee that you will get a job postHO. Being in Malaysia, with no transparency in any selection process, I doubt it will be fair. JPA, MARA scholars and local uni grads will obviously be given preference
this is regarding the last comment below:
There are actually more universities hiring than you think. Even the private ones, for lecturer’s positions.They hire specialists and consultants too. I have friends quiting KKM to join.
About the private hospitals: They do hire specialists (not sure about consultants), but I have friends recently quit KKM to join
They UK/Irish grads are accepted overseas. Including those doing conjoint degrees. My friends still wok overseas pursuing specialist training there. Some are just afraid to come back because they are afraid of the Malaysian work force.
Friends who have come back from Australia, had a try of HO ship here lasted 2 months and went back there (to pursue specialist training)
Friends of friends quiting KKM to join LPPKN.
Friends quitting KKM and joining MLM (!)- personally against this (but just saying)
Friends joining the army (better pay)
Friends of friends working at pharmaceutical companies and with lawyers (don’t know them personally)
This is to name a few. This is to highlight that if you really are afraid for your job, then I guess look at other options.there are some.
But I DO see your point Dr Pagalavan. I do agree we need to control the quality of medical graduates, but I do see this sometimes as to improve the Dr’s quality of life-reduce working hours. We have suffered working too much hours.
and to give hope to those who aspires to become a doctor
I think we are talking the same thing from different angles. Yes, There are many oppurtunities out there but every thing has a limit. Most of the 36 medical schools in this country ( without a university hospital) do hire doctors BUT only specialist/consultants. You can NOT become a lecturer without having a postgraduate degree. I know some which are hiring MOs as lecturers but mainly to teach primary care only and thus the number of post are limited.
Of course, private hospitals hire specialist. Infact, they ONLY hire specialist who instantly become a consultant. However, these specialist/consultants are NOT employed by them. You are self employed! The competition is so great now that some are not earning enough.
Of course UK/Irish degree holders can go overseas to work. How many of them are from these countries? A bare minimal. majority are having degrees which are unrecognised elsewhere which means you are stuck here. That’s the reason I keep saying that try to get a degree from a reputable international university for better prospect.
I am actually saying the exact things that you are saying but from different point of view. You don’t need to be a doctor to work in pharma companies, right? so, what I am saying is that if you do medicine hoping to get a guaranteed life and good money, then you will be dissapointed. I know some who have quit medicine after HO and has become successfull businessman and flying all around the world!
Total input of doctors last year 5000+. total number quiting from civil service : 500+, not even 1000. We will hit a oversupply in another 3-5 years.
It’s indeed a very sad turn of events when we have a disfunctioning government. I faced the situation many years ago as a professional returning to Malaysia without a job. So I took a big gamble and changed completely. Now it seems I’ve come full circle. It’s my daughter’s turn as she is in her 3rd year of medicine! Had I failed in my duty as her father?
I thought I too failed in my duty as a parent when my 2 kids recently graduated as doctors. At times I went into depression could you believe that? Anyway it was my kids decision. I wanted them to become accountants but they loved medicine. I know one thing very seldom I make wrong decision. If at all any wrong decision made I’ll immediately go for damage control!!!!. That’s it. Today I am very happy because yesterday I had the rare opportunity to spend time with my kids. I sat with them and made a decision. Let them practise medicine as their passion but for money I’ll set up a business to suit their buzy schedule. We have shotlisted a few business!!!!!
I believe things are bad and ugly as it is. But being a med student, I still try to be as positive as the superpositivehouseman just to cheer myself up. Yet, I won’t deny the fact that at times, I am considering to change the course even after three years in medicine T.T the only thing that is keeping me in this course is that, “if I can’t bear this, who can and would do so?”
As long as you have a genuine interest for what medicine is all about and willing to put up with the frustration along the way: go ahead
agree with dr paga. fatimah, with genuine interest and knowing the fact that the road in front of you is going to be long, winding and difficult, you should continue to do what you aspire to do and be.
local masters trainee and pag
1 medical training is not about the survival of the fittest.its about acquiring skills and learning the art of healing.its also not about making condescending remarks on other’lazy’ doctors etc
what is a good doctor anyway?some 1 enrolled in the masters programme?some1 who qualifies from cambridge?some1 who make millions? some1 who joins mfs etc?
well its such a contentious issue that we can argue till the cows return!!!
being a specialist or trainee does not mask the fact that JOBLESS MEDICVAL GRADUATE is imminent or near certainty in the immediate future and there will be too many specialists in 2-5 years time not unlike the UK,singapore and Hk
dont be complacent that specialists are ‘immune’from an oversupply -perhaps not now but definitely in the next few years
having a doc-pt ratio of developed nation status does not make one a ‘developed’ country-there are many parameters use in this definition
the gdp/capital is a more appropiate instrument use for this purpose
sing has a a gdp/capital of 60k us$ malaysia is a paltry 12k
the budget allocated for healthcare in this country is less than 3% vis a vis of most developed nations with an average of 6%.it will be a herculean task to accomplish healthcare of 1st world countries even if there are no leakages in our system
lets not delude ourselves into believing that having ABC machines or xxx doctors will make us leapfrog into another stratosphere of premier medical services in the world .
like it or not healthcare like all other service industry /commodity is about $$$
no budget of yyy$-unsubstainable healthcaresystem etc
Appologies for being condescending to my fellow colleagues. Yes, there is no benchmark what makes a good doctor, but there is one (im sure) as a dangerous one right? We face a problem of quality vs quantity ( so much in the media on this). I would prefer to look on the bright side the more we have, the more choices we have to pick the quality ones ( in this context- not the dangerous ones ).
I do agree about the ratios not being a benchmark of a developed nation. Ratios may not mean anything.
i dont quite understand or comprehend the term ‘dangerous’doctors
all graduates go thro 5-6 years of medical education learning the fundamental/basic of medicine which makes them equal in any respect
the anatomy of the human being will not change even after a million years-blood will still flow from the periphery to the heart!
putting a jugular will still be the same albeit with more sophisticated instrument etc
theres only one golden rule that all doctors must follow-if unsure or unable to make a diagnosis/treat-REFER even if you are a consultant
thats the final message from my professor 30 years ago and it has serve me well
The problem now is the fact that even the basic /fundamental of medicine is lacking in “so-called” graduates!Some don’t even know how to take history and yet graduated.
You only really learn medicine in practice. Medicine is not learnt from textbooks. Medical school gives you the background knowledge to understand things, but it does not make you a person who manages patients. Medicine has far more to do with being a manager than applying textbook knowledge. Being able to call the shots with confidence and make judgements on what to do with patients is no easy task. Any mediocre student with access to wikipedia can spew diagnoses and facts about diseases. But what do you do to a patient sitting in front of you in real life? It’s not that simple. It’s a bit of intuition, backed by knowledge, and the confidence of calling the shots. You do not get this from medical school. You get this from experience.
Every intern will tell you the same thing: you dont know sh*t when you first start out. Sure you may be able to regurgitate the umpteenth causes of upper abdominal pain, but what do you do to a patient sitting there in front of you and how do you work the system to your patient’s benefit is not taught anywhere.
This is why internship is crucial and you are not a doctor until you’ve completed internship.
How do you define quality?Who defines it? The patients or doctors. How would a patient know that so and so doctor is lowsy or good? How do the patients pick the quality ones? Our patients are not knowledgeable enough to decide that unlike the west.
Excellent comment on the macroeconomics of the issue. Gosh i never knew Malaysia only spends 3% GDP on health… that’s kind of sad!
We will soon become like Indonesia where their own citizens do not trust them. I can already see it coming. Oversupply will definately reduce quality
i dont subscribe to this hypothesis of of mediocre/bright medical students.bright literally means good material for PG training and not so bright slated to be ‘ordinary’ doctors
do one need to have a distinction in surgery to be a surgeon?
most surgeons and in fact most specialists are average grade students in my class(of course in the 70’s,you need good grades to be admitted into medical school,after 1979 when margaret thatcher started the ‘privitasation’ exercise u need a wealthy father to see you thro med.school.fees increase exponentially from 450 pounds to 5000 pounds per annum and grades were no more the sole determining factor)
i still think that all medical graduates from any place on earth are the same or equal .medicine is about rote learning -one need not be intelligent or possess a super iq to qualify as a doctor.
surgical/medical skills as mentioned can be acquire in the course of one’s training and even average grade students can be brilliant consultants in their respective field and not the preserve of so call brilliant medical students/intern
I don’t totally agree with you. Whatever said, a person must have a certain level of intteligency to be a doctor, not necessary a A star student. You can’t expect a SPM failure to become a doctor, right? Unfortunatly, it is happening. BTW, pioneer surgeons were not doctors, they were barbers. haha. In that sense you may right!
lol…that’s why they prefer to be called “mr” in the UK.
Layman, are you a medical doctor? as a doctor myself, i see how brighter students are able to remember more of what they study in med school, learn and absorb more during clinical internship and training years and able to better apply it when they come out in practice.
I have seen many medical students or interns, even senior residents, who aren’t book smart and hence knowing much less basic and fundamentals of medicine than their peers. These group of doctor-to-be or trainee doctors are more prone to make less accurate diagnosis and less likely to know how to manage the multitude of their patients problems. At the same time, i am not saying that all smart people know what they are doing but what are the chances in students who gets D or lesser in SPM or pre-U studies can remember the 3000 pages of information in the medical textbooks and try to integrate those into the clinical scenarios. And medicine is also more than just reading the book, one has to see enough of cases to understand how complicated every single disease can be and without sufficient exposure and good guidance, the trainees aren’t going to be able to be good doctors. It’s a big mistake to let these people to graduate because every little mistake can lead to a fatal complication.
Again, i should reiterate – i think as long as the medical schools are getting SPM or pre-U students at the level of average of Bs with one or two C, these students may still do ok or well in medical school and if these average students can pass medical school exam, they then should be fit to move on to be doctors. But the problem IS – MOST MEDICAL SCHOOLS IN MALAYSIA ARE MONEY MAKING MACHINES -WHO KNOWS WHAT TYPE OF STANDARD THAT THEY SET IN “PASSING” THESE STUDENTS. Hence, we loose another important barrier to filter out those who are not quality to be doctors.
pag
i have classmates in the 70’s who failed their LCE/MCE or the SRP/SPM equivalent who went to med school in the sub continent and return as doctors!!!!
alas,you dont need a lot of grey matter to be doctor
Of course, even monkeys can become doctors. There are so many medical schools nowadays who are printing degrees and giving it to the students after 5 years. They don’t teach a single crap. Medical education has become a money making business. Majority of these ” SPM failures” become useless doctors, sorry to say. I have seen enough.
Oh my, having people who fail exams to be doctors is certainly not something to be proud of but who knows if they improve during their med school time. However, at the same time, if not, they could be one of those bad apples that are giving bad names to the profession. I wouldnt want them to treat me or my family and friends, or anyone else because we do have rights to demand to be treated by competent doctors. Just my 2 cents!
Oh god you’re actually saying that intelligence is not a pre-requisite of the medical profession
If the government shares that belief (there is reason to believe so), then you will have a chance to prove that hypothesis. Just watch the standard of healthcare, incidence of litigation, and general fear of leaving relatives in public hospitals over the next few years!
It is sad that we have people who doesn’t see a problem having students who fail their exams to become doctors. I believe i am hearing complaints of incompetent doctors everywhere already, his hypothesis is being proven already!
btw, the standard of SPM in malaysia has dropped so much comparing now and the 70s, students who get C in the 70s could be scoring A or B now in our current system. So, those “average grade students in your class” that you are talking about could be straight As students if they are to sit for SPM today!
I really dont see why they cant just put a damn percentile score to the SPM results. Problem solved. Everything’s relative anyway.
mcfan
obviously your flawed argument about ‘failed’candidates who manage to qualified as doctors are not equipped to treat xxxx is sheer ludicrous and by extension if you dont come from a reputable university i will not consult you etc.and we can even broaden this outrageous, arrogant ,self fulfilling attitude to other spheres of medical care -if u are not an FRCP(some1 with an MRCP for 10years and on recommendation of other fellows and payment of a fee is bestow this honorary title) i wont let you manage my hypertension/medical problem
layman,
please read my comments carefully before making conclusion
1) if you read my above comments above:
Again, i should reiterate – i think as long as the medical schools are getting SPM or pre-U students at the level of average of Bs with one or two C, these students may still do ok or well in medical school and if these average students can pass medical school exam, they then should be fit to move on to be doctors. But the problem IS – MOST MEDICAL SCHOOLS IN MALAYSIA ARE MONEY MAKING MACHINES -WHO KNOWS WHAT TYPE OF STANDARD THAT THEY SET IN “PASSING” THESE STUDENTS. Hence, we loose another important barrier to filter out those who are not quality to be doctors.
2) I have not commented directly on “reputable vs non reputable” medical university. I would be more concern on university that are accredited vs non-acredited and recognized vs unrecognized.
3) I have seen enough to know that good students are clearly better doctors than not so intelligent students – you can that their knowledge background and skills are ways apart and you only need to have a complication/death as a result of the incompetency of these substandard doctor to say….”Oh my, how did manage to become a doctor? or I hope that their licence will be revoked soon!
4) you can go on defending those doctors who “qualified” with failed results…i guess you may not understand the definition of “fail” (= to be or become deficient or lacking; be insufficient or absent; fall short …quote from dictionary.com) …but i still don’t hope that they are the one treating anyone including you when you have hypertension because they could miss the reason of why you have high blood pressure and you may die of a stroke the next day!
bye!
Dear all Mo Spec and Prof,,
First question is i heard last few days ago that the salary will increase 13% but today i as a Ho recived my salary which is same as before ,, ontop oncall claims are cut down and no extra 600 is payed to any of us yet,,, any one can update me regarding that…..
Second MOST IMPORTANT CHALLENGING QUESTION TO ALL::::
i have been reading these line ” over loaded HOs” etc ” alot of HOs” from the past few years….
i have few question for all of you… before answer that question dont forget you guys are trying to creat a system for future medical field…
1. if HOs are alot why they work like donkeys
2.i have seen 2-3 HOs working under 6-7 regs…how you all justify this..
3. recently Ho allounces , oncalls etc are cut down and salary of a HO is almost equal to salary of a Staff nurse…
4. i have seen if we use to speak words Hos word the REGS PROF or SPEC will make a kind of face…
5.why you seniors are our enemy..we do mistakes yes but you guys was also HOs and most of you also did alot of mistakes
6. LEARN from NUrses community how they treat their juniors
7. teach us and do your duties ,, you also try to skip your duties by not teaching us..we can ask million time to you guy cause you all are payed for that..
8. if you all talk about QUALITY.. who will make Quality…you guys will make better envoirnment ,, better plans ,, beter attitude to teach fresh Hos ..so they will be better future….now only all seniors can do is blaming to HOs…please do blame yourself…you guys are not doing justice with your jobs…..
9. i am not trying to fight but trying to tell you for GOD SAKE .. we are doctors and respective profession ,, dont bring down your profession by blaming and cursing juniours,,,,
10..you guys want QUALITY ok,,, BE a good leaders all will be fine…
Thanking you all
You are in Malaysian government service which moves at snail pace. Before any salary adjustment is done, JPA will need to issue a circular. Only after that the local hospitals can process the payment which will only occur 2 months later, backdated of course. Same goes for your shift allowance ( I heard some hospitals has already started to process this).
1) There are enough HOs all over but the issue is maldistribution between hospitals and between different departments. This has been going on for a long time. The person who decides on this is a clerk sitting in Pengarah’s office. Secondly, the idea of shift duties is not to cut down on your workload but to reduce the number of housemen working pershift. Thus you will find only 2-4 housemen working pershift/per ward but more MOs in the ward as MOs do not work shift duties. This is assuming you are in MOH hospital. University hospitals limit their HO intake.
2) The salary of HOs/doctors will eventually go down further once all the post are filled. If you are in for the money, you will be dissapointed. Be thankful that you are actually getting a much better salary than 5-10 years ago.
3) as for the rest, I agree with you. All seniors should teach the juniors unless the juniors got attitude problems, refuse to learn and take orders which is happening quite common lately. However, every enthusiastic juniors should be thought and encourage to read and learn. Unfortuantely, many of the good specialist and consultants have left the civil service, leaving behind world travellers and apple polishers. That is the main problem affecting our public sector. Those days, every HOD will do grand (teaching) rounds almost weekly. Do you see that happening now? The civil service is rotting away and the good ones will get frustrated and leave. When I was in SCHOMOS in early 2000s, we did bring up this issue to MOH( to retain good senior doctors) but their typical answer will be ” you tak suka you boleh keluar!
Bravo HO (from the comment above)! That’s what in my mind reading all the arguments between our so called seniors in this profession. Aren’t we thought not to look down or talk bad about our fellow doctors?
We need guidance…not stories about bad doctors been repeated over and over again. Have some pride (and faith) with what we’re doing (saving lives).
How naive of DrT. You must not have been in service long enough to notice the impending crisis faced by the profession. The same crisis that Dr Pagalavan’s been sounding the alarm throughout his blog. Unfortunately, there are those like DrT that choose to keep their heads under covers and not notice the happenings around them. Looks like Dr Pagalavan’s work is far from over.
As for HO’s comments, this truly personifies the attitudes of recently graduated house-officers. We of an older generation were trained that MOH means SERVICE first and above all else. Your job comes first. Do your job well and you will get the training you need. If you do not receive enough training, it just means you have not been working hard enough. As with all other professions in the world (lawyers, accountants, engineers, etc.), professional training means on the job training, so if you don’t work much on the job then you get no training.
New graduates seem to believe that they have not left medical school yet, and that they deserve to be molly-cuddled around the wards and clinics. They see a few patients and whine about sore feet. When they’re asked to retrieve an urgent result that may SAVE a patient’s lives, they whine about being made to work beyond their job scope. Well GROW UP or GO HOME.
Doc,
This article does highlight the harsh reality that is going to hit us soon. the other day, I was approached by agent who told me that I would be able to treat patients after being a houseman for a year. The very thought of it scares me as the life of patients are up against my inexperience. But these agents make the whole course sound so easy but what they fail to highlight is the ‘what happens after you earn degree’ part. The saddest part, is real talent and passion is often overshadowed by this influx of graduates. In america, medicine is a postgraduate course. And mature undergraduates with research backgrounds qualify for it. Why can’t we adopt this system? Oh, and what do you think about the USMLE and specialising in US?
It will take many more years for Malaysia or any developing countries to adopt US based system. In fact, even UK and Australia is just about to move into this system.
You can sit for USMLE BUT even after spending huge amount of money and time, no guarantee that you will even get a residency post over there. You will be competing with thousands from India, middle east etc etc.
Every action has a reaction therefore if a door closes looKk for the window for access.Any consideration being made to serve out of country or outsourcing the talents and competencies, restructure your plans. Do the electives somewhere else; do not have to be in Malaysia.You may be more rounded.
Do electives in other countries Google and apply once you have good recognition from the institution you trained. On eneed to take risks and take a plunge go out of your comfort zone.Do you realize the externally exposed graduates do better than the once processed locally, home grown.Life has challenges, so we must be Asianize them by treating them as opportunities.Raise up our crosses and seek Divine wisdom to deal with secular problems.
Ampusam Symonette
Good day.
I’m a medical student in the middle of my final exam.(what am i doing here?) Wish me all the best for my papers next week! 🙂
Hopefully I can change the system in any way possible.
best of luck and I really hope you can change the system.
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i truly disagree with the statement that
” Most want to practice in UK, US ad Australia or even Singapore. Only when they have no option, they might come to Malaysia. Those who came (especially those from India, Middle East etc) are all with dubious quality. Most likely they are already not dong well in their home country and wish to have an easy life here killing our patients. Malaysia should not be the dumping group fir such specialists.”
First of all,
1) Passing post grad exam is not an easy job… by passing the post graduate examination, you have proven that you have sufficient knowledge to manage a patient safely at a general level. “not killing patient at least”
2) Malaysia is not the last resort, once you become a specialist, you’re wanted in every part of the world, Why MALAYSIA? There’s no such thing as dubious quality, MMC has set a standard guideline what qualification you need to call yourself a specialist…
3) There are specialists who come back solely because their family are here and they love their country more than anything…
We all knows that our medical education for post grad training in Malaysia is very poorly established and most of the doctors didn’t get the chance to pursue master programs and ended up struggling alone or went overseas to seek training opportunity.
The cruel fact is that most of us will be dispatched to district hospitals and ended up become “chronic” MO there.
A lot of Chronic MOs fed up with the system ended quitting their job or setup their own clinic.
i’m just defending the Malaysian doctors who are working overseas…no offence.
1. I guess you are not in the system. We all know that those capable specialist are most likely not willing to come back because of the huge difference of the benefit they get so we always do not get the best specialist. Ask anyone who had works in states especially in East Malaysia, they will have lots of horror stories to tell, their surgical skill is in doubt and many of the times, they have to sent back to major hospitals for ‘retraining’ before being sent back to home countries.
2. MMC is currently a joke. They can’t even have a minimum standard for the medical schools and don’t hope that they will do the same for the foreign specialist. What it needs is just a cabinet decision that all these rural specialist post must be filled no matter what, the MMC will just approve anyone to work there. However I think the recent decision that ALL new specialist must work in rural area for at least 6 months may improve the situation.
3. There are indeed SOME or FEW specialists do come back for family and love of the country but this group is a very small group and not the majority. Otherwise why we still have the problem of JPA scholar hiding in UK, Europe, Australia or US and refuse to come back despite the treat of legal action. And also tell me why NO ONE ever stay back in Russia, India, Uzbekistan or even Indonesia? The reason is obviously, this is human instinct.
Here is an interesting news today. A JPA scholar who never returned!!
MALAYSIAN DOCTOR GUILTY OF SEXUAL ASSAULTS
MELBOURNE, March 24 (Bernama) – A Malaysian doctor was found guilty on March
20 on two counts of sexual assaults on women in Adelaide.
The Elizabeth Magistrate”s Court in Adelaide this week found that Dr Mohd
Zaki Ibrahim, 36, had committed the offences on March 31, 2010 and on July 16
the same year.
A court spokeswoman told Bernama the case had been adjourned to April 27
when submissions on the sentencing will be heard.
The doctor, a Public Service Department (JPA) scholar, is believed to have
worked in a rural town in South Australia before moving to the Adelaide suburb
of Elizabeth with his family.
— BERNAMA
http://www.mmail.com.my/story/msian-doctor-guilty-sexual-assaults
I think the statement is about foreign specialist who come to Malaysia and not Malaysians.
MMC do not monitor specialist. Their job is just to provide practising cert to practise as a doctor and NOt a specialist. MOH is the one who accreditates a specialist as previously foreigners cannot work in private sector and Malaysian who return need to do 3 years compulsory service. That’s the reason NSR was created to credential specialist but unfortunately it is not yet compulsory till the medical act is amended.
NSR is a joke, I got so many friends who resigned when they are still MO and got their membership qualification (MRCP / MRCOG) while they are doing locum in GP clinic. These ‘specialists’ can easily get their name registered under NSR by just filling the forms and paying the fee with 2 of their best friends private consultants signatures as nominee / referees. They do not need to get through the gazattement period like their counterparts in gov hospital to gain minimum clinical experience as specialist and yet they declare themselves as specialist and even sub specialists practicing in private.
Yes, this happened when NSR was first launched. I had a friend who never completed his gazettment and left 6 months after passing MRCP but still manage to get NSR registration. However, NSR is quite strict now and need you to provide the MOH gazettement paper for them to process.
A very interesting article, followed up by an equally interesting discussion by many individuals. But there were a few things that I though i just must add in here….
1) I graduated from University Malaya 7 years ago and as bad as some of the Ho’s are now, I do sometimes wonder if they are any worse from some of my batchmates back in uni days. There were a few clearly lost (and totally blur) souls who studied with me and made me wonder how in dear God did they ever enter there. I ask the seniors here, didn’t you study or work with similar people? Were they all good student / doctors in your time?
2) What I can compare with the housemanship i went through with the housemanship now is clearly the lack of dedication, sincerity and commitment of the seniors. I would not blame it on the fresh grads only. And I’m not taking about my consultants, we hardly met them, but my MOs. They are the one who taught us many things, management of patient and work ethics. We worked hard together, and also had good times like breakfast and dinner together when we had the time. I see that system slowly eroding. MO’s now are not strict on the HOs, dont teach and dont even know when their HO’s go missing. I cant imagine pulling of such a stunt and escaping those days!! Their only excuse, too many HO’s. Come on, they are young, fresh grad and some may not see yet the importance of their roles. What has happened to the check and balance system that had survived for so many years. Even if 1 MO has 4 HO’s in his ward, dont tell me he cant or should not find out where there are and why any task is not completed on time? Should he give up and do it himself, scold all of them or take the harder route of finding out the core problem maker? I know HO training are supposed to be the task of specialist, but i remember learning more from my MO’s than my specialists.
3) Isnt housemanship about building ethics, attitudes and responsibilities as much as knowledge? Who do we blame… the medical school for not teaching all this? or the over enthusiastic parents forcing their children to do medicine? Or ourselves, the ones who are supposed to guide the new breed? or a system that fails punish the rotten apples?
4) In my limited experience, I have worked in a district hospital for a few years and a state hospital for a year. What irritated me during my working days was the hospital management. I so felt my welfare (and that of my colleagues) was just not taken care of despite all the work that I do. Which is my I had privately pursued my MBA and am now on track on doing management. I wish to refute the claim by “poor doctor” who feels that admin is run by idiots and only the clinician do the real work. I’m not saying its good, but how many who are really good have tried to do it to make the situation better?
My choice of doing admin was not to get a 8 -5 job, not because i’m stupid or lazy but because i feel there is a need for change in the area. I know the obstacles and frustrations ahead, but how long are we going to blame others if we dont step up? Someone has to dive in rite? Why arent the talented ones willing to lead? Not try to change from outside but change from the inside.
I’m not defending the policies set by the gov to open so many med uni’s, to recognize so many foreign uni’s or how they treat us doctors. I’m not defending the HO’s out there nor do i claim to know everything what my experienced seniors are talking about. But i believe.
I believe I have a responsibility with this title. I believe changes must be made and CAN be made one small step at a time. And it will require the cooperation of every doctors from all fields.
To my fellow doctors, i plead, dont make this profession into just another job to make big bucks. What will happen to a profession that has been considered sacred for many centuries? What has happened to ethics? What will happen to MOH if the best all leave? What will happen to the country and our childrens children if we leave policy making unchecked to the dubious few?
To the aspiring doctors… please do step in only, and only if, you have a love for medicine. For as frustrating this job may be, its can also present the most fulfilling rewards.
Well said! Yes, even than, there were poor quality housemen but the numbers were much smaller and still manageable. The good doctors/consultants that use to teach those days are gone as well as I have mentioned many times before due to our government beraucracy.
Doctors must be united!
Ah well Pagal, we all knew this was coming.Government of the day is just intereted in making a fast buck. What’s more interesting is that private hospital chains now want to be involved in post graduate training of doctors.
Yup, I heard Perdana uni wants to start residency style postgraduate training of their graduates in their private hospital!! WTH!!
At the moment training in private hospitals is not recognised but who knows, anything can happen in this bolehland.
Perdana’s not the only one. And some people in private hospitals think they are actually the right people to train specialists as well. I’m really not sure if this is a good idea though.
It may be true for some subspeciality but not for general training. General specialist training is still best to be done in government hospitals unless the entire health system changes. Certain subspecialist in big private hospitals may be usefull for part of subspecialist training.
Hi there Dr. Pagalavan.
As someone who has been in the medical fraternity since the early 90’s and had worked in Ireland, HKL (before there was Selayang, Sungai Buloh, Ampang and Serdang to lessen its burden), HUKM and now teaching and dong orthopaedics in Kuantan since the year 2000, I can see where everybody is coming at from the comments made.
However, I pity the medical students and housemen who still do not have the experience to take what is being said with a pinch of salt or to properly judge what they should do in light of all these revelations. To them, I would say that if you really feel that you have a passion for the profession and want to do your best for the patient’s sake please continue your learning and training wholeheartedly as Malaysia need more doctors like you to help improve the current scenario for the better.
But, if you are already putting yourself ahead of the patients’ well-being during your housemanship years; such as telling yourself it is OK to finish your meal before responding to your pager, or to see the patient early in the morning instead of in the middle of the night because you feel you can’t get out of the on-call room bed, then please consider stepping aside and doing something else before you end up destroying someone’s life in the course of your duties. You are only bringing disrepute to yourself, your colleagues and the profession.
For example, I have come across HOs who do not even put a stethoscope on the patient’s chest when reviewing them before ward rounds in the morning but have the gall to write/draw “lungs clear with no added sounds” in the notes! On one occasion the patient actually developed fat embolism the previous night and is on oxygen mask with SOB and obvious creps on auscultation!!! This speak volumes on the ethics, character and attitude of these HOs.
I have also come across HOs trying their best to put a large IV canula into patients brachial artery at the elbow instead of the median cubital vein. Imagine what would happen to the patient’s upper limb if the artery became completely thrombosed!!! When I question them they really believed that the median cubital vein is on the medial aspect of the elbow! And we are not talking about fresh HOs in their 1st posting in many cases, but those who are already a year or more in their housemanship!
However, I have also come across many housemen and MOs who I am proud to call colleagues as I believe they have the right attitude and character to be a good doctor who works for the benefit of their patients instead of for monetary gains or popularity/glamour with family members or the kampung folks. Despite all that is going on I am sure that the profession will continue to do good for the common people.
Kudos to those of you who have written in with positive attitudes and advice to the passionate medical students and junior doctors.
Dear Prof Kamarul,
Thanks for the insight. I have not seen you here for a long time, haha. Anyway thanks for the advise and you have summarised all that I have been saying all this while.
Documentary Movie by Michael Moore with the title “Sicko” explains clearly how US healthcare system was revamped and its implication. Looks like Malaysia is revamping its system just like US. Here is the irony, now in global news, we see US wanting to reinstate the old system.
If the Raykat have clear understanding of what is at stake, i won’t be surprise diorang naik darah and support the docs.
Dear all
Can I suggest something. I am a psychiatrist and received few houseman who do not want to be a doctor and referred to us because of “missing in action”. There are intelligent but force to be a doctor . The have No way out unless to finish their HO. Some of them do go to Putrajaya and begged to be transfer to other discipline other than medicine
Pitty them also , become the victim of authoritarian parenting . I suggest MOH channel some of them to become a researcher, scientist , allied health specialist , lecturer and etc by creating a path for them to join university or other allied health department.
Yes, I have also heard a lot of these type issues when I was supervising housemen before. Unfortuantely having MBBS does not allow you to do any of the jobs that you mention above without completing HO. To be a reseacher, scientist, allied health specialist and lecturer, you need to complete postgraduate education which you can only apply with full registration with MMC. The only option will be to do Basic Science Master’s programme to become basci science reseacher or lecturer. I think some uni do accept applications without full MMC registration.
I know a MBBS holder from an unrecognised uni who applied to become a teacher and the education department laughed at him!
dr pagal what is your opinion on graduated doctor from india and middle east..i heard there are not perform very well when they are back to serve as HO..is it the rumor true?
if the fact is true what kind of things they can’t perform? can you clarify it precisely
Not the country but the medical school they come from. Some don’t even know how to take history and examine patients! Some lack basic medical knowledge that you should have known before you graduate.
hello doc,does this apply to the future doctors serving in the army?is it a better alternative to join them?
How many hospitals do army have? That will tell you the outcome
Dr pagalavan, u should open up a twitter account and spread your views there too. A powerful medium.
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So much for doctors in the government service. You should see what is happening in private GP practices ! Hiring so called Dr’s with no APC, HO’s etc. We even have have private clinics selling health products concocted in the kitchen ! Where is our conscience! Do you know the amount of cheating, lying and stealing for financial gains ! No one cares anymore for patient care. It’s all about MONEY !
A Sad Doctor !!!
YES, as I have written here https://pagalavan.com/2012/07/15/for-future-doctors-how-desperate-have-doctors-become/
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Dr. if i enroll in medicine course in Universiti Pertahanan Nasional Malaysia, am i guaranteed a secure job after i graduate? please im just a form 4 taking my SPM next year and being a doctor is the most right thing to do. thanks for helping out.
What do you mean ” the most right thing to do?” There are many options out there.
Nothing is guaranteed in the future!