My 1st part of this topic was published about a week ago https://pagalavan.com/2012/06/29/for-future-doctors-subspecialist-training-in-moh-new-rules-and-regulations/. I just returned from the Malaysian Rheumatology Society annual conference in Penang last weekend. I had a oppurtunity to discuss various issues regarding the topic above with my colleagues from MOH.
The new rules mentioned before is causing a lot of dissatisfaction and disappointment among the specialist. It seems that the offer letter to do subspeciality must be signed by the DG and KSU. The authority to offer subspeciality training is now directly under the DG. I feel that it is indeed a good idea to have a system like this, if it is transparent. Previously, many specialist can take short cuts to enter subspeciality training. For example, a specialist under certain department in certain hospital can easily enter the subspeciality training as long as the HOD accepts him/her. This scenario will NOT happen again.
I was also made to understand that when you apply for subspeciality training programme, you must now determine where you are going to work after completing the training. The place you choose to work post-sub training must be agreed upon by MOH. If MOH do not agree, they will determine where you will be posted after completing your training. This place of practise will be included in your contract. For example, your contract might say that after completing your subspecialist training, you will be posted to Miri Hospital etc. If you don’t agree, you don’t get the training post. This is to prevent specialist from rejecting any transfer after training. With the new contract, the MOH has already decided where you have to work after completing your training. Furthermore, you will also be bonded with the government. It looks like, it is a well “planned” programme. Didn’t I say it is coming ? Please read my article in MMA which I wrote almost 6 years ago: https://pagalavan.com/my-mma-articles/july-2006future-of-government-doctors-die-another-day/. The same might happen to MO post soon where you can’t reject any transfer if you want to keep your job since the post will be limited with oversupply of doctors. I also heard rumours that the same rule might be applied to Master’s application soon.
However, as I said earlier, it might be counterproductive. It seems that the MOHE hospitals a.k.a University Hospitals do not follow the same rules and regulations. These hospitals can accept you into subspecialist training immediately after MRCP or Master’s gazettement. This is because they have their own rules and regulation of gazettement etc. It looks like, many specialist might resign from MOH and join these hospitals for faster training programme. When the new promotion scheme was introduced by MOH in 2010 https://pagalavan.com/2010/04/02/government-doctors-promotion/, the scheme was better than the MOHE hospital’s promotion scheme. Many who wanted to leave to MOHE hospitals decided to stay put in MOH hospitals. The reverse will happen soon.
Recently I had a comment saying that I am talking rubbish and a lot of issues that I bring up is just rumours and not conclusive. He said that people must only take info provided by the higher authority. Well, I never forced anyone to accept everything that I say but at least I am doing some sort of public service by informing the public and medical fraternity of what is coming. If you go back and read what I have been saying in this blog over the last 2 years and read what I wrote in my MMA Magazine over the last 8 years, you will realise that almost all that I said and predicted have come true. So, it is up to the readers to decide……………….
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Dont bother about those people who cant accept facts and choose to live in delusion
You are doing great service by highlighting the various problems faced by our profession.many juniors do not follow new developments in The profession and your blog is like a summary of events and it makes good reading.
I for one have always enjoyed reading your blog, even though I have long realised the issues that will plague our once respected profession.
Keep up the good work
Ignore the delusional people.
I am sure that many others like me feel thankful that you are taking the time to inform readers about such issues.thank you doctor for enlightening us.
Currently, those already in training, their posting after gazettement is decided by the subcommittee but now I guess , DG decides. As far as I know, except for Urology, the other subspeciality training have different requirements for those in the universities and those in KKM. Basically those in KKM have a structured 3 to 4 year programme but only god knows what the buggers in the universities do, they go for an attachment here and there and end of the day call themselves a subspecialist, no log book, no proper training, no paper, no assessment, as if they are above all regualtions just because they are in the university!!! The KKM doctors are gazetted as a subspecialist once all the requirements are fulfilled and there are quite a few who are not gazetted because they did not fulfill the requirement (most of them would not have produced the 2 papers required) but again, only god knows who gazette’s those from the universities (I dont want to talk about claims and entitlements a Universiti fellow gets compared to a KKM Fellow) and I think the next step is to regulate all subspeciality programme so that the KKM and University doctors undergo the similar training programme.
yup agreed. NSR or the Academy of medicine Malaysia must regulate the subspecialty training. It should apply to BOTH MOH and MOHE hospitals as well as foreign trained specialist.
Working in the university nowadays is not as greener as many people thought…There is a rumours that MOHE will impose a higher penalty(abut 3x – 5x higher) if someone resign earlier than 6 or 7 years, as compared to rm160k at point in time…but of course, for future intake..btw, i think the ‘craziness’ to do sub-speciality as soon as gazzetment need to be reviewed.
Fair enough, this is win win situation for both side. For those who are willing to serve in unpopular places, their reward is to get training spot earlier. For those who just want the comfort of the place they prefer, this means the queue is longer and thus the waiting time.
more like a win-some-lose-some situation to me.nobody is winning here.pros and cons.
Thank you very much for the excellent articles. I’m a have just recently completed the MRCP.
I have heard rumors saying that gazettement period for MRCP holder will be increased to 30 months. Could you please shed some light on this issue ? Thank you.
I think the rule says that you must have at least 4 years of internal medicine training before you can start your gazettement process
Dear Dr, you said :
“The authority to offer subspeciality training is now directly under the DG. I feel that it is indeed a good idea to have a system like this, if it is transparent”
What is your opinion, do you think it will be transparent? or it makes no difference from the old system which the HODs make the decision?
might be more structured then before. Being in Malaysia, nothing is transparent
thank you dr paga for the article. The entire exercise aims to curb specialist from going into subspeciality and thus making themselves more marketable for the private sector.
In summary the current scenario for medicine in the country is as such . There is over supply and little need anymore in terms of manpower in terms of doctors. The two groups that suffer from what has transpired under the new DG are the houseofficers and the specialists . The houseofficers function akin to nurses now and because of this they have no say in terms of dictating their rights in the profession . The specialists have a “apa kita bagi kita boleh ambil balik” motto thrown in their faces and thus little chance for them to progress as well . I guess the government has won this round hands down . They have managed to create a subversive and obedient workforce to dance to their tune in the form of medical officers having no where else to go but remain in the government service. Why have we come to this? We allowed it to happen.I do not take anything away from the MOH though . They have systematically executed this to perfection . First by suggesting time based promotion , then by reducing houseman hours and increasing call claims , all done to blind us from the reality , then starts the agenda to increase doctors exponentially as if there is too many then cannot ask anything ma…., next came the possibility of SBPA but we all knew it was a smoke screen and then systematically introducing circular after circular from penempatan to finally the fellowship training putting MOH in the drivers seat and all of us mere slaves.
We have stood by and just let it happen .Where are the office bearers now . They report what the DG and KSU has ordered . they do not suggest anymore i presume and even if they do , their suggestions merely falls on deaf ears. I still remember how some ( in fact major) parties were so happy the previous DG stepped down , well it looks like the previous DG is a godsend compared to what we have now. MOH , now are the kingmakers and also the back breakers.
I thank you again Dr Paga for your insight and your articles, my wife and i have gained so much in terms of guidance and also in terms of direction particularly with our children . i hope you can improve on this site by inviting suggestions to improve our predicament . Too many people comment in this site without giving suggestions on what we can do to fight this . If there is definitely no way to fight this current unfairness , then trully all is lost .
I think you have mistaken the MOH’s intention. The entire practice is to curb the subspecialists from leaving the public service too soon. ALL the subspecialists training can only and must only be done in public hospitals because only in public hospitals, there is enough patient load and oppoutunity for the doctors to gain experience. The investment for training of subspecialists is enourmous and naturally the MOH is wanting to retain such talents in public service as long as possible. Whether the perk offered currently is good enough is entirely another issue. MOH being the sole provider for subspecialists training will naturally uses their advantage to the max. They have to consider providing services at unpopular areas as well. So such move is understandable and those who are willing to ‘sacrifice’ in order to advance must be given advantage for training opportunity. The solution may not be the best but it is the most reasonable at current senario.
If one can neglect the monetary opportunity that they might lost as subspecilaist in private sector just because they are not allowed to leave early, this remedy is not that difficult to swallow.
That is the whole idea. Mahathir once said that we will flood the market with doctors so that they stop demanding! In another few years time, even getting a job will become a previlage!They know that the private market is also very competitive and getting saturated. So, people got no choice but to stay in government service.
i’ve read most of your post and somehow i felt remorse in many of them.Do you regret being a doctor ? because i cant stop to notice how demoralizing your posts are to budding doctors.
If you got passion for the job, you won’t be demoralized. But if you do medicine hoping that you can earn big bucks, drive BMW and easy life than you would be disappointed.
FYI, I am telling the truth and the reality. Truth will always hurt!! Please read my articles and you will know whether I regret being a doctor!
People always want to hear only good things BUT I am telling you the reality that you must be prepared to face. This is all based on my experience dealing with problematic young doctors who were never aware of these issues. Remember that I NEVER said “don’t do medicine”
Dear Dr,
I have been reading yr blog for almost two years. It has really been an eye opener for me yet I’m still very much interested in medicine. Due 2 financial constrains I’m currently in the medical assistant diploma course in a gov college. After i join the the gov service I’m planning to further my studies in medicine and become a doctor. Do you think it is a wise move or should I consider other degrees in the medical profession?
Do you have the qualification to do medicine? If so, why don’t you do a degree course in a medical related field rather then a diploma? Once you join the government service, you can’t simply leave and do medicine. There is no such thing as part time medical course. You have to resign and become a student again.
Hello Doctor,
As you can see from the previous line, I\’m a future medical student. I\’ll be starting in UM this September. Right now, nothing much in the future, for instance Masters or specializing concerns me because I have about 5 years before I\’ll face it. Right now I\’m just facing a huge dilemma between applying for Jpa and not. As the Jpa application window is pretty short, I\’d really hope you can give me an insightful take between these two options as soon as possible. So far the only thing that caught my interest is the \’rumor\’ that if you are bonded with Jpa, you\’ll be guaranteed a job in government. Financially,I\’ll be fine without the scholarship though. Of course, I wouldn\’t be counting on going private soon after the compulsory bond but who doesn\’t want to be better off in private?
Please do take your time to help me solve this Jpa dilemma. In fact, I welcome any opinions and take from anybody here. I really really appreciate anyone\’s help. And so sorry for being such a rush! As soon as possible sorry!
Thank you!
IF you are a JPA scholar, you will be bonded for 10 years which means the government must give you a job. By the time you graduate in 2017, there will definately be surplus of doctors. So, taking JPA scholarship is a better option.
There is no money in medicine anymore. By the time you graduate the 1Care system would have been implemented. This means you can’t open a clinic as you like. The 1Care system will decide where you can open your clinic and you will be paid by this scheme. You can still earn a decent living but the income will not be much different from being a civil servant! So, no such thing as better off! Furthermore, by that time you will need a postgraduate degree to become a GP to open a clinic.
Thanks a lot doctor for your in depth insight! I appreciate it! I heard some chatter about JPA not 100% being offered anymore to medical students like me, as compared to last year where everyone will 100% get Jpa (still referring to medicine). Is this true? Also can second year medical students apply for Jpa too? ( Say I’ll go in first then I’ll apply next year) I’ll be really grateful if you could also share some opinion on these two matter.
Yes, I heard the same. This may indicate that not all graduates going to get guaranteed job in near future. JPA probably knows this and thus are not interested to give scholarship to everyone.
BTW, as far as I know, you can’t apply JPA scholarship halfway
I see Doctor. I really can’t imagine a future where graduates of arguably one of the hardest courses in universities being unemployed. Doctor, do you by any chance have an email address where I can reach you if ever I have questions on related topics? It would definitely be a great deal of help if I had someone experienced to ask, I know only few doctors personally not to mention someone as experienced and insightful as you. I do understand if you wish to it private, we would just have to communicate through comments.
My email: pagal72@gmail.com
I still feel that local graduates will be given priority for jobs but being in Malaysia, nothing is transparent
Thanks Doctor for wonderful info.
I am still a medical student currently studying in Indonesia. I’ve been reading your blog for a while and its very informative, thanks.
I would like to ask your opinion about the future of Sports Medicine in Malaysia. I heard that Sports Medicine is a sub specialist for Orthopedic. Is it true? One more thing is, could you please explain how do I get there. Thanks a lot doctor.
Yes, most of them do sports medicine as a sub speciality after Master’s in Orthopaedic.
UM do offer Master’s in Sports Medicine for MBBS holders but this does not involve any surgical procedures, meaning you can’t do surgery.
Sport medicine orthopedic surgeon- the path:
After graduation 2 year HOship, 3 years (or more provided you got the master program) MO in surgical or ortho department, 4 to 5 years master ( no external exam for surgeon or ortho available, only local master program) 6 months gazattement, 2 years east Malaysia posting (DG requirement) another 2 years waiting for subspecialist training post (if you got cable) 2 to 4 years sport medicine training (plus minus the duration of fellowship overseas) 2 to 4 years gaining experience before to private. Total about 19 years post graduation of basic degree before you are eligible to get a job in private sector as sport medicine ortho surgeon. Are you prepare to invest such time and effort into this?
thanks everyone for answering my question. Well, I guess, there are lots of things to consider beside time and effort. At least, by knowing all these, I could think further and replanning my future.
One of my biggest concern is family. I still don’t know where my future is going to bring me, but I know that God has the best plan for me. So thanks a lot for sharing this info. May HE grants all of you true happiness. =)
keep posting doctors… =)
Hi Dr Pagalavan.Can i ask what is your opinion about being a specialist in University Hospital vs MOH hospital presently?which one is better with regards to workload,salary and promotion scheme?Im currently works as a housemen planning to settle down soon.I also loves teaching and Im considering to be a lecturer if it worth the workload.
Workload is less in university hospitals but salary is lower. Promotion depends on many factors. In university promotion depends on your publications and of course many hidden factors. KKM does time based promotion.
Hi, Dr
May I have some information on the 1 year M.Sc Clinical Dermatology conducted by St John’s Institute of Dermatology, London or Cardiff University, Wales ,UK ? Is it a useful qualification in the Malaysian context and are there any restrictions on non UK medical graduates applying for it ?
These are usually research based master’s degree which does not make you a specialist. As far as KKM is concerned is it of no use but it can be done for your own self enrichment.