“The storm is coming , Mr Wayne…………” Well, I just watched Christopher Nolan’s “Dark Knight Rises” movie last friday and I must say that it will go down as one of the best movie trilogy ever made. A superb ending for the Batman trilogy. I have written twice on this topic above https://pagalavan.com/2011/11/07/for-future-doctors-the-storm-is-coming and https://pagalavan.com/2012/03/07/for-future-doctors-the-storm-is-coming-part-2
I first started to write about the deteriorating quality of medical graduates and the reasons behind it almost 7 years ago https://pagalavan.com/my-mma-articles/november-2005current-quality-of-medical-doctors-are-we-going-down-the-drains/. How true has it become and people still say I am talking rubbish. Now, let me show you 2 speeches written by 2 well renowned clinicians in Malaysia. The first was my former dean of the medical faculty of University of Malaya and former Vice Chancellor, Prof Anuar Zaini. He was also my boss when I was with Monash Malaysia and he is still the Head of the School of Medicine, Monash Malaysia. He delivered this speech when he launched the book “TJ Danaraj Doctor and Teacher Extraordinaire” on 5th May 2012. Here is the speech which I find very interesting. FYI, he is also an elected MMC member. http://mmc.gov.my/v1/docs/bulletin/2012%202%20Medical%20Education%20Then%20&%20Now%20Prof%20Dato%20Anuar%20Zaini.pdf
For those who don’t know, TJ Danaraj was the founder dean of University Malaya medical school.
Prof Anuar has quoted very well that we will be having surplus of doctors and most of the medical schools are not producing doctors of good quality. It is very clear that MMC’s hands are tied! He has also commented on the attitude of the current generation of doctors who wants office hour job and are not keen to really care for the patients. The shift system is just a knee jerk reaction from MOH to reduce the “surplus” scenario on public’s eye.
Then came another speech from our Ex-DG, Tan Sri Dr Ismail Merican during the MMA AGM in May 2012. His speech, even though is long, does tell us the current scenario that the medical fraternity is facing in Malaysia. In fact, his title ” Medicine at the crossroads: The Malaysian Dilemma” is well worded and appropriate. You can view his speech here https://dl.dropbox.com/u/55059024/Ex-DG%20speech.pdf According to him, we are already having surplus of doctors as we do not have enough training hospitals and trainers. He has also commented on the attitude of the current generation of doctors and parents who interfere and pamper their “grown-up” kids! A well written speech, I must say.
So, can anyone still dispute what I have been saying all this while ? We are hearing from 2 people who have held high post in government service who knows what is really happening and what is going to happen.
So, the storm is coming …………… for sure!
Pagalavan's Avatar 
I think you are wrong Dr Paga.
The storm is not “coming”… we are smack in the center of it.
Yup, forgot. The storm is already here but the typhoon is coming………
haha.. thats more like it.
In any case.. ive been following ur blog for a few years.. and i would have to thank u … some of ur articles are not just enlightening, but more ‘prophetic’… it wsa literally reading the future unfold itself…
i think Malaysia is going to go through turbulent times in the next decade…
Clinical specialists will be facing a situation where there are only 3 sane things to do….
1. stay in government and work hard for a meager income (relatively)
2. venture into private practice and live in shark infested waters
3. try to migrate to another country
The government is creating the supply and demand chain in order for the medical business to run.
Demand = patient = factor inducing risk factor = people will get sick (patient)
(Imagine a minister is promoting fast food for younger generation? – He is clown / devil of the year)
http://thestar.com.my/news/story.asp?file=/2012/7/23/nation/11713148&sec=nation
Supply = doctor = more medical centers = people who treat (doctor)
But Health Ministry is doing nothing……just catch small fish and do cover up.
This is why more medical schools are needed now because more patients are expected. By pushing them (younger generation) into become hyperlipidemia / DM / hypertension & etc. later. Business can run and all the patients will be ‘bonded’ for the rest of their life.
If you work with passion and ignore the measures that prevent you from going to private sector too soon, then these measures might not be bitter to swallow. All the dissatisfaction mainly are due to the fact that they can’t get the training post at the soonest opportunity, can’t get salary comparable to the developed countries and can’t go to private sector in the soonest manner.
You are absolute right! I had met many medical students (incuding my family members), even before they graduated (to be HOs), they already talking about they want to be specilaist for this and specilasit for that. They just think too soooooon!
Haha, I have had emails of budding medical students who asked me which speciality can make more money in the future!! I did give them a piece of my mind!
karen, having a goal to become a specialist (it could be a specialist in family medicine or surgery or any field) is what drive young doctors from the beginning. They are not thinking too soon! The road in medicine is long, if one can identify their interest and work on it from the beginning, i don’t see anything wrong with that.
They must have been shocked with the answer, which is short, sweet yet brutal I presume. Haha. It is sad to see that young doctors cannot dream, and have to succumb to the system that destroys hopes of being a specialist. Well, to be fair, medical students learn under specialists in medical school, see the specialists doing well in their field, being “legendary beings” in their eyes. One cannot help but to admire their great teachers and aspire to be like them. Don’t you think?
Sometimes, it is good to give perspective to the medical students and young doctors on the actual journey of actually arriving to that level.
Dreams are meant to be nurtured, not destroyed. However, young ones should be thought how to dream realistically.
Honestly, if want to become rich fast, do business!
Hi, mcfan,
I do think It is good having goals for these young medical students, regardless of whether they are having them for money or for passion. The problem is getting medical specialist training posts nowadays are very difficult (either doing locally or overseas) due to limited places and many other criteria. If THOSE who think too soon (to become specialists), MOST of them would be disappointed, demotivated and demoralised sooner than others. This is one of the reasons why Dr Paga is having this blog – to reveal the reality.
My personal opinion is that young medical students should be encouraged/motivated to concentrate doing well or at least passing their MBBS exams first and then aim to be a responsible and competent MOs. I believe It is not too late at all for them to plan what speciality they want when they are in they system doing their housemanship.
I am a resident (final year) in the integrated cardiothoracic surgery program in the USA.I am hardly moved by all the latest fiasco in the medical world in Malaysia.
Unlike alot of other doctors,I graduated from an Ivy League medical school and like it or not pedigree does factor in.
I plan to return to Malaysia and I do know alot of my colleagues are not in my league.Arrogant as it may sound, I have scrubbed in Malaysia before and I know for a fact most of the surgical residents in Malaysia don’t hold a candle to the calibre of my institution.They have inadequate presentation skills, poor anatomy knowledge and an overtly gung-ho approach to surgery.They look more like technicians than scientist scholars.i won’t even bother commenting on some “doctors” who do not even have what it takes to be a “real doctor” in the first place.
So if you have the brains and the cash- step up to the club.
The cream will rise.Medicine is saturated- but only the best will rise.
Dear JiMD,
I will concede you raise some valid points:
1) chronic and worsening decay of the healthcare institution of Bolehland
2) hugely variable quality and consistency of training and trainees
3) that there will never be an excess of excellent doctors, and the best are never afraid to step up to the mark to compete
But I think your mentors would likely feel ashamed that your Ivy League pedigree and world class training have failed to instill in you any tact, grace, class or humility.
Excellent training and skills will stand you and your patients in good stead. But the fact is that common conditions occur commonly. An average surgeon who practices safely within his skillset and treats his patients with compassion will have no less a rewarding career, or be any less beloved by his patients than a high flying megalomaniac with divine skills.
Ego is no bad thing in surgery. It drives us to excel. But the problem with towering arrogance is that you are then honour bound to be perfect. Wish you well with that – as far as I know, only one person in history has ever walked on water.
PS: It beggars belief that someone with such an immense pedigree would consider returning to a backwater healthcare state. Have you not been offered a tenured position in your lofty abode already?
But I think your mentors would likely feel ashamed that your Ivy League pedigree and world class training have failed to instill in you any tact, grace, class or humility.
Well said.
Is it just me or do surgeons fit a certain profile of people? Im pretty sure I see more tattoos in surgical than anywhere else in the hospital :p
I hope you do well in Malaysia the cardiothoracic surgeons are starving in Los Angeles.I know because I practice in Los Angeles since 1977
@Allen: Are you by any chance an interventional cardiologist? It’s like video killed the radio store.
Dear Dr.Pagalavan
I have been reading ur articles for some time now….to be honest, ur the dark knight for many of us with ur useful & informative opinions. Im 30 years old now, been in the government service for almost 5 years and the past 2 years as a medical officer with anaesthesiology department. Currently im in conflict & dilemma either to quit & persuade my ambition to become a General Practioner & have much freedom in my personal life or continue for masters in anaesthesiology. To be a clinical specialist in the future, doesn’t sound any easier too. Do enlighten / forecast us about the future of General Practise in Malaysia (advantages,disadvantages, income margin & etc) compare to being a clinical specialist. Thank you.
With warm regards,
Dr.Kalai
Frankly speaking, many of the young GPs are struggling. I konw a few who have closed shop and gone back to government service. The competition is just too great and the income you get can be mediocre compared to the amount of time you spend in your clinic.Remember, when you start your GP clinic, you have to work from 9am till 10pm daily, 7 days a week. If after working so long, you can only make net profit of < RM 15 000, does it worth it? Might as well you stay as chronic MO in government service with all the benefits. The introduction of 1Care system in the future may make the situation worst. Generally, the income of all GPs will drop gradually but will still be enough to earn a living. Furthermore, when the 1Care system is implemented, those with Family medicine degrees will be given preference to become their panel.
If you want to become a GP, I would suggest to open your clinic in smaller districts or rural towns. You may need to charge lower but the patient load may be better.
Thanx for ur input doc…in the other hand it means i have to work harder and be more passionate!! U deff made my day boss… 🙂
Unless you want to become part of this :
Hi JiMD, how about solving the problems in your country first? Arrogance aside, you honestly think the rest of the world gives a damn?
You are an embarrassment to the professions. No doctor worth his salt goes around talking about pedigree, elitism or Ivy leagues when dealing with the art and science of medicine.
Do you know who is John Murtagh? Now that’s a true classy doctor. He practiced in the rural areas of Australia, served the Aborigine communities, and oh he also authored one of the most famous textbooks of family medicine there is.
What have you done? You have scrubbed with aliens? You have re-invented the wheel? Get lost if you have nothing positive to contribute.
Relax I thought this guy don’t deserve any response.
Well said. Most probably he is just an empty vessel. Or could it be he looks more like a technician than a scientist scholar by his Ivy Leagues medical peers, so he plans to return to Malaysia ‘cari makan’ ??
It sounded more like a self-glorification kind of statement rather than for the patient’s sake.
I respect your point of views and opinion.
I however request that you respect mine irrespective
of what your personal beliefs are.
I am coming back because I am on a J1 Visa
and also due to familial committments.
Whether you think I am arrogant or not,I will be
practising soon in Malaysia-my home country.
Yes, I am an “elitist”- and am proud of it.
You won’t see me “degrading” people in the OR or on the wards.
But let me tell you this- pedigree ensures a certain level of training
and competence.You(JJ) want to raise “patient safety” issues-kindly check
our own backyard before moping the floor with self righteous statements.
Like i reiterate-I have no qualms on the current condition.
May the best men rise.
If you’re a Malaysian or have been born and bred in this country, you should have known long ago that in Bolehland, it’s the heavy majority fat-free milk that rises above the cream, and the even heavier well connected milk proteins that rises above all.
With your kind of attitude, all your cream will go rancid at the bottom.
Hi JiMD,
I have a background in medical education and feel somewhat compelled to lend my views. Please indulge me for a moment.
I have always viewed American postgraduate training with some suspicion. Over-supervision of trainees, shorter training programmes, smaller caseloads, a lack of general medical background, etc are all major shortcomings in my opinion.
Having said that, the emphasis on research and scholarship activities in the US is something the rest of the world should aspire to (but can’t mainly due to lack of funds). Even then, US residents tend to be quite ignorant of research done elsewhere due to their overemphasis on North American journals. Another major positive of ACGME programmes is their structured nature, although UK and Australasia (but probably not Asia) have made major strides in this area in the past 5 years.
Nonetheless, I think the most major shortcoming of an American postgraduate training is the arrogance that it breeds. I have seen this time and time again with American residents doing fellowships in my hospital, although it doesn’t last very long as they quickly realise the limits of their own competence in comparison with others. I am unsure whether this is due to the training programme itself or a larger social effect. I suspect it is a combination of the two.
Do I think your training is better than that of your Malaysian counterparts? Probably – but I suspect there will still be things you can learn from them. If you feel that you are much more superior skill-wise (and you might be right), then I challenge you to share your knowledge with your colleagues when you start work back in Malaysia. The challenge is to do it in a way that does not offend them or their intelligence. Otherwise, your arrogance will overshadow most aspects of your competence and you will get nowhere.
As a consultant in the UK system, please allow me to also share some insights. There is no doubt that in the UK surgical training system, trainees have to learn to project themselves with a reasonable degree of self confidence to make themselves standout. And with the fierce competition for training posts, one does have to stand out (for the right reasons) or risk becoming one of the majority who fail to progress on the career ladder.
It is the nature of western medicine that a humble trainee who has excellent potential but is reticent will likely fall under the radar. I suspect that this is the case as well in the US system.
I have had numerous subcontinental and east Asian trainees over the years whom I would entrust the care of my family to. But they struggled to progress in the UK surgical training system due to a cultural predisposition of being modest to a fault.
It would appear that our young colleague with his ivy league pedigree is fortuitously(sic) not saddled with the ball and chain of a modest east asian predisposition. Still, if he truly is as good as he believes, then his patients and fellow Malaysians stand to gain from his return. In the end, the clinical outcome is what counts and it’s not like we’re out there playing happy families at work – even if it is nice to be nice.
Jon J, I agree with your comments, as a surgical fellow, I rather be operated by a skillful and competent surgeon who may be a bit arrogant than someone who is nice, with excellent bedside manners but has poor surgical skills. Many great surgeons that I have worked with (unfortunately) are not humble. I will however entrust my life to them if I require an operation!
Is the Malaysian masters (UM, UKM) training program better or worse than :
1) UK specialist training program
2) US residency program
3) Indian post-graduate training program
4) Singapore residency program
5) Australian training program
Based on your experience of final year Masters student. I just want to have an idea of how competent are they?
Which other countries recognize Malaysian Masters?
I am contemplating/thinking of Malaysian Masters – UKM/UM/USM as a career path.
My end goal is to be competent – and be well recognized in other countries as well (I would like to feel proud during international conferences of my alma mater)
p/s : asking for your experience/opinion. I know it will take a long time, but please don’t put me off… yet.
Every training programme has their pros and cons but each is suited to their own healthcare system.
UK specialist training is more established and well structured.
US residency system does not mean anything as you are NOT a specialist after the residency program. You are just a GP! Only after completing the fellowship, you can be considered as a specialist.
No comment about Indian PG as the standard varies. You can even buy one.
Singapore residency is something new , so can’t comment
Australian training is a well structured programme like UK.
Malaysian Master’s use to be tough and good those days. The failure rate was almost 50% in 1980 and 1990s. Many drop out along the way. BUT unfortunately, many of the well renowned academics have either retired or left the uni to private since late 1990s. This has caused a serious deterioration of quality among the Master’s graduates. Now, I am seeing many Master’s graduates who do not even know how to do simple surgeries. Malaysian Master’s is not recognised elsewhere except for some Middle east countries like Sudan etc.
How competent you are will depend on you. There is no more spoon feeding after you graduate. You learn the hard way.
Seethi,
That’s a very difficult question to answer. Each country’s vocational training system is best suited for that country to a certain extent.
The UK and Australasian vocational training programmes are very similar. The American residency-style programmes probably suits the practice in the US but not the way medicine is practiced in most Commonwealth countries. Similarly, UK-trained specialists will probably have to alter their practice somewhat if they were to practice in the US.
Indian postgraduate training is very variable and dependent on where you do your training. The top institutions are excellent but it would be difficult to comment on the rest. Much like their med schools I guess.
Singapore has switched from a UK/Australasian style system to residency-style training. Some training programmes have ditched exams altogether. It is in a state of flux now and some of my colleagues working in Singapore are also unsure as to what is going on.
The Malaysian masters programmes are also quite variable. Some departments have retained influential and excellent teachers whereas others have promoted lecturers based on criteria other than competence, and have probably suffered as a result. Visit the websites of some of these departments and check out the CVs of some Associate Professors. I know some excellent med students with better CVs. I do not know enough about every department in UM/UKM/USM (and now UPM and UiTM) to comment further.
If I were in a position where I could choose, I would choose US/UK/Aus/Singapore training over Malaysian masters, but not an Indian postgrad. Many will not have a choice because their undergraduate degree limits where they can practice and hence the postgrad training they can do.
The United States introduced the J-1 Exchange Visitor Visa Program under the Mutual Educational and Cultural Exchange Act (Fulbright–Hays Act of 1961). The J-1 visa was administered by the U.S. Information Agency (USIA) to strengthen relations between the US and other countries. It fell under the purview of the USIA and not the Immigration and Naturalization Service because its main purpose is to disseminate information; its goal is to give people training and experience in the U.S. that they can use to benefit their home countries.[6] These exchanges have assisted the Department of State in furthering the foreign policy objectives of the United States.
The J1 Program started by bringing scholars into the United States temporarily for a specific educational objective, such as teaching and conducting research. It then extended to several other Exchange Visitor Programs that shared the same objective, like the Au Pair, Government Visitor, Professor and Research or Short-Term Scholar, Work and Travel USA and the Trainee Programs. [7]
The program became the subject of scrutiny in December 2010 under allegations of human trafficking when it was reported that female J-1 visa holders were being forced to work in strip clubs, and again in 2011 when hundreds of J-1 visa holders walked out on strike at a Hershey’s chocolate plant in 2011, citing low wages, managerial improprieties, and abusive working conditions. They had paid for their visas with the impression that they would be given staff positions that would enable them to learn management techniques. Instead, they were assigned menial chores in a warehouse packing plant at low pay and long hours. The plant was operated by a sub-contractor to Hershey and had been staffed by a third-party agency. Hershey’s response was to offer a paid day of vacation with a trip to a local tourist destination.
Dr. Pagalavan, I stumbled upon your blog, your door was open and unguarded! No wonder Dr Ivy League sneaked through and trampled all you guys, surely good doctors.
Ivy League or not, people can still, believe it or not, be healthy, be happy adults, even without an Ivy League pedigree. They can EVEN have careers that are not only fulfilling but prestigious and remunerative. Yes, it’s possible.
If they do get into careers where Ivy League pedigrees are the norm, they will take more pride from it due to the fact that they do not have an Ivy League pedigree as Dr Ivy League (Jimd) has proven himself to be!
I know for a fact most Malaysian bred doctors are a wonderful lot who have scaled up on their own ability and no less successful and happy.
Of course we have very lucky Malaysian doctors who are “heavy majority fat-free milk” who rise above the cream, and the even the “heavier well connected milk proteins” who scale up too fast too on above all simply NOT because they are Ivy League pedigree but because they are “Ivy League” material in our Malaysian context as I read from Cap teko comment, when he scorched on Dr Ivy League.
I am not surprised if he is NOT of Ivy League class, as you read one such but real Ivy League doctor from a long ago incident from http://gothamist.com/2007/05/16/driver_arrested.php
People don’t just come into our corridors, degrading others and then claim “I respect your point of views and opinion. I however request that you respect mine irrespective of what your personal beliefs are.” just because Dr. Pagalavan seems like an honest and simple guy (I say nice and simple after reading your family outings post, doc), So Dr Ivy League just barges in, pulls down good people, and wishes to stay righteous.
I think Dr. Pagalavan’s blog or any blog for that matter, is not the right forum to show one’s true colors, especially someone talking about self glorification and worse still, using the same platform to mock others.
So i think Dr. Pagalavan, you need to tighten security on your blog comments and as for Dr. Ivy League, he need to thank Dr. Pangalavan for been a gentleman to say your piece and get away. Perhaps be gentleman enough to apologise to Dr. Pangalavan’s blog friends, who are obviously real people.
BTW, I am no doctor but a friend of good doctors still i our midst.
Thanks for the comment. My principle is “freedom of speech”. Since I started this blog more then 2 years ago, I have never censored any comments. However I presume any intelligent and educated person will give comments intelligently and not emotionally.
There’s nothing wrong with JiMD statement. How many Malaysian surgeons/physicians who actually have completed fellowship in Harvard/Mayo/Cleveland other than the elitist at IJN? Surgical training in Malaysia used to be impressive. If you read accounts of Bakri Musa when he was working and developing the surgical programme in HKL back then surgical trainees in Malaysia used to be the academic-scholar-surgeon type. Of course in those days getting into medical school locally was just as hard as going to Harvard given the circumstances. But now any dick and harry can go to medical school, recognized as docs by MOH then later MO with scalpel operating based on “experience” without evidence and proper tutelage. It is a case of the blind leading the blind these days. So yes their skills are at par with surgical technician..even MAs in the yesteryears are better surgical technician than the current junior MOs.
I’m sure those who are currently working overseas(OZ maybe) especially chillax, mint berry crunch can relate to their RMOs peers who used to be “experienced surgeons” back home ending up in different career altogether because they can’t survive in western system or simply not good enough to the OZ standard.
So yes in the end the cream will rise. But in Malaysia those who polish apple the hardest will rise. By the way Harvey Cushing was an arrogant surgeon who contributed a lot to modern neurosurgery and I’m sure he did not contribute much to the native indians in America like J Murtagh. See the difference?
Dear anakmalaysia,
Quoting what you had said, Harvey Cushing was an arrogant surgeon who contributed a lot to modern neurosurgery, but what has JiMD done ? (still awaiting his response to this question posted by Chillax on 23 July).
It is no point “ada gaya” ( being arrogant), but ” tidak ada isi “(but no contribution yet). See the difference ?
I think AnakMalaysia has missed the point.
It’s a fundamental issue of attitude and maturity. This blog has always managed to attract it’s fair share of “holier than thou” ppl over the years, and JiMD falls smack in that typical prototype.
When Dr Pagalavan first started this blog many years ago, it has become a great place to read an alternative-insider view of the state of our nation’s health system. We are trying to discuss and exchange opinions about whats happening to the system, and possibly keep un-interested people from entering medicine and regretting later. ITs a great source of information for people interested in our health system.
Obviously its bloody irritating when characters like JiMD come along and says something like “I plan to return to Malaysia and I do know alot of my colleagues are not in my league”. When a doctor says that openly, its a classic example of narcissism. And if he can say that on a blog openly, then I can trash his monkey ass openly also. IT is the internet, after all.
This is typical of doctors. Prestige, pedigree, etc, etc. YA we all know how important all this is. Unfortunately, it has also blinded the best of us and has made the profession the unethical corrupt beast that it is today.
Btw, Cushing’s surgical techniques have not just benefitted the native americans, but practically every minority group in the world. He was a pioneer neurosurgeon, and ppl all over the world flocked to learn from him. He has touched every kid with a hydrocephalus out there. Murtagh would have been elated to be mentioned in the same breath as Cushing.
This JiMD character more and more sounds to me like a typical wannabe.
the point i’m making is harvey cushing prolly didnt have any sense of humilty and yet he was an excellent surgeon and contributed to neurosurgery. Of course humility is long for but not required. How do u know JimD did not contribute to his field?
arrogant dicks are everywhere but intelligent ones are way better to have then stupid ones.
well hey this is the internet, trolling is common. if we want to be serious about our healthcare. we need to take it to street rather than become keyboard protesters. do you guys have the will ?
Like I said previously, the current system is beyond repair. Maybe thats why chillax and mint berry are overseas instead. What we need is a reset to the current system, amalgamation of medical schools, standardization of training by means of licensing exams. But Malaysia is no Gotham.
So maybe instead of repeating news of blunders and mistakes of our current government plans and policies maybe pagalavan should blog about solutions and more solutions to our current problem. i agree awareness is important but im sure we are all beyond that.
Dear anakmalaysia,
An arrogant man (like harvey cushing) who had contributed a lot to the society would be ‘ forgiven’ (by most people) and his arrogance will be ‘upgraded’ as being confident, but an arrogant man who does not have any significant contribution, will be ‘downgraded’ as ’empty vessel’. We (including you?) definitely do not know what JiMD has contributed to his field as we have yet to receive his responses on the question posted by chillax. on 23 July (the question is : what have you (JiMD) done?).
However, I do agree with your good points.
Should his arrogance (JiMD) be temporarily ‘downgraded’ as “empty vessel” until he has reponded to the question posted to him ? ie “What have you (JiMD) done?
Good News for Doctors…
Liow: Doctor, specialist fees to be revised up by 14%
KUALA LUMPUR: Doctor and specialist fees in the private sector are likely to see a 14% increase if approved by the Cabinet, said Health Minister Datuk Seri Liow Tiong Lai. He said the ministry carries out the revision every five years. It is now finalising the dental fees before a new structure is presented to the Cabinet for approval.
“We hope to bring it to the Cabinet this year,” he said after the ANOC Neuroscience and Orthopaedic Centre launch.
Liow said the fees were revised to make them competitive as the fees here were low compared with other parts of the world due to Government controls.
He said currently, the main complaints were not on doctors’ fees but the exorbitant hospital fees which the Ministry was working on resolving with the private hospitals, insurance and managed care organisations.
source: The Star Online
I doubt that. I think to discuss fee revision during election time means most likely this proposal will be ‘rejected’ on the ground of ‘rakyat didahulukan’. It is so politically incorrect to do this. I think this is propabaly a propaganda to raise this issue and later to reject it so than to give credit to BN.
Anyway, the high fee of private healthcare is not due to the doctor fee. The main bulk of the fee is due to the hospital charges which is not regulated. They can quote any fiqure. The doctors can also increase their income but billing thier patient creatively. E.g. A surgery like appendiciectomy or a LSCS can be charged additional with added items like adhesiolysis, BTL etc.
I am sorry to say Dato Liow is the worst health minister we have currently. He has no idea about healthcare judging from his performance so far. He don’t even know how a specialist is trained under current system. Most of the time he don’t know what he is talking about!
Actually this has already been in MOH since last year but was not approved by cabinet due to political reasons. Our fees has not been reviewed since 1998! The major bulk of charges(70-80%) in private hospitals is from the hospital and not the consultant fees!
However, I think it is about time for them to review it. Somehow I feel this is a political stunt. Nothing will happen till after the GE.
http://pagalavan.com
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appreciate the good points AnakMalaysia 🙂
It sounds good when doc fees to be revised but there will a be trade off..once the private fees are beyond affordability of majority of rakyat..then we will again hear the proposed 1Care to emerge…then the debate continues..
our health system is in shambles.
1. The public health system is under-performing and inefficient due to the management system in place and poor incentives
2. The private health system has high demand due to the under-performing public health system –> this drives the high prices in private care
3. equity is non-existent. Rich people are paying out of pocket or have huge access to insurance cards to private healthcare for medicine they don’t really need. Poor people and the deserved have to wait for appointments in gov hospitals despite have poorly managed diseases
4. Quality human capital (the good doctors, specialists and consultants) are leaving the public system to serve in private system, compounding the problem above.
5. The private health system is not being strictly regulated, and non-doctors who have control over prices drive charges higher –> doctors who do all the hard work dont get rewarded. Shrewd businessmen + big capitals pay a high dividend
6. The public health system is also tasked with training new doctors and specialists. The lack of quality trainers under competitive incentive structures mean the new doctors are not receiving the best training. Add to that a twisted postgraduate training system and you can imagine the problem we are having
7. The private health system tends to focus on high return healthcare –> procedure intensive and risk averse. As a result, the system is incentivized to push patients to undergo procedures they dont really need. This drives costs higher and higher.
I can go on and on….
Chill-dude, I’ve never quite figured out if you’re a health economist, sociologist or socialist! 😉
lolz! thanks Jon… ill take that as a compliment
dear dr pagavalan,
i am currently medical officer in surgical department.I choose this field since i prefer hands on skills,however after 2 years in these field i start to have doubt either i should continue this field and apply master next year or not..i am going to get marry soon and i do realize master program is not easy and even more for female doctors to balance with studies and family..it seem now the aesthetic medicine is getting popular in malaysia,i am wondering should i study master for this field which may offer me a better lifestyle?however i am bonding with the government for 10years since i m under jpa sponsorship..so will it be risky for me to quit government and join aesthetic? May i have have some advice from you..Thank you
There is no Masters in aesthetic medicine. Unfortunately, this sham of a specialty has gained increasing legitimacy and there are now diplomas out there that you can do. Aesthetic medicine practitioners are glorified beauticians. Nothing more, nothing less. Easy lifestyle and good money but a waste of a medical degree.
UCSI do offer “so-called” Master’s in aesthetic medicine which is not really a postgraduate degree. That is the reason the ministry is going to come up with a registry to register Aesthetic medicine doctors. Yes, many are venturing into this purely for money!! BUT don’t forget the high litigation rate and indemnity insurance involved.
Nowadays, a JPA scholar who resigns will have to pay back the penalty as stipulated in your contract.
I will offer a counter-view on this… however it’s best you seek a balance of opinions..
I’ve met patients/people who are very concerned about their ‘dermatological’ appearance. We are living in an increasingly superficial world where looks seem to matter more and more. These patients use modern technology like internet and forums and find out that laser treatment and chemical peels are quick fix for their perceived problems.
Traditionally, aesthetic surgery is the domain of plastic surgeons. It is expensive for patients as the demand and cost for plastic surgeons are quite high.
On the other extreme are beauticians, who can’t administer laser, botox, chemicals, etc.
Out of this dilemma, the experienced GP who has a special interest in skin and aesthetics has filled in the gap. Make no mistake, this is not just a Malaysian thing. Australia, Singapore, France, etc… the aesthetic physician is no more just a plastic surgeon or dermatologist… but GPs have joined the group as well, although in a more limited role.
Some are very successful, and truly make a difference to their patients lives. There are also horror stories of unqualified people decimating faces with badly administered treatment.
Yup, that is the reason why aesthetic is considered as part of medicine by all the medical councills in the world. However, we must have a proper registry to register the properly trained aesthetic medicine practiotiners.
well , that ‘s what we call a god complex. A human being who ignorantly rated him/herself as among the god,too good to walk among human.i know several colleague who claim the same,( with the pedigree and all) but fall rather shortly on many aspects.shame.
Hi, mcfan,
I do think It is good having goals for these young medical students, regardless of whether they are having them for money or for passion. The problem is getting medical specialist training posts nowadays are very difficult (either doing locally or overseas) due to limited places and many other criteria. If THOSE who think too soon (to become specialists), MOST of them would be disappointed, demotivated and demoralised sooner than others. This is one of the reasons why Dr Paga is having this blog – to reveal the reality.
My personal opinion is that young medical students should be encouraged/motivated to concentrate doing well or at least passing their MBBS exams first, and then aim to be a competent MOs. I believe It is not too late at all for them to plan what they want to do when they are in the system doing their housemanship.
http://www.theborneopost.com/2011/07/11/ministry-to-increase-specialist-surgeons/
Quality is more important. Are we going to see another “lambakan”?
yup, another “lambakan”. Obviously our politicians will be going overseas for treatment!
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I agree with you Jon. A certain level of self-confidence (at times confused with arrogance) is required to excel in surgical training in the western world. Subcontinental and East Asian trained graduates frequently fall short in this respect and hence tend to feel more at home with the physicians when working in these countries. There are of course exceptions and some adapt quickly to become ‘one of the boys’.
it’s not that we have too many doctors.it’s we do not have enough well-function hospitals and clinics. the population is about 27M, which if we have 27k doctors- 1 doctor shall take care of 1k population. roughly. and do we have 27k doctors? let’s say not all 27M of the population will be sick, well, does doctor only take care of the sick? in UK history, the doctors fight for cheap healthy foods like milk meat and vegetables. doctors also set laws like fine to the reckless driver who then will use civil money to get treatment. doctor also may fight for cheap/ free hospital service as like our neighbours. doctors is responsible for the well-being of the 27M. so, we have enough doctors?
YES, we have enough doctors. The total number of registered doctors was already 22K in 2009 and with almost 4 000 doctors entering the market in 2011, the number will be around 30 000 by now, which is more then the figure 27K that you quoted. AND this number includes all the doctors who are involved in non clinical field like you have mentioned above. The doctor:population ratio is targeted to achieve 1: 600 by 2016 and 1: 400 by 2020, according to the government’s statistic. If you include all the hospitals in this country ( private and public) , klinik kesihatans and private GP clinics, the numbers are more then enough to serve the population. The only problem is maldistribution. For example: klang valley has a ratio of 1: 400 already!!
So, we have enough doctors and glut will only get worst from now onwards. we will produce close to 6000-8000 doctors by 2016!
And just to clarify Dr P’s comments – that’s 6000-8000 new doctors PER YEAR .. after the ‘target’ has been met.
It’s not the number of doctors per se. It’s that we do not have enough hospitals in which to train them. There are too few hospitals in Malaysia with specialists and specialist services. Many ‘small’ towns aren’t actually that small anymore and should have more facilities in their hospitals.
This cannot open overnight. Even if you have the specialists, you need the trained nurses, technicians, radiological services, theatres, etc. All of this of course costs money. Even when this govt tries to build them, they can’t get it right (e.g. fungal infestation and leaking sewerage pipes in Ampang Hospital and of course the Shah Alam Hospital fiasco).
In an ideal world, even if we did have the hospitals and facilities, we would still overshoot our target of doctor numbers because the number of medical schools that have been approved are just enormous.
So basically, the years of chronic mismanagement has left us in a current, irreversible state. Typically, (oil) money will be spent to solve the problem. And if the solution is a pretty good one, then any financial gains will go into you-know-who’s pocket. Thats been the model of governance all this while.
Except now, even money cant solve this problem. So how? Let the system rot?
For JiMD his training is much more needed in Malaysia.
Also he sounded like a good son not wanting to leave his family behind in Malaysia.Probably he has a well off family.For the best way to make is to inherit it still
Are you implying that those who choose not to return to Bolehland on completion of their training are somehow bad sons/daughters?
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