Looking at the news everyday feels like, probably I will have to continue this title till Part 100 ! Just when I thought I had enough, here comes another news report from a Sarawak MP who came up with a brilliant idea ! No country will come up with these kind of ideas except in Bolehland. Why don’t MMC just close shop and create a free for all market! Then, definitely we will be seeing MBBS holders working as taxi drivers and cashiers.
It is a well known fact that there are many students from Sabah and Sarawak who goes to universities in China which is NOT recognised in Malaysia. This was one of the reason why our great Health Minister came up with MQE exams in 16 medical schools and ordered MMC to recognise atleast 10 medical schools in China (in progress). It is always politics in Malaysia. Politics should NEVER get involved in education system of any country. It will only create a mass. Education should always be left to the academics. I wonder how he came up with a figure of Rm 25 – 30 000 to sit for the MQE exams! And, what does he mean by excellence result? Everyone knows how some foreign universities give away their degrees. Money talks!
BTW, the country is not dependant on foreign doctors anymore. The remaining foreign doctors will be slowly phased out and many of the young doctors will be sent to Sabah and Sarawak as the posts in Peninsular Malaysia will be full by early next year.
An interesting letter was also written in The SUN commenting on their report on “No Oversupply of Doctors”, as attached below. The letter basically says almost exatly what I wrote here in my blog.
Call to allow medical grads to skip exam
BARISAN Nasional (BN) lawmakers yesterday proposed that medical graduates from reputed foreign universities be exempted from sitting the Medical Qualifying Examination (MQE).
Datuk Seri Tiong King Sing (BN-Bintulu) said this would help overcome the shortage of doctors at government hospitals.
“I’ve received many complaints from medical graduates, especially from China, that they have to undergo the exam that costs between RM25,000 and RM30,000 prior to housemanship at government hospitals.
“There should be a mechanism where they could be exempted, especially those with excellent results,” he said while debating on the 2013 Budget.
Tiong said the move could also help reduce the country’s dependency on foreign doctors.
The proposal was seconded by Datuk Mohamed Aziz (BN-Sri Gading), Datuk Ismail Kasim (BN-Arau) and Datuk Alexandar Nanta Linggi (BN-Kapit).
Dr Mohd Hatta Ramlu (Pas-Kuala Krai) said it was about time that the government looked into this, as currently there were many locals studying medicine overseas.
Later, Deputy Health Minister Datuk Seri Rosnah Abdul Rashid Shirlin told the house that the waiting period at emergency units of government hospitals was at a satisfactory level compared with other countries.
She said the waiting time for non-critical cases was just 90 minutes, compared with 120 minutes in Australia.
“Non-critical cases are classified under the green zone. More serious cases fall under the yellow zone with 15 minutes waiting period while the red zone, or critical cases, are accorded immediate attention.”
She added the ministry was taking steps to improve the waiting period, such as enhancing infrastructure at consultation rooms and extending the operating hours of clinics and hospitals.
Read more: Call to allow medical grads to skip exam – General – New Straits Times http://www.nst.com.my/nation/general/call-to-allow-medical-grads-to-skip-exam-1.155922#ixzz29Hm7eA5p
How many doctors do we need?
I READ with utter amazement (and some degree of amusement) “No oversupply of doctors” (News Without Borders, Oct 8). I beg to differ.
First, the article quoted “47 public and private universities in Malaysia producing 2,000 medical graduates annually”. I do not think that the figure is correct. In the news published in the NST, April 30, the health minister said that there are 3,500 “produced” annually. It is impossible for this figure to be reduced drastically to 2,000 doctors.
The MMC (Malaysian Medical Council) website showed there were 3,150 provisional registrations in 2009 and 3,257 registrations in 2010. Provisional registrations are given to housemen just starting work. Of course, the MMC figure includes graduates from outside Malaysia who would want to do their housemanship in this country. This comes to my second point.
Forty-seven public and private universities in Malaysia is a lot of medical institutions. We tend to overlook the number of Malaysian (and non-Malaysian) graduates from outside Malaysia who intend to practice in Malaysia. The MMC website shows that there are 358 medical institutions outside of Malaysia that are recognised in Malaysia.
Imagine if there are only 10 medical graduates from each of these universities wanting to practice in this country, we will have an additional 3,580 graduates. Of course, not all of them have Malaysian medical students.
The figure “10” quoted above is arbitrary, just for us to visualise the impact of the number of potential medical graduates. Bear in mind that those are just recognised medical institutions. We also have graduates from unrecognised universities who can still practice in Malaysia provided they pass their Medical Qualification examination.
The World Health Organisation recommends that we need to have a doctor to population ratio of 1:600. Now it is 1:800 and by 2020, we will pass the recommendation and achieve 1:400. In a mere eight years our doctor to population ratio will drop from 1:800 to 1:400. And if the number of doctors graduating remains constant (which will not be the case), in another eight years, there would be 1:200.
The problem arises when medical graduates are guaranteed a job in this country. It won’t matter if a medical graduate needs to sit for his or her final exams once or had failed their exams three times, they will still be guaranteed a job. To make things worse, there is no written exit policy for doctors unless the doctor starts killing patients.
With 3,500 doctors going into the service yearly, how many leave the service? If there aren’t any, or only a handful, then, it comes back to my first argument. There will be an oversupply of doctors.
Doctor
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hi doctor.i always wanted to be a doctor..but after go through ur blog,now i’ve changed my mind to any other course but i still wanted to stay in the same science field.what would be ur best advise to me?i wanted to take up biotech but x sure bot the prospect/future of it in terms of salary.how bot biomedical or any other courses?tq in advance for ur reply.
Hi Vikil! I’m a biotech graduate from the US. I just want to give u an advice.
DON’T CONSIDER BIOTECH AT ALL!! There is no prospect in Malaysia. Me, my friends, seniors and juniors all have suffered searching for biotech-related jobs in Malaysia. In the end, we ended up working in an entirely different field like Human Resource & Banking. Some started their own business. Others further their studies in Master/PhD with the aim to become a lecturer. If you’re into academician, then by all means choose biotech. If you want to become a researcher, then it’s better to work overseas. Since Pak Lah was replaced by Najib, BiotechCorp no longer receives a significant budget from the government. There are small numbers of private biotech companies in Malaysia, but most of them are looking for sales officers/managers to sell their products.
every PM have their own agenda! that is the problem in this country, no continuity………..
do what you are really interested and have passion in. Before deciding you need to know the reality out there. That is the purpose of this blog. If you have real passion and willing to put up with all the frustration, then go ahead. If not better to decide on something else then regretting later. Biotech is a developing field BUT not in Malaysia. malaysia DO NOT invest much on research and development unlike developed countries. Furthermore there are just too many biotech graduates nowadays. Welcome to Bolehland’s human resource planning!
Frankly speaking, the prospect for science field/profesionals is not that great in the near future. The money now is in technical field. In most developed countries, 60% of the job market are for people in technical field.
dr, what do you mean by technical field?
I am thinking of studying Biomedical Science in melbourne.
engineering, IT, automotive technicians, network engineer, software engineer etc. If you do biomedical science in Melbourne, pls get a job over there.
dr, want to know what you think about studying law too.
I think I have seen more law firms than clinics around.
I can’t comment but having a sister with a law firm, I can say that there are too many lawyers around. Unless you have a family member or close friends with a law firm to hire you, you may just end up as legal adviser for companies. The good thing about law is that you have many other options like being a legal adviser for companies, universities, lecturing and even government sector. Not necessary for you to become a court lawyer.
At least a law firm can hire 2-3 lawyers but a clinic is always a solo practice.
Dear all,
I’m writing out of concern after years of reading Dr.Paga’s blog. I’m sure Dr.Paga’s intention here is not to divert/change the minds of youngsters to do something other than medicine but instead enlighten everyone on the current situation of the medicine field. Although it may scare some off, i really hope those who r really determined to be a doctor still pursue this field. Or else we’ll end up with lazy,unmotivated doctors who got into these field because of their parents or other reasons (i.e status/money) who will resign as soon as they finish their compulsory service…ending up giving substandard care. Although substandard care is seen even among specialists with tons of experience.
So don’t lose hope, with qualifying exams or difficulty in getting masters.Prove to yourself, work hard and do not be deterred. Personally every department i went during HO, not a single specialist encouranged me to take up their course, complaining its not worth it. I was rejected twice for my masters although i knew i did better in the entrance exams from those who got it (was told by the dean herself&was even recommended…but dumb quota system in KKM). Now i’m pursuing my masters privately..who cares if it is recognised in Malaysia or not. As long as i’m self-satisfied with my progress.
The world is getting tougher in every field & saturated (unemployment is everywhere, in every country), so do what your heart tells you.
I hope we’r not chasing away hopeful candidates with this blog.
Thanks for your comment. As you have rightfully said, the purpose of this blog is to tell people the reality. Those who have real passion and determination, will still proceed and do well as they know what they are getting themselves into. BUT never do medicine for wrong reasons.
hello dr,
i could not accept the fact that why our malaysian people not welcoming common qualifying exam for medical graduate?; the medical student should able to go through such an exam with out fear and anxious as he / she already went through full medical course with plenty of exams.
Moreover, it is just an another exam we are going to face along the journey of medical life. I understand that medical studies is a continuous learning process. How come MMC not strict on this and why the government has to be afraid to implement this ? If the local students are competent enough, the would pass the exam right ?
I am not frustrating over this matter because im getting sensitized by your blog. all i wish is, there would be a fairness by the time im taking this exam. I made my mind to take my MEQ exam with one of the 3 public university with just RM200 because i believe my hard works will pay off . beside that, i wana get self sanctification in acquiring same knowledge with the local public medical student. I hope my dream will come.
thank you dr pagalavan.
i always value your advise 🙂
it’s called politics! Introducing common entry exam will put many MARA, JPA, Majlis Agama sponsored students into trouble if they do not pass the exams. This will have a lot of political implications which our great leaders will try to avoid!
Wow our politicians are really fantastic. In stead of letting the local medical schools to have extra income through these back door exams, he want to kill off their money source with this idea. This will further increase our foreign exchange loss as students now are more willing to spend in their respective unrecognized medical schools to ensure they get excellent result before they are back to Malaysia and ask for exemption! Malaysia meant BOLEH!
then can u suggest any field that have a good future in malaysia?tq again
Nothing is guaranteed in the future. Do what you are interested in
What ever happen to the “Pengarah hospital must meet HOs on a weekly session”?. As usual, knee jerk reaction without thinking syndrome.
hi dr pagalavan, i would like to enquire yr comment/advice on the prospect and future of the aesthetic medicine in malaysia. As we can observed, there are number of HO/MO rushing into this ‘so-called new field’ due to the good money return and the easy going life. Eventually this field will be saturated as well. As there are still no proper regulations from the authority in the near future, and no proper examination/trainning being conducted in any local University. How are you feel about this growing aesthetic field ??
Thanks you.
ng.
Aesthetic medicine basically means you are glorified beautician. Even though it is a recognised branch of medicine worldwide but it is NOt a speciality, atleast inMalaysia. The litigation rate is also higher and thus the high indemnity insurance. At the moment there is no proper regulation in monitoring these aesthetic practitioners and MOH is in the process of coming up with it.Everyone seem to be jumping into this purely for money.BTW, it is not a easy going life. If you mess up any one’s face, you will get yourself into serious problems. Remember, some of your clients are rich people with connections, including underground!
In the U.S, the most competitive subspecialty after internal medicine is Gastroenterology, and Cardiology. Reason is because, both are very procedural specialities, with median income of 300k to 400k USD per year, based on a work study report.
Is this the same for Malaysia? Or how about Singapore?
Yes, generally.
I am curious to find out how’s the lifestyle and income of various subspecialties of internal medicine – in the private sector.
Do you mind to provide your comment on the lifestyle, income and future demand of the subspecialties of internal medicine (cardiology, gastroenterology, oncology, nephrology, respiratory physician etc).
I think this would be an interesting topic that many readers would like to find out on.
I have written about this before. Please read my other articles under ” for Future Doctors” topic.
I read your posts, but I was thinking for of – insight into income and lifestyle of different subspecialties?
Eg :
– cardio –> median income about RMXX,000k per month, but have to attend to emergencies middle of the night?
– dermato –> median income about RM XX,000k, but only see clinic cases?
– nephro –> usually runs own dialysis centers?
The above are just my guesses
Thank you. Perhaps it may be too large a topic to discuss. Interesting, nonetheless.
whatever it is , you must understand that in private sector, you are all alone. You got no houseman, MO or registra to assist you. Income varies even within the same speciality depending on how strong the competition is, not only within the hospital but also with the surrounding nearby hospitals. And don’t forget the unethical practices etc.
I got impression that you might want to goose a particular specialty based on the how much xx,000 the income and the lifestyle. I think this is the wrong attitude of choosing the medical profession let alone being a sub specialist. This you make your life miserable during your journey o become specialist doctor. Perhaps a business venture is more suitable as you tend to see the money flows in much easier and faster.
Well, I am in the business field (health-care related).
I am asking this for my younger sister, who completed her MRCP recently and is now also finishing her gazettement.
I encouraged her to go for the medical course 10 years ago, and of course, she suffered quite a bit during her working years, but she managed to pull through.
She don’t really have any specific subspecialty in mind, but did mention to me before that being a regular internist is just not enough to make a good living.
Hence, I would like the opinion of Dr Paga. If an MRCP holder comes to you, asking on which subspecialty should she/he pursue, what would you advise her/him?
Or rather – similar to the same idea that one should not take up MBBS because its future prospects is not good, which subspecialty of internal medicine has poor prospects?
I think she should just do what she is interested in rather than where the money is. Nothing is guaranteed in the future. As I said before, many like cardiology and gastro because of money. Frankly speaking, cardiology is saturated in private sector. This is because, cardiologist can only practice in hospitals with cath lab. NOT all private hospitals have cath lab. Even if they have, how many cardiologist will each take? Maximum usually 3-4. Do you know that there are many cardiologist who are still looking for a place in private hospitals. As for gastro, many are fighting with surgeons in private hospitals since both of them do scopes.
I would suggest chest physician as the country is still very short of this. Many private hospitals are looking for one. However, by the time she complete the training, things may change.
Being a MRCP holder, she probably knows the sub specialist field better than you as she would have gone through all the training before she got the qualification. She should decide for herself based on her interest and passion to serve her patient.
Thank you for your reply.
Dr. Paga, what are your comments on nephrology, rheumatology, and oncology?
I personally find it my duty to research more options, and perhaps guide her. Reason is because – my parents and I encouraged her greatly to pursue her MBBS course. And now, it seems that what we thought would be for her a great paying job with easy clinic life is not what she is living now.
As for having interest, I would think that for a lady, good lifestyle with comfortable pay comes first.
I don’t think she knows much about the lifestyle/pay/demand of these subspecialties in the private setting, as she did mention that the doctors she mix with are those from the government side.
That is why I think Dr Paga, you will be able to provide a lot of information on this, because you are working in the private sector.
As I said, it is best to do what she is interested in. No point thinking about money and lifestyle as these are almost impossible in medicine. This is one of the reason why I started this blog. I am sure many out there are not aware of what medicine is all about!
I am a rheumatologist, I can say that only less then 15% of the time I see rheumatology patients. The rest are general medicine cases. Same goes to nephrology. As for cardiologist, nephrologist can only practice in hospitals with dialysis centre, thus limited.
How many patients can afford chemotherapy drugs in private hospital? That’s the reason why you don’t see many oncologist in private hospitals. Only big hospitals have oncology services and at the most they just need 2 oncologist.
I would suggest dermatologist if she do not want any ward work and just want to run a clinic. Even then, she probably have to run the clinic from 9am till 9pm everyday.
Thank you for your reply.
From what you say, dermatology sounds like a suitable field for those who want a stable clinic life. But I am also saddened by the fact that long hours of work still remain.
Looks like those who start the medical course is on a one way road to a busy life – forever.
Do you have any of your classmates who are sub specialist, but using their skills to run a business? Like nephrologist opening up dialysis centers, or those who go into hospital admin?
Passing by federal highway – I see the signboard of Ko Skin Specialist. Heard that he runs a successful dermato business.
Yes, I have friends who ventured into business BUT not medical business. They ventured into other business like food business, land scape and even selling insurance!! Who wants to sit and work for the rest of your life? That was their comment. IN medicine, if anything happens to you, your income will be zero! A lawyer, engineer or even a accountant who has his own company, his company still runs and he still gets his income, whether he is there or not! That is the difference between a medical business and others!
Yes, Dr Koh runs a sucessfull dermato clinic BUT have you heard about the tragedy that happened to his son? What he said after his son’s death tells you what a “successful” doctor lacks !!please read here and here
Is haematology a good field?
Yes but prospect in private sector is limited.
Pardon me for my ignorance but why do you say prospect in private sector is limited if it is a good field?
How many patients can afford chemotherapy in private hospitals? Those who use insurance will finish their limit with just 2-3 cycles of chemo. That’s the reason you don’t see many wanting to do haematogy.
Same goes to oncologist
Frankly, Dr Paga, I am very impressed by your endurance in answering the questions posed by the readers not just in this posting, but in many previous postings.I think people are not getting the point that you are trying to put forward.
Dear readers, if your question about medicine and specialization revolves around “which is the most lucrative/competitive?” then you have missed the point entirely.
There is no more guaranteed lucrative/competitive medical speciality anymore (barring very specific exceptions). The last bastion of low risk-high income medical subspeciaty fields evaporated with the saturation of medical graduates in this country.
In the past, being a humble general practitioner who owns your own practice or a premier general surgeon in a private hospital automatically means you are driving an imported European luxury sedan.
That group of people still exist, but they are smaller in number relative to the overall population and medical staff expansion.
The majority of doctors are struggling to break into the elite upper class, and are now defending themselves from falling into the lower class of society.
Just because a speciality is doing very well in another country does not mean the same is happening here. American, British and Australian medical fields are fast becoming distinctively different compared to the Malaysian scene.
The very notion of doing medicine for a ‘better life’ is already a paradoxical oxymoron, as previously argued multiple times on this blog.
Medicine is a sacrifice where financial rewards is no more a guarantee. You can choose to be unethical in practice, but that is no longer going to be easy in the internet and globalization led transparent-future.
You can choose a ‘difficult’ speciality, but the macro-factors (technology, consumers, education, information, income, etc) that decide what is difficult/lucrative is constantly shifting. So it is possible, twenty years from now, Rheumatologists may not be necesarry (dont take it personally, Dr Paga).
We do not want to give rise to a generation of doctors who are interested in conning the patient to compensate perceived hardship and financial investment borne by overbearing family members on that said individual.
Do medicine and specialize for interest and passion. Everything else is a bonus with an ounce of luck.
Primum non nocere.
Thanks for the comment. As I said before, many people don’t like to read nowadays or do their research.
BTW, Rheumatology almost went missing till mid nineties when the biologics came into into the picture!
there remain one specialty that will make u superrich -plastic surgery
I can assure you this is a stereotypical view of plastic surgeons and not necessarily always true! Most plastic surgeons made their specialty choice on the basis of the great variety and challenges posed by complex reconstructive surgery. The aesthetic side is a nice bonus. But the finest aesthetic plastic surgeons are also truly excellent reconstructive surgeons.
it can also make you super bankrupt!one mistake and a million dollar legal letter will be waiting for you.
to err is human-of course we demand the highest standard of care by trained professionals ,most doctors are covered by indemnity insurance anyway
i dont see plastic surgeons as particularly ‘vulnerable’ to legal redress as an obstetrician!!!
jonj- its not stereotyping plastic surgeons as the best paid/remunurated in the medical profession-its a fact!!!!
forget about your complex reconstructive surgery which is not that complex afterall-most plastic surgeons begin their training as orthopaedic surgeons before ‘venturing’ or sub specializing in reconstructive & plastic surgery-that was the route taken in the 80’s in all commonwealth countries ,perhaps its not the same anymore or not in malaysia???
by the time you are certified as a plastic surgeon it will be about 5-8 years after your FRCS .i think plastic surgeons should be well rewarded financially
Already being disrupted by “aesthetic” gp’s
aesthetic is different from plastic /reconstructive surgery
in fact plastic has encroahed upon the ‘territory’ of dermatologists and asethetic physicians
plastic surgeons are into filler,botox injections and light treatment aka lasers which was once the domain of the latter 2 .
‘pure’plastic surgeons are trained in reconstructive surgery but not in light treatment etc.however in the ‘real’world you kowtow to $$$$$
again you missed the point.
It doesnt matter how much you make today. Your specialty cannot guarantee you $$$$$ 5-10 years from now.
Unlike small business owners, specialists are not financially liquid and risk averse. They cant insure their skills. If their skills are not required, its time to tutup kedai. While I am obviously oversimplifying the concept, the idea still remains.
Entrepreneurs reinvent themselves every decade. Tony Fernandez was a chief executive at Sony before his current position.
As you said, plastic surgeons are trained for true reconstructive surgery. Very unfortunate that young Malaysians are losing their limbs and face every Hari Raya season in a rural because some plastic surgeon is busy filling up some old lady’s face in KL.
Whats the value of health and life anyway?
“Unlike small business owners, specialists are relatively not financially liquid and risk averse”
3 latest medical schools: quest international university Perak, university college Shah Putra and Asian metropolitan university.
Not latest, it has been there since last year. I have mentioned it. ASian metropolitan is actually Masterskill.
Dr Paga, thanks for your insights. At present time, would a specialist with MRCP be better off staying put in government hospitals?
if you want to go out, you need to be a sub specialist. I know many cardiologist are waiting to go out but no place available as most hospitals with cardiac facilities are full. If you are going to earn only RM20-30k/month, might as well you stay in government service. Most are getting about RN 10k in gov with min tax. I private sector, everything is taxable. Usually 1 month salary will go to tax. Furthermore, don’t forget you are oncall almost 24hrs a day 7 days a week.
“most are getting about RM 10K with min tax”.
Dr, how much is that min tax? less than other sectors?
Government servants only pay tax for their basic salary. All allowances are NOT taxable. Almost 40-50% of the total salary are allowances! So, you can make your calculations.
In private sector, almost everything that you earn is taxable.
Salam Dr,
I know too well about the fear of foreign doctors taking over a country’s Health System, in Romania it is the opposite situation, doctors are starting their residency/internship in Germany, France or UK’s Foundation year, fairly easy since our varsities are widely recognized in Europe, so we are lacking doctors in our own hospitals… Just a salary problem.
Anyway, since I will live in Malaysia for a year at least until my wife gets her UK family permit which takes ages, I wanted to begin Housemanship training for 1 year in Malaysia. But all thes stories about being sent to a medical programme God knows where….and after 6 years of uni …to pay at least 25k RM for extra training BEFORE the exam, not being to work for months ? and to be sent in other states IF Ill pass? Maybe I got the message wrong…
Salam Dr,
I know too well about the fear of foreign doctors taking over a country’s Health System, in Romania it is the opposite situation, doctors are starting their residency/internship in Germany, France or UK’s Foundation year, fairly easy since our varsities are widely recognized in Europe, so we are lacking doctors in our own hospitals… Just a salary problem.
Anyway, since I will live in Malaysia for a year at least until my wife gets her UK family permit which takes ages, I wanted to begin Housemanship training for 1 year in Malaysia. But all thes stories about being sent to a medical programme God knows where….and after 6 years of uni …to pay at least 25k RM for extra training BEFORE the exam, not being to work for months ? and to be sent in other states IF Ill pass? Maybe I got the message wrong..