I just received info that our DG is going to go ahead with the plan of opening up 1Malaysia clinics for GPs. The pilot project will be conducted at Kg Kerinchi 1Malaysia clinic. GPs who are interested will be paid an allowance on an hourly basis. This issue was first published in The Star , April this year . I was informed that there were mixed feelings towards this but MOH is going to go ahead with the plan. I am sure many knows that the offer for private GPs to work in Government clinics has been implemented since mid 2000. However, the response was poor despite the government paying RM80/hour with certain limitation of total number of hours. I know a few GPs and freelancers who took up the offer and end up earning more, with less work ( no administrative work) compared to the permanent MOH MOs. This caused a lot of frustration among the MOH doctors and thus some conflicts happened. The criteria for the private doctors to get a post depends of vacancy at the respective KKs. With most of the KK’s post are filled nowadays, the chances for GPs to get a post is almost nil.
Thus, now the government is trying to use the 1Malaysia clinics to entice GPs to work for the government. It is a Catch 22 situation. If the GPs are not keen, then the government will say that the GPs are money minded %^&* with no social responsibilities. If a GP take up the offer, he/she will be cursed by the rest of the GPs in that area! The rest will accuse this GP as trying to attract patients to his/her clinic etc etc.
I was also told that the government is planning to introduce a system where some chronic diseases will be passed to the GPs to manage. I presume he is talking about the impending 1Care system. The first chronic disease will be Hypertension. I have a feeling that this is to test the ground or a prelude to the introduction of 1Care system, which is being planned for 2014. For a beginning, the government may pay a fee for each patient but the patient may need to collect the medicine from the nearby government clinic pharmacy.
Well, as I have been saying all this while, many things may change along the way within the next 5-10 years. BUT no one knows for sure what is in store. There are many doctors who are staying put in government service and there are also a few who are rushing to open up a clinic, hoping they can become a panel for the impending 1Care system. Who has made the right choice is difficult to say at this moment. Whatever it is, life is not going to be easy for doctors in the future. You may still earn a decent living but don’t expect a luxury life or a return of investment.
I will be giving a talk for SPM students this Saturday 27/10/2012 12pm at SRJK(T) Permas Jaya on what it takes to be a doctor, life as a doctor and future prospect. Those who are in JB are welcomed. It will be in English, though I may mix some Tamil depending on the audiences.
Sayonara……………
Pagalavan's Avatar 
Dr. pagal:
do u mind having some one record your talk and post it up to your blog? i think it will pack a greater punch to visitors of your blog by adding visual effect rather than just words…
dont u think its a bit risky?
Which part?
im not sure, im just saying….
Risky in what sense?
Reading though your post i cant help but wonder if you have certain plan to improve this field in our nation.I’m sure among the readers,there are people who might have the power to improve this field but do not have a clue how.Maybe your list of suggestions could shed some light on matter of concern.From there, reader can compare and share their thought on whats would and wouldnt change today’s scenario.
The only person who can change this are the politicians!! That’s the reality. All suggestions are in this blog but you need to read between the lines. No matter what we say, the government is NOT going to listen. What they want are just votes.
hmm, maybe some of the remarks …are racist or…sensitive…though the issues are real. maybe it could land …in problems, as you know, simple things are are twisted or…for other people’s political gain. and there is no freedom of speech in msia.
So now the government dictates the kind of chronic diseases that GPs are allowed to treat? We’re supposed to look at the patient as a whole, not to just label them as the “hypertensive” one. Wow. Seriously? This is starting to get more ridiculous.
Dr. Paga,
Sometimes I find it difficult to reconcile with your views on the impending glut of doctors and your discouragement of future students to take up this profession.
On my visits to the Government of Tertiary hospitals I see quite a number of foreign doctors (e.g. from the Sub- continent, Burma, Middle East, Africa and sometimes Western countries) the merits of these doctors are at best questionable. If at all there is a glut, how and why are these doctors given employment by the Ministry of Health? I am not a health professional and this is my observation as lay person, your
say on this issue would be greatly appreciated. Thank you.
I am not sure which tertiary government hospital are you talking about? As far as I know, most of the foreign doctors which was recruited in early 2000 till 2005 is being slowly phased out. I know only a few still hanging around. Unless you are talking about the University Hospitals. These hospital do take quite a bit of foreign Master’s student as part of their international student intake. So, if you go to UMMC, HUKM or HUSM, you will see a lot of these doctors around.
MOH hospitals Do not employ any doctors from Africa or Western countries. Few Burmese, Indian, Pakistani and Bangladeshi doctors are still hanging around. These doctors were employed way back before 2005.
For example, the whole of Hospital Sultanah Aminah JB, there are only 1 Pakistani doctor in medical department and 2 Burmese MOs in Chest unit. The rest are all Malaysians.
We have 36 medical schools in the country , all the private and other then 3 public medical schools uses the government hospitals as their training hospital. Many of these colleges are dependent on foreign teaching staff from India, Pakistan, Sri Lanka, Burmese, Vietnam and even Egypt. You may also see these doctors hanging around in the ward.
Thank you for your detailed reply. I had the chance to be attended to by a Burmese doctor at the University Hospital, Petaling Jaya at A & E department. On checking the MMC register using her registration number, I found that she was given full registration on May,2012 expiring on May 2014.
She is a Medical Officer(maybe on contract) but definitely not a Masters student. This goes to show that foreign contract doctors are still being employed.
ACtually you are mistaken. You cannot compare university hospitals with MOH hospitals. The biggest employers of doctors are MOH hospitals.
University hospitals generally are not attractive for service medical officers. MOst of their Malaysian doctors are Master’s students. Thus, they lack service medical officers. Their salary scale is lower than MOH doctors. These hospitals are under MOHE and semi private. THis is the reason you do not see Malaysian service MOs in UH, even from those days when I was a student over there.
MOst of these service MOs will eventually given a Master’s post under the foreign quota. The 2 year contract is a prerequisite for this.
Dr Paga,
With only some 42 hospitals gazetted as teaching hospitals and 36 medical schools in the country, I would suppose some teaching hospitals have more than one, two or three medical schools sharing the hospital for teaching. Can these foreign teaching staff in teaching clinical skills to their students actually examine and touch the patients? Wont these hospitals be too overcrowded with too many medical students and teaching staff from one too many schools causing some disruption to actual medical care to patients? I just wonder as I do know that in Birmingham, England, there are some 15 teaching hospitals for 360 medical students from just one medical school.
Welcome to Bolehland, again. Yes, you are right. Some hospitals are being shared by atleast 2-3 medical schools, especially Klang Valley hospitals. The initial plan was only to allow 1 medical college per hospital but since 2007, the government decided to allow more than 1. MOnash came down to JB because by 2005, all hospitals in Klang Valley was taken up. BUT after coming to JB, suddenly in 2007 the government allowed more than 1 uni to use a hospital. The MOnash Malaysia management was upset and even wrote a letter to MOH then. Given a chance, Monash would not have come down to JB.
Most of this foreign teaching staffs do NOT do any clinical work like treating patients etc. However, they do teach bedside clinical teaching to the students. Yes, in some hospitals, the teaching do interrupt patient care.
you say ..” MOst of these service MOs will eventually given a Master’s post under the foreign quota. The 2 year contract is a prerequisite for this ”
I asked Univ Int Islamic Malaysia, there is no 2 year contract prerequisite, just several month of clinical attachment for foreign doctors wishing to do master of Obstetrics and Gynecology
You also say ” University hospitals generally are not attractive for service medical officers. Most of their Malaysian doctors are Master’s students. Thus, they lack service medical officers. ”
So at university hospital there are two : one is medical officer in service and another is medical officer studying master ?
Can’t the univ hospital use medical office in training to cover everything and to do roster ?
Thanks
Different universities have different rules. Some may be few months and some 1-2 years of contract MO job before being absorbed into training.
YES, some of the MOs in university hospitals are service MOs. the number of Master’s trainees are NOT enough to run the hospital.
http://www.heavenaddress.com/Dr-Richard-Teo-Keng-Siang/424153/379719/content. This dr teo’s story sound familiar to us. I hope this piece of article does give inspiration to those who wants to become doctor. Some may find some clue on which is the lucrative subspecialty field in medicine. Anyway I doubt any of those who read this article will realize the importance of life other than making money and wealth. History will repeat itself. I am very sure some of those dental students did curse themselves for choosing the wrong field.
Yes, I read this few days ago and planning to post it in this blog. He did also mention that many doctors out there are only interested making money by using patient’s weakness as what he did.
You said foreign teaching staff do bedside clinical teaching but not the clinical work like treatment (I know that some of them cant even practice in Malaysia but ironically, they can teach). But wont that be like teaching a sudent how to cook without actually doing any cooking? Does the same apply to local teaching staff and clinical teaching at the University hospitals? As a layman, I am just puzzled by many things in Bolehland
Clinical practice needs APC which they don’t have. Teaching no need APC. Local teaching staff if they got APC are usually allow to have their clinical practice.
That’s the reason why I keep saying that this concept does not work.
The situation is not the same in University Hospitals like UMMC, HUKM and HUSM. Here the lecturers work full time beside teaching
Reading though your post i cant help but wonder if you have certain plan to improve this field in our nation.I’m sure among the readers,there are people who might have the power to improve this field but do not have a clue how.Maybe your list of suggestions could shed some light on matter of concern.From there, reader can compare and share their thought on whats would and wouldnt change today’s scenario.
Hi GabaB,
the ultimate solution would be implementing COMMON QUALIFYING EXAMINATION (CQE) for all medical students, regardless local or oversea.
Malaysia is a developing country only in economy but not in health care system. The base of Healthcare in malaysia is medical education and the students who later going to run the system. Improving the system alone as your only treating the symptoms and not the underlying disease. Again, we should not treat the disease only but also need to treat the patient. Students are the patient and every problem in the health systems are the symptoms. Dr Pagalavan already identified the problems and he been creating awareness through this blog.
I am just a medical student, every day thrive for betterment and keeping his advise in my mind and working hard to achieve my dream to be a doctor. I personally welcoming the CQE , because im studying in unrecognized university. I’m putting double work than the local students. (only god knows)
Only through this exam, we can bring the changes. Who can make this implement? that is the question now! I sent message to MMA-Student council and no one bother my message because, i am not equals to them. In addition to this, the students themselves don’t like CQE for some reason. Malaysian’s students are too much pampered by parents, and the governments. For examples, SPM made easy, Foundation course became 6 months. So, how one will appreciate the value of medicine studies and the value of patients care. Starting from the beginning, they only dreaming about luxuries life.
Finally, every action has it’s equal reaction and hard work pays off. I believe in the above quotes always.
Honestly speaking, as a doctor who has practiced both in the Klinik Kesihatan setting for a few years, and am currently a physician, if I am a policy maker, I will not allow some of these GPs to treat my patients. First time hypertensive patients, prescribed Bisoprolol or ARBs without pre and post ARB renal profile, diabetics poorly controlled, first line abx for URTI Azithromycin, fever for one week just cont stepping up antibiotics rather than do an CBC, some of these GPs are just not fit to be even called doctors. The last one I met, told a patient to take her hypertension meds EOD, then biweekly and then on a prn basis. WTH?! How do I trust my patients to be seen by these GPs? Not to mention some of them hire house officers for locum
Yup, you are right. I have also seen enough and I have also written about this before under Malaysian Healthcare system for the dummies topic.
That’s because any muppet with a medical degree can be a GP in Malaysia. No assessment, no training programme, no further study – just open your own practice like someone opening a coffee shop.
When they hire locums, they have ‘recipes’ put up on the wall to help them. Basically, match the symptom with the drug and get the patient to pay for that drug. Even locums that know what they’re doing aren’t allowed to stray from that recipe (all about maximising profit).
this is medical malpractice!!
But, it is not shockingly, the same problems goes to Dentistry!!
A number of my friends managed to see some real examples of inappropriate management on their patients(done by dental GPs) during routine baseline intra oral radiograph in our clinical years in university hospital. things appear fine clinically but radiographically reveals malpractice….
There are many UiTMs in Msia. I hd checked the website….they do recruit International students as well. But, am not too sure if only open for Muslim International students. As for local…it is very clear- Bumiputeras only.
Unwritten rules, unchallenged criteria….
What?? Bumi’s only?? After 55 years of nation building?? Surely not?
No matter, at the rate the brain drain goes, there will be less and less non-Bumi’s to exploit in time. When Malaysia hits 80% Bumi’s how will affirmative action work since almost everyone will be equal…
That’s the irony, isn’t it? they are willing to take international students ( mainly from middle east countries) BUT not their own citizens of different ethnic! Pure discrimination when the entire university is supported by tax payers which is almost 70% paid by non Bumiputeras.
It is not an unwritten ruie. It is VERY much written, in fact in an Act of Parliament, no less, the formation of Mara, and now, UiTM. It clearly states it is only for Bumiputras.
As long as non BUMI s are given opportunity to study and work in this country,,be grateful men…stop racisim
Of course STOP RACISM!! The issue should not even be mentioned.
Hello again Dr. Paga! How are you? Hopefully you and your family are well.
Yesterday was the last day of medical school for me here in Western Australia. Feeling really sentimental added with some anxiety on leaving the Australian medical system and soon enough diving into the Malaysian Health system.
Just to share some insight on how it is in Australia compared to Malaysia…
In Australia, GPs are a compulsory part of of the primary health care system. Everyone has to have a GP and the GP are the frontline of the healthcare system. Hence everyone see GP first, then if serious or require further/higher level care then they will be referred to the hospitals/specialists. This is the mainstay in the public system. This is why GPs here in Australia have to qualify through the FRACGP before they could even practice! As they are the frontline who manage and filter patients accordingly.
In Malaysia, as GPs are basically Drs with money to open clinic but without any proper training/assessment on the wide variety/complexities of cases from cardiology, renal, dermatology, respiratory, neuro, msk and etc. It can be indeed dangerous for patients who see GPs and when patients only opt to go for the public system, it will flood and over work the public hospitals. This is why EDs in public hospitals and klinik kesihatan are so overcrowded with patients who some require minimal interventions that could be easily managed by a good GP.
I am also a little bit worried as many GPs are disconnected with current EBM (evidence based medicine) practices and are still practicing the same medicine they learnt 10-20 years ago.
Here in Australia, it is basically impossible for interns (= to HOs in Malaysia) to be able to do locums in GP practices. Only training GP registrars practice in GP practices as part of their training and registered GPs.
The bottom line is – it is about time to do things properly. If we intend to include GPs to the equation in the public healthcare system, proper training, assessment and accreditation is necessary. Not an option. GPs are once doctors too and not all GPs are useless – it is a worthwhile thing to give training to GPs through compulsory refresher courses or at least updating them regarding the latest practice guidelines through circulation of information (GOV websites, books, pdf books etc). We have a lot of good DRs trained from a lot of reputable medical schools from Malaysia and all over the world, I sometime wish that we could cut out the politics, racism, bureaucracy, senior vs. junior bullying,ego, and do our work properly. If not for the sake of the patients care, at so that people do not die because of substandard care not due to lack of expertise or resources. Hmmm…..
Absolutely correct. It will takes years to change our system which need a lot of political will. Hopefully the younger generation will pursue this matter.
Our DG is busy having sex nowadays. After getting caught for khalwat, will his position be affected? Personally I think he has irritated lots of people. Loss of hops Malaysia with this type of DG!
No he will not be affected. It’s a political appointment. many People are very happy with him, especially those in power.
Our DG has been suspended pending PSC decision on further action
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