2012 was a year with a lot of surprises and sadness for the field of medicine. In my various articles published in this blog, I had mentioned the challenges that future and current doctors will and are facing. I had given a summary yesterday about the performance of this blog for 2012. It had almost 520 000 views last year with the highest views per day was 4 887 on 25th March. Every year, my peak is always in March. Anyone can guess why? The answer: that’s when the SPM results are announced. Since I started this blog in January 2010, I always see a sudden increase of viewers to my blog about 2-3 days after the SPM results are announced. I hope I have given the budding doctors the true reality of the field of medicine. However, I always feel that many do not believe what I say. I still receive emails from many young doctors asking me how to quit medicine. They realised it too late! Anyway, I hope my total blog views will reach 1Billion mark by March/April this year (893 695 currently). Some of the articles that I wrote in September 2010 such as “General Misconception of being a doctor” and ” Housemanship, Medical officer and Postgraduate training” are still being viewed daily and has the highest number of comments.
It is not a public holiday in Johor for New Year. Thus, it is work as usual. Unfortunately, a death awaited me in the wards. A 63-year-old lady just died after a Massive Left MCA territory Cerebral Infarct. I use to say that doctors don’t save life’s all the time. It is ” to comfort always, to relive often and to cure sometimes”. Many at times we are just prolonging life. You do need a lot of luck to survive.
I wanted to write something about the screwed up education system of our country, initially but then I noticed that I had written enough about it before, like over here, here and here. I noticed that a lot of my friends have started to send their children to International schools this year. As like the mushrooming of the medical schools, there seem to be a sudden increase in the number of international schools since the government approved 100% local student intake since last year. Another money-making business. Our education system has gone to the dogs and it is creating a class and racial divide. The rich is going to International schools, private schools and across the causeway. The elites especially the Bumiputeras are going to MARA colleges, Boarding schools and agama schools. The insignificant “poor” souls are going to the national schools. Why the public especially the non-Malays have complete distrust towards the national schools? The answer is very obvious when you ask anyone. Racial and religious discrimination is very obvious in these schools. My relative who is a teacher in a national secondary school in Malacca tells me that the top 2 classes in her school are only for the top Malay students. The Non-Malays will be sent to the 3rd and 4rd classes even though they are among the top students there. This is not something new. Many years ago, in early 2000, the then NUTP Sec-Gen Dato Siva Subramaniam did bring up the issue to the government. A special committee was formed and they quietly closed the case. This is an interesting letter to read. We seem to be producing the highest number of straight A students in the world with NO quality!
I just saw the pamphlet below that was given to Standard 2 Muslim students during a religious celebration in an all girls National school. I got NO issue regarding the fact that everyone should be properly dressed BUT the way it was done. Look at this sentence at the right lower end corner : “Ciri-ciri mengenal kera memakai tudung adalah seperti berikut: ” and ” Cuba perhati sekelling anda, Ramai tak “kera” ? Is this what they are teaching a Standard 2 student is a national school? Is the dressing issue so important to be thought in this way to a Standard 2 student?
GOD save this country………….. Happy New Year everyone. It is an election year for sure ……………
Pagalavan's Avatar 
Probably still living in the past for the Malacca school.
Graduating from a National Secondary school in Subang Jaya, I’m pretty free from these racial discrimination academical wise in my secondary years. The best will still be the best whether you like it or not and academic merit is all matters to be in the first class.
However, things still do get racial stepping into tertiary, especially with the matriculation racial quota system. Though I’ve rid the system by entering the university using STPM, it’s still obvious when it comes to number. 24 chinese, 3 indians and 75 Malays? Well, the lecturers will beg to differ in the quality of the students to the quantity. Still surprised on how most of the number persist after 3 semesters though. Personally, knowing their grades can seriously question how’d they got into the program at the first place.
Generally, this sort of racial issues occurs in schools where majority of students are Malays. In town schools like Subang Jaya etc, the have a good mixture of Malay and Non-Malay students and from upper class community. Thus, they don’t dare to do it
It is rather sad to see that pamphlet. All that tells me is that some people believe it entirely justifiable to denigrate others and call them apes on the basis of religious ideals.
How does a child of 8-years then go on to learn respect, tolerance, consideration and care for their fellow human beings if they are being moulded in such fashion from a tender age?
Doctor, I apologize if the question above sounds very shallow and insensitive, please enlighten me,
In the case of the 63 year old woman highlighted above, why is it that the deceased require your attention as a rheumatology specialist? Because according to my understanding, her condition is some sort of a stroke right? Also, why does she need any medical specialist’s attention? Considering that there’s no more treatment plans left for her…why is it that her death awaited you in the wards??
Rheumatology is my subspeciality. I am an INternal medicine specialist before I subspecialise in Rheumatology. Thus I can treat any general medical cases. In private hospitals, all patients are under a specialist care. There are NO housemen or medical officer.
It is a massive stroke which is almost fatal but we still need to treat them as much as possible, hoping for the best!
he is rheumatologist but his hospital does not have neurologist, so he happily takes over the care of patient. If patient came early, he should refer patient for thrombolysis with tPA instead of keeping it. however we assume patient coming late, with massive oedema or hemorrhagic conversion. That is why said fatal.
another thing what we can say even though patient came late, but the hospital does not have neurosurgeon. So craniectomy cannot be done for decompression. That is why he said patient is fatal. Again i will salvage patient no matter how, just refer as simple as like that. Unless he said everything is not available in Malaysia. Speechless.
FYI, pt’s pupil was already fixed and dilated with cheyne- stokes breathing. I can bet you that even if you call all of the neurosurgeons in this country, no one will take the case!
Again, pls don’t accuse others when you do not know the details.
Haha, the person who said that private doctors throw the shit to government hospitals is now asking us to refer no matter what. Speechless!
Salvaging is one thing, quality of life is another issue all together!
dont be overreacting. as what I have said, if patient came late, that it is too bad. I agree with you, quality of life is important. anyway r u going to tell the judge like that in the court? for me, most of time we r doing something to satisfy patient or family as long we do no harm to patient. if u said quality of life, indirectly r u saying morphine using doctor (palliative) should not exist? this is my personal view as a layman to challenge you this big doctor. put aside the issue of throwing shit to gov hosp, patient safety comes first.
Throwing shit was your statement!! Not mine. I am NOT overeacting. It is you who is accusing others of not doing their job! Stop accusing or I will bar you from coming to this blog. And stop saying you a layman, I know who you are!
NO, doctors who satisfy patients and relatives are NOT doctors! Doctors are people who assess the situation and tell the relatives the prognosis. AND you are doing harm to the patient when you send them home as a vegetable!
I never quite understand why Dr Paga even bothers to dignify your straw man arguments by entering into debate with you. Dr Paga would easily pass the Bowlam test on any of the cases he has raised in his blog.
Bolam rather… darn autocorrect
Sending home vegetable = doing harm to patient? I have no comment. Since we practise in different country and I have left Malaysia since long time ago and there is no community hosp in Malaysia, that is why we have a lot discrepancy. You may be right in ur own way. And I may be not wrong at all time, just we r in diff places. Anyway u should practise in somewhere where euthanasia is legalized.
Passive euthanasia is legal in almost all countries. Suddenly you are NOT a layman!! What a lie!
If you are not practicing here than you got NO right to comment anything about this country. Pls leave this blog for good. The next comment from you will be spammed. Liar and manipulators are not welcomed. I am sure the rest will agree.
Yes. Sending a pt as a vegetable is doing harm to patients. That’s the reason why palliative care exist. Are you going to ventilate all terminally ill patients?
Anyway I am barring you from this blog. I think you seriously need psychiatric help.
How about the racial issue at post graduate training / specialist training at UM, UKM, USM ? Does the director of program ( who has MBBS diploma from abroad, FRCS/FRCP and other titles ) discriminate those who are non-Malay ( especially Indian ( or South Asian ) and Chinese ?
How fair is the entrance exam / interview especially in favorite specialist training ?
Is orthopedics training at UKM good enough ?
Happy new year 2013
You can find out by talking to people who have gone through the programs
Actually not really true. In UM at least for my batch, they get majority of the candidate for my discipline from Indian Universities graduate and non malay. maybe a coincidence. How fair is the entrance exam? I presume if a Malay passed the exam, this is favorism and frault maybe involved. If a non malay failed the exam this is definitely racism. Sad truth for malaysia, everything is along racial line only.
It is too sensitive to say that but you are telling the truth. While doing medicine in the national university,top and briliant students always come from some groups. You all know what I mean. Just look at the hall of fame of each university. No intention to hurt anyone here. But the system make certain groups even weaker and non-competitive.
To all who claim racial seaves are used in the selection of candidates for medicine or postgraduate education.. why state something that is obvious? This is not just medicine but extended to all national policy.
The more important issue is the socio-political reasoning behind this seave. And it can be both argued as right or wrong. To state that a certain race is more competitive than the other itself is racially tinged.
The point is, do the best that you can in your given situation. Be thankful for the oppurtunities that you have. That itself is enough which many don’t do.
Discrimination is coin with two sides. The end of discrimination means the eradication of the human perception of his/her own social identity. Is that possible? No.
I am not saying discrimination against races is good and should be encouraged. All im saying is dont use THAT as a reason why you cant be who you want to be.
Sir,
Here’s something I feel unhappy about. It is about HUKM dispensing Vit E only to a certain ………………
It is so wrong. I believe many doctors will treat patients irrespective of race or religion.
https://twitter.com/HarithIskander/status/281396283221098496?uid=803975815&iid=ad54066c-91e9-4f14-9188-9535bcd7fc5d&nid=85+513+20121219
I have a feeling that it may be related to some research. We need more info before jumping into any conclusion
Just verify with my friend in HUKM. It is related to a research study. They are trying to eliminate the bias for race. It is sad to see people jumping into conclusion that this is racist. Why not they blame HUKm for being anti young group, anti smoking group, anti sick people and anti those have no surgical history.
Couldn’t HUKM be responsible enough to include in the notice that it was for a research? Even if had been written by some minion in the department, it should have been vetted by the co-ordinator. Racial sensitivities aside, it’s basic professionalism.
I think HUKM is just naive without consider that most Malaysia are racist and think along racial line. It is their fault for such ‘mistake’. They already taken down the banner and new one will probably up soon.
Agree that HUKM could have done a better job. It is their fault for the misleading notice. The rakyat are ok despite a whole generation of “superior” conditioning given.
Dr. Pagavalan: Kindly put in a pseudonym for my previous post..I posted my real name LAU YOKE FHAN. But I don’t want my son to read my post as he is feeling bad enough
in my secondary school, they is no racial prob. as if they’re the top students, then they have the right to get the 1st class. i’m a Muslim. In our religion dressing issue is important to be thought since young so that they will not away from the right path. About they wrote the ‘kera’ maybe just because they want the student to realize but i know it is not too suitable for standard 2.
Not only for STandard 2. You should NOT teach religion by degrading others.
Dear Dr. Paga,
I hope 2013 has been a good year so far for you and your family.
It is a sad reality that religion is taught in this manner. Just wanted to say that teaching the young basics of religion, good mannerisms, courtesy and common sense should not be done through degradation of others, racism, comparison with animals and sarcasm.
It is becoming a worry that more and more people are growing up to become educated on paper but sadly in real life a very nasty human being.
yes, exactly
Well, that was disheartening. Embarrassing, even. It’s so sad to see that some people are still so shallow in their thinking. I think my school never got to such starkly blatant racism simply because the non-Malays made up the majority. The furthest hint at any racism was that the principal insisted on a 3:2:1 ratio of Malays: Chinese: Indians in our choir before we could perform in Putrajaya.
However, my Bahasa isn’t good enough to appreciate how bad the pamphlet is. What does kera mean? Google yields ‘pitcher plant’ but a friend claims it refers to a certain primitive cousin.
And what can we do about this problem, doc?
What problem?
Hi Jon J,
Guess Lin’s problem is either
1) Not sure whether ‘kera’ is ‘pitcher plant’ or ‘a certain primitive cousin’.
or
2) how to stop “others” from calling “others” as “kera”
Kera = monyet = monkey.
And what problem are you talking about. National or school level?
Are you a voter?
Sorry for the lack of clarity in my comment. I was referring to the general education system issue and how the younger generations are being brought up. Seems like the public schools are really dropping in standards if there are these racial classroom segregation and teaching such nasty terms like “kera”. In fact, I heard a similar such ‘racial’ incident in a prominent KL boy’s school years back. The school principal insisted that for every non-Malay student that wins a prize/medal/trophy for any category, there must be a “best” Malay student picked out to accompany that non-Malay on stage to collect his prize. But when a Malay student emerges top in a category, the principal doesn’t bother to pick the “best” non-Malay as well. This outrageous practice stopped when the principal retired.
So far I don’t see such issues in Chinese schools, I hope it stays that way. I believe school culture plays an extremely important role in a child’s molding. I’ve never seen Malay or Indian kids becoming racist in Chinese schools (be it primary or secondary). Just an observation and am not condemning other people.
Yessir I am a registered voter. This would be my first time voting.
Vote wisely……….
Sent from my iPad
Hi Lin,
Sure, no such issues in Chinese schools. Instead they teach you the following:
– do business only with other Chinese (after all, Malays are lazy and Indians can’t be trusted)
– hire only Chinese in your company, usually under the pretext of being able to speak Mandarin (check the ads in the papers)
– bribe government officers to get your projects approved (to the point where these officers now universally expect bribes)
– complain about having to adopt Malay cultural norms in what is a Malay country but more than eager to ape Western culture
– cross the road if you see a young Indian man walking towards. He must be a thief or a gangster.
Racial stereotyping is everywhere in Malaysia. MARA schools and Chinese schools are equally guilty in preventing true racial integration from occurring in Malaysia (Tamil schools are dying a natural death anyway). This fragmented education we have, with the excuse of ‘preserving culture and language’ is the primary cause of racial division. If you don’t grow up with children of other races, you will never learn to accept them as part of your social life as an adult. The Chinese right-wing educationists who refused to accept the Wawasan schools or PPSMI are no better than Malay right-wingers of the Perkasa mould.
FYI, I’m not Chinese but my 3 best friends are and I speak fluent Cantonese.
“Sure, no such issues in Chinese schools. Instead they teach you the following:
– do business only with other Chinese (after all, Malays are lazy and Indians can’t be trusted)
– hire only Chinese in your company, usually under the pretext of being able to speak Mandarin (check the ads in the papers)
– bribe government officers to get your projects approved (to the point where these officers now universally expect bribes)
– complain about having to adopt Malay cultural norms in what is a Malay country but more than eager to ape Western culture
– cross the road if you see a young Indian man walking towards. He must be a thief or a gangster.”
Nav,
I always have high regards on you being sensible and rationale, it seems I am wrong! If you say “MOST” Chinese only doing business with Chinese, hire only Chinese and bribe government officers, it is still acceptable but is not totally correct. It is very irresponsible for you to just “generalise” and “blame ” the teaching of Chinese schools!!
Being not a Chinese, having 3 Chinese as your good friends and able to speak Cantonese, do not mean it will qualify you to make such irresponsible statements.
It MAY be true that “MOST Chinese’ hire Chinese, and “SOME Chinese” bribe government officers, but it is not the teaching of “Chinese Schools”. Those you mentioned happened to all races (either black or white, brown or yellow) locally and worldwide.
The ‘kera’ case mentioned by Dr Paga in this blog is a different issue because he had posted proof of pamphlet being distributed in that school. But do you have such pamphets from any Chinese school advising their students to only hire Chinese, to bribe government officers (the wrost accusation), the Malay are lazy and Indian cannot be trusted? Or are you reading from newspaper advertisements (on recruitment ads) and news (on curruption cases) and then put all the blames on the teaching of Chinese Schools? Is it a fair statement from a person like you with high education? When a person practises what you had mentioned (such as bribing government officers or hiring their own race), I personally feel that It is more on family background, upbringing, cultural and peer influence, enviroment and the individual’s personality. These are also some of the reasons why some principals and teachers had created racial problems/issue in schools. IF you are teaching in a school or university (that is worse!), the chances of you being a pontential racist teacher/principal/lecturer instilling all these accusations to your students are very high.
Do you have children? With your attitude and mindset, I hope you have not ‘poisoned’ your children in Australia that Malaysian Chinese only hire Chinese and do business with Chinese, bribe government officers, Malay are lazy and Malaysian indian cannot be trusted. Even if you feel very strong about these ‘grievances’ happening in Malaysia, please do not blame it on the teaching of “Chinese schools”, as I have said it is more on family background, upbringing, cultural and peer influence, enviroment and the individual’s personality and it happens to all races locally and worldwide.
“– cross the road if you see a young Indian man walking towards. He must be a thief or a gangster”.
Dear Aunty Nav,
That’s interesting! Please advise what should I do when I see a Punjaji aunty like you walking towards on the road?
FYI, I am non Indian.
The first half of my previous post, on what is taught in Chinese schools, was sarcasm. If that wasn’t obvious to anyone reading, then I apologise.
However, I completely stand by what I wrote after that. A segregated education system does no good for nation-building. Different communities that do not learn to interact with each other will inherently distrust one another. With the increasing Islamisation of our national schools, I do not blame more Chinese for opting to send their children to vernacular schools but there can be no real social cohesion unless we have a single education system where no community is disadvantaged in any way. Unfortunately, Malaysian politics will not allow that to happen any time soon.
It is not so much on whether it is a single or segregated education that allows or prevents us from interacting with others, it is more on the failure of our systems that had segregated the rakyat. When they (students ) are in primary schools (regardless they are from national or vernacular schools), the segregation is less because most of them do not know what do quotas and merits are meant for. The segregation grows when they are in high school because they know the true meaning of quotas and merits in Bolehland. Even if the government is to put the whole population staying together in a special XXXL longhouse interacting with one another all years round, the segregation will still grow unless some systems are changed.
Anyway, Thank for your effort (and sincerity) to apologize in this blog for the ‘sarcasm’ you had made. No hard feelings.
A girl had told me that she starts hating a childhood best friend ( another race) from the same national school, primary to SPM, when she failed to secure a scholarship. Her result is much better but the ‘quota system’ may had failed her. It is the quota systems and the special privileges (awarding contracts or buying properties) that has segregated the rakyat.
That is why I always say, no matter what they do, vision schools, NS, sloganism, etc, the reality hits home after Form 5. Hate may be too severe, but certainly the friendship will distance itself, if nothing else, because the pathways diverge.
I absolutely agree with what the 3 of you wrote above. Institutionalised racial discrimination is probably the major factor in preventing true racial harmony.
I know I present a somewhat radical view when it comes to vernacular schools, especially since many non-Malays view it as their right. Imagine this though – what if all the racist discriminatory policies in Malaysia were removed? You would still be left with a situation where most of our children do not mix with those of other races until after secondary school, despite living in one of the most multiracial societies on the planet. That is why I see vernacular schools as one of the barriers to nation-building.
Anyway, I have had to alter my views somewhat in the past year because the govt has decided to allow open access to international schools for all Malaysians. This means a new divide has been created, one of class. Rich parents of all races will send their kids to these schools because they have no faith in the national education system. That of course is their right. I would probably do the same if I were living in Malaysia and could afford it. There is a huge boom going on due to the overwhelming demand, with some universities even opening international schools.
I don’t see any way back for the national schools. The government invests more in MARA schools because all the best Malay students get sent there. The chinese community never fail to rally around their local chinese schools and donate money for sports, new buildings etc – something I admire greatly – because they get no support from the govt. Teaching is seen as a last-resort profession, something you do only if you can’t do anything else. Even then, all the best teachers are offered jobs by the international schools.
A somewhat radical way to solving some of the problems of national schools (just my thoughts & opinions):
– Make Mandarin compulsory for everyone to learn in National schools (you take away any ‘advantage’ of vernacular schools + Mandarin is an important language to learn these days)
– Stop/prevent islamisation of national schools. These schools were fine 20 years ago without it. Parents who wish their kids to be in that environment have the choice of sending their kids to sekolah agama.
– Invest in the teachers. Pay them well, and hire only good ones. You will need to decentralised teacher hiring to do this efficiently because you can never really get rid of an underperforming civil servant.
– Do not discriminate on race in schools. The quota system is a wider issue and we can talk ad nauseum about that.
nurul. ..
dr paga is a muslim. ..
🙂
Is it true?
Should it matter?
What an odd question…
Not only should religion be kept out of school, it has no place in government too! You and your GOD, me and my GOD should be kept private. Otherwise, arguments will start on whose GOD is better and finally lead us into fights and disunity. The kera case above is just but an example.
Just my 2 sen.
Hai doctor,how long have u served in the government before going for private practice? Can you tell us more about your history like when u take mrcp?how long it took for u to finish yours?what age?etc..then how long with gov as specialist?what age you go to private sector?it would be interesting to know,giving us some idea on what to expect more or less likely.. 😀
Actually, a summary is available in this blog. Read under “About me”.
Best news today – aaron banned! About time, Dr Paga!
Dr Paga, Aaron is a first class Troll. The definitive management is operative debulking.
http://en.wikipedia.org/wiki/Troll_(Internet)
and Jon’s correct.. .dont bother with these type of characters.. we will trash him for you..
30 years ago when internet trolling did not exist, head cases like him took out their issues by becoming MRCP examiners! 😉
Thankfully such characters are now dead (the always refuse to retire), demented or sacked from Royal College exam boards.
the other issue is that some of your replies to Aaron did have some details that should have been kept confidential. Cant help but wonder whether Aaron was baiting you to reveal these details..
in any case, just watch your back
I have already spammed him. Thx for the support.
Even if you have spammed him, he can still use another new email to ‘kacau’ u. The best method is to ignore him.
Well the same thing happen in singapore.the malay is being suppresed by the gov.i think anywhere in this world true equality never really exist.unless if u r an idealist, a hypocrite and live in a fantasy world.
This is terrible; I never knew that Singapore also had substantial racscist policies enshrined and condoned within its national constitution.
Nothing substantial, just Article 152 which they ignore:
“The Government shall exercise its functions in such manner as to recognise the special position of the Malays, who are the indigenous people of Singapore, and accordingly it shall be the responsibility of the Government to protect, safeguard, support, foster and promote their political, educational, religious, economic, social and cultural interests and the Malay language.”
[…] bawah tempurung” graduates who get a shock of their life when they enter working life. In my New Year 2013 post, I mentioned what is being distributed among Standard 2 students. So, together with this new video […]
well, i agree with your say doctor. i was one of those affected due to the racial classification during my secondary school in negeri sembilan. such bias situation happened every single up-to form 3, i used to come back home crying even with good grades there were no upgrading of classes due to the ratio as followed by 20 : 10 : 10, during that time in our school.
Nav
Referring to your comment on the school system, if what you recommend in your comment is implemented I will gladly transfer my children back from international school.
International school has their own sets of problem it is not all roses as people sees it. Malaysia school system and syllabus is good but it is the implementation and the ‘extras’ in it that is the main problem.
Hai doctor, what do you think about doing usmle for residency and specialization training in usa? If one is a jpa sponsored student,is this possible to do? Or no chance? Also,to do specialization in malaysia, do you have to PAY for that specialization course? Is master progrmme for surgery only?not internal med?again, do you pay for the training?i heard that you are PAID $4000 per month by the hospital in usa for the training and not you paying the hospital as in malaysia. True?im not sure though. People said you can be a specialist at age 30 in usa.
Specialist at age 30? What specialty did you mean? I don’t know about physician specialties, but in surgery, even if you have the paper qualification, you’re unlikely to be sufficiently experienced at age 30 to be an independant Consultant specialist surgeon.
There are 2 aspects to being a specialist. One is the paper qualification, the other is the skillset and experience. Because surgery is a practical skill, you can’t cheat time. Numerous studies have shown that it takes an average of 10,000hrs to become expert at a technical skill.
But of course most high school and medical students can’t ever seem to believe this when they are told just how long it takes. Most appear to dream of becoming specialists in the shortest possible time so that they become millionaires in private practice ASAP. Wrong career choice if that’s the intention.
I think you should spend more time reading this blog. ALL the answers are available in this blog.
As a JPA scholar, you are bonded for 10years and thus you need to pay the penalty if you were to leave.
Passing USMLE dOES NOT guarantee you a residency slot. You also may not get the speciality that you want to do. FUrthermore, you are competing with the whole world and their own citizens graduating from overseas. I know many who did not get a slot. It is also expensive and a lot more money need to be spent to get a post. If I am not mistaken, the total number of IMG matched for residency last year were less than 4000. India tops the IMG list.
There are Masters program for every field. YOu don’t need to pay anything as JPA will give full sponsorship to everyone accepted, of course with a bond. IT is mandatory to take the JPA sponsorship.
NO, you can never be a competent specialist by the age of 30!! US healthcare is totally different and finishing residency does not make you a specialist. You are only equivalent to a generalist aka GP.
Can you become a competent specialist after MRCP?
NO. MRCP is an entrance exam to speciality training. You need atleast another 3-4 years of training before being competent. Malaysia is still following the old system of using MRCP as an exit exam. However, recently the MOH has come up with strict 4 years training before being gazetted as specialist.
Senior high school : age 18
pre-med college in USA : 4 years
Med school USA : 4 y
Residency : 3 y internal medicine
internist : age 29 years
salary resident : http://www.umm.edu/imres/sal_ben.htm
Completing residency in US does NOT make you a specialist. It is equivalent to a GP. Their healthcare system is different
Yes it does. If you undergo Opthalmology residency, you come out as an opthalmologist. If you want to pursue further, you can go for fellowship to become a neuro-opthalmologist or a pediatric-opthalmologist for example.
To become a GP, you need to undergo “Family Practice” residency.
Yes, but this so called ophthalmologist are not allowed to do many procedures as their training scope are limited. That’s the reason why they only call those with fellowship as specialist.
If one finishes opthalmology residency, one can work in private as an opthalmologist – doing procedures which opthalmologist normally do, and seeing regular eye patients.
If you don’t call this a specialist, then what do you call it? General practitioner who does cataract surgery?
Cataract surgery is bread and butter surgery for any opthalmology trainee. Even registras can do it. I have seen enough numbers of so-called specialist who claim have completed residency from US, Taiwan etc but unable to make any decisions or do any proper procedures. THe healthcare structure is totally different between US and many asian countries.
I have no qualms about “competency and residency”.
I am just trying to correct your statement “Completing residency in US does NOT make you a specialist. It is equivalent to a GP.”
If completing opthalmology residency in the US or Philippines or Russia makes you equivalent to a GP…. does a GP perform cataract surgery?
I hope I make my point clear.
You made yours about “competency” clear as well, and I understand what you mean. But here we are discussing about the term “specialist”.
the salary quoted is annual salary, if I am not mistaken. Furthermore, please don’t forget the tax and medical indemnity premiums which are very high in US. Please read this which is an interesting article http://www.physician-salary.org
when you finish residency ( in USA ) you must take ABIM exam, then apply job http://www.abim.org/certification/policies/imss/im.aspx
job at journal of american medical association :
http://jama.careers.adicio.com/jobs/browse/category/internal_medicine
ABIM exam is not compulsory and it also does not make you a specialist. You are an internist doing GP like job. Specialist training in US is under fellowship. You must understand that the healthcare structure in US is totally different. Look at the residency training program and see what they really need to know. It is very basic and they don’t need to know any procedures!
Probably it is because their residency program is more geared towards their subspecialty of choice. If you want to be a surgeon, you do residency in surgery, opthalmologist in opthalmology department/hospital and etc etc. I read somewhere that some malaysian are considering usmle due to glut of doc in malaysia and cant really learn much with too much houseman. If you get usmle score of 240 n above, its easier for u to choose where u want to do ur residency program. Theorectically, 300 is the max score fot usmle step 1. And average passing grade for americans is 220. To pass you have to get above 180. But for the number of available place, some percentage of people have to fail somehow. (Not so sure though)But if u score 270+, ure in that 90 percentile chart of very small amount people with outstanding result.Btw, do you need to pay for specialty training in malaysia? 😀
It is easier said than done. It is NOT as easy as it looks to get the residency of choice and even a job in US after spending so much of money. You can try your luck for sure.
Completing residency makes you a specialist (eg: internist, opthalmologist, anesthesiologist, pediatrician). Completing fellowship makes you a sub specialist (e.g.: surgery–> vascular surgeon, internist–>rheumatologist). To become a GP, you must undergo a residency of “Family Practice”.
The singapore system is now following the US residency system. Upon finishing residency, you can work in the PRIVATE setting. Other countries with the residency system includes: Canada, Taiwan.
The British system is where after medical school you serve as a house officer and rotate through various disciplines. This system is adopted by Malaysia, India, Australia etc.
The house officer system is good for countries which need to send people to the rural areas to serve. These people work as “medical officers” and are the jack of all traits but master of none.
As I said, the healthcare structure in US is totally different. YOu are a specialist only after you complete fellowship, meaning subspeciality. AFter you complete residency, you are a generalist. You will know what I mean when you look at the syllabus. E.g: a internal medicine resident do not even need to know how to insert CV line, chest tube, bone marrow aspiration etc etc.
The training is NOT suitable to be a specialist in our healthcare system
The Singaporean residency is not equivalent to the US version.
For example, in anaesthesiology it takes 3 years of residency training in the US after internship. These guys come out ‘competent’ after their training and work as attendings (specialists). Throughout their 3 years, they will have had 1:1 supervision at all times. The first time they practice independently will be as an attending. These guys who turn up for fellowships at the hospitals i have worked in sort of know what to do but don’t really know how to do them and tend to be indecisive in their decision-making. They also do not know how to deal with certain situations that i would consider routine for my trainees. This is a product of their limited duration of training. If you place them in Malaysia, Singapore, UK, Aus, NZ at this stage – they will not be able to function as specialists in those healthcare systems. You do not even need to sit for the board exams to become a specialist (although most do for private practice reasons).
By contrast, the Singaporean residency system for anaesthesiology is 6 years long and the primary and final exams are compulsory.
I am not able to comment about other US specialties but, in my opinion, 3 years is not long enough to gain the breadth of experience necessary to function as a competent specialist in most specialties. They seem to be able to function in their large institutions in their healthcare system but then again, outcomes in US healthcare is pretty poor relative to the amount of money they spend.
Just so I’m clear, Jak. What you’re saying is you believe that at the completion of 4-years of a surgery residency, you will be a specialist and competent to practice as an independent specialist surgeon?
I’m not asking in terms of paper qualification, but in terms of whether you believe that 4-years of surgery training is sufficient.
No. The question here is what one defines as “specialist”.
Does passing MRCP make you a specialist in Malaysia? Yes. Does that mean you are competent? No.
Now as for the question about competency… do you believe a 4 year Masters in surgery program graduate from UM/UKM is competent enough to practice independently in the private setting immediately upon graduation? Or even after the required gazettement? No. Do they call themselves “Mr.”? Yes. Are they considered specialist? Yes.
Yes, exactly. That’s the reason we should not give false impression to the youngsters that you can become a specialist fast etc, because having paper qualification does not mean anything.
FUrthermore, in US they do have a good monitoring system and regular assessment unlike Malaysia.
As for “competency”, I believe years of training and experience is required to achieve that, especially in a technical field like surgery.
And the exact duration of years of training/experience to achieve what we term as “competent” depends on the training opportunities you receive at whichever institution or hospital you train at, the type of pathologies you get to see etc.
And I also believe “competency” is too broad a term to define. An old time surgeon may be deemed extremely competent. But if I wanted a laparoscopic gallbladder removal, would I want him to perform the surgery? Probably not. I would probably want a younger surgeon, who recently trained at a major laparoscopic center. The kind of surgeon which old timer surgeons will deem “not competent yet”.
Hi Jak,
Actually, passing the MRCP does not make you a specialist in Malaysia, not anymore. You now need a period of gazettement – Dr P will know the exact duration required. In the UK, this would be a 4-year structured training period. I doubt it would be as structured in Malaysia but would be happy if proven otherwise.
You are right that competency is difficult to define, or rather benchmark against. Different people will have different ideas of competency. The person who has just completed their 3-year residency in America will probably be competent in their health system but might not be in a commonwealth country (not immediately anyway).
You pose the question, asking if a Malaysian Surgical Masters graduate is competent after 4 years of training? They actually might be. Some have been an MO in surgery for 3-4 years PRIOR to their masters whereas some get in straight after housemanship through various schemes (e.g. Skim Latihan Akademik Bumiputera). Both are supposed to be equally competent according to the conferring institution but one is definitely less experienced than the other. Another factor is that their experience during the masters may have differed but it is up to the training institution to make sure that trainees have the appropriate experience. To just assume they will get the necessary experience would be bad medical education practice.
As far as being called a ‘specialist’ is concerned, this term is also applied differently in different countries. In the UK, someone who has passed their MRCS and is a new surgical registrar who has just got their training number is already called a Mr. Some will proudly say they are specialists. BUT, they have not yet completed their surgical training though. In Aus/NZ, you get to be called Mr only after you have completed all of your surgical training and get your FRACS.
As far as ophthalmologists in the US go, yes they are considered specialists in the US after they have completed their residency and I suspect what Dr P was trying to explain is that they are not the same as specialists here in the commonwealth in terms of their training. But I’m not a mind-reader 🙂
The gazettement for MRCP graduates is 1.5 years, gazettement for Masters graduate is 6 months. From last I heard.
Anyways, my point is after completing a US residency, you are called a specialist in the US. If you head to Singapore to work after you pass your US boards (which apparently quite a number do), you work as a specialist. Not as a registrar, and definitely not as a “general practitioner” as some might think/mistaken.
As for whether US residency grads, MRCP grads, or Masters grads are deemed “competent” – that’s another whole subject to debate on. My perception is that it depends on the individual person, not the training system where that person originates from.
A point to note about the MRCP – from my knowledge, there is no specific structure to the gazettement. A funny personal experience I can recall is a friend of mine who, upon completing the MRCP, went to Singapore in pursuit of subspecialty training in Nephrology. After shifting to singapore, the university notice that she did not complete many of the required rotations during her “MRCP training”, and had to do 1 year of rotations in various medical subspecialties – including cardiology.
Yes, I must admit that training for MRCP is very much self directed. It is up to the candidate to take the effort to do all the rotation. Some HODs do make sure that the trainees undergo all the rotation. MOH do have a log book which every MRCP holder must submit before gazettement. However, the entire responsibility lies on the HOD’s hand and not MOH. The HOD is the one who signs the gazettement papers.
The gazettment is actually 6 months but they use to have 1 year post MRCP training. That why is was 18 months. Since last year, MOH has made it compulsory for MRCP holders to have atleast 4 years of training in Internal Medicine before undergoing the 6 months gazettement process.
Another interesting point about working as a surgical MO before entering a surgical Masters program.
I wonder how will one feel if the pilot flying one’s plane is a pilot training officer, and have not undergone a formal pilot training program.
On the similar note, its funny how senior doctors always tell the young ones to go to East Malaysia to train because you get more “experience”. I wonder if these senior doctors will send his/her relative to the hospitals where their students “train for more experience”. The best training should be one which has the perfect balance of autonomy versus supervision.
Another paradox would be to hear how some Malaysian doctors brag about how much “hands on” experience one gets in Malaysia as compared to their classmates who went to UK/Aus, but at the same time thinks lowly of contract doctors from Myanmar or India, who probably has more “hands on” experience than themselves.
Its also funny how Malaysian medical students complain that their degree is not recognized in other countries, but do not realize that Malaysia does not accept foreigners for housemanship training.
I agree with your last post, Jak. The “extra experience” one gets as a new MO should be under appropriate supervision. Essentially, complete supervision at first with gradual independent practice over time. The problem is, structures are not in place for this to happen in some countries.
Different specialists will have different opinions on how much supervision an MO should have, even within the same department. One way to be consistent is to show evidence of competency before being allowed more independent practice. Using a simple example: A new MO must assist in 10 appendicectomies and then operate competently on 10 under direct supervision, before being allowed to perform the procedure with the boss not present. My numbers may not be accurate, but it’s the concept I’m trying to highlight. This is done informally currently but a more robust system would be required to check the cowboys who try and do things on their own, inappropriately.
Iatrogenic injury and death are more common in some countries because there are no repercussions. If there were independent investigations into medical complications in Malaysia (i.e. if MMC did its job and was given adequate resources) things might change.
Interested to hear a surgical perspective on this.
Oh btw doctor, do u know any book or website where i can learn all the procedures which will be done as houseman? Like lumbar puncture, catheterization, central line,thoracocentesis etc? Where can i find the LIST OF ALL the procedures?and step by step guide?i want to read all these before i do my housemanship.
Your seniors or those who are doing housemanship will have the log book which will list down the procedures that you need to do. You can go to any medical bookshop and look for any books that teaches you the procedures.
Is there a quota that you must fulfill? Does the MOH monitor this quota?
How is the healthcare outcome in Malaysia?
Interesting question. Firstly, how would one define healthcare outcomes? The most commonly used method is a country’s life expectancy because it should take into account the whole healthcare system.
Avg Malaysian life expectancy was 74 in 2010.
This is actually not that great, a little better than half the countries around the world. And this might be because we spend a very low % of our GDP on healthcare.
I like to use this graph when talking about this: http://ucatlas.ucsc.edu/spend.php
The 2nd graph titled “The cost of a long life” shows you what life expectancy is achieved based on how much the govt spends. You can see that the US govt spends tons of $$ but has an average outcome, if you ask me. On the other hand, Japan, Aus and Canada spend much less but get better outcomes.
Some caveats to that graph. It does not include private healthcare spending (which would make US cost go up even further!) hence why Singapore spends so little of its GDP (public healthcare in Singapore is not truly subsidised for anyone). There are other lists that have data on total healthcare expenditure but I’m sure a resourceful net-savvy person can search for that themsleves.
i think the pamphlet was send by just random people and not the school system..it was just for muslims that non muslims cant understand
Nope. The pamphlet was given to Muslim students in the school by their agama teacher ! These are primary school students. How can you distribute such a phamplets to students who are just in Standard. 2 ?