I received the following circular (see below) via a Facebook friend of mine. It is a very interesting circular from the office of the Deputy DG(Perubatan) of MOH. Again, didn’t I say so? Via this letter, it is confirmed that MOH is running out of post. It is clearly written that almost 95% of the MO post in MOH has been filled with some hospitals/kliniks being oversubscribed. I had a chat with some senior doctors in MOH and was reliably informed that all MO post in N.Sembilan, Malacca and Selangor is FULL. Many who finished housemanship in these states are being transferred out of the state. The district of Johor Bahru which has only 90 MO posts for health side are being filled up to 110 post. Where are these extra posts coming from? It is being borrowed from the upcoming Klinik Kesihatans which is being planned in near future or under construction. It basically means that the post for these upcoming KK has already been filled! How many more post can the government create? Pilot project has also been started in some KKs for shift duties till 10pm.
If you look at the letter carefully, MOH is now concentrating on improving the quality of care by asking MOs to become housemen. Housemen will eventually become a 6th year medical student who would not need to take any responsibility. It is also mentioned that shift system MUST be implemented in ALL hospitals. Any shortfalls should be covered by the MOs since there are enough number of MOs to run the service. There is nothing to cheer about for the housemen as you will become a MO soon and need to follow the same orders. Worst still, you will be under trained and underexposed. I can already see that happening around me. I have junior MOs who just finished housemanship who do not even know that ACE inhibitors can cause cough, Amlodipine can cause leg edema and Hydrochlorothiazide can cause rise in uric acid! These are information that I knew when I was a final year medical student! The “training” is getting bad to worst and many are being released with a “license to kill………….”. I just saw a 74-year-old lady discharged with Pottasium tablet 1200mg tds and Mist KCL 15mls tds after 1 day of admission in a hospital. Thank GOD she came to see me the next day! Do they know that Potassium can kill?
I was also informed that very soon, HO post will be given under temporary post. This means that you are not going to be guaranteed a job after housemanship. You also cannot choose where you want to work as you will have to go where the post is available. Remember what I said over here. Again, can anyone deny what I have been saying all this while? All evidence is pointing towards an oversupply and jobless doctors…………….
Pagalavan's Avatar 
First it’s the graduates, then it’s the HOs, now it’s the MOs. The future = specialists also kena clerk.
But always look at the bright side of life. With pengarahs getting slashed nowadays, you can bet the rakyat will be getting better and better service.
Thank you.
Many housemen here must be really envious of UM and UKM medical graduates who can get higher salary , better training and almost guaranteed a HO posts(and maybe even MO) in Singapore.
Med students are sponsored by jpa and so they cant leave for 10 years anyway. Hehe
Not really.Nowadays many students in UM and UKM don’t take up JPA but other private companies’ sponsorship.
It is true that many people are envious of UM and UKM medical graduates for having a CHANCE to work in Singapore.But who knows when the door will be shut off?
it will shut soon as 2 more medical schools will be producing doctors in Singapore
well…i heard working in singapore is the worst, pay is very good, but if u dont have life, what is the point really? this is from one of the specialist from singapore that quit and refuse hospital director position and come back to malaysia. she gave speech to us about job during pre-exam . so, no, no envy at all for those who go to singapore. i dont say it okay, but she did
I am not aware there will be 2 new Medical Schools in Singapore. The new NTU/Imperial school will take it’s 1st batch this year, so it will be another 5 years before they graduate. In the meantime, 2 new hospitals will be completed soon, so the demand for junior doctors will persist for the immediate future.
what I meant was the 2 new med school that was started recently, DUKE and Imperial. Singapore is basically a hospital based health care system. Their primary care is almost not existent. Their A&E department runs like an Outpatient department. With their ageing population, almost everything gets admitted. Majority of the admissions are not necessary but most of the time the admission is for comfort care as there’s no one to take care of them at home. The litigation is high as thus unnecessary investigations are done
Not all UM and UKM grads are accepted to work in Sg. They are interviewed prior to being offered a 3 years contract. But usually the top 20% of the grads in the batches are accepted during the interview. Others, failed badly in the interview, as you see, not all local grads are equally as capable or able to reason out, judging from the way the entry into local varsity had been scrutinized. Some failed in their total lack of proficiency in English as well (It’s only basic command of English, for goodness sake, where I think at least MUET band 4 would ought to do!)
Every year, there are 10-20’s of UKM medical grads going out to Sg (And of course a number from UM as well). It may seem a handful few out of the almost 250’s a year, but since they are usually the top 20%, you can say half of the top few are brained drained. Sg may not be the best option, it just gave us an alternative should the health system crumble and any fallout occurs.
For your information,not many students interested to work in singapore.It has certain race predominance in terms of applying for the interview.Its their choice.Nothing wrong about it
like …. higher salary and guaranteed HO post i agreed…. but i disagree with the better training as over here we cant do much procedures.
Why “can’t do much procedures”? Is it because of you are a graduate of Malaysian uni, or because of all housemen can’t perform those specific procedures? (Just curious if it’s targeting Malaysian graduates)
Good news is there are plenty of specialist post available. So for MOs quickly take ur exam or do masters etc, we need more specialists and consultants! Start publishing papers, get involved in research and audits. This is also how our universities will be recognized as 30% of the assessment goes to research and 30% for citation etc.
This is expected. MO quality now = old time houseman. Specialist quality now = old time MO. Thanks to medical school mass production and HO pampering from the KKM. In fact this it is good to protect patient life.
You mean plenty of specialist post available in Malaysia or Singapore?
Dr P, I’m a medical student sponsored by jpa studying in the UK. it’s really upsetting to see news like this, especially when jpa is still so adamant that sponsored students in the UK return even though most secured a job in the UK. Most of us just wanted the GMC recognition and gain experience working as a house officer (where we have more opportunities to manage patients and perform procedures) and return as better doctors and serve the government but unfortunately i really don’t understand why jpa is so adamant that we return when MARA students easily complete their housemanship in the UK. it’s blatantly unfair, and given the current situation, i think jpa is being ridiculous in fact. some of us have tried to request jpa for this but the officers would not agree to it.
That’s not the point. The point is you took RM1 million of tax payer money and already signed the contract pledging that you will come back and serve. So that’s no reason for you not to come back.
hahaha i really agree with you poor doctor.
Yes, the point is these JPA scholars who stayed on in UK are leechers. We don’t need to send students to UK for medicine. Exorbitant price to train doctors in a system not compatible with our health system. It’s one of those election ploys to make people grateful (Which of course failed since JPA students tend to go the other way round)
The way to go is to stop all those overseas scholarship esp medicine to such places. Saves lots of money. 😛
@metamorphoses, if not sending to uk, u prefer students being send to russia indon? I dont think so. Assuming not in malaysia.
I can’t agree more with Poor Doctor. Not every doctor trained in the UK is is so damn good and not every doctor trained locally is so bad. To claim certain university produces better doctors is also untrue. Everything depends on his or her efforts to be a competent doctor. The university would provide you with the basics then you have to dig yourself to gain more knowledge, skills and experience.
hundred % agree with u
Agree completely with Poor Doctor.
i graduated in ireland, i worked for a year as an intern there, came back home and continued another year as an intern…yes i got to do more procedures/managing patients here in d malaysian hospital..back in ireland, i can say that i only do the ‘clerking’ jobs…filling in blood forms..putting in cannulas..take blood..i believe there’s not much difference between d nhs n hse in ireland..so u might have gotten some wrong perceptions of what u’ll be experiencing in your future internship…as for d current situation now referring to the circular, i think its just not much difference to compare d situation in d uk/ireland..d later u come home, d later u’ll be upgraded to d higher salary grade…my salary now is 1 year behind those who came back earlier than me..hope this helps 🙂
JPA is scholarship but MARA is a convertible loan. It is unfair of course and I have written about it before.
As a sponsored student , you must come back and serve the country. To say that training and exposure in UK is better, is NOT right. An enthusiastic student will learn more here in Malaysia than in UK. Furthermore, HO in Malaysia is 2 years unlike in UK. This means that after FY1, you still need to complete the remaining postings in Malaysia.
For most grads who did internship in UK or Aussie, its hard to revert back to Malaysia’s system. Few of those who came back from Aussie and UK called it quit when they came back to complete their 4th-6th postings. One of them had to be under Psychiatry while doing Peds posting. -.-“
If u wanted to gain those valueable experience in UK, you should use your own money for studies. I believe the situation in UK is not much of a difference compare to Malaysia in terms of gaining clinical experience as they implemented shift system much earlier than us. You can put it the most polite and convincing way but too bad you are using the tax payers money
Its blatantly UNFAIR and ridiculous that malaysian taxpayers are paying for your education overseas and yet we do not get you to provide service to us. Ridiculous, dont you think? We have every right to demand what we pay for.
My opinion is probably different from everyone else’s here, but I think ‘medical student’ should be allowed to stay in the UK until he/she finishes their specialisation. Why I think this:
1. There is a surplus of MOs in Malaysia, and people coming back from overseas before specialising will add to the problem
2. There is a lot to be gained from doing your postgrad specialisation overseas
3. Because you are on a scholarship, you do have an obligation to return home, and I am purely differing on the timing. If you think you don’t want to come home even after specialising, then you should pay 3-4 times the fees!
I don’t control the rules, this is just my opinion. I think many people are emotional about those who have scholarships because they tend to be of a certain race and there is a perception of unfairness. In my opinion, each individual wants to do what is best for them, and there is nothing wrong with that. If you have received government aid, then that should be repaid in some form … how that is done is up to the individual conforming to the rules of the day.
The problem is, the timing of the specialization can be quite far behind as they may decide to do their masters perhaps 10-20 years later on? Our money for free education is not to be spent like that. Plus, not many who stayed back did their masters. Some just wanted a sedentary lifestyle there. Hence, no one can guarantee 100% they are able to get masters there or anyone to police them over their job there.
if u want to work at uk so much, just contact JPA and pay back all the money u hv used, if they allowed it la. if not it will be much harder if u have passed and they call u to go back to malaysia…..whats the point signed a contract with JPA if u know u will want to stay at UK? go serve UK people, dont come back , that’s much easier for us medical student in malaysia who will fighting for the position in KKM later. Im a medical student in malaysia, seeing this kind of news everywhere is frustrating as my colleague have fall into depression because of their colleague and supervisor, i mean whatever life will be hard anywhere, doktor makin cukup n all fulllllll but I dont know why all my colleague complaint they still tired working all the time, and no, the shift system is still not be implemented in all KKM, Im not sure if I care about it, because even as a medical student I have practice oncall , delivering babies, and everything. and yes I do expect that dr’s life will be suck, but I go to class and ward round even when Im sick, or having pneumonia, or having severe dysmenorrhea, so yeah im expecting the worst because all my friend cried when they go into housemanship. will I ? not sure. people build medical school in malaysia and they release dr who not even suppose to be doctor, who dont even know how to rule out and clerking in a complete and good way, who dont even know freaking basic things, Im as medical student know more compare to that HO in that uniersity hospital. u know how frustrating it is?( im sure she is not from my U), how freaking way these people got to passed MBBS and become doctor? nowadays it so easy to passed MBBS in so many universities. all parents still want their child to be doctor, this should be put into pause for awhile! im under JPA and I cannot wait to serve my own country rather than other country
Bebo, which university do you go to? I just want to make sure my children go to a good medical school if they do wish to study medicine
yt….before u suggest to your kid ( no offense) to do medic, make sure that he/she know what he/she get into. this a honest suggestion, because by the time we got into final year, most of us regret really, because we learn to start doing oncall in this year especially. oncall is where ur child will have to work from 8am TODAY to 8am the NEXT DAY, and may even have to go back late. and from what i heard……even when not oncall, doctors need to work very late and long hours. the earliest they can go back is probably 9-11pm at night.
Im a UM student. im not saying that UM produced such a great doctor, that would be depend onto.. individually, but it also depend on the professor and lecturer who teach us right and wrong. i would say UM is not easy to pass. im not sure about other university ( but ive heard new school is so easy to get A ….while we here struggling to even get C!), but due to the so many grown medical school nowadays…..even my lecturer are whining, because who are teaching these new schools? what are their experiences? im in no position to comment on those thing as im just a medical a student. beside…who are the one who allowed those school to be build? gov of course. but i have heard that student from IMU are very good too. know lot of stuff and rajin. hurm….i dont know the reality as i have been bumped onto them ( i think it was them) at emerngency….and they look so blur…probably because its not their own university hospital.
ive heard so many story about UM and UKM graduates being bullied when they into HO’ship…no comment. some of my senior refused to say that they are from UM dt such circumstances. as for myself as a student, it such a discrimination when my senior said that med graduate from indonesia was treated differently..in a way if they dont know how to do certain procedure they will be taught gracefully, this is the opposite when it come to local graduan….which is dissappointing. we DONT KNOW EVRYTHING. we go into ho’ship to learn the skill better.( eg. procedure like chest tube ke, central venous catheter ke, its not like we can do it when we still student…we just know the step theoretically , and watch the procedure from our dr here).
as for back up why im saying that i probably know better than the HO in that university hosp which is not my senior…well..she doesnt even know tachycardia. how can she get UMMC? unbelievable.
but again, im not the one who passed her.
being a doctor is about serious responsibility, not for the one who love fun every single day. in KKM , we need to manage patient first before we report to the supervisor if we unable to do it, or failed….so think again. it will be a heart-brain shock for someone who not into this. some of my friends have falled into depression before even be a doctor ( eyh depression very common nowadays lah), but wasnt it sad that the one who should take care of other are not even that healthy?
one more thing….its a community service….u are giving ur children to take care of other, so im not sure if u will want to blame them if they dont even have time to reply ur sms/ pick up your call. we really serious people 😛
my advice is….let your child pick what they want. if they love what they do, they will be happy, and if they happy, they will work more rajin. more rajin and more money…and thats actually in the end will gonna take care of u if u fall sick, unless u a gov retiree. but for myself, i will never let my children do medic, dont think so, unless they want it by heart
my lecturer and professors are really great here btw. i love most of them 😛
Many of these young doctors who complain about feeling tired etc do not realise that that is the life of a doctor! I work 24hrs a day 7 days a week even after 15 years! There are enough doctors in most hospitals now but the workload is as such that you will be tired at the end of the day!
Eh bebo, are u allowed to round wards while having pneumonia? :O
how to say….usually if i have fever i easily get breathless ( im a fit person, not obese or something like that, it just i used to get lethargy when I had fever) so i had SOB and I still go to class because it was not that bad ( i thought) till I go back to room after class finish and hyperventilate till got perioral numbness and leg numbness =.=…almost pengsan also. if i got sick/ or if i deal with sick patient who obviously was/is respiratory case, of course I wear mask la ~ and avoid touching…even if touch patient, wash b4 and after. paeds la…so many respi case…even student got infected ma…that was when I posted at HTAR in 3rd year…klang is so overcrowded.
one more about being a doctor…..we are always exposed to biological hazard….i heard 2 case of my senior got TB …so sad esp the one who got miliary TB one ( scary kan?)
… and of course i have screened myself for TB, so far no la. so maybe the breathlessness whenever i fall sick were just because lethargy, it go away with rest anyway
oh and wonderkid….ward round is very usefull to learn, we cannot miss class or ward round, its too beneficial to be miss, some of doctors allowed us to sit during wr if we not well,so thats why demam ke, dysmenorrhea ke ( heck public can get mc with dysmenorrhea u know, but i cannot miss my class), and beside… if attendance is bad, we can be bar from exam. UM is very strict about discipline. u tak ikut peraturan, u probably will be kick out, and they serious about it . this not only applied to faculty medicine, but also our college.
dr. pagalavan….i believe that this declined in quality is because these doctors are just not interested to be doctor in the first place, but they got passed anyway. or they regret choosing med when they got into reality… as for myself…it is kinda hard to accept that we learn to take care of other people healthiness, while ours are neglected ( no sleep and rest is very unhealthy, not eating how can work? all those hours of walking, running, standing, tahan kencing while wr….it seemed very unhealthy eventho u can consider some of it are cardio exercise lol , we need to advise patient to at least exercise 30min 3x per week, but doc themselves do not have time to exercise, i think they prefer sleep) im not trying to back up all those pemalas housemen, but let face the fact here that we are all human being. how can doctor face the fact that he/she have killed some patient becoz of unability to be alert due to lack of sleep? not all people can stay alert and even doing their job properly without good rest and some wholesome food ( not just maggi and biscuit of course, mana proteinnya, mana vitaminnya). my senior complained to me that she really want to quit, but how? she not even dare to tell her parents. she just cant do it anymore. her father is a doctor.her mother hv shown disagreement on her to quit. this back to the family structure , some parents understand, but some menangis2 tak bagi anak quit medic. will u do that to ur children? its not easy to further study into master and all, i know its very hard, how to say ah…i respect all my prof and lecturer because not only their position, their knowledge and experience, but also because they spend time on teaching us, using their own very precious time. they really inspired me….im just not sure if i able to be like them
all parent should know that they only should allowed their children to go into medic if their children is really3 strong….otherwise, life is really more than just medic. my senior is not happy with her life…i just feel so sad for her. to quit ho’ship also not easy,, need to take account the family, the JPA , the etc etc..its not about pushing yourself anymore, its about can one do their job well and not kill patient? and nowadays ,people are of so many kind. i hv work part time before as cashier, what i learn was….it doesnt matter how easy the job is , but with whom we hv to work ..it does really2 matter.
Yes, exactly. As I have said it many times, many do medicine for wrong reasons. That is the purpose of this blog. To educate future doctors wanabe and parents
Ummm, you signed on the dotted line for 1 mil of tax payer’s money. Stop the drama and pls return to serve your bond. Joker.
hi singh, why cant you be polite…this website is useful for many and serious dicussions going on and you can see the dr.pagavalan is answering to people comments..
Is it the problem with us Indians ( my self indian), who cannot carry on a serious discussion without hate comments, bad languages……I am ashamed to read the comments that comes after a news in Times of India…
the quality is so bad now, i have to take some of my time to accompany my relatives to clinic/hospitals so that nobody would get killed. Negligence lawsuit are too costly….
lawsuits are increasing and that’s the reason Indemnity insurance is compulsory from next year onwards for ALL doctors.
Another jpa-medical studentcal student.why not just let us graduated in UK to work here.Gaining working exprerience and then come back to serve the country. Instead of hanging around, job insecurity etc due to overflow of HOs. Would it be better if i can further my career here and perhaps coming back as a consultant/if not maybe a better doctor? Taking the fact that med students graduated here are given equally chance and place to do housemanships, it is a shame to let go of this opportunity.
same logic can be applied later, after you are a recognized consultant in UK, and can apply for PR, it is a shame to let go of this opportunity, isn’t it?
Why Malaysia keeps sending students abroad to study medicine is totally beyond me – no other country does that !!?? Has to be a few hundred million, even billion ringgit spent already – this coming from a country where they can’t afford enough medicine in rural hospitals – where is the logic??????
Welcome to malaysia. Politicians want to send their children overseas mah! have you noticed that most politicians children are NOT in this country?
As a JPA scholar, you will be guaranteed a job by the government.
Based on the current immigration laws, the chances for you to get a post after FY in UK is very slim. Many had returned home.
So, might as well you come back and serve your bond.
I study medicine in UK. The NHS system and Health System in Malaysia are totally different. You can gain more experience by doing FY in UK but when you come back to Malaysia, I’ve heard you still need to do houseman in the hospital. Simply because both system are different and there are few procedures which are prohibited in UK but still applied in Malaysia. So, you will undergo extra years of training unless you continue your specialist training after finishing your foundation year. In this case, it is quite impossible for JPA scholar because you have 10 years of contract. So, the best option is you go back to your country and let say there is no place for you, then you can apply for FY in UK. I am not so sure so please correct me if I am wrong.
The more logical thing to do is to come back to Malaysia, serve your HOship and then go on do your Master or postgraduate specialist courses. Then apply to go back UK for subspecialty training. The single reason why most want to stay back in UK is because you get better pay and benefit in UK. After certain years, many will opt for PR status. You never hear the same stories of those JPA scholars want to stay back in Russia, Indonesia, Bangladesh or India. So be honest and come back to serve.
Unfortunately if we don’t do housemanship in UK, we are not allowed the same chance at subspecialty (SpR) training in UK later, due to visa regulations. I.e. only after all the UK and EU people have applied and there are still spots left, only then they consider us, even though we graduated from UK. In reality what this means is that we won’t be able to get a spot unless we are going for paeds/psych.
If you don’t do your housemanship in UK, you don’t get full GMC registration. However, even if you do FY there, the chances of you getting a specialist training post in UK is VERY slim due to the immigration law.
Oh just realised you meant do SpR equivalent I.e. masters in Malaysia. Im sure you know how Masters places are highly limited, and the selection isn’t exactly transparent. Only a few specialties have Masters, you’re out of luck if interested in other specialties. On top of that it’s not recognised in UK anyway.
I think one should get away with this mentality of having recognised degree by UK. You took RM 1 million to study medicine there and you are obliged to serve your rakyat once you complete your study. You are JPA scholar which mean you have a guaranteed post for here in Malaysia and you are certainly having an advantage of given a Master program placement later. You can even take the overseas exam like MRCP, MRCPaed, MRCOG Part 1 in Malaysia. Your first commitment is to serve and honour your agreement then only you can have the privilege to persue your specialist training. Otherwise you should consider break your bond and pay the compensation / penalty.
What another jpa student say is so untrue. Please do not comment based on hearsay. I totally agree with poor doctor. I myself is local grad. Did my postgrad masters in surgery locally and with no UK external exams. But I sit manage to get gmc registration to do my subspecialization there with no problems. FYI, the RCS in UK now recognizes local masters for gmc registration via their own sponsorship. My friends also fully local trained, most of us graduated from um, ukm, usm, managed to get post cct fellow jobs in UK in fields such as cts, neurosx, colorectal and UGI. As long as you boost up your CV, work hard, publish papers you will get noticed.
People who whine and expect food to be fed to their mouth will never find success.
If I am not mistaken, this type of registration is for training purposes(fellowship etc) and not for long term employment in UK.
Graduated in malaysia, worked in malaysia, passed HOship smoothly, became MO, still have to continue the hardship of working as HO as no trust put on current batch of HOs, specialists just know to give orders without helping much, got depression, leaving my job………. Lalalalalalala
JPA must be the best agency in the world – how can they let so many students off scot free and still afford to pay for all these students year in-year out? I wish banks were this lenient with loans :))))
YES, you are right
is it true you cant touch patient in UK in your medical studies?
Not true. You just have to ask permission from the patient and inform them that you are a medical student, as you should in Malaysia as well.
I also studied medicine in UK, but I totally disagree that you gain more experience by doing FY in UK. I gained more experience in the 12 weeks that I spent in UMMC as an elective student than my entire FY1 and FY2 combined.
As some states are overfilled, many more are also needed in d east msia. I think that the allocation is also one of the major issue, though i couldnt deny that sooner or later it will be overflooded. But for those overfilled sites in the west, they shud b placed here in d east. Why are some repeatedly staying in d east but some in d west has nvr even been posted here?
Unfortunately unless being forced to East malaysia, they won’t rather stay in UK than serviing the East Malaysian. It may be ‘worth’ sending JPA scholars to Russia than to UK or Australia (if quality is not the main consideration factor). For the same amount of money, you can have 5 doctors from Russia and all are dying to come back to serve (even in East Malaysia).
Sorry I meant they WOULD rather stay in UK than serve in East Malaysia.
To go to Russia means government is paying money to produce doctors who are incompetent? I think that is definitely a money wasting thing to do! Rather have one well trained doc!
Graduates from Russia, India, Indonesia not necessarily less competent than graduates from UK, Ireland, Australia or even Malaysia local graduates. I’ ve seen many HO who graduated locally, especialy from private unis have worse knowledge and they are more arrogant.
Have you visit their universities in Russia lately? The malaysian students there conduct their own study group there orientating with malaysia requirement, latest malaysian cpg etc. besides study to pass exams there (Russia have their own field of medicine. It is another civilization u know. They even authored their own eponym) .The students there are doing double. They are allowed to touch the patients and in fact, the patients there are more open minded. They even do not mind to show their boobs to the student 🙂
Yes, they are dying to come back and serve the malaysian rather than staying there to treat the Russians.
So, graduates from Russia are incompetent doctors is an understatement and to label them so is unfair. At least not all of them.
I myself not totally agree with government sending students to study medicine abroad, but until there’s enough quality unis locally which can produce quality doctors (not like some local private unis which offers medic degree for the lucky sons of dato who have plenty of money), guess it is a choice to be considered.
One more thing, i think the east coast side esp Kelantan also short of MO. Are the MOH being political?
eventually, all states will be filled
All talk about these Russian, Indonesian graduates revolve around quality. Yes, some may be questionable but the other half are just as competent as their counterparts as I have seen during my HO’ship days..more and more specialist in the future will have a basic degree from Indonesia and Russia..then are going to be less quality specialist? I doubt it
Yet there are plenty who moaned and groaned when first posted to Sabah and Sarawak, then kick up a real fuss when they decide to settle in these two states, and to have to abide with stay restrictions there.
Yes, soon almost everyone will be sent to Sabah/sarawak after housemanship
Good day Dr,
I would like to know about this new programme homeopathy which is recognized by TCM unit(traditional and complementary medicine). I was informed by my colleague about this exam which can be taken by medical doctors as well as nurses and MAs. Also claims it’s recognized by KKM. Kind of fellowship programme for doctors which wil upgrade us to specialist level. I want to know how far is the truth and what’s the future prospect?Was also informed The part two is Masters equivalent. MA n nurses have different titles not LFHom and MFHom. This professional qualification is recognised as requirement for NHS doctors in the UK to work in their homeopathy hospitals. In Malaysia the stance of the TCM unit is they recognise any degree recognised by country awarding.
Please enlightened me about this. Thank you, much appreciated.
Satu lagi project kroni, I guess the student probably qualified for PTPTN loan and the newly launched study loan for private medical students. Try in your own risk.
since when homeopathy is part of medical specialty? I don’t think you should go in unless situation is clearer
Homeopathy is never a branch of medicine and as far as I know, there is NO such thing as Homeopathy being a recognised postgraduate degree! Yes, you can practice in Homeopathy hospital but this hospitals are not allowed to practise modern medicine. TCM practitioners are not allowed to practise western medicine legally. You can only do either one.
dear Dr.Pagalavan…I am from India…our situation in india will only be worse than in malayasia. But I really appreciate you efforts to get the message across…
Didn’t you post this in another page? If you are unsure about homeopathy, please read this:
http://www.howdoeshomeopathywork.com/
hi dr.P, im a final year medical student who going to finish mbbs in 2 months time. im fr unrecognized private u. we are the first batch of mbbs. accreditation is a question mark? i feel so stressed to think abt my final exam as well the housemanship and my future.i feel so blurred. may i hv ur advice which will be useful for me and also my classmates..tq
This problem keep on repeating itself. Why in the first place some still want to go to these unrecognised U and make your life miserable? Sorry for the harshness but I am just very curious. Anyway currently MQE is available in the private medical colleges, so I guess is a backdoor qualification as long as you got the financial mean to go for these exam. However, is your school in this list of unrecognised medical colleges (http://mmc.gov.my/v1/docs/UNSCHEDULED%20UNIVERSITIES.pdf) which are eligible for the MQE exam? If not, God bless you.
which uni is this? Has MMC done their accreditation process? If MMC do not recognise this uni then you need to sit and pass the MQE exams.
Is it true that the passing rate for students sitting for MQE are getting bigger since the private medical schools are allowed to conduct this exam??
any evidence to say so?
No evidence yet but expected
Mr Consultant (so called) we r not horseman but HOUSEMEN..do u think u can run a ward w/o ho?? Hahaha …don brag that u r genius n v r stupid..wen u entered ur medical training, u would have been one of the stupidest..u know we all practising as doctors including u and nobody is perfect..since u r super great I ask u 1 question wat could b the cause of sudden normal ecg in an 80 yr old woman with chronic bundle branch block and wat ix u take … stop bragging urself n start teachin to ur junior docs..be proud that u r better but u must realize that u might b the last in good category…
Firstly, if you want to make such comments, introduce yourself properly rather than pseudonym!
Yes, it is HOUSEMANSHIP. It is a typo error as my Macbook changed it automatically.
FYI, wards can run without HOs. Just less than 5 years ago, most of the hospitals which is currently taking housemen DID NOT have housemen!! Didn’t they run as per usual? When I was a MO/Specialist, each ward of 40-50 patients only had 1-2 housemen, sometimes NONE. We could still run the show!! So, YES, we can run the ward without HOs. We just need 2-3 MOs and few nurses who can take bloods.
If you do not know me and what I have done before, pls do not make comments that make you look like a fool! Ask anyone who has done housemanship under me before and see what they say. Most of them are specialist now!
Sudden normalisation of BBB: acute inferoposterior MI and Acute PE.
The whole comment of your shows what type of doctor you will become in the future! It shows clearly!
God, what kind of doctors are we producing….
Dumbass. If you disagree with someone, at least have something smart to say.
The way u comment sound like a horseman rather than houseman. U need to see in a bigger picture, what was written here by dr P is to educate the public on the real stuff happening in our healthcare system. Someone need to remind the public how deep is the hole we are heading. All parents wants their children to be dr, but they fail to realize not all their child can be dr. Most of the student sitting in medical university have no idea what they want to do with their life. They were there either some of their friend were there or their parents wants them to be there. At the end of the day it is those who open the med school laughing all the way to the bank and not us drs or the public
dr mohamed, you should not be the stupidest when u entered medical training imo. if you dont know ace inhibitor causes cough etc, might as well stop medic.
Sad to see these are the doctors, fraction of them, produced by our country or other countries, it’s hard to differentiate nowadays. This clearly indicates the need for interviews, psychometric tests, and MCQs as entrance requirements for medical schools.
A tip, do not argue with a rheumatologist about diagnostic and medicine. You will lose horribly in the end.
Agreed. Rheumatologist, together with Geriatricians are the 2 most astute and all rounded specialists in the medical profession.
Not really….family medicine specialists are more all rounded.Anaesthetist???nothing much to say about this..most of them are less stressful than surgeons..
Mr. mohammed, this is insulting & painful . Kindly go through all the articles Dr.Pagalavan has written. why he has put so much efforts to collect the information and to answer most of the queries. If your point of view is different this is not the way to contradict . If you have anything to prove him wrong go ahead and put a link or start your on page…
By the way Dr.Pagalavan kindly forgive the man behind the mask. some people are self expressed morons. they dont do anything good,. they open the mouth only to eat and complain. You wait and see, Mr. Mohammed will come up with all the glory of a moron and start attacking this reply……but will never try to prove his point in a legitimate way….
Ummm…his name is Mohamed…..so let us forgive him… for he knows not what he says.
Dear doctors. PM announcement in 2010. Target doctor: population ratio 1:400 by 2020. At present 1:800. It means government will almost double the doctors post by 2020, so nothing much to worry.
Nope, I think you misunderstood. The ratio includes the private sector and not just government sector. Government has it’s limitation as we have a bloated civil service already.
They will just remove compulsory service and let you find your own job.
The ratio will hit 1:600 by 2015 and 1:400 by 2017, with the current rate of production.
BTW, the ratio of 1: 800 was achieved in 2011.
I’ve been in a district hospital without specialist where the nearest referral hospital is almost 2 hours away for almost 2 years and still counting. I really dread the time i return to a tertiary centre with HOs.
Just this morning, i had a shock of my life (i’ve not had regular contacts with HOs since I came to this hospital) when i sent a case to the tertiary hospital. The CONSULTANT was doing his round with only one specialist and one MO. There were at least 10 HOs in the ward, looking busy but not a single one paid any attention to thr ongoing ward round.
When I was a HO (yes, i know how we hate this phrase), we would drop everything that we were doing the moment a consultant (or even a specialist or MO) walked in so that we could follow their rounds because that would be the best opportunity to learn/ train.
It is really scary to think that our lives (and our loved ones) might be in the hands of these people in not so distant future. And i doubt these new generation of HOs would survive MO-ship especially if they are sent to the rural areas…
I have had a HO who was a 3rd poster (i was an MO in a tertiary hospital for several months while waiting for my district posting – and no, i never appealed to stay in a big hospital. The placement simply came late and i extended my stay for another month and cancelled my leaves because my department then had a sudden shortage of MOs) who didn’t even know how to start manual bagging for a patient with a high flow mask. And she didn’t even know how to do proper CPR (she looked like she was kneading bread dough). Worse still… She didn’t even know that we’re supposed to start CPR for a pulseless person (instead, she was busy doing ECG).
scary isn’t it . I hear the same stories as well.
First of all, thanks for ur post.. it really give me some light about the reality of our medical society.. i’m a HO btw and will bcome an MO mayb in June dis year.. currently i’m doing my Housemanship in sabah n i never regret of choosing sabah coz there are lot of things i’ve done and learn and sometimes i need to act aS MO and making decisions if my MOs busy handling with other pts(plus currently in standby mode as dealing with the war btween us n sulu). I do agree with u as currently we r flooding with HOs n the quality of our HOs is also declining.. comparing myself to my junior HOs, i’m way hardworking ( not to brag about myself but..) and sometimes i wonder y they want to b a doctor if they dont want to serve people well??? My hospital now starts to hv lots of HOs and mayb that is the reason y my junior bcome more lazy:-( hope that our DG will try to fix this issue so that our country will provide better medical services to our people.. i ‘m proud to become a houseman and cant wait of becoming an MO and look forward for a chance of becoming a specialist:-)
I wonder why ago many people are worried to work in east Malaysia? As far as I am concern east Malaysian lifestyle and culture are much more better compare to west. I was born and raise in Penang btw.
they probably dont want to do too much works?(in west, too much housemen = not much work) but that is the point i think..more work = more skills and exposure and learning. 🙂
In my opinion, the young these days are ‘scare’ to explore the world. They feel insecure to leave their comfort zone. Perhaps is the way the being brought up by over protective parents or perhaps life is jut too good with no hardship. Correct me if I am wrong, comments are most welcome.
Not all become a doctor to help people! many do it for job security and money and forced by parents!! wrong reasons
instead of whining probably we can change it during this election? haha just jk. well we all has a sense that to make our life as comfortable as we could. cant totally blame those jpa holders if they plan to work abroad. put it simple i throw 1M to ur hand will u giv it back? or use it to make more? life is always unfair beat it. i found this blog is more of showing off rather than helping.
Explain showing off rather than helping?
Showing off? Yes of course! showing off the reality on the ground!Government should just stop sending students overseas. We have enough medical schools locally!
[…] « For Future Doctors: The Hurricane is coming…….very soon Part 5 […]
[…] has been proven wrong many times in this blog; the latest was the last article, which I wrote on 7/03/2013. Many countries are now struggling to create jobs to all their medical […]
Well, it all comes down to attitude and diligence no matter which university you came from (be it local, UK or russia or from arab). I have come across those graduated from UK (JPA sponsored or MARA) and IMU who dont even know how to interpret ECG, blood taking or insert line.
I would say the more hardworking and positive attitude you are the further you will excel. I manage to do 8 BMAT and multiple chest tube insertion, countless LP, pleural and peritoneal tapping and etc during my 4 months stint in medical. That because my hospital only have 13 HOs with 5 wards ( total 150 beds in which most of the time are full house). But there are 9 MOs and 7 specialists in that said department. Isnt that cool – MOs + specialists > HOs. We helped each other out. Sometimes specialists and MO help to clerk new cases. They never grumble. Why? Because we as doctors regardless at the bottom of the food chain to the top have the utmost responsibilities to help the patients. Be humble, stop grumbling and be responsible.
IMO, those graduated from Indonesia are the worst – terrible attitude, lack of skills, no soft skills, MIA and etc. Maybe I am wrong but that is what I had witnessed. The best would be from UM – no doubt
YEs, it all depends on who did medicine the for right reasons!! Universities do play an important role but it finally up to the students to learn the most during their student days.
U seem to be boasting about yourself by saying grads from Indonesia are the worst. Some may be but to generalize is a big big mistake.
Yes, you are wrong big time. I graduated from Indonesia and i never got extended, did all the procedures u have mentioned above , passed my ho’ship with flying colours to the extent they thought i graduated from Malaysia or UK.
So yes, u maybe are right about a few but not all are.
After all they are all Malaysians so if they lack in something its your job to help out your colleagues
Dr, I’m a final year med student in UKM currently. Will be sitting for my final exams soon. Based on ur article, it seems the situation here is just getting worse. I have an oportunity to go to Singapore for my housemanship, but to be honest I would much rather stay here. I am even willing to go to East Malaysia. I had pretty much decided to stay here until i read this article. If even MOs might be out of a job soon, would it be better to just go to Singapore. I would appreciate it if i could get ur views on this?
R u sponsored?
No. I am under PTPTN loan but i intend to repay it either way.
I would suggest to stay here for the moment. If incase any issues come up later, you can always go to singapore then.
You mentioned that an Singaporean-citizen graduated from Malaysia Monash medical school CAN”T do housemanship in Malaysia because she is NOT Malaysian. Can Malaysian-citizen medical graduate ( who is not spouse of an Singaporean ) do housemanship in Singapore ?
Yes, can if your degree is recognized inmsingapore
whatever it is, local Uni are heavily subsidised eventhough it is not sponsored. Paying Rm15k for whole course while government is paying RM 250+k for your course (stated in your very 1st offer letter) I would advice to complete your total 4 years (HO + MO) service before going off to Sg. At least, until the next situation does not require your service. I’m so called self sponsored in UKM(No JPA/PTPTN), but I would like to honor my social responsibility 1st, although it is good knowing there is an option out.
I am a final year student studying in India. I cannot wait to be back HOMEEEEEEEEEE!! I am looking forward for the long hours in in MALAYSIAN Hospitals. Heheh.
Thanks Dr. for the enlightenment. Actually this so-called “hurricane” was already anticipated to happen since long time ago, especially since the gov decided to allow more private medical schools to open & continue sending students to study overseas. If all can produce equally competent and quality doctors then it should not be an issue, too bad it’s the other way round that happened (as expected).
Not saying that I’m as good as previous old timers who went through tough times and survived harsh housemanship, I do not understand why my colleagues still complain of today’s housemanship training. Some of the complaints:
1. Working long hours (even though shift system has been implemented)
I agree that some hospitals’ shift system is not perfectly implemented 100% based on current KKM’s circular, but I personally feel our working hours are still less than previous doctors who worked 24 hours a day, 7 days a week ever since they were HOs. In my hospital shift system is being implemented but there are still HOs who complain of tiredness, and some even tried to ‘fight’ for their rights to have ‘enough hours of rest in a week’ as instructed by KKM (although it’s a bit unpractical if my hospital were to abide by it)
2. Being insulted and treated like coolies
Let’s face it, almost all senior doctors have gone through the period and survived, it’s just a cycle of life. Almost every other profession has similar scenario where juniors will feel the same way.
Actually it’s very subjective. Being ‘insulted’ or ‘treated like coolies’ can be perceived in 2 different ways : one is meant literally – where the MOs and specialists really intend to do it (probably as a revenge because they received the same treatment during their housemanship?). Another one is actually one of the ways to teach houseman to be more competent. Most of the times they don’t even mean it (deep inside their hearts they want us to be better) but a lot of people will misunderstand it. It’s true we are ordered to this and that but we must understand that it’s part of our job. So we should stop whining and take it positively. If you ever feel mistreated just think positive (don’t think the negative ones like they want to avenge because they were also mistreated etc)
Well there’s a few more but I’m starting to feel like I’m blabbering rather than discussing. In conclusion it all comes down to reasons of choosing doctor as a profession. If you do it for right reasons you should be able to find a way to overcome “these difficulties” and adapt. Personally I still think that on-call system is better than our current shift system. If really want less working hours, maybe can try to provide a 1-day off after each on-call (less working hours than conventional on-call system, and better continuity of care than current shift system)
So for all HOs nowadays, let’s be thankful and be more passionate for the sake of our patients. Let’s face the fact that we have “better life” during our housemanship as compared to our seniors (it’s true. Just try to imagine working as HO during their time and now – really a big difference, no joke)
Thanks Dr. Pagalavan for the enlightenment. Actually this so-called “hurricane” was already anticipated to happen since long time ago, especially since the gov decided to allow more private medical schools to open & continue sending students to study overseas. If all can produce equally competent and quality doctors then it should not be an issue, too bad it’s the other way round that happened (as expected).
Not saying that I’m as good as previous old timers who went through tough times and survived harsh housemanship, I do not understand why my colleagues still complain of today’s housemanship training. Some of the complaints:
1. Working long hours (even though shift system has been implemented)
I agree that some hospitals’ shift system is not perfectly implemented 100% based on current KKM’s circular, but I personally feel our working hours are still less than previous doctors who worked 24 hours a day, 7 days a week ever since they were HOs. In my hospital shift system is being implemented but there are still HOs who complain of tiredness, and some even tried to ‘fight’ for their rights to have ‘enough hours of rest in a week’ as instructed by KKM (although it’s a bit unpractical if my hospital were to abide by it)
2. Being insulted and treated like coolies
Let’s face it, almost all senior doctors have gone through the period and survived, it’s just a cycle of life. Almost every other profession has similar scenario where juniors will feel the same way.
Actually it’s very subjective. Being ‘insulted’ or ‘treated like coolies’ can be perceived in 2 different ways : one is meant literally – where the MOs and specialists really intend to do it (probably as a revenge because they received the same treatment during their housemanship?). Another one is actually one of the ways to teach houseman to be more competent. Most of the times they don’t even mean it (deep inside their hearts they want us to be better) but a lot of people will misunderstand it. It’s true we are ordered to this and that but we must understand that it’s part of our job. So we should stop whining and take it positively. If you ever feel mistreated just think positive (don’t think the negative ones like they want to avenge because they were also mistreated etc)
Well there’s a few more but I’m starting to feel like I’m blabbering rather than discussing. In conclusion it all comes down to reasons of choosing doctor as a profession. If you do it for right reasons you should be able to find a way to overcome “these difficulties” and adapt. Personally I still think that on-call system is better than our current shift system. If really want less working hours, maybe can try to provide a 1-day off after each on-call (less working hours than conventional on-call system, and better continuity of care than current shift system)
So for all HOs nowadays, let’s be thankful and be more passionate for the sake of our patients. Let’s face the fact that we have “better life” during our housemanship as compared to our seniors (it’s true. Just try to imagine working as HO during their time and now – really a big difference, no joke)
Sorry I forgot to introduce myself (the one who posted above comment). I myself is a houseman as well who studied in Ireland and Penang Medical College (twinning program) under JPA scholarship.
yes, exactly
“Worst still, you will be under trained and underexposed. I have junior MOs who just finished housemanship who do not even know that ACE inhibitors can cause cough, Amlodipine can cause leg edema and Hydrochlorothiazide can cause rise in uric acid!”
Dear Dr Paglavan, I am a JPA scholar fortunate enough to study in Australia. Even though I made the correct decision of coming back to Malaysia for my housemanship, I would not recommend the same for my juniors.
I was lucky to have MOs who were from the on-call system. It is horrible to have my generation called the ‘strawberry doctors’ but it is WORSE to have to work with the strawberries.
The level of MOs my generation are descending to are simply despicable. I have to frequently override my MOs order at my own risk or seek superior authority to override their dangerous decisions. Imagine having to work with MOs who orders you to google for a normal respiratory rate because he can’t remember normal RR, orders 0.1mg atropine for bradycardia (because 0.5mg will caue arrhythmia), S/C Humulin 10u QID for an NBM patient (because diabetics have high sugar levels, and scolding HO for not studying enough), reading fast AF as sinus rhythm. I have even had to fight with a O&G specialist because she thought a burst abdomen could wait for 6 hours for the patient to be truly nil by mouth, and argue with a MO to admit a child who was attacked by his father with a machete by his (the MO wanted to discharge the boy to avoid paperwork).
It makes me shudder to think about what the on call system is producing. We are producing monsters with poor medical knowledge and zero ethics. Before and during my time, housemanship in Malaysia is still good training but I beg to differ for the generations behind me.
“Worst still, you will be under trained and underexposed. I have junior MOs who just finished housemanship who do not even know that ACE inhibitors can cause cough, Amlodipine can cause leg edema and Hydrochlorothiazide can cause rise in uric acid!”
Dear Dr Paglavan, I am a JPA scholar fortunate enough to study in Australia and finishing my housemanship in a month. Even though I made the correct decision of coming back to Malaysia for my housemanship, I would not recommend the same for my juniors.
I was lucky to have MOs who were from the on-call system. It is horrible to have my generation called the ‘strawberry doctors’ but it is WORSE to have to work with the strawberries.
The level of MOs my generation are descending to are simply despicable. I have to frequently override my MOs order at my own risk or seek superior authority to override their dangerous decisions. Imagine having to work with MOs who orders you to google for a normal respiratory rate because he can’t remember it, reading fast AF as sinus rhythm, orders 0.1mg atropine for bradycardia (because 0.5mg will caue arrhythmia), S/C Humulin 10u QID for an NBM patient (because diabetics have high sugar levels, and scolding HO for not studying enough), . I have even had to fight with a O&G specialist because she thought a burst abdomen could wait for 6 hours for the patient to be truly nil by mouth, and argue with a MO to admit a child who was attacked by his father with a machete by his (the MO wanted to discharge the boy to avoid paperwork).
It makes me shudder to think about what the on call system is producing. We are producing monsters with poor medical knowledge and zero ethics. Before and during my time, housemanship in Malaysia is still good training but I beg to differ for the generations behind me.
With KKM finally taking all responsibility off houseman for the care of a patient, they are finally given the official 007 license to kill
c3051476,
Aren’t you belong to the generation of “strawberry doctor” too! You posted your comments as if you are a consultant. So the action of KKM will also give you the official 007 license to kill too as claimed by your post?
agreed
I am one of the strawberry doctors as well, however I was lucky that most MOs that I work with were from the on call system. As my housemanship is nearing to an end, I am working with MOs from my generation and there is a glaring difference in the quality. The point is made to attack the ridiculous policies- ie. shift system, HO are not expected to provide patient care etc… therefore producing products like US. I am not trying to sound like an expert, just trying to demonstrate the incompetence of doctors my generation is becoming.
And yes, WE are given the license to kill. That IS the point I am trying to make if nothing is being done about these idiotic policies.
The worst thing is that consultants who actually take action to weed out the irresponsible junior doctors are threatened with HO who bring in their lawyers, and letters to KKM accusing them of being racists. Its like housemens are at the top of the food pyramid.
Additionally, I myself have peformed errors in patient care- that were corrected by capable MOs from the old school training. With the strawberry generation (us) becoming MOs, I would well advise curious to keep your family far away from the public hospitals.
c3051476 or 7?? quite strange! you sound more like a MO from the old school training rather than a houseman who is soon completing his internship. hehe.
Let us look into the healthcare system in Singapore. They predicted a shortage of doctors due to aging population. Hence, they increase the salaries of public-sector doctors to prevent exodus of public-sector doctors. They also introduced new medical schools (partner with prestigious university) and control the number of students intake. These new medical schools will only take about 50 students each year and will increase gradually, adjusted with the supply-demand.
Finally, they have high entrance requirement, such as BMAT, MCAT, interview, personality test, and essay test, besides the usual straight A’s. They want well-rounded doctors, who are not just competent, but also students that can survive the MBBS course and become leaders of their field in future.
This is the right way to manage things. Instead of pumping the number of medical schools, with minimum regulation, and low entrance requirements. I am aghast that we are accepting students with credit in their Biology, Chemistry into Medical Schools. I’m not being discriminative here, just realistic. Let us ask ourselves, if they can’t manage these sciences at high school level, or do not have the discipline to study, what are the odds they will survive medical schools ?
These students will one day be doctors, GP’s, MO’s or Specialist. The question is do you want them to treat you, with “license to kill” ?
This is the mentality that I don’t agree. If we want to succeed, than there should be no feeling of jealousy, inferiority etc and instead we shd help each other. Some are saying system in Malaysia is not perfect etc but when the poor jpa student was asking to get experience abroad, straight away you jumped saying no, no come back quickly and do your part and serve. Lets be realistic, open-minded and logic, as we are mostly doctors here. If it means you will get experience, doesn’t matter where you do it, but go ahead and learn be it Malaysia, Ireland, Egypt, Russia, Australia etc. And stop pointing to others and instead lets find solutions. If you feel you can pursue postgraduate training quicker in Malaysia, then do it back home, if you feel its quicker wherever you are currentlt studying that do it there. We should speak to JPA to give some time limit regarding this. But not just for internship as you can easily do that in Malaysia. Continue until at least MRCP, or masters or do sub-specialty training eg musculoskeletal ultrasound, or reseach etc if you can get a chance. But make sure there is always progress, not just enjoying life overseas and being stagnant. If you think you are always right and whoever against you or have a different idea is wrong, then better look in the mirror, and see if you have the right attitude to be a doctor. Besides doctors are teachers and healers, not somebody who inflict pain to others
You are missing the point! You should discuss this with JPA when you signed the agreement! Once you sign the contract, you are required to follow the contract. IT is as simple as that. If you don’t agree than don’t sign!
Many years ago, JPA did allow students stay back for another 4 years to do postgraduate BUT unfortunately many did NOT come back after that and just paid the penalty. So, JPA has removed the benefit! Previously the penalty was just RM250K but now I heard it has been increased to the actual amount sponsored!
To me the solution is simple! Just stop sending students overseas. We have enough medical schools in Malaysia and it is NOT going to be a critical field anymore!
JPA can start considering sponsoring students for post graduate education only, for overseas
Utter bulls***, hello please be frank and honest. No one want to stay back in India, Indon or Russia to get experience or pursue postgraduate qualification. They are all dying to come back to get a job here. But the same cannot be said for those who ho to UK and Australia, most if not all want to stay back because they have better quality of life and pay. I don’t believe this BS of getting better experience and come back to serve (maybe they mean after retirement). Most of them want to stay back eventhough they don’t get the postgraduate opportunity, they would rather get a job or even a locum job so that they can stay long enough to apply for PR status. You want to stay there, payback our tax money. British graduates not necessary are better. that’s why I always say it is a waste of money to send scholars there just to get basic degree. We should save that money for sending postgraduate students or doctors to do fellowship there in subspecialty fields which we are severely short of specialists.
For those who doesn’t realize this tax here in UK Ireland are half of what you get. So for a specialist 4000 euros is your back home money. To compare with specialist in Malaysia who is also teaching is around 12k so where are uou coming from when you say ppl are staying abroad for the money? Have you not read the news for the past couple of years re economic situation in Europe? People are here to finish up their training too, SpRs, Masters, PhD. I can easily make triple of what I’m getting but I need to finish the PhD and SpR and once I’m done, can’t wait to change the negative mentality of SOME docs back home.
MInd you, the tax in Malaysia is also NOT low. IN government sector only half of that RM 12K is taxable but for private academic staff, 100% is taxable. This means you will be taxed at 24-26% with maximum exemption, comes to about RM 1800/month and minus the EPF, your take home is about RM10K. Also don’t forget the cost of living like buying a car, daily groceries etc etc which is way more expensive in Malaysia. Try taking RM10 to a grocery shop and see how many items you can buy unlike taking 10 pounds? So, don’t compare the figures, it is worthless. Few months ago, there was an interesting article in Star regarding this issue.
Oh, by all means, try coming back and changing the mentality of doctors back home! I wish you good luck!
And just another thing, you Pava you just identify the problem which is too many docs, yet you refuse to accept ppl continuing their postgrduate training overseas when they finish. If guys in JPA is clever, they will choose their students overseas and some shd be given at least 4 years oversea stay to continue their education. These are solutions we are looking not just identifying problems and letting the poor junior docs feeling miserable and depress. Forget about seniority that is so stuck in Malaysians heads. These is the new era, whoever strive will get what they want. Went there is a will, there is always a way. And if you feel your opinion is the only one that is right, then think again. Start learning to accept others opinion only then people will start listening to you.
Is there anywhere in this blog I said that only my opinion is right? When you give opinion it should be based on facts and figures and not emotional. You are emotional in your argument. I have given enough solutions in this blog over the last 3 years, you need to read each and every entry in this blog. It is a continuos blog. Since when I did not accept your opinion?
My opinion has always been the same:
1) JPA should stop sending students overseas since we have enough medical schools in Malaysia
2) JPA should concentrate on sending post graduate students
3) Since you sign an agreement with JPA, it is your duty to fulfil it
Again, JPA did give this 4 years period till about 4-5 years ago. The reason were simple! MANY did not come back. By the time they finished their specialist training, they had comfortable job and already got their PR. They did not want to come home and take a pay cut. Trust me, it is easy for you to say now about coming back and serving the people after completing specialist etc etc but your view will change eventually. I have seen enough! AND how many of those who return wants to work in government sector? NONE! Previously, everyone had to do 3 years compulsory government service even if you are self sponsored. Even then, many will just come back, go to one of the University Hospitals and resign 3 years later. So, don’t come and tell me about serving the public in government hospitals after staying 7-10 years overseas. As some one said in this blog, it is BULL***.
When the government removed the 3 years compulsory service for those who have worked 10 years overseas, NONE came back to serve the government hospitals. Everyone went to private hospital. The shortage of specialist is in GOVERNMENT hospitals and NOT private.
BTW, i do not know why you keep saying about seniority, old mentiality etc etc, I don’t see any relevance of that in this argument.
My principle is the same: if you sign an agreement with JPA to come home, then you are legally required to come home to serve the bond. Anything else need to be discussed with JPA and not in this blog!!
Instead asking to stay back, why don’t you ask JPA for guaranteed Master’s seat! Isn’t that a better option?
Let’s not argue or discuss over matter that has been resolved. Dr Pagalavan, JPA has stopped sending students oversea for medicine. Only students that successfully obtained unconditional offer from top 10 medical universities (such as Oxford, Cambridge, Harvard) will be considered for scholarship under PILN (if not mistaken). Another option would be studying medicine in Malaysia, which JPA will sponsor provided you pass the requirements and interview and that’s under PIDN.
Yes, I heard about it.It is not a critical field anymore. Surprisingly, JPA is sponsoring students to medical schools which is yet to be accreditated by MMC.
I remember when going for JPA interviews post-SPM, the most common answer for “reasons to send you overseas” is to gain more experience/exposure.. typical SPM essay answers. But when asked how can it be better, no one can answer. as the generalization is non specific and just shows how shallow can the thinking gets. Can’t blame them, they are not into the reality yet, when their minds are actually filled with “going overseas”, whether if it’s for personal achievement or family pride, it is part and parcel of growing up. We just do whatever we see right instead of letting them off as leechers.
going overseas can be better in many wayss…
is has pros and cons
are you the one who couldnt answer that?
are you the one in that particular generation?
Why cant answer? They can answer different country expose to different method to be brought back to home county. Etc..lol
Great, thanks for recognising the emotion and passion that I’m showing. Now I will tell you why.
Why don’t we start by talking about many of my younger colleagues especially final years who are abroad, be it Ireland, Australia or Egypt (surely others too), all scared when they look at certain blogs (ehem..) and heard stories from others about the hostile environment at work back home. Stories about junior doctors being screamed at, scolded in front of patients and were sometimes treated without respect. Here junior doctors will drink coffee and taken to dinners, or even bbq at end of rotation to show appreciation after on-calls, rotation etc. And from observations, even some patients back home especially in public setting are being mistreated and with force (first hand experience while doing my electives).
Do they want to go back? Of course they do. How many do you think wants to stay overseas to pursue their career? most of them would want to go back home with close family and friends, settle down and establish themselves in their career. Even the people who continued on with postgraduate training would love to come back and serve the nation. But instead (not everywhere) first they read blogs saying that our medical system is doomed, but hey since there is no choice anyway as they have signed the contract, they have to go back home and so they did. Then reality checks in. Shouting, scolding etc comes in place, as if it’s a routine normal thing to do. Well that won’t help their confidence nor character building. Will that make them work harder, or learn more? I don’t think so. Depression kicks in and whoever that is not strong enough usually will end up nowhere.
This is the first thing that I think we should change. If we plan to scare people lets come up with ideas. Instead of telling the whole world our interns are not as clever as us since they don’t know thiazide can exacerbate gout, why not we make weekly or fortnightly compulsary journal club(and should be run in a relaxed manner: coffee scones etc with participation of senior who should present too!), or audit to see how many knows how to manage acute and chronic gout, then present findings/solutions before finishing the audit loop by re-auditing, or even teach the guys not just the standard treatment but even polish them with more info for example adenuric/febuxostat as preventative measures or even Anakinra (anti IL-1) in very resistant cases! make it more interesting and make these guys love medicine more! Only then we will get a generation that would enjoy what they do, and not doing something just because of peer pressure and what the rest of the world are doing. Only then people will work harder, stay longer, publish more and staying fresh at the same time.
That’s only my first point, if you want I can give you more about why I am emotional about it, but at the same time I respect this is your blog so I think I’ve written enough for the time being.
Do they want to go back? Of course they do. How many do you think wants to stay overseas to pursue their career?
I guess this may to a greater or lesser degree depend on whether you’re a member of the master race, no?
Well Jon I have no intention of starting racial tension here so hope you do the same
Fahd,
I don’t think Jon is trying to start racial tension. He is merely stating that non-Bumis are much less likely to want to return home because they have to work in a system that practices institutionalised racial discrimination, where people become HODs, A/Profs and Profs based on their race instead of their ability.
The system actually disadvantages Bumis who are genuinely talented and who have done the hard work (possibly like yourself) because everyone will assume they have made it to the top based on their race and not on merit.
Fahd,
I’m not trying to stir the racial stewpot, though I appreciate that some might misconstrue my facetious comment.
Your post implies that most Malaysians would prefer to return home(sic) than to remain overseas to pursue their postgrad careers or to settle in another country.
This decision depends on a balance of push and pull factors. This varies greatly between individuals, but the fact is that if one is a Boomi, there will generally be many more pull factors than for a non-Boomi.
It is not just about opportunities for personal career advancement but job interest. Sone of us have subspecialty medical/surgical training with a scope of work that is not commonly done in Bolehland. So we go where the work that compels us is undertaken.
Then there is consideration of the environment that one wants for his/her children to be raised in. Again, strengths and weaknesses in everything, but we choose what we think is best for our future generations.
The issue of family is usually foremost for why many choose to return from overseas. Probably food and east Asian culture are considerable factors as well. But in the grand scheme of things, these are “single generation” concerns.
I might miss my parents and some aspects of Malaysian life that I was raised in. My children who are born in UK do not have similar sentiments, despite my ensuring they spend at least 6 weeks every year in KL (to the extent that they will happily sit by a roadside drain to eat hawker food with me). They do not view Malaysia with any form of sentimental longing.
I hope they embrace the “child of earth, citizen of the global village” philosophy that I have. The world is a small place now, and those able will choose where they want to be for any number of reasons.
FYI, all this is being done in every hospital!! ,now let me tell you another version.
ALL hospitals have teaching sessions and CME sessions. BUT you know how many interns attend the sessions despite being compulsory? Less than 50 percent! In fact most of the time, only about 20 – 30%!! So, stop blaming the hospitals or superiors!
The problem is not the superiors, it is the system which cannot be changed because it is too centralized and big.
ABout teaching. As far as I know, every consultants teach! BUT how to teach a so called graduate when he does not even know how to clerk, examine patient and know basics of medicine? This is the reason you go to medical school!
You are talking about taking for drink etc. This can be done if you have proper ratio of consultant, MO and HO. BUT when you have 50HOs, 3 MOs and 1 Consultant, how do you expect the seniors to do it? As I said, it is the healthcare system and NOT the individuals. Pls come back, enter the system and tell me how you are going to change it. Till then, you won’t know the real situation.
http://pagalavan.com
Sent from my BlackBerry® wireless device via Vodafone-Celcom Mobile.
Right so we identified the problem there. Like I said earlier, junior docs could not cope with the stress, long hours etc so no way they will have the right attitude nor the interest to learn. So first the environment has to change, which I think is changing and improving in the university hospitals. And how did you turn up to be a specialist/or consultant so early? I feel we should focus and emphasize the importance of MRCP which is not at all difficult if you learn and have dedicated training. We need to discuss this at management levels, especially among consultants and at the level of specialists, not at the level of MOs. They are the one that need training (but they need to be fostered so they become keen like they used to be once when they were medical students). We should come up with a structured plan, and do weekly MRCP tutorials in each department. Government should also play a role and we should discuss this further with them (we will need a strong representative, and start a committee and this should be from influenced individuals) to discuss role of government in producing more specialists. They might a quarter of the MRCP exam for example which is quite expensive and make full payment if the person passes. This will act as a motivator for the doctor to work hard to ensure they pass. At the same experienced doctors like you who has passed MRCP will be key as you know the trick of the trade to pass this exam. Tips on the way to answer, body language, what are expected etc. If this can happen will would double on triple the number of specialists in no time.
I have identified all these problems long time ago and have mentioned it in this blog so many times, giving solutions as well!
FYI, after the introduction of “shift system” from september 2011, the number of interns attending CME sessions has dropped even further. So, to say that they do not attend the session due to work load is rubbish.
Don’t talk about university hospitals. One of the reason why I never talk about university hospitals is because they are totally different in management, hierarchy and number of specialist/consultants. Furthermore, these hospitals are not only used by undergraduate but also postgraduate students from Year 1-4 of their training. It is a teaching hospital and only people who are interested in teaching will go into these hospitals. BTW, do you know that they can reject patients, only take selected cases and limit their number of housemen? That is the reason why they do not suffer from overloaded housemen and shortage of staff. On top of housemen, they have service MOs, Master’s trainee ( Year 1 till 5), junior lecturers, senior lecturers, Ass. Prof and Prof! So, don’t compare these hospitals with general MOH hospitals. MOH hospitals are the major healthcare providers in this country. They take almost 70% of the load with private /university hospitals taking about 20-30%.
ALL this MRCP training that you are talking about is being done in almost ALL major hospitals in Malaysia. In fact, 2 hospitals in Johor even conducts MOCK exams twice a year where I do attend occasionally as examiner. So, to say that this is NOT done in our busy hospitals is NOT true.
Well look who is emotional now 😉 Anyway that is good and it is current practice (and should be!) re CME sessions but we have to think to ourselves why these guys are not coming? Do all consultants or specialists go to this meetings too and lead by example? and for the junior docs, do they have the time besides coming in very early to do bloods and going home late nights (or has this changed? please correct me if I am wrong..) are there reward for best presentations so it is not dull boring…and are they being scolded during these teachings? I think we should try to identify the reason (besides fully blaming them for being lazy) and come up with solutions.
Emotional!Hmmmmm. I don’t remember being emotional, just replying to the false impression that you have about the system. Specialist and consultants do attend this CME sessions which is held every week. May be not ALL but most of them do. No one scolds them during this session and it is for the whole hospital, mainly targeting the HOs and junior MOs. The talks are usually given by specialist. Some departments have their own weekly or biweekly CME sessions taken by specialist. After the introduction of “shift system”, it has become worst as the HOs who are not working at that point of time do NOT attend. So, it has nothing to do with workload etc etc. Worst still, some have been caught doing locum outside.
You see, I don’t think you are getting the point. You are not looking at the bigger picture. You are siding to one side and forgetting the attitude problems that the current generation of young doctors are having. This type of problems are minimised in UK, Ireland etc because they have a good monitoring system and a good undergraduate education with strict exams. Only the capable ones are graduated. Any incompetent ones will eventually be eliminated after that as well. In malaysia, once you are in the system(government service), you can never be removed whether you work or not. It is a one way ticket to pension! Same goes to the superiors and HODs.
Why are we talking about MRCP? I thought the Msian Gov is not keep on foreign exams, and prefers to train doctors through the Masters pathway? There is even talk about de-recognising it, just as they de-recognised the MRCS after it was rebranded from the old FRCS in general.
Paying MRCP fees? Wow. More tongkats?
An I agree with most here, anyone signing a bond with JPA, MUST abide with the rules of the contract. Otherwise pay up the bond. Anyone intending to stay on after graduating in UK/OZ (people normally don’t want to stay on in the other countries) should NOT take up the JPA scholarship, unless they can persuade the JPA to insert a clause in the agreement allowing them to stay back.
and please don’t use taboo words such as utter “BS” etc as we are doctors, so we should act like one! 😉
what a positive point of view from you FAHD…come on..come back to this country and serve to university hospital
student would appreciate you because you seem to be good in teaching student..not arrogant..not superior type..humble..not scolding type of person
not underestimate people..not downgrading..very positive but yet critical..
this is the type of teachers that medical students need nowadays.
this country should have more specialists and consultants like youu..
come on..lets discuss a bit
so let say a 60 year old man come to the clinic…provisional diagnosis now is acute attack of gout..so..how would you go about from there
tell your plan and management
Taboo?? No such thing
A person who has the intention to cheat the tax payer money by breaking his bond not really qualified as doctor morally.
If you read my notes clearly it said to rediscuss, nothing about cheating. I feel sorry for you “poor doctor” for being so negative, even your internet name goes with that. I wish you the very best in what you can achieve but I hope nobody will follow your roots. It’s time Malaysia have more positive people, and can move forward.
It’s interesting to listen to a lot of things that you say because it looks like you are being a hypocrite. You talk so many bad things about the system in Malaysia, superiors etc etc but you decided to stay put overseas to enjoy a better working life/ having cup of coffee. You should come back and work with the junior doctors over here and try to change the system. Only then, people will respect you for what you do. I can bet you that after completing your specialist training overseas, you will either go to a private hospital in Malaysia or to one of the university hospital! Only time will tell but I hope you will proof me wrong! I will respect you if you come back and serve your 10 years bond in MOH hospital and try to change the system.
Haha, this just shows how superficial you are as you can even judge a person by just looking at the Internet name. My tone maybe harsh but what I stated here is the truth which you may have difficulty to accept.
This will be the last time I’m writing this down so please don’t be ignorant, I am currently doing my PhD (outof programfrom my specialist training for 2 yrs) then I have 2 more years to finish the specialist training so stop asking repeated question asking me to come back now. I will return and I will go to the university hospitals and I will teach. And no I was not a JPA scholar and no I don’thave to work with the government for 10 years, and yes I would love to work with the government, and yesI will try to make some changes and will liasise closely with the government when I return, including to try to get private wings for consultants so they would stay longer with the government. This will be my last reply in this issue.
Private wings are already available in all university hospitals and some government hospitals. Well, it is all about money again!
http://pagalavan.com
Sent from my BlackBerry® wireless device via Vodafone-Celcom Mobile.
Really poor doc? Your harsh words? Haha that’s nothing. If I put much notice to people like you I will be nowhere, and by the way, if you don’t change, you will stay nowhere too 😉
How to get involve with private wings? 🙂
Don’t worry about me. I am fine. You are able to be doctor because I paid my tax and have a right color skin.
Dear “Positive”, thanks for that. Surely once I’m finished with my full training that is my plan. If you want we can start the discussion no problem 😉 But we should ask the permission of Dr Paga 1st as this is his blog. There many intervention we could choose for an acute attack, but as we have been trained before, thorough history and good clinical examination is key. This should include concurrent meds which we know can exacerbate gout, family history, past history, diet and social history including alcohol should be asked etc.
Presenting complaint is also key as you would easily realize that it is a gout attack when they give a history of sudden attacks of swollen, tender, red and warmth joint which usually spontaneously resolve, usually at 1st MTP, in more elderly ankle joint is also common especially around the lateral aspect near the malleolus. If it’s a unilateral (mono-arthritis) joint involvement especially knee, we need to stick a needle in (aseptic technique obviously) and look for crystals versus C+S as one would wary about septic arthritis.
Clinically we have to be careful not to confuse with cellulitis as podagra or even at any other joint could manifest and look like cellulitis. Important teaching point is your uric acid levels could be normal during an attack. OK this is getting a bit too long but anyway treatment options would include short course of steroids or NSAIDS (but be careful esp NSAIDS in elderly or patient with history of peptic ulcer disease of kidney disease), colchicine low dose (maybe just 0.5 bd po to avoid it’s most common side effects of diarrhoea and this could be used in short term or up to 18 months!), intra-articular injections (if you have learned ultrasound, this will be much easier especially for the one at the ankle as we need to be careful of the dorsalis pedis artery.
Previous thought was not to start preventative treatment i.e. allopurinol/febuxostat etc at the same time but this has change in current guidelines. Well if Dr Paga allows maybe we should have more discussion and surely he who is expert on this too would have more to add 🙂
Malaysian Rheumatology Society in collaboration with Academy of Medicine Malaysia has already published CPG on “Management of GOUT” in 2009. Pls visit their websites.
Not to forget, control BP, cholesterol, weight is also important as part of its management OK OK I’ll stop now 🙂
To all the junior doctors and even medical students, don’t worry about starting your career in medicine. Start with pride, honour the new job, and respect and give your best to your patients. Always remember the judgement and the actions should be for our patient’s best interest. Always try to improve, learn something new, and read about things you have just seen or managed and check if there were anything you missed or could have done better. Start learning basics of research and audit, and try to read journals. To get good information and updates, uptodate is one of the good websites but with fees. Try the hospital’s library if they can subscribe to this, if not try to ask hospital management to sort this out. We need to speak up for ourselves, but things will be easier if done in groups. Medicine is not dull, many outside of the field are fascinated with the things we deal on our daily basis. Take Dr Pava for example, look at his hardwork and see where he is now and that didn’t take that long. Finish the MRCP if it’s difficult to get into Masters, publish some papers, can start with case reports maybe as that would be easiest. Decide what you like and stay in that specialty. It’s actually very, very simple. Remember there are many people that care (do know that there will always be minorities that would not care or will try to bring you down, but don’t put much notice in them). I wish everyone the very best and remember, after the rain, there’s always sunshine 😉
If everyone who does medicine do it for the right reasons, then there are no issues. As you have rightfully said above, people who do medicine for right reasons will do everything you mentioned above without anyone telling them to do so! I published my first paper when I was a housemen in a government hospital in Malaysia despite so much fewer housemen then.
Unfortunately, the group that you mentioned above are becoming a minority nowadays.
How to publish paper? Where to start? What to write? And where to submit? Any guide on this? The paper must be about something which has nt existed right? Or how?
wonderkid,
You should have been taught the basics of this in medical school. If that wasn’t the case, then get in touch with the specialists in your hospital – almost all postgraduate training programmes now have an element of research or statistics built in to their training.
@wonderkid,
Do some justice to your moniker, unless you’re just wondering perpetually.
Do we produce “spoon fed” generation under our “first” class education system.
Dr. Paga, many thanks to your blog.
Dear Dr Fahd, with all due respect- it seems you have been training overseas for some time, missing out on the great leap of backward that our hospitals are descending to.
It is a common observation that the quality of houseman entering the system has deteriorated greatly. As I was a houseman (sponsored by JPA for undergraduate studies in Australia) trained partially in the on call system and the shift system, I hope to provide answers to your questions.
1. “Do all consultants go to this meetings and lead by example? and for the junior docs, do they have the time besides coming in very early to do bloods and going home late nights?”
With the shift system, it is rare for us to have to work like you had to in your training days. eg. the surgical female wing in my hospital houseman outnumbers patient numbers on most days (eg 8 HO, 6 patients). Yet CME meetings are still not attended- and yes, our colleagues have been putting extra time to profit making locuming. It is a regular occurence for the consultants sit waiting for the HO to file in (from chit-chat session) to start CMEs.
2. “Junior docs could not cope with the stress, long hours etc so no way they will have the right attitude nor the interest to learn”
The amount of stress and hours we have to cope with is miniscule compared to your generation. However, the right attitude or interest to learn is also proportionally miniscule- because of the mushrooming of medical schools, in entry qualification and almost perfect passing rates. In the old times, entering & graduating in medical school is sufficiently difficult that the uninterested/incompetent were eliminated. Nowadays, I frequently meet junior housemens who have not done a short case in their life unable to clerk, examine patientsp; medical students who walk away from consultant lead ward rounds for ‘mamak’ etc.
Dr Fahd, it is certainly not encouraging for students abroad to have to read disparaging news before coming back- but we need everyone back to make a positive change, and to take heed of the negative examples not to live by. We hope to see you come back and persevere on teaching in spite of the negative, heart wrenchingly difficult climate of the local medical system. It is almost impossible to continue as a teaching consultant in a local MOH hospital, and I give the highest salute to the good souls who continue to do so.
C3051475,
Hi, I ‘suspect’ you are a MO who ‘fake’ as a HO and lamenting all your grievances which could be directly or indirectly caused by HOs. If I am wrong, my sincere apology to you.
Funny that all you folks are there complaining that JPA students don’t return.
If you dislike it, bring it up somewhere – to your local officials, your local newspaper, or form some awareness group. Of course you can complain and lament about it here as well – not that it’s gonna change anything.
You can also vote for the smarter party the coming election – and influence the people around you to do the same.
Dear curious,
Seems to be an unnecessary step to do- faking to be a HO? I am completing my HOship in a month, which may explain my tone. There are many housemens like me, trying to do our best to do what we can… yet we are far outnumbered by others who don’t take their job seriously and compromise patient care. I have many colleagues who’s full time job are locuming, and part time job as a houseman. Yet there are no action taken against them in fear of another HO suicide…
No action can be taken unless they are caught outside doing locum by the state UKAPS unit.
The HODs suppose to take action as well if they don’t come to work but MOST HODs don’t as they do not want paper works. Such is the system!
I dont know why you guys having so much grudges on HOs…haish…pls stop boasting and start teaching us with your experience knowing that our level (HO) is not up to your expectations … everybody was born as a baby with 0% knowledge of anything so all are learnt from experiences and teaching from the experienced but you guys always doing it opposite. .once you were all HOs so show us some respect..referring to your comments earlier..you stated ward can be run by MOs and Specialist..of course yes but those were HOs in d first place…never read even Einstein was such a boaster eventhough he is the SMARTEST.. children…children.. Teach us and dont humiliate us..
No one said we are not teaching! To teach you need to know your basics. That is the reason why you go to medical school!
If you want us to teach you basics, then might as well don’t go to medical school! Just come after SPM!
I agree with you perdition..i pity these HO’s… How basic is basic i wonder ??
Basics are things that medical school suppose to teach you, without which you should not have graduated!
Do you expect seniors to teach you how to clerk, examine and come to a diagnosis after 5 years of medical school? Housemanship is to teach you about management of patients and not BASICS!
I guess you are referring to 1st poster HO’s . Yes i have encountered those 1st posters who do not know how to clerk, properly examine or diagnose . Most of them will usually come from Russia or Indonesia, which i fully understand why it happens. They are just not trained the way their Malaysian counterparts are trained but they get better as they settle in. No need to sound too harsh on them, thats why they have senior HO’s to guide them. HO’s need to be guided, not bullied..no need to get all stressed up over these things maybe they’ll even surpass their specialist.
As far as I have seen all these years, I hardly saw any HOs being bullied. Yes, there were and are some isolated cases of bullying which happens. These are seniors who are born like that! And it also happens in many other countries. As long as the HOs knows their basics and willing to learn, then I don’t see why they should be bullied!
BTW, do you know how many of these HOs who complain becomes one of the bullies themselves when they become a senior? I have seen enough of them.
Unlike most other jobs and possibly, other professions, doctors NEED to have their basics right at the point of starting their working life, ie HO level. That is NOT the time to start teaching medical school all over again. Therefore, there is a minimum presumed knowledge AND experience (that is what clinical years are all about) a HO MUST have right at the start of their 2 years. Further teaching will build on that baseline.
The problem nowadays, with graduates from so many different med schools with so much variation in standards and ability, is that many are BELOW this presumed minimal knowledge and experience. HO is NOT the time to teach how to clerk a patient, for example.
Therefore, it is understandable why the profession feels so disappointed with young doctors nowadays.
Actually HO is the period when theory becomes practice. Otherwise, what is the use of housemanship if everyone expected to know immediately all alone how to do thoracocentesis, lmbar puncture etc. If scolded right away on first attempt, then that is wrong way of teaching. Otherwise Can become mo straight if know everything adi like that.
Nobody gets scolded for not knowing procedures. They get scolded for not knowing basics. What are basics? Like anywhere in the developed world, housemans/interns are expected to know how to take a good comprehensive history, do a thorough and accurate physical examination, use theoretical knowledge to formulate a working diagnosis, and on the basis of that, order relevant investigations, and then start appropriate treatments commensurate with the provisional diagnosis. And finally, one very important skill; know when to ask for help.
If any houseman fails in one of these basic skills, they SHOULD get scolded. And the most important reason for scolding is the last one. The repeated incidences of incompetent housemans not making the appropriate diagnosis, and not making the appropriate decision to ask for help. The next day, perforated appendices, dka, extradurals etc have to be sorted out.
A friend’s father went in to get a routine colonoscopy procedure done at a government hospital, and ended up with a perforated intestine. While this is a known, albeit uncommon complication, said patient remains admitted in hospital after two weeks.
It all depends on who did the scope. You need to check whether it is done under supervision.
Perforated intestine/bowel can happen in private hospital too. A friend did a keyhole procedure in a very established and well reputable private hospital in klang valley but ended up with a perforated bowel. Unfortunately this was not discovered immediately and she had to enure a lot of pain and discomfort. She underwent an emergency repair and lost a total of 20kg in weight.
So i guess when the risks are explained prior to procedure, can we say “please don’t pierce my intestines?” 🙂
It is a known complications and if you had signed the consent, you are willing to take risk of the complications mentioned
Hi Jaz,
You are right in saying that it is a known complication of the procedure. I have seen it happen with experienced and competent surgeons. If it happened to a family member of mine in a govt hospital, I would ask who was performing the procedure: Was it the specialist or an MO? If it was an MO, was he competent in performing the procedure? (i.e. has he been deemed competent by available objective and subjective evidence) If not yet competent, was he adequately supervised by a more senior doctor?
Truth be told, these types of enquiries usually come to nought because it all gets brushed aside and you hit a stone wall trying to get to the truth.
In government hospitals, trainee specialists who undergo training posts may not competent enough to carry out the procedure but are allowed to do so because they need the exposure to learn and practise their skills. Patients go to government hospitals have no choice but to take the risk.
I disagree karen. A trainee who is not yet competent in a procedural skill should be gradually trained by their specialist. For example, 10 procedures assisting the specialist, 10 procedures performing the procedure supervised by the specialist, then able to practice unsupervised. Of course, the actual numbers would depend on the complexity of the procedure. Patients are not guinea pigs and just because it is the way things have always been done in Malaysia doesn’t mean it is the way things should be done.
Looking at the other side of the argument, there is a balance between service and training and in a situation where there are not enough specialists, MOs who are not yet up to the mark may be performing procedures beyond their capabilities.
Problems can also occur during procedures supervised by the specialist because the trainee is not ‘skillful’ enough. Heard some ‘horror’ stories from medical students, not only happened in Malaysia but also happened in overseas too.
Dear Dr Pagalavan,
You mentioned here that you were working in Singapore then you moved to Malaysia, why ? Did you worked at Singaporean government hospital or private one ?
You also mentioned somewhere in this blog that Master of Orthopedics has the toughest entrance exam among other master programs. Why ? Is it because orthopedics specialist can make a killing fast ?
I came back for family reasons. I worked in SGH.
IT is not the toughest entrance exam. It is the most competitive MAster’s program which receives the highest number of application every year. It is considered as one of the easiest Master’s program with almost 100% passing rate!
u keep worrying people…can u come up at least with a solution/suggestion for these future doctors so as to face the hurricane safely?
The solutions are all here in this blog if you care to read all the articles and comments in this blog.
Passion,endurance,intelligence and empathy
dr Paga,
my lecturer told me that bio informatic will be a new promising career in science field but when i went to a clinic for treatment recently the doctor even ask me what is bio info actually and if i choose this course in what field can i pursue my master? tq
It is a new field. Malaysia has a long way to go into this field but you may be able to get jobs in upcoming industries and also in Singapore
i’m studying the medic course in this country. IF my daughter insisted on doing medic is MAHSA good choice? some doctor friends even told me to go to AUCMS (UKM) or Perdana or even Egypt which is easier to pass. And what about medic engineering in ukraine? Tq for yr time doc
I would not recommend any of it! Try the more established ones like IMU, Monash, PMC .Your daughter should spend more time reading this blog before deciding.
None is recommendable judging from the fact the hurricane is coming. Choose other subjects. In 5 years time, by the time she graduated they will be enough doctors, so much so that the KKM will only hire the selected few especially local grads. I dont know why so many kids nowadays are dreaming of becoming a doctor. Before you pay for her education, ask her few questions – 1. what is her main reason to study medicine? 2. Do you think you can handle the stress? – some doctors do go PSY either during or post study. 3. Tell her in 5 years time, they are so many doctors that she might have to wait for months or years just to land a job. 4. what does she know about medic engineering? is she interested in it or she is interested as long as it is medical related.
dr paga and bestrong, thanks fr yr comment..my daughter is studying yr blog now..i hope she’ll get a clearer view and choose what’s best for her. You see, her elder sister scored 11A’s in her spm and 8A+ and didnt get thru her jpa overseas interview for pharmacy and now study in local ipta. I hope she make a better option
Hello Dr. P.
It has been mentioned that the posts for MO in N9 are already full. But as in my clinic (a KK in N9) our workload is – in my humble opinion- still quite heavy with 150-170 patients per day. I am currently attached to maternal & child clinic, where sometimes a patient might take up to 10 minutes to manage, (for scan, routine exam etc). A few complaints have been made by clients due to long waiting period but it can’t be helped because we are shorthanded.
As an MO in health side, we are required to do the admin job as well. There are a few KDs (klinik desa) under our supervision as well. It’s not always an easy job behind the desk in health side.
I have not been taking any leave since January, and i can’t attend any course since then due to lack of MO. It really makes me wonder, whether the posts are really full or it’s just based on the paper in JKN. Perhaps there is maldistribution issue within the state. I’m not sure about it. I have raised the issue to the district health office but we were told that new MO will be coming soon, just be patient and bear for a while. Most of them were appealing not to come to health side.
Some MOs are leaving soon for master program, yet no news of replacement for them as of today.
Just sharing my views in the grassroot level.
This situation happens everywhere. It is mainly due to maldistribution of workforce. Busy and non-busy clinics will have the same number of post for MOs!
Furthermore, there may be many post which are still occupied by doctors on leave, maternity leave, unpaid leave, master’s leave etc etc. So, you will not have exact full number of doctors at any one time.
You can’t run away from admin work as long as you are a civil servant.
Hi, I was wondering about the availability of MO posts in Sabah and Sarawak. Currently, it seems many hospitals and KKs esp in the rural areas there still lack MOs. Heard of Hosp Tawau that only has 5 MOs, where 2 MOs oncall every night meaning an MO oncalls every other night/once in 3 days. Hospitals here also don’t run the complete shift system for HOs cz there isnt enough of them. HOs still do oncalls aka double shift. Do you have input on this Dr? Thanks.
I had mentioned about this many times. It is because of maldistribution of doctors and pulling cables!
However, this issue will be solved once the surpluss of doctors hit the nation. Once all the post becomes full in Peninsular, everyone will be transferred to East Malaysia. You can’t say NO if you want a job!
Dear Dr, I’m a final year med student due to enter the workforce sometime in August this year. Am a Swakian, and plan to serve in swak. I was wondering about the situation of MO posts in Sabah and Sarawak. From what I’ve heard, it seems that the hospitals and KKs there still lack doctors. MOs still have to oncall every other night/once in 3 days and the hospitals still cant run the complete shift system bcz thr isnt enough of them, so they still do oncalls aka double shift. Perhaps it isnt an issue of saturation of posts, but poor distribution of doctors. it seems that from previous comments, in many areas there is still a need for more MOs. Perhaps MOH shud solve the issue by reevaluating the appropriate needs and distribution of MOs in diff areas instead of claiming that posts are full. Is there any way the MMA can provide feedback to MOH on this? Any input on this Dr? Thanks.
This is a well known fact for many years. Nothing new and MOH is fully aware of it. Maldistribution of doctors has been happening since even I was a houseman.
However, this maldistribution will automatically be solved when all the post in Peninsular becomes full. MOH will then flex their muscles and transfer almost all who complete housemanship to East Malaysia.
You just have to wait.
Which part of swak u plan to go to? Isnt it in september?
i study at moscow,russia now..n wil graduate on 2016..So is it this is best time or still safe for me join as Ho’s.. and which specialization is most demand right now..? hope get reply 4m u sir..10q
2016 will still be OK but you may not get where you want. Demand among specialization changes with time
I had just graduated from matriculation and i am going to attend medical course this year. May i know how many years are actually needed to become a specialist?
I think you should spend more time reading this blog! All the answers are there
Think of finishing your medical course first. Dont think of all this specialization. No point of thinking it so early. You can dream but dont think too far. Dream of becoming doctor first. Hehe
take one step at a time my boy,good luck 🙂
Hi Dr.Pagalavan..I’m First year medical student from Universitas Sumatera Utara..Will graduate in year of 2018. Is there any Housemenship position in Malaysia in that year.? Pls reply me soon.Thank you.
No. Hehe. All will be filled. Jobless. Government will go bankrupt in 2019 unless miracle happens during GE 14. I am sure the current cabinet will approve more medical schools in malaysia. Cronies everywhere.
No one knows for sure. BUt definately the government sponsored and local public university students will be given priority.
What I think is this,hope Dr Paga would concur.what u medic students have decided is to read medicine and have done precisely that and work towards it.there is nothing u can do to worry or fret about what will and can happen in the future.Your worries may not change anything for the better of this profession so just let it be and hope for the best!.Good luck
Dear Dr. Pagalavan,
thanks for pointing out the predicament that may be encountered by the fresh graduates in the future.
I am a year 3 medical student and expected to complete my MD in year 2015.
I am so worried with the current situation and i wish to get Dr’s enlightenment on the following issue:
1) what should we (the fresh graduates) do in case there is no post offered to us when we graduate?
2)are JPA-bonded or public Uni Graduates prioritized in allocation of jobs?
3)isn’t the MOH going to implement any policy that can overcome the over-flooding of doctors?
thank you for reading and resolving my inquiries.
best regards.
1) wait in the Q
2) yes
3) why should they? They never promised any job to anyone! Do they promise job for all engineers etc etc?
It is all about money. No one thinks in our government
i’m currently an MO..
i have no interest to work with KKM anymore but still has 6 years JPA contract..
any chance for me to resign without being sued?
Why would u be sued?lol..n why u want to resign? Would be interested to know.
You won’t get sued but you will have to pay the compensation that is mentioned in your contract.
Hello sir,I am a MO and im planning to be a ortopedic surgeon,I read few of your posts and found out,the field will be quiet full soon(or maybe its already full).I love ortopedicthough but i wont get a job when i finish doing my specialisation,,Just need your opinion,what you think? continue with my dream of becoming a orto surgeon (where i will get job satisfaction) or should i choose another field,where job is more guaranteed.like pathologist or dermatologist (where there is few interested in the field)?job satisfaction or guaranteed job?
tq,
best regards,
brian
If you finish orthopaedic training you will defnitely get a job in the public system. Private work is market driven so is another story altogether. The bottleneck for you is actually getting on to training. If you are an MO, you already know how difficult this is, so good luck.
The first problem you will face is getting into Masters in Orthopaedic program as it is the most competitive field.
Secondly, since you are a government servant, you will definately get a job in public sector. It is the private sector that is saturated at the moment.
Do u know which specialties are unsaturated in private department? And in need?
hello doctor,i am a local private uni student studying medicine graduating around end of 2015 or ealy 2016. i was wondering wat will i do if i dont get government job by that time.can u pls give me some options. my friends has told me to sit for usmle but it is too expensive and i am self sponsored without ptptn loan. and plus my degree is only recognise in malaysia, sri lanka and bangla. can u help me by giving me some options.thanks
Likely, you will still able to get a housemanship job if you graduate by 2016 but not sure about MO job.
Please read the article on” What if……….”
Dr, i would like to know whether is UNIMAS a good university to further my studies for MBBS?
OK
[…] March 2013, I wrote and published a circular from MOH that almost 95% of the post for MOs has been filled in most states. Today, I received an […]
[…] that the MO’s post for Peninsular Malaysia is almost FULL. Â Almost a year ago, I published this circular from MOH which stated that the MO’s post in certain states are deemed full. One year forward, […]