I am very sure a lot of us would have read the article in The Sun 2 days ago. It was about the petition that was sent to DPM from a group of Malaysian students graduating from Australian medical schools seeking our government’s intervention in securing an internship place in Australia. I wrote about this issue and the petition concerned almost 3 months ago over here. I had given my views. The person who initiated this petition is a self sponsored student but majority who signed it were government scholars. BTW, I don’t think our Minister of Higher Education knows anything about internship in medicine based on his reply over here. He probably thinks “internship” here means equivalent to internship in other fields where they do it as part of their course. This reply in The Sun is interesting to read.
Now, coming back to the topic above. I mentioned in my last post that I will reveal some changing strategies of medical schools in getting students. IMU, the first and most established private medical school in Malaysia, has sent out a survey to their alumni and students asking for their opinion on the introduction of USMLE preparatory course. What interest me the most was the content of the message that was sent out. Every single issue that I had written in this blog that many refuse to believe over the years has been reinforced and confirmed by this message below:
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However, I would like to reiterate that sitting and passing the USMLE exams do not guarantee you a residency post or a training post in US. Yes, US is still short of doctors simply because many of their own citizens are not interested in being one. The high litigation rate and demanding population are some of the reasons quoted. Oh, don’t forget the high indemnity insurance rate, so much so, it is even higher than the income they earn in a year for some speciality. There was once a saying that there were more doctors resigning in US than being produced, not sure how true was that statement.
USMLE exam is needed for anyone to be able to work in US. It consist of 3 Steps with 2 parts in Step 2. It does not come cheap either. Just this year, the fees has been increased again as mentioned here. Despite spending huge amount of money, there is NO guarantee that you will get a residency post. If you look at the ECFMG fact card over here, you will realise that only 40% of the Non-US citizen IMG got a matching for the year 2012. If you look at the ECFMG annual report over here (page 20), you will realise that Malaysia is not even in the top 45 countries from where the IMGs are coming from! The highest IMGs are from India (16%). Despite that, I just received a comment from a doctor from India who said this “Fed up of applying to every match, sir. Not getting matched. So quit trying. Looking for other opportunities based on usmle credentials like abu dhabi, malaysia, sir” .
I got no issue of IMU conducting this course but they make it sound like it is very easy for students who pass USMLE to get a training post in US. I think it will be as tough as getting a specialist training post anywhere else in the world. You are competing with the whole world! BTW, IMU is not the only university encouraging students to sit for USMLE. Few of the newer medical schools in Malaysia have also started to promote USMLE for their students.
Well, once someone said that we will become a maid (aka graduates) exporting nation by 2020. It looks like we will also become a doctor exporting nation soon………………
Welcome to GTP, government Transformation Program…………………
Pagalavan's Avatar 
Don’t need a fancy expensive course conducted by IMU or Manipal. There already are Malaysians offering USMLE information and books, which I easily googled online : http://www.usmlemalaysia.com
Soon, Malaysia is going to be the new India – exporting doctors overseas.
And Manipal already has tried conducting a USMLE course for RM 14,000. Not enough people were interested and they cancelled it.
Yes, a lot of their tutors are from India. Already students spending RM 300-500K for undergraduate, then RM 14K for course, another RM 10-20K for USMLE and a lot more money for attending interviews etc etc, who will bother unless they are desperate and from rich family!
You can check it at this website : https://www.facebook.com/KaplanMmmc?fref=ts
If you are in the academia, then you understand why this thing is going on. For the univ and top people, this is the opportunity to rake in more moolah. For the junior faculty who is tasked to run this program, is given an opportunity to become a “clinical assoc prof” in the next few year, on the basis of “great contribution to the university”. So it’s a win-win situation. But for the rest of us, I really dunno.
Johndoe, Er, what u mean by academia?What is that?also what is more moolah?junior faculty run rm14k program? Not sure if any would want.
Dr Pagalavan, you are very right saying that it is not easy to get into residency program in the US. I sat for USMLE and scored excellent points (over 200 points) in all Steps and still cant get into Residency. After trying 3 years and lots of money spent,I finally call it a quit. I did get interviews during those times but I didnt Matched into any of the programs (I only applied to Family Medicine Residency) that I interviewed.
Nowadays, most programs require that applicants are either a greencard holder or a citizen of the US. Not many programs are willing to sponsor visas to foreign doctors due to the cost.
Some programs give preference to graduates from Caribbean med school as these grads did their clinical years in American hospitals. So they are very familiar with the healthcare system in the US.
Trust me. There is no need to join fancy courses to pass USMLE. I did mine studying on my own while working fulltime as a medical doctor in one of the busiest hospital in Kuala Lumpur (completed up to Step 2CS in a year :)) . The only reason I did it was because I am married to an American citizen (my only advantage is I have a greencard when I applied for residency) and now Im living a good life as a housewife :p
Cheers!
Don’t fall for these fancy courses for USMLE exam preparation. In the next few years, residency posts will be very very limited to IMGs as US medical graduate numbers are increasing to fill in the ‘unwanted’ spots. Also, US-IMG graduating from carribean schools are fighting for the same spots. Not to mention that in 2015 onwards, MD/DO match will be combined and DOs will have the same share of allopathic and osteopathic medical residencies as MDs. IMGs will have only the last crumble of this very lucrative medical pie. Also, US government is currently deep in debts and are trying desperately to reduce medical costs and insurance costs with the introduction of Obamacare. Medicaid funds to doctors and hospitals are drastically cut.
Even if one manages to score >250 for USMLE exams, you need to have US clinical experience, letters of recommendation from US doctors of the field that you are interested in, letters from medical program directors, research experience and hospital volunteer experience to apply on ERAS and be considered only for an interview. After getting an interview, you have to fly to US for face-to face interview. The whole USMLE exam, ERAS application, and interview process will burn at least RM 60-70k without any guarantee of a spot.
A few years ago, if IMGs are not super picky, there are still open spots in rural family medicine, rural internal medicine, pediatrics and psychiatric residencies. This 2013 match year was particularly brutal, even for US medical grads, as FM and Peds are totally filled. There were only 10 SOAP (scramble) spots for pediatrics after the main match and most of these SOAP spots are filled by US med grads who tried to apply to more competitive areas like rads, surg and derm but could not get in and resolved to taking any residency spot available. One would think, why does US med grad who didn’t get a surgery spot would have to stoop low for peds? It is because, on average a US med grad will graduate with at least USD 300,000 in loans and these loans accumulate interest as they go, so US med grads are in deep trouble if they cannot get any one spot for training. No residency = useless MD title. They would rather work as family medicine doctor and pay back their loans than risk not being able to practice as a doctor at all.
The only possible route of getting into US is via IMU-PMS with Jefferson or IMU-PMS with canada medical schools (as they are LCME approved). There is a lot of struggle involved in training to be a US doctor, even during residency, one will have to study for boards, do teaching, be good in research and paper writing, submit abstracts for regional seminars and international conferences and after all that, doctors will have to apply for medical license in the state they will be practicing (each state will need individual state license and licenses typically expire every 3-5 years). So, doctors cannot just up and move to another state for a different job on a whim. Also, doctors will have to stay current with their knowledge and accumulate CME credits to be able to reinstate their boards certification every 10 years. It is a lifelong commitment and sacrifice and there is no light at the end of the tunnel. Heh! I would akin being a medical professional in the US as walking on a pebbled road rather than a tunnel, it is a journey with lots of obstacles and you will have to transform yourself (have tougher feet??) to walk on this path.
Elly, are you practicing in the States? If you are, good for you 🙂
I am a graduate from a local medical school in Malaysia, and matched into my first choice University program for internal medicine residency. I have no green card or any family in the U.S.
I think I spent about RM 15,000-20,000 in total for my USMLE steps, application for the match ($25 per program!), traveling for interviews, and so on.
It was all worth it for me.
My advice to all who wants to pursue this path is to be ready to sacrifice your leisure time and study hard for the USMLEs. To stand out as an IMG, you need to have really good scores to prove that it is better to take you in than a lower tier US-graduate.
Also, aspiring students please go google and educate yourself of the ERAS application and NRMP ranking process. And google Student Doctor Network where many US grads come together to discuss strategies for matching into medical fields. I end with a chinese proverb: you need to know your enemy to win a war. If malaysian students are truly keen and dedicated to the US pathway, enter with open eyes and sharpen your swords.
Rm 14 000 for prep course? That is unbelievable lol. Some of my friends canadians went for usmle and the only money they spent for prep is the online qbank and application n books..and they did very well. I was tempted to try on usmle because some of my friends(european) will take it soon too nxt month. They are studying crazy for it despite having classes in the day. But because of my gov bond signing, it is not possible for me. 😛
Why Rm14000 for a prep course?
Ans: Many aspiring doctors have been used to being spoon-fed. Pay to get results. Sounds familiar right?
I don’t think anybody can pay to get the USMLE results as the exam is not marked locally whereby the university or college concerned can just pass their candidates.
I don’t think Andy is referring to cheating, but to the common practice of Malaysian students needing the help of ‘tuition’ to do well. Especially if the teacher is ‘national marker’ or similar. 🙂
oh, not to forget the realistic aspect of what we call life. Once you match, you have to think about apartment rental, getting power connections in your name, getting internet and water in your name, car and rental insurance, applying for social security number, getting your driver’s license, open a bank account in US, buying a car, getting title and registration for your car, getting furniture for your apartment, cooking and maintaining your house etc etc. How about if you are a female and you have got a non-medical tagging spouse? Will he move for you? He might not (highly likely) find a job in US. Then what? Are you alright with sacrificing your best reproductive years (presumely you finish residency and fellowship at 30?) working? Can you live with the idea that you might not find a partner in US and possibly end up alone? And if you are a male, if you have a non-medical gf/wife, will she be willing to move with you with same possibilities of not working in US? Moving internationally is not as simple as one thinks. If your spouse’s degree is from a local uni, chances are it is not recognized in US. And, if any of you ever read the news, you would realize that the unemployment rate in the US is through the roof even for their local graduates!
There won’t be mommies and daddies writing letters to the government and complaining for you. No one will be holding your hands. You are entirely on your own. Sink or swim. That is the reality of life.
“The only possible route of getting into US is via IMU-PMS with Jefferson or IMU-PMS with canada medical schools (as they are LCME approved)”
IMU-PMS Jefferson or canada medical schools are not the popular choices for the majority IMU -PMS students, the reasons being to match to Jefferson one must pass Step 2 before leaving for US, and there is no guarantee that they can work there unless they pass Step 3. Most students need to struggle hard for their pre-clinical exams here so they do not wish to be burden with extra USMLE exams. As for the canadian medical schools, most do not like to go there because like Malaysia, international students are not allowed to do internship in Canada. Most students usually go for universities with cheaper tuition fees, Edinburgh is therefore not the top choice for most of them even if their results are good enough to match to Edinburgh. Ireland is another unpopular choice also. Most parents prefer their children go to UK or Aus. Once Aus universities were the most popular choices but now with the strong aussie currency, most prefer go to UK.
Australia is now not popular partly because of the strong AUD, partly because there are now few places for the undergraduate stream, and partly because the news about not getting Intern jobs after graduating has finally hit.
UK is generally cheaper, even Edinburgh, but there is no more guarantee of FY jobs any more, as graduates exceed FY places. The MOH has promised all eligible graduating doctors will get FY placement, but there are almost 300 in the reserve list at the moment. There may not be such guarantees for international students in future, if they start prioritisation practices like Australia. This will inevitably need to happen, when there are not enough jobs to go around.
It seems to now be a case of “do medicine at your own peril”. Without training opportunities, the course is just useless.
Well, there is always a price to pay when decisions are made. If you graduate from Jefferson, you are essentially us med grad needing a visa and Jefferson has pretty solid reputation so no problems in matching. Canadian grads are categorized differently compared to all other international universities and they typically have slighly higher preference -66% match rate as compared to 44% for all IMGs. You cannot have your cake and eat it. No way you can skimp out and attend cheapest school possible and also get an upperhand in match chance.
The total tuition fee for Jefferson and Dalhousie University is not that expensive compared with some universities in UK and Aus because the duration of the course is shorter, ie 2 and half years for Jeffesrson and 2 years for Dalhousie. (previously it was only 2 years for Jefferson). Shorter duration means a lot of saving in other costs such as living cost, accommodation, transport, etc. Most IMU students do not put these two universities as their 1st choice because of the USMLE exams and cannot do internship there.
Sorry for the error, Jefferson is 2 1/4 years.
very well written Elly 🙂
Dr Pagalavan, I am a student who has just received my stpm results.I intend to do traditional chinese medicine course at UTAR.do u think this course has a bright prospect in msia?
TCM is bomoh practice repackaged in a veil of science. The only reason is rose to prominence is because Mao Zedong either killed or banished the intellectuals (including doctors) during the cultural revolution. They then realised they had not enough doctors so promoted TCM to some sort of science-based medicine in the 1950’s and 60’s. A lot of the ‘natural’ TCM medications have an active chemical ingredient, sometimes hidden (ephedrine is the most common one used). They have as much basis as homeopathy and other So-Called Alternative Medicine (SCAM) practices. In my humble opinion.
I strongly disagreed with your opinion. In fact, most of the western doctors who are against TCM always claimed that TCM is full of steroid and etc, this shows that they don’t understand what actually is TCM. In fact, the profit orientated TCM practitioner tends to prescribe steroid to convince patient his treatment (but not all TCM practitioner like that). This is same as western doctor who only prescribe symptomatic treatment.
There are so many principles in TCM teachings. If you manage to find a good TCM, he can cure your illness as well. I see it myself in multiple cases where the patient was not treated well with private specialist (or going to be slaughtered by private specialist), these patients were well treated by TCM practitioner.
One of the best one is ‘Jing Fang’ (not many practicing it because no profit – only use minimal medicine) where they diagnosis disease alone take them one hour and they only use one or two medicine (without steroid), the patient get healed significantly in 3 days.
TCM in China has been eroded by westernized capitalism like what drugs companies controlling western medicine now. China might not the one who will excel in TCM because currently they are distorted from their original pathway. In fact, American might be the one who will excel in the future.
The western value has come to a blind end, the more advance the technology, the more ruin our value / health in mind and thinking. Currently the westerner has started to come to Asia to look for higher wisdom. Not the wisdom Asians are having now but Ancient Wisdom.
My opinion is no matter what treatment a patient is receiving, the ultimate aim is to cure and cause no harm. So, I am not against TCM or homeopathy as long as they are mean to cure a sick patient with their knowledge.
Hi private,
You have every right to disagree with my opinion, but allow me to outline why I believe alternative medicine is a scam
Putting aside practitioners who add steroids into their drugs (and I agree that unscrupulous mainstream doctors also do this), there is no absolutely no evidence for the basic principles of TCM (or homeopathy or ayurvedic medicine, etc)
Basic TCM principles:
1. The five-element theory is used to describe the properties of the organs in the human body, how they are related, and pathological changes. The five elements are metal, wood, fire, earth and water.
2. Health is achieved when yin and yang are balanced. Certain parts of the body and it’s organs are ‘yin-organs’ and other parts are ‘yang-organs’.
3. Excess yang produces a ‘heat syndrome’ and excess yin produces a ‘cold syndrome’.
4. Apart from action, TCM medicines are also describes by taste, smell and yin/yang (cold/hot) nature. When someone has ‘cold syndrome’ a ‘hot medicine’ is prescribed. There is no place for bacteria or antibiotics in TCM concepts.
The 3 basic laws of homeopathy:
1. The law of similars – whatever causes your symptoms, will also cure those same symptoms. Thus, if you find yourself unable to sleep, taking caffeine will help; streaming eyes due to hayfever can be treated with onions, and so on.
2. The law of infinitesimals – the more dilute a remedy, the more active/stronger it becomes. Now, how dilute are we talking about? 1 drop of caffeine + 99 drops of water creates what is known to homeopaths as one ‘centesimal’. One drop of this centesimal added to another ninety-nine drops of water produces a two-centesimal, written as 2C. This 2C caffeine potion is 99.99% water and just 0.01% caffeine. At 3C the dilution is 0.0001% caffeine and so on. Homeopathic remedies are commonly sold at 6C (0.000 000 000 1%) and even 30C (0.000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 1%) dilutions, which homeopaths will often drip onto little balls of sugar to sell. I should note here that at At 12C you pass what is known as the Avogadro Limit, the point at which there is likely nothing of your original substance left (even if it did work!)
3. The law of sucussion – vigorous shaking of a homeopathic remedy increases its potency by allowing the water to retain the ‘memory’ of the original substance.
The main issue here is that NONE OF THE ABOVE HAS BEEN PROVEN – THERE IS NO OBJECTIVE EVIDENCE WHATSOEVER. I apologise for the capitalisation, but I am just trying to emphasise a point. Like jk said, if these things are proven to work, they will be adopted by mainstream medicine and will cease to be ‘alternative’.
People ‘feel better’ when they go see alternative medicine practitioners because these quacks spend time talking to them, listening to their problems and acknowledging them, empathising with them, and reassuring them. This is something mainstream medicine should be better at but is obviously not. When you do all these things, endorphins are released from your brain. Endorphins bind to opioid receptors in your body (the same receptors morphine binds to) and really do cause pain relief and mood elevation. This is called the placebo effect. Easily explained by mainstream medicine. That is also why alternative medicine targets people with chronic pain and mood problems, things which are very hard to cure by drugs alone. Would anyone here see one of these quacks if they had a heart attack, meningitis or a broken bone?
Hai Nav:
Basically, I think that it is inappropriate to use the western basic theory (physiology, biochemistry & anatomy) to explain the how TCM is working. I did have the same perception as you last time but I was proven wrong.
This statement of NONE OF THE ABOVE HAS BEEN PROVEN – THERE IS NO OBJECTIVE EVIDENCE WHATSOEVER is also not appropriate because we can’t use modern technique of research to prove an ancient theory. The treatment of a disease is not solely dependent to 1 medicine to cure 1 disease / symptom alone because many other factors also involved in the interaction. For example, the patient’s emotion, nutritional status, weather, habit and many others.
I think you also agree that human body is a very unique machine. It is not as simple as you give PCM and the body temperature will goes down. It is not as simple as endophine to create pain relief. Our human body is much more complicated that what the science think of it.
Human body is part of the nature. If your lifestyle is against the nature, a person will get sick. Anyone is confident that he is 100% healthy at the moment? This answer is NO because most of us are in what we call sub health state.
“Alternative medicine targets people with chronic pain and mood problems, things which are very hard to cure by drugs alone” – A TCM practitioner told me that it is hard for them to treat a ‘fresh’ patient because in Malaysia, most patient seek TCM consultation AFTER patient got failed treatment from western medicine. The medicine given already altered or changed the body reaction to the TCM. Why I said that, because I saw multiple fresh cases that a TCM lecturer’s treatment expelled out uterine fibroid without any surgery done.
It is hard to believe but it works. For the past few years, I keep think of the 2 different worlds of treatment but I think we should not reject them just base of ours ‘presumed’ assumption and also the TCM bad apples.
I am not promoting TCM but I think we should not criticize and reject them without knowing them in depth. Imaging a world without machine (with electricity) and drug tablet or injection, do you Western Medicine can still survive? But TCM can still survive because their ‘drugs’ is in the nature. Just my 2 cents of comment.
Thank you for your reply private.
I will try to keep things short. If TCM and other alternative therapies work, they should be able to prove that it works. It is as simple as that. To say that we “can’t use modern techniques of research to prove ancient theory” is preposterous. Where did this theory come from? Either:
1. Someone discovered it a long time ago through experimentation
2. It was given by divine inspiration
3. It was made-up, and perpetuated over time
Take your pick. If someone discovered it through experimentation, then have to be able to reproduce said experiments. The other 2 options are self-explanatory.
It is akin to me saying: “I have special water flowing from my taps that I have bottled. It is special because there are special crystals in the pipes leading to my house (and only my house, not my neighbour’s). The normal techniques you use to assess the efficacy of a treatment does not apply to the special water I have, because it is special and your western medicine cannot possibly understand it. It will work on all sorts of ailments, especially those ailments which cannot be objectively quantified (e.g. pain, mood, feeling, etc). I do not have to prove any of this to you.”
What you claim to be “western medicine” is scientific medicine. Science admits that there are things we do not understand and continuously seeks new knowledge. If new evidence is discovered, and able to be reproduced, then it eventually becomes part of theory and scientific knowledge. this applies not just to medicine, but to physics, engineering, etc. All the modern technology you and I use is based on this concept of science and experimentation. If someone dismisses that, then they are truly ignorant of the world we live in.
I agree that modern is not perfect, but it readily admits it is not perfect and strives to improve itself through new discoveries. No doctor will claim to understand the body 100% because there is so much we do not know. That does not mean that others can claim that knowledge without providing evidence.
If your fibroid story is true, the practitioner should be able to prove it and not just provide case reports. IF it were true, don’t you think mainstream medicine would have adopted it by now? It would save a lot of govts a lot of money!
Hai Nav:
First of all and thank you for your reply. Unfortunately, in the world now. TCM is not given the same platform compare to the Western Medicine. The first stage itself doesn’t provide a fair environment to make comparison.
Secondly, the world now is dominant by the Western Medicine and sad thing to say the the TCM does not have equal chances or body to make things right.
Malaysian TCM is still in the very early stage where there are no organization or standardized exam to screen through the bad apples. Therefore, most likely the chance to see bad apples is high.
Are we heading (western medicine) to the right direction? For example why chronic disease in Malaysia in getting more serious over the years with the advent of the new drugs and more medical personals graduating? Sometime is wrong right?
The example that you gave got flaws in it e.g It will work on all sorts of ailments, especially those ailments which cannot be objectively quantified. This statement itself make it mostly a con job. The statement indirectly will lead the reader to answer ‘NO’.
My fibroid is just an eye opening to me that there are other knowledge that is beyond our comprehension. This does not mean to take over the O&G specialist job in the community. We choose to think the other side of knowledge is fake at the first place because we already have perception in our mind.
You last advice is true. If what we called ‘alternative medicine’ work to certain illness, why government don’t do it. This is same as a lot of western doctors now still prescribing ‘chelation therapy’ to hypertension patient that cost them RM150 session/week just to cure Hypertension. I always tell my patient to avoid it with the same reason you mentioned……but no use.
I do not against science but the existent of the alternative therapy could provide us some clues of how to see patient from different aspect or explain the illness from different aspect. We are eqiupped with basic science knowledge therefore we couldn’t accept fire, water, wind and etc in TCM to explain illness
Ancient theory is left out because nobody (good student) is exploring deep into it. The knowledge will disappear if nobody pass it the next generation.
I rest my discussion.
Expelling fibroids?…. holy cow, this I want to see!
Is it the same as expelling gallstones? This one I have seen, indeed, they pass greenish lumps which look like gallstones. Unfortunately, the repeat U/S shows the stones still there, and the lumps passed are soap!
And why is ‘chronic illness’ getting more ‘common’? Because people live older, that’s why. You live old enough, you WILL get degenerative illness and/or cancers. In the past people die from Measles, Malaria, Dengue, simple diarrhoea, malnutrition, TB etc. (Go to some under-developed countries eg in Africa, and you still see the same). Now they are cured of these, they live on, and guess what? They still have to die of something someday. And guess what they die from?
Which finally begs the question: what is the reason that life expectancy now is longer than 100, 50, even 30 years ago?
You ask if ‘western medicine’ (I prefer the term science-based medicine) is heading in the right direction. I say yes, because developed societies are constantly finding ways of eradicating disease and prolonging life. Vaccines, antibiotics and anaesthesia are just but 3 things that have changed the face of medicine in the very recent history. All of this is based in the scientific method. People perceive that chronic disease is getting more serious or prevalent because modern medicine is allowing us to live long enough to actually get chronic disease! And then there are lifestyle factors as well of course (e.g. teenage Type 2 diabetes) which adds to the problem.
If one claims that an alternative therapy can provide us with clues on an illness, then one must prove that the alternative therapy actually works. It is really as simple as that. The claim that the standard way of establishing proof does not apply is highly convenient, and has been perpetuated by these quacks for a while now.
If some plant or herb is proven to treat particular ailments, then scientists will investigate to discover the active ingredients – in order to manufacture a pure form that can be given with reliabilty. This has already happened in modern medicine (e.g. atropine, colchicine, digoxine, physostigmine,quinine, etc). This would be much better than relying on some leaves where the amount of active ingredient might be variable depending on the dryness, quality, season-grown etc of said leaves.
Live long enough is not the definite and only answer.
You should not compare life expectancy now with 100/50/30 years ago.
You should compare life expectancy since the emerging of human in the human histories.
100 years is too short to compare
http://www.examiner.com/article/decline-of-human-longevity-after-the-flood
I don not mean to either practice Scientific based medicine or TCM. There is no point to kill or degrade either one of them but both of them can co-exist.
One simple comparison is the Vitamin C from bottle same as Vitamin C from the fruit? (Of course this analogy does not apply to all others….)
After the flood?! What have you been smoking? Do you also believe the earth is only 6,000 years old? Using the bible as a source of factual history is probably not the best idea.
I am a Christian, but I would caution against the accuracy of time and age in the Biblical annals. Like stated above, based on the Old Testament timeline, the Universe was created just 6000 years ago. How that translate in the light of modern scientific knowledge is a matter of Theological argument and speculation, but it is commonly acknowledged that the time as described may not correspond to our present measure of time.
Be that as it may, we will have to depend on whatever verifiably accurate recorded history, and that probably dates from maybe the Egyptians of 4000 years ago, both recorded history and physical remains. The human average life span through the ages from that era supports the fact that current average lifespan of ALL the earth’s population is at a current high.
it depends what you mean by good future. Most Chinese medicine have steroids in it and I have seen so many cases of steroid side effects.
Yes, I do know a few TCM practitioners who are earning good money.
The point to note about this TCM is, if there is evidence that these ‘alternatives’ work, it ceases to be TCM.
And as pointed out above, these ‘alternatives’ aren’t actually alternatives. They work because of active pharmachemical content which is hidden, commonly steroids, NSAIDs and sympathomimetics.
Live long enough is not the definite and only answer.
You should not compare life expectancy now with 100/50/30 years ago.
You should compare life expectancy since the emerging of human in the human histories.
100 years is too short to compare
http://www.examiner.com/article/decline-of-human-longevity-after-the-flood
Dr Pagalavan, I know you get questions like this all the time, but would you mind answering one more? I tried searching online but I couldn’t get the answers I was looking for. I am currently doing my A levels, and I am holding several offers for medicine from local universities and have an RCSI(Ireland) interview coming up. assuming that the cost and entry requirements aren’t an issue. is studying in Monash/Newcastle/PMC/Perdana, IMU-twinning to aus or UK, or the direct entry to RCSI the best choice if I plan on doing my specializing overseas( Aus, UK, Ireland) ? If I am unable to do my housemanship in Ireland, can I do it in Malaysia and then go back to Ireland for specialist training? One last question, if I chose Newcastle Johor, will I be able to specialize in the UK? I just stumbled upon your blog recently and im very impressed with the amount of work you put in writing the posts and also replying to the comments! Thank you for all the work you have done!
If you want to specialise in Aus/UK/Ireland:
1. RCSI – degree not recognised in UK, can work in Aus/NZ if you have done your internship in Ireland, can stay in Ireland unless things change in 5 years (the country is on the verge of bankruptcy)
2. Monash Malaysia – very slim chance unless Australia massively increases the number of intern spaces in the next 5 years
3. Newcastle Johor – very slim chance unless UK massively increases the number of intern spaces in the next 5 years
4. PMC – same situation as RCSI but very much less chance than those graduating directly from RCSI (find out how many from the last class actually got jobs in Ireland)
5. Perdana – no point. Have to sit USMLE to work in US (even then no guarantee) and you can sit USMLE with any med school degree
6. IMU-twinning – equal to graduating from that country, so transferring to Ireland/UK/Aus/NZ will depend on those countries’ circumstances in 5 years time.
You have to realise that just having the degree alone is useless. If you graduate from Newcastle UK or Melbourne or RCSI Dublin, WITHOUT doing your internship in those countries, you will not have full registration and therefore will not be able to simply return 3 years after graduating. This will be the situation if you were unable to secure an internship post and had returned to Malaysia to work first. The only route then available to you to return to these countries is to get some sort of partial recognition of the specialist training you may have done so far.
It goes beyond the ability to get registration in these countries. Even if you are fully registered, the relevant immigration laws will often prevent you from working. Remember, you are a foreigner in these countries, and to work there you will need some kind of visa that allows you to work. You CANNOT just walk in and work. Even if you have a job offer, you CANNOT work unless you have the necessary visas.
I think Nav has given you the answer.
Looking at the situation in UK, Ireland and Australia, by the time you graduate it is very unlikely you will even get an internship post there.
Thank you for the replies Nav and Dr, does this mean that I should just do my medical degree locally? since the internship chances are low there and I would have to come back to Malaysia anyways?
If I was just starting med school now (and parents could afford it), I would go to the UK either directly or via IMU-PMS. UK medical schools have a 10% foreign student cap and internship places are tied to med schools, so you should at least get your Foundation Year places there, which will give you General Registration and freedom to move should you need to. Whether you can stay beyond no one really knows at this stage.
The debate between Nav and Private was very very good and I think Dr Paga should publish it as a post for all to read. Not to take anything away from both, but its a brilliant point-to-point debate worth talking about.
I actually enjoyed reading the comments too!
I found it most entertaining for Private’s extensive exhortations from an orifice not normally used for speech.
But then, I am a surgeon and a skeptic, so complementary therapies with their poor evidence base are nought but snake-oil in my view. Happy to be proved wrong though.
In fact, for all our sakes, may someone come up with a cancer cure as simple as energised water. Drink up, m’lads, and put them barbers out of a job!
I find it demeaning, distasteful and utmost unbecoming of someone who claims to be a surgeon to pepper his comments with sneaky allusion/s(note that orifice line) simply because one’s view is different from your highness.
Yes, you are a skeptic, you are witty and you are a surgeon, but please stop being condescending to lesser mortals unlike you. What if your patient decides to read up the Internet or Merck Manual of Med Info Home ed. and refuses your diagnosis or proposed plan of treatment? Will you stealthily ambush him/her with your brand of ”sauce”?
I agree with you TCM is at best a pseudo confidence booster/ placebo effect stunt but do give some credits to Private, at least he doesn’t bash people when all his points were refuted.
Still, I am very glad you know surgeons in ages past were barbers multitasking it all, so please pay some homage to your personal barber every time you go in for a cut or shave.
And lastly, if your post were made out of the spirit of 1st of April, then please pardon this rude peasant, my high and mighty lord.
Hey doctor, Malaysia is soon to be overwhelmed by all the bad doctors, i finish my Phase 1 in IMU and started my course in one of the PMS, the teaching standard and the qualities of my peers are really different. In Aussie, most of my colleagues are really good, they’re top of their country, with good clinical knowledge and good communication skills. The fact that IMU graduates are already consider good among all the medical graduates in Malaysia and I struggling to perform in Australia ( I did well in IMU), I can imagine how bad the situation is going to be. In the Aus hospitals, you can see so many malaysian doctors, those who are really dedicated, they all decided to migrate, all because of one reason……………….The entrance into postgraduate is affected by your skin colour, whilst in Aus, everyone has the same chance.
The correlation has always been there. The most important determinant of quality and competency is the quality of the academic ability of the student. Note that this is NOT the same as being a ‘good’ doctor, as determined by patients. What a ‘good’ doctor means can fill a full thesis, suffice to say medical schools try to moderate this with their aptitude tests (UKCAT, BMAT, UMAT, ISAT etc) amd interviews.
But underlying all these, the basic criteria remains: only the BEST students are selected.
The liberalisation of education in Malaysia, extending it to medical studies, means unfortunately, commercialisation, ie selling to the highest bidder. That means taking in mediocre students because they can pay the fees.
In the light of the current Malaysian fiasco, the 3 best med schools are probably the 3 oldest: UM, UKM and USM, as they still take in the best students, yes even the Malay students are of good quality.
Hi eve,
You are struggling to perform in Australia is common for most PMS students because during your pre-clinical years in IMU, you did not have the same amount of hospital exposures/experiences like your assuie course-mates had gone through during their 3 years preclinical years (in fact all Malaysian preclinical students, regardless of from public or private universities, all lack the hospital exposure as required by preclinical students in developed countries). If you did well in IMU, you should have no problems to pick up very soon if you are willing to spend longer time at the ward to gain more experiences. All the best to you.
There’s always a rumour saying that we can get more clinical experience in Malaysia but the fact is that i actually get to do more stuff in Australia compare to my Seremban colleagues, i got many chances to scrub in, there’re only 3 medical students in the department (eg.vascular, colorectal), and their expectation over medical students are high, i don’t really get to get off earlier, everyday i have to be there at 730- 5pm, i’m writing here so that some of the IMU students can see this and make sure they prepare well for their clincial years, i don’t want to post on the facebook page because i really appreciate the stuffs i learnt in IMU, I don’t want to pull down IMU’s reputation. It’s so stressful when the students already know the differential of common presentation very well, antibiotics, liver enzymes, it’s like a catch up game from the very beginning.
the first issue is the entire education system of this country: too much spoon feeding and chasing the grades. Too easy to score As nowadays so much so, people say B is = “Bodoh”!
I have also said many times that most of our 36 medical schools are not fit to be called one by any international standards.
We should also standardise our Pre-U entry course for medicine, limiting to just 1 or 2 courses.
Yeah exactly, i would say many of those who got straight A in Pre-U actually not good enough for medicine. All my colleagues in AUS are top 1% in their australia matriculation ( ATAR 99)
That’s why this has been harped on by some seniors that A levels AAA is not equivalent to those who got got ATAR99 in Australia.
Be it UM, UKM, USM, or IMU, MMMC, or India, Indonesia, Malaysian medical graduates are still malaysian medical graduates. Having the mentality of the Malaysian education system, and thought by Professors with the same education mindset, where “the teacher is your lord”.
Compare that to the western training midst – which encourages students to think and debate with superiors, and to think outside the box.
Just look at university rankings. What is the rank of our top schools – UM / UKM?
In the international committee, graduating from University of Melbourne vs graduating from University of Malaya would probably be as different as graduating from UKM vs Kursk State.
I wouldn’t want to say other universities are bad, but Msia is definitely losing many good doctors, they all decide to stay/migrate oversea, Msia seriously need to stop the racist quota, even in AUS, everybody has the same chance while i born in Msia, i love Msia but i may not get the position just because i’m indian or chinese, the place i born and grown up.
‘The entrance into postgraduate is affected by your skin colour, whilst in Aus, everyone has the same chance.’
Hi Eve,
Don’t be too optimistic that in Aus everyone has the same chance. Colours do paly a role even for the posts of MO. In Adelaide, you hardly see Malaysian doctors working in RAH, most are working in QEH or other rural hospitals.Be prepared so that you won’t be disappointed. Some of them told me that it is difficult to get postings in big hospitals. Only a few lucky ones will have the same chance. Wish you good luck.
Hey curious, are you PMS student? Do you feel it’s a catch up game or it’s just in my PMS
Interesting that you guys are talking about this. I was an IMU-PMS student, now a consultant still working overseas. I got an AusMat TER of 91.7 which at the time would not have been enough to get into any medical school in Aus except Tasmania … but was a breeze to get into IMU. Once I transferred overseas, it was obvious that as whole, the domestic students were of a different class. BUT we still had IMU-PMS students in my year who were in the top 10% of our class, just as good as the domestic students.
The IMU-PMS students who did really well were those who:
1. Could speak English well
2. Were already high-achievers with top marks when entering IMU
3. Worked hard
The ones who did just ok (or struggled) were those who:
1. Could not speak English well (esp. if you were from a Chinese school)
2. Got average marks to get into IMU.
As a whole, I think IMU prepared us well in terms of the knowledge we possessed. We were going to hospital once a week in our pre-clinicals so that aspect was not an issue either. This was over 10 years ago so I have no idea how things are now.
Well, i have just received national scholarship from JPA. It allowed me to further my studies anywhere and whatever course i like. I would like to ask which country is better to study medicine? How many years to complete my study? What is the entry requirements if i want to study medicne in uk? Well, i am one of the top 50 best spm students in malaysia and i think my future is bright in this field.
Pls read all the articles in this blog. All the answers are there.
I’m so sorry.Not to be rude or what.From my experience,being the best in SPM is not gonna secured your future.Many of top students inSPM failed to retain their position as top scorer once they enter the real university life.But still,if you have the passion,not the greed or arrogance,maybe you can be what you want to.Just remember,being one of brightest students in SPM which is merely memorizing is not gonna guarantee your position unless you change the attitude.
Yes, being a top student does not make you a good doctor if you do not have passion in doing medicine. As I always say: never do medicine for wrong reasons
I thought jpa stopped sending students oversea and cancelled medicine? Unless ur scholarship means anywhere inside malaysia.
I think it’s premature to ask “which country is better to study medicine”, at this stage. AND, if you don’t already know how many years it takes to complete a medical course, then you ought to spend some time reading up. Seriously, a couple of taps on the keyboard will land you into info-sphere. Right now, you should only concern yourself with which pre-u to undertake, as the earliest you will be even looking to apply to UK will be Oct 2014 for the 2015/2016 cycle, and for Australia, it will be towards the middle of 2015 for the 2016 academic year. Between now and then, a few thousand medical graduates would have graduated, and find themselves without training spots.
So yes, read ALL the articles under “For Future Doctors”.
Lastly, reality bites. 🙂
How did you work out that you are a top 50?
Jon, the top 50 spm scorers are given “national scholarships” to pursue any course they wish. I am not sure if the condition for top 10 unis for critical courses apply in this case. Logically speaking, it should apply, but policies are not consistent here.
I sense arrogance here. If you are that good, I wonder why you can’t even do your own research on the career that you are about to get into? This is the problem of our ‘world class’ student, they expect spoon feeding in everything even in matter about their career. They are too lazy to go out to seek the information for themselves and decide. Go out aND ask around, go to education fair, interview some doctors, see some consultants if possible or even do some tagging in medical school or even in hospitals, google about the list of recognised univerities, check their curiculum and compare, check their teching force credential etc etc. SO much thing you need to do in order to decide and you expect some one just answer your 2 lines question and you make your decision based on these answers.
In all honesty, I didn’t ask Happydoc my “top 50” question as a way of disparaging him for tootling his own horn. I am so long out of the Malaysian system that I wondered if one could now tell from SPM results where he/she ranked overall.
It’s a free country (sort of) and I’m comfortable with Happydoc if he wants to be a little arrogant about his success. It came out of hard work and he’s earned it. From a demographic point of view, he’s the type we should be encouraging to go into medicine anyway. The current problem of half-baked doctors flooding the HO ranks stems largely from opening the floodgates to masses of borderline and frankly should-not-have-been-admittted students to half-baked medical courses in dubious universities locally and internationally in the first place. We reap what we sow.
Consistent excellence in pre-university results is a reliable marker for strong likelihood of success in medical and surgical careers. The best doctors are intelligent, highly dedicated, hard-working and have excellent clinical common sense. Anyone with a consistently strong high school academic record usually demonstrates those first three attributes, so has a high probability of success.
So I wish Happydoc every success in future. But remember, right now, you’re a big fish in a small pond. When you get to medical school, there are a lot of other big fishes, slightly bigger pond. Come postgrad, you’ll be in a sea of sharks. Not everyone makes it in postgrad specialist medicine and surgery. And hard work alone is not enough. Until you graduate from medical school, it’s as easy as doing your bookwork and scoring well in your exams. After that, it’s a whole new ballgame.
FYI, i had searched about all the careers in the internet, education fairs and even my sis is a doctor. I just want to have an advice from the expert one in this field ( dr pagan). Not FROM U actually!
…like Dr Paga said..read ALL the articles…
You just make me wonder about the rest of SPM holder after 50 top scorer …
Good luck for u….
Dont do medicine. You gonna regret your life. Even if you graduate from oxbrigde/ANU, nobody gives a shit when you start as a house officer at KKM. Chances are you will have a MO and probably a specialist who graduated from ex-USSR states who will despise your achievement and jealous for the fact you are successful. Your life will be a living hell when you start to question their practice and reason with them with whatever you have learned at medical school. It doesn’t matter whether your professor used to be the leading expert in their field because in Malaysia it is all about what the ‘Boss”/Jaguh kampung says/wants.
You will better off with other degrees. Save your thanks for me later.
Sincerely
Top SPM Student 2000
Being good in pre u does not mean u are good in medicine. Medicine is about passion. Is not about passing exam. Is more than that! Is about caring for another human being , is about helping ur fellow human being.
I beg to differ. Medicine has a lot to do with passing exams, both at undergrad and postgrad level.
A caring nature is ideal to have for a doctor, but clinical ability and knowledge are what make for good outcomes in patients. I have known many physicians and surgeons who are socially inept but so good at what they do that I would entrust my health in their hands.
One does not need to be nice to be an excellent doctor. But being nice without ability is a short trip to medical negligence.
Yes you are right BUT you can’t do medicine without certain level of intelligence. From my experience, most good doctors were good students with certain level of good grades.
the priceless combination of ignorance and arrogance here, is really quite laughable. please keep up this attitude!
eve, am a IMU PMS student – i did not feel that it was a catching up game, similar level
Can I ask a question? Why must Malaysian students scores lots of As a must to do medicine? Have the young minds of malaysia have no other aims in life beside medicine? Perhaps everything is being told and arrangee for them which result in a generation lack of creativity, lack of sense in life. Perhaps I am wrong in my assumption, comments are welcome.
You are absolutely right. Malaysian student generally lack of creativity no thanks to our ‘world class’ education. The only life they know is to become a doctor, engineer or an accountant and than thinking that they can live luxurously with these career.
Happydoc is still in cloud nine, being a top 50 scorer, and therefore thinks his/her “future is bright in this field”. If he/ she is smart enough, and read all the blog posts here, perhaps different questions will be posed, thereafter.
yes, that is what I am trying to say in this blog as well
Jaz and Dr Paga
I would like to press the “like” button but unfortunately we don’t have this. Cheers
I think if you attend one of the top caribbean medical schools, the education is equal to anything you can find in the US. I have done a lot of research before choosing UMHS and I definitely feel confident in what they offer, as well as in my future career.
Happr doc may sounds arrogant but I suppose we can’t judge a person’s character and attitude much through his or writings except to say that he or she may or may not make medicine his or her choice of profession in the end even if happy doc insist that he or she has the ability to do so.
Good luck and All the Best HappyDoc!
Hi Dr. Paga,
I’m a SPM Leaver and would like to pursue a degree in Medicine.
I’ve encountered many blogs (like one of yours) talking about the bleak future in Medicine and stuff, and even HOs quitting their job.
I encountered especially this one here
http://quittinghousemanship.blogspot.com/2012/12/just-to-clear-few-things-up.html#comment-form
One anonymous left his comment here:
“Your deskjob of 2.5k per month will be a pale comparison to the 8K of a freelance locum, 13K of a resident GP, 20K of a private ED MO, if money is your drive, and this is just the mo level, only 2 years away. So diverse is this field of medicine that it can cater the needs of a nerd, an authoritative asshole, an idealistic zealot, or even a slacking freeloader. Do not leave. Do not ask a nobody from thr internet.”
Is it true that even a resident GP earns 13K per month? That’s very lucrative if you ask me, even I might not be able to be a specialist one day.
That’s why he is anonymous!
8k of freelance locum? Even if you were to earn this amount of money via freelance locum, you need to do locum for atleast 8 hours a day 7 days a week. This means you need to quit government service and complete horsemanship + compulsory service. It is possible but it is the same for any other profession.
Resident GP earning RM 13K! Well, this is something new. As far as I know, most resident GPs working in chain GP clinics, is paid about RM 6-8K/month. For this you need to work from 9am till 10pm daily with 1 day off.
RM 20K for ED MO!! Well, this is totally wrong. Most ED MOs in private hospital earns about RM 10K/month. I got no ides where he got this figure. Furthermore you must understand that the rate mentioned is the current rate. As the supply increases, the salary will generally drop. At the moment, the government is able to absorb all graduates and thus it is very difficult for clinics and private hospitals to be able to recruit good doctors. Thus the demand is high with limited supply causing the salary to be on the higher site. When the supply hits the roof in another 3-4 years, they may be able to get an MO for just RM 5K as many will be looking for a job!
Finally, don’t forget the tax. For a salary of RM 13k, your net take home salary after income tax and EPF will be slightly less than RM10K.
Pls spend all the time you have to read this blog in detail. If you are doing medicine for money, then you are in the wrong profession!Don’t forget that you would have spend atleast RM 500K before even graduating (if you are not a scholar).
BTW, you salary generally never increases after that!
Well, never thought I’ll see you again cardipin. I am rather fortunate that here in Dr Paga’s blog, he does not censor me for fear of what I have to say. He is civilized and open minded, unlike the owner of quittinghousemanship who allows supporting views and blocks those against his.
Pardon my intrusion dr paga, I wrote that comment on that blog as anonymous as I dont have faith in the security of the net. It is no different than naming myself nav, navi or jon j. Nobody knows who they are for sure anyway.
The figures I wrote is true dr paga. You can contact Pantai Hospital Cheras and speak to a friend of mine, Kiow. Basic is 8k as ed mo and after incentives, if you’re hardworking, may reach 20k. After tax 12 to 16k. You can call owner of klinik damai kuala selangor who pays her night shift resident 13k. You can also call up klinik kita ampang who has been offering 8k as resident gp. It depends on the place. Maybe you would consider leaving nusajaya and join pantai.
When I first saw that page about quitting housemanship I realized 2 things: joining medicine for the wrong reasons, and quitting housemanship for the wrong reasons. Nothing much I can do for the former, but I don’t want the latter to grow either.
I didnt talk about doing medicine because of passion and interest because obviously the audience of that page is seriously lacking in that. No point preaching about that there. So the next best thing as of to why you should do medicine can still be the pay, but provided patient care and ethics is not compromised. I tried to say that all you need to be is a good and competent doctor, and housemanship is just another learning period, but the owner found that to be too strong maybe for his audience of quittong hos.
The next question is why bother? Because I had friends who quit before and I could not help them then. They didn’t turn out that well and some are even now doing illegal locum.
I dont do medicine for money. I do it because I like it, despite knowing what I can earn outside. Im still serving and learning in a government hospital. But my point is money pays bills also. I intended to provide the group of wanting to quit hos something to look up to. One of them quit housemanship just because of the working hours (shift).
We can’t save quitting hos, but I feel we cant allow people to mislead hos to quit to do underwriting so that he can come to work at 9, have lunch breaks 12 to 3 and leave at 6. We should encourage hos realisticly to learn. But if out of passion they want to do underwriting like cardipin here, please dont wait another minute more and quit.
Thanks for the comment. YES this is what I am trying to say. IF you are “HARDWORKING” you can earn a lot of money in whatever field that you are doing. It does not need to be medicine. Yes, there are differences in terms of salary and income between KL and other states. You have just confirmed what I said about the salary but of course, I did not mention about the allowances that you get when you do extra work/calls. I was talking about basic pay. Also remember that these hospitals like Pantai etc are busy hospitals and that is the reason many do not want to become ED Mos in these hospitals. Thus the resident MOs will do extra calls, shifts etc to earn a lot of extra cash. So, what I am trying to say is that, no matter what field you are in, money will come if you are hardworking and have passion in what you do. Unfortunately, many of these “quitting” HOs want to work minimal number of hours and earn big money. This is common among the younger generations in all field. Many join medicine thinking that they can do this by just sitting in a clinic and seeing cold cases!
As for night shift resident MO, if the clinic do not pay well, they will not be able to find any doctors to work night shift. Also don’t forget my “supply vs demand” theory. Once the supply hits the roof, the salary offered by these clinics will drop drastically.
Thanks Anonymous for the comment.
You’re right, and I agree with what you’ve said.
Wish you all the best in the field.
SPM Leaver,
Never ever join Medicine for the wrong reasons.
That’s what Dr. Paga has been trying to instill to his readers all these while.
Why the quality of graduates are declining, rate of unethical practices are increasing, exponential increase in incompetent junior doctors – many were attributed by the fact that young people like you joined this profession for the wrong reasons.
I have a friend of mine working in a bank as a Portfolio Manager, who is previously an Ireland medical grad, completed his internship there, and came back to Malaysia right after that.
He always had the passion for finance, but his family thought otherwise.
Despite the risk of being disowned by his family for quitting the profession, he pursued a professional course as a Certified Financial Analyst (CFA) which took him a good 4-5 years, while working as an executive in the Investment Department in one of the Malaysian Bank.
Now, he’s a Portfolio Manager, managing investor’s fund for Asia Pacific, earning a good RM 16,000 per month (yet to include his big fat 6-12 months bonus, yearly guaranteed increment, share option and retirement scheme offered by his employer).
Oh and by the way, he only works during office hours, 9am to 6pm, 5 days a week.
Again, it all about this important quote,
“Do what you love”
SPM leavers seriously need find their own rhythm, to search for what they like to do, or what kind of career they are willing to commit, rather than joining a particular industry because of fame, money, and glory.
Please spend time to read all the articles within this blog to gain further insights about this profession.
And again, no one is discouraging you from pursuing Medicine, it’s only about whether one joins for the right reason.
And yes – “You can be successful in any field, provided that you’re the best”
Wow cardipin, when I talked abut salary previously you made me look like george soros.
It’s okay to do finance for the money, not okay to do medicine because of money(despite clinically competent and safe)?
Wow…
Hi Anonymous,
Take it easy, So u think cardipin’s passion is underwriting? Then he is either a hypocrite or a psychotic. Mmmmm, most probably he is more of a psychotic caused by precipitating factor of under tremendous stress during his halfway internship…… take it easy, everyone……. Dr paga, sorry if I sound rude in your blog.
‘Now, he’s a Portfolio Manager, managing investor’s fund for Asia Pacific, earning a good RM 16,000 per month (yet to include his big fat 6-12 months bonus, yearly guaranteed increment, share option and retirement scheme offered by his employer)’
Hi, cardipin, yearly guaranteed increment? retirement scheme? That is provided he can keep his investors with him. Investors come and go, no guarantee.
sorry, should be known as new ho soon to be mo.
If you had to choose an subspecialty – would you choose cardiology or gastroenterology? What’s their future in Malaysia?
Depends on what you mean by “good future”?
Higher job satisfaction rate, assuming that one loves the gut as much as the heart.
I asked some spm top scorer students who received national scholarship today and Most of them wanted to do medicine. Even during the Q&A session it was all about medicine. Whats wrong with all of these people! Medicine doesnt make your rich! One more thing it is hard to enter the top medical schools in uk or us.
I heard that in a few years it will be a shift sytem for the doctors. Is it true? If true, the future new doctors will be less stressful and at the same time can earn rm3k per month.
Yes, that is what I am trying to say in this blog. Many are ill informed!
Yes, when the system gets overloaded with doctors, many departments will have to do shift system to reduce cost and to distribute manpower equally. However, this does not reduce the stress level. It only reduces the working hours. Medicine is stressfull if you really intend to work as a doctor and NOT as a clerk!
Unfortunately, many of the younger doctors only want to work as a clerk and not as a real doctor.
Dr pagan. I had read the content of your blog and i felt sad there were not many people who were aware of this issue. I think u should go to the media and tell them ‘ we will have too many doctors in a few years’. Maybe my idea sounds ridiculuous.
It has been made. Last year, the issue of oversupply of doctors has been mentioned in the news. That’s the reason the government issued moratorium of new medical schools. Unfortunately, many of the current generations do not read much!!
I had read it. But most of the parents didnt agree with that. They still want to make their children a ‘doctor’. What i mean is the effort to realise the community should be consistent in order to achieve the goal.
Maybe after PRU, the policies will be changed. I dont know whether politics had affected the education system in malaysia. Perhaps, if the current government does not allow the students to do medicine, many parents will be angry and do demonstration and boycott the government. Hmmmmm……….
No one can prevent you from doing medicine etc BUT the government never promises everyone a job except for government sponsored students.
Do u make profits by posting this blog? Im curious as a lot of people are visiting ur blog
NOPE
Sir,I am planning to attend either IMU (the 5-year local programme,not PMS) or Melaka Manipal Medical College (1st 2-and-a-half years in Manipal and the 2nd phase in Melaka). Where do you recommend I go in order for me to pursue my medical degree? Thanks in advance.
IMU
Do explain why,Doctor. I’m really sorry but I need to weigh the pros & cons of each institution before deciding.Thank you.
IMU is more established and reliable
Dr,I am planning to attend either IMU (the 5-year local programme,not PMS) or Melaka Manipal Medical College (1st 2-and-a-half years in Manipal and the 2nd phase in Melaka). Where do you recommend I go in order for me to pursue my medical degree? Thanks in advance.
Is it true that the trend these days about consultants leaving for private sector, coming back to gov sector because private is too tough n no life?
Yes, this is common nowadays. Usually they take a long non pay leave like 1 year and test the water in private sector and if thing not rosy, they will come back.
Poor doc. Are u a doctor? If yes, how many years have u been involved in this field?
YES, in fact not many are leaving to private sectors nowadays. My hospital is looking for another paediatrician for the last 2 years but still unable to find one. Firstly, the salary for specialist in government hospitals has improved over the last 4 years. Most specialist in government service are earning about RM 10-11k/month with minimal tax, easier to take holidays, not oncall everyday, less workload as you have junior doctors doing most of the work etc etc. The Private sector on the other hand is becoming too competitive, daily on call, income varies every month, can’t take holidays as you like, as your income will be affected etc etc. I have said this before that if you think you can earn big money easily in medicine, you are mistaken.
I am more than 17 years in clinical practice. I can assure you thing is not as good as you might perceive. 15 years ago, you can get a postgraduate qualification and go out as private consultant and earn lots of money. However it is not that easy nowadays. To join a reasonably good private hospital, you probably need a subspecialist qualification with special interest as well. A general physician qualification (specialist in internal medicine) may not ‘worth’ much, probably is more like a ‘high class’ GP. In fact a GP will probably earn more than a physician. To get a job in a repuable hospital, you probably need to be a subspecialist like rheumatologist, endocrinologist, cardiologist, nephrologist etc. In public hospital a consultant will get net salary about 12k plus other benefits like oncall allowance, housing allowance, 30 days annual leave etc but in private sector, the hospital might promise you a minmum income like 15k for a year than you will be on your own. You have to work 24/7 and with no paid leave. To set up your own medical clinic is not easy as well consider that there are so many rules and regulation to comply in the new medical act. Not to mention the increasing patient demand and low tolerance for medical complications hence the incresing trend of medical litigation. This is why you need passion to get you going, otherwise, money factor won’t get you far, you will be easily get depressed. So before you plan to get a ‘luxury paid job’ in a poshy hospital, you must prepare to spend next 20 to 25 years from your undergraduate medical course till you get your sub specialist qualification plus necessary experience to enable you to apply for such job.
How old is too old ( what is the “pensioner” age ) to practice as a specialist in private hospital, government hospital ?
Are you kidding the private hospital promises at least only 15 / year ? Is it 15k /year or 15k per month ?
Thanks
Rm15k per month but the whole income is taxable and you probably reach tax bracket 26%. In gov hospitals as consultant you probably get 12-15k net income per month but your tax bracket probably at 10% only. I am an O&G general specialist. There are many Malaysian specialists in Singapore but there maybe even more malaysian doctors in Singapore working as registrars or medical offciers. The Malaysian specialist qualification (Master or UK based qualification) is probably enable you to work as registrar only in Singapore.
Hai,poor doctor,what is ur salary as o n g specialist? Mind to share? 🙂
Private hospitals DO NOT pay you a salary. Your income is what you charge the patient minus about 10%. You can work till you die but you have to work 24hrs a day 7 days a week. Would you want to do that at the age of 50?
Poor doctor, are you a GP or specialist or specialist with special interest ?
Do you have blog too ?
Are there many Malaysian specialist or GP moving to Singapore today ?
Is working in Singapore more lucrative/rosy ?
Thanks
You seem to be so much into the money and easy life. Then you are so wrong
There is nothing wrong into easy money annd comfortable life, as every one ( including you ) wants those thing as long as it is done legally. a lot of ( medical, dentistry, engineering ) students want to pay back student loan, car loan, housing loan, and to pay his children education ( kindergarten, primary school, wife’s living cost ) to pay for his parents’ holiday ( preferably abroad – pilgrimace -) and and the list goes on and on
In life, there is NO such thing as easy money!You have to work hard to earn money. this goes for any field
whether you can work in Singapore or not, depends on your degree.
Most well established private hospitals now prefer experienced specialists, and one of the common requirements is at least 5 years experience post specialist qualification. Assuming the pathway is smooth, from leaving school, it will take 5-6 years med schools, 2 years HO, 2 years MO, 4 years Masters, maybe 2-3 years sub-speciality training, 5 years working experience, making a total of 20-22 years before one is ready to join the private sector and ‘make big bucks’!
From my observation in well established private hospitals in klang valley, 20-22 years may not be ‘ long’ enough for a private specialist to make big bucks, as the most he/she will only be around 45 years old. In most patients’ opinions, he/she is still not ‘experienced’ enough. Those who earn big, big bucks are all usually at least 50 years old or above. So it means at least 10 years working experience after sub-speciality training.
Good day to you sir.After reading and following your blog for a really long time,honestly speaking,i’m scared.Yes,i’m a person who learns,studies for the sake of money and job security.In my younger days,i had always thought being a doctor is just like sitting in the air-conditioned clinic waiting for the patients,smiling,doing some diagnosis and bam!there’s the money.And yes,a lot of my friends have the same thought.The only thing that we’re scared at that time is the hard examination and test.”Medical courses are worthy to take even if it has a long duration because of the promising salary and job security”.That’s my mindset for about 5 years ago.Someone(a specialist) had once told me that becoming a doctor nowadays are harder than before.Securing the job is a tough competition.When you think you’re the best,enter the real HO,bam!lots of people are better.Sure,you can become one of the best with efforts,but are you a person that really wants to study in a long duration of time,spending your times in medical just for something that you don’t have enough passion unless for money?That really took me back to reality.With a lots of undergraduates per year,the competition increases and medical courses are not critical anymore generally.So,after thinking about all these sorts of things,i’m honestly quite confused.What should i take then?Since i need to choose a course for the degree,honestly,i really think that education sector had better futures.Yes,better futures are subjective.But,for me,it’s better since i’m not willing to undergoes all those hardships for something even i didn’t know if i would really achieve it.I decided to take be a lecturer in any pure sciences.In your opinion,by which criteria should i choose?by my own abilities,say,which subjects do i perform the best but i don’t really like it,or by subjects that i love,but my performance in that is in average?I’m not going to beg for a spoon-feed or anything.Just your honest opinion.And,may a suggest,seeing that you’ve a lots of views mainly from younger peole,could you please write a post on what path or courses do you think will be in demand for the futures?say,dental hygienists maybe?Oh,and does all those hardships mentioned all this time are applied to dental courses also?Well,obviously yes anyway.Thanks for replying this if you’re gonna reply and thanks for writing all those valuable posts sir.
it depends on you. Do what you are interested in and not about money. People succeed the best in what they have real interest in. Never do medicine for “easy life and good money” It is not.
For SPM leavers, doctor job is only for straight a and a+ students. For those who got b, dont apply to be a doctor as u are gonna kill the patients. Studying medicine is about good academic background and good practical skills.
If u want to be glamour, be an ARTIST/CELEBRITY
If u want to be rich, be a POLITICIAN
If u like biology, be a BIOLOGIST
If u like to help people, be a VOLUNTEER
If u like blood, be a VAMPIRE
If ur parents force u, says GO TO HELL in a good manner : )
Im sorry for any inconvenience
Cheers.
Well, that also apply to u. Do you still want to be a doc? More people want to be doc means more competition for u. And to be honest. Straight a+ doesnt make u a good doc.
It is not about competition but it is a reality that there were too many doctors in malaysia. Students who didnt get straight a bcoz they didnt put extra efforts to score in SPM. Studying medicine requires extra efforts and excellent memory in order to be a good doctor.
I feel sad to know that there were many unqualified spm students who took loans from bank in order to become a doctor. Some of them also went to the middle east to study medicine after failing to get a scholarship or secure a place in IPTA. This scenario were common for the unqualified spm students.
Well, there are many careers that can make u rich, glamour and etc others than DOCTOR.
Try to open a restaurant. Lets say a meal is rm10. U open restaurant from 10am to 8pm(10 hours). In one hour you have lets say 10 customers. You can earn rm1k per day. In one month rm30k. Easier le. Of course these are underestimates. Shud be more hours and much more customers. U can easily get rm100k per month. Like kfc,mcD. Then you hire people to work. Rm1k per person/month.u hire 5. U bring home rm20k per month. If u get rm100k, u stil bring home 80k..in a year/2 can easily become millionaire. Life easier. No hustle. No suing.Lolz
For some students that are hell-bent in saving lives but lack academic rigour, they should try to do their best in their pre-university and achieve academic success in their course. However, a tower with weak foundation are more often than not, crumbles in the end.
They should understand, along with their parents, not everyone can be a successful person. If everyone is a doctor, engineer, or lawyer, who will be designing your dress, selling you flowers, or treating sewage ? Of course, for the people that manage to reach the upper echelon of the society, they have made their path, usually through sweat, and sometimes blood.
Therefore, make an informed decision. Do not try to satisfy your ego and understand your limits. As far as the world concerns, academic performance is rarely an indicator for personal wealth.
Finally, to students with poor academic performance that is still committed to this noble profession, welcome aboard. Just make sure you survive the examinations, the constant mugging of thick books, the ‘evil’ administrator, the ‘greedy’ lawyer, the ‘disturbed’ conscience for ‘accidents’, and lastly your ‘flaunting wealth’ classmates that open restaurants near your clinic.
People hell bent on saving lives but lack academic rigour should become nurses.
“If ur parents force u, says GO TO HELL in a good manner : )”
Happydoc,
You should not tell others to say “GO TO HELL” to their parents. Do u know what does ‘go to hell’ mean? It means that so and so father or mother must die first then only he or she goes to hell. Why tell them go to hell even if they force u’ ? Why not say GO TO HEAVEN instead, if hell and heaven do exist.
My personal opinion is better to tell them ‘not to interfer’ in a good manner.
Happydoc. From your replies I already feel you are very cocky and I really don’t think medicine may suit you well. You don’t need to be the smartest to do medicine. Consistency and hard work is the WORD. If you really want easy money go use it as a start up capital to open a company and if it does well, you would definitely have a better life in your early 30s than your medical colleague. You will definitely feel it when you are still studying in the library at the age of 30 when most of your friends are enjoying their life.
What is the pensioner age in government hospital / private one ?
When is someone considered too old to work as a doctor ?
Thanks
Gov hospital : 60
Private : none
Hey Happydoc,
Being a student with straight A’s doesnt make you a doctor straightaway.
Who told you student who score B or C are going to kill the patients?
I think you need the get the facts right and learn how to respect others.
Also, being a TOP 50 students like you doesnt give you a priviledge to bash or judge others just like that using your fingers on the keyboard!! Everyone has their own’s dreams. Never kill one’s dream. If you cant help, the least thing you can do is to motivate others.
Besides, I guess you are 18 ? 19? still a green horn. You need to learn how to eat a humble pie! There are still a long way to learn! Medicine world is vast and it is important for you to understand and listen to others.
Least but not last, being a doctor is not enough, you need to learn how to be a GOOD doctor with compassionate and caring which such species are almost extinct.
Never underestimate of other’s ability. The competition in the medicine world is not about IQ and it is also about EQ and AQ. If you think straight A’s can get you into medicine then you do probably be prepared to be KO. Besides, altitude, ATTITUDE is also important. You need to make friends with others not create enemy. Do you know arrogance can be as fatal as CVD?
By the way, I’m the 2nd year matured medical student.
Would like to hit the “LIKE” button for your critics towards Happydoc. (Dr paga, thinking of adding that feature to your blog?)
A person with such attitude will understand the reality when he start to be a clinical phase student, where the nurses wont give a damn to whom he is despite being top SPM scholar.
Dear Dr. Pagalavan. First of all, hats off to you on all the infor you have been providing us students. well, i just finished my spm, and would love to become a dentist one day because of the job prospects and the income. i just would like to know, if dentistry in malaysia is productive? there are very few institutions providing dentistry course. imu is just ridicolously expensive and others are well really confusing, need some advice or recommendation of where to study? and if there is a demand for dentist in malaysia?
looking forward to your reply, thank you soo much!
at the moment the demand for dentist is still high but can’t say much about the future.
Hi, Dr. Pagalavan. Thank you for posting up all the useful information. I really enjoy reading your blog. Recently, I am having some dilemma about choosing my internship. It would be grateful if you could give me some advices.
I’m a final year student who is studying in Scotland and will be starting my internship soon. I’ve had got my job offer both from NHS Scotland and MOHH Singapore but I’m not sure which one will be more suitable for me.
The benefit of working in NHS Scotland is less working hours which means I have more time to prepare for my post-graduate exam. Also, I can get my GMC registration after completing one year of my internship although I’m not exactly sure how important is it. But, I’m a family-type person. I know I won’t be staying in Scotland until I complete my specialist training which takes another 8-10 years.
I did my elective in Singapore and I understand the workload in Singapore is very heavy. I’m afraid that I don’t have much time to prepare for my exam. Also, I’m afraid that I won’t be able to get into their residency programme. The good thing it’s very near Malaysia and I can fly back anytime I would like to. I’m a bit lost at the moment and it would be good if I can get some opinions from you.
Thank you.
If you do not envisage ever staying on in UK, GMC registration is not relevant. Once you leave, you will eventually get you name removed from the main list, otherwise you need to keep on paying for the yearly license.
There is no guarantee both in UK and Singapore of getting postgraduate training. In UK however, you will face another obstacle, that of getting a work permit under EU laws as applied in UK. You will have less issue with that in Singapore.
There is a window of opportunity in Singapore at the moment, with 2 new hospitals opening, and current shortages to continue until NTU/Imperial graduates their students.
The downside to Singapore is the greater workload, higher work pressure, pressure cooker social environment, expensive housing and cars, and a generally claustrophobic environment.
If I am not mistaken, even in UK, there is NO guarantee that you will get a training post after Foundation year. The immigration law will take effect after you complete foundation year. I know quite a number who had to return after their foundation year as they could not get a job in UK.
If you do get a training post in UK, then I would suggest to complete everything there before returning.
Singapore residency system is still new and not sure whether Malaysia will recognised the training system.
My two cents is this-
90% of new medical grads who are practicing in Malaysia today will not pass the USMLE.
USMLE does show that u have mastered your undergrad knowledge.
It does not show that you are a good doctor.
But good doctors must have mastered their undergrad knowledge.
We have too many wannabes around.While its a free world and people have free will to decide what they want to do- It doesn’t mean it is good for the healthcare system.
guys like chillax just do not see the big picture yet
I disagree..i think alot of those private student who cannot work in malaysia due to unrecognize uni and dun wan to take the exam to work in msia are turning to usmle and passing it. But whether they get the place or not there is another matter.
Greetings sir,
I just done with my foundation in science at MSU. So sir, my question is..should I pursue my further studies in MBBS at MSU itself? Are the MSU MBBS Graduates performing well as they graduates from MSU? I cant afford to go with the twinning program, so i had to do it in Shah Alam campus itself. Highly need your advice sir.
Thank you.
MSU is yet to produce any graduates of their own. Difficult to comment
Dr,
My son is interested in doing Pyshology Biology – a new course offered by Sunway college. How do you think this course will fair in future?
Psychology has a good future but I am not sure about psychology biology
Thank you doctor… at least my son will be more confident now although he has to give up hopes on being a doctor.
Happydoc
first of all, you are very immature and arrogant of thinking you score top 50 in SPM make you very proud as like very smart, don’t be childish, Malaysia SPM system of grading mostly depending on the political factor, and the so called- A+ might be lower than 80 to get this title.
because of your ultimate childish and arrogant, you said that non A+ and A should pursue in medicine, how pathetic to say this, not only this, from the English sentences you wrote, always in the internet language, and I doubt of your so called ENGLISH can score A+, I bet your IELTS never score higher than 8, you so-called TOP 50 scholar. Especially what you wrote “Well, I am one of the top 50 best spm students in Malaysia and I think my future is bright in this field.”
How stupid for your thinking, a good score on sheet in examination, and only secondary school SPM can state your future is so bright? haha, by this immature statement, either you are A. arrogant or B. low IQ for further thinking, for your information, when you deal with the true reality world, you sheet of A+ SPM will not helping you, thousands of scholar I have seen are working with the boss with no further education on university. Because they use brain before they talk unlike you.
from what you wrote, it can be decided, you still live in your own world that you are so smart and very success, did you beaver know, the success is not purely on the paper product of saying how many A+++ you scored, but the way you communicate and many other non than academic, many of the successful person are not really step in the university and not even so called cocky TOP 50 SPM. In Malay language, it called, KONONNYA PELAJAR TOP 50 DALAM SPM, not even practice and write a good sentences of English
In above deducing, other than you a machine for examination, you are totally a failure of getting many people accusing and condemn what you wrote just in internet, and how about those person near to you, most probably to form of more hatred to you, even cursing you behind.
Say to your parent goes to hell. oh my poor mother, such “filial” son said to the parents you are really bad apple that your parents have educated you, causing and only teach you to score A+ but not mannerism,
for you, keep your brain up for your maturity, and you only 17/18, little kids, but not by the age, I have seen 17 years old students are more mature and success than you interim of examination and thinking skills.
FOR YOUR INFORMATION, I score 15A1 in my SPM, and during that time I am also top scorer in SPM, but I never am such cocky like you. If you parents fail to teach you, then the people in this society will come and teach you what lesson you should learn from.
While I am in no way siding with anyone, it is also very obvious that your command of the English language is really no better, and frankly quite horrible.
@jk, my thoughts exactly!
I suppose it is a sign of the times, that someone with an alleged 15A1 (which means in past SPM, as it’s now A+, A and A-), ie with a presumably A1 in BI, will write this piece of rather bad English prose.
It just again proves that the SPM exam measures mostly exam technique, and gives a poor indication of the actual ability of the student. It’s value is mostly a qualitative measure of the relative ability of students, rather than quantitative indication of absolute ability.
It is not necessary that a student with 15A1 must be proficient in English because he could be from a national or Chinese school. We should blame our education system instead of passing ‘unpleasant’ remarks on their standard of English to demoralize them. Those who are proficient in English (especial those from private schools or international schools) maybe good in English but not necessary they are good in other subjects. It is the same that in Japanese or Korea or Taiwan, do you think we should said their top scorers from their national schools are all not up to par just because their English is no good? It is their education systems to be blamed.
Get A1 for English and yet not proficient in English? This is exactly what I am pointing out. If an A1 grade does not indicate proficiency in English, does it indicate proficiency in the other subjects?
@jk, my thoughts exactly!
Good heavens! How low can it go? At he rate we are at, there shall not be anything left to cherish!
Hi, I’ve always been a keen reader of your blog posts and was weighing my options between PMC and IMU MBBS for my daughter. Was wondering if you could shed some light on this?
Both are OK but PMC is a twinning program
Thanks Dr for your prompt reply. With your detailed knowledge of the medical field, which would you recommend? I’ve heard that the PMC twinning doesn’t have a good recognition even if it’s an Ireland degree? Is MBBS IMU overrated? Thanks again!
If you want proper recognition, then you need to go overseas. Local IMU program is OK but not recognised elsewhere. Same goes to PMC.
Indonesia, Egypt and Russia are also overseas, doc. 😉
hahah