Well, we just received our first of the many presents that we are going to receive for voting the current government. I use to tell people that our debt is just too huge for the government to go on spending money by whatever name they want to call it. Unfortunately, since most of these in formations come from the so-called “opposition” supporters, the hardline pro-BN supporters will always refuse to believe despite showing the facts and figures. Tomorrow, as a Merdeka present , RON95 petrol price will go up by 20cents! With a pathetic public transport system, we’re going to see many more motorbikes on the roads soon! Wait for the budget and I am sure you’re going to see the GST and 1Care system being mentioned. The government got no choice but to cut their expenses, after spending money like it was their grandfather’s money! Janji dicapatikan and good for those who voted for them all these years. Stop the leakages and you will earn money, as what Selangor and Penang is doing!
Now, coming back to the topic above. I had written about the realities of medicine since I started blogging in 2010. The article below (The Star) was written by a good friend of mine and a fellow UM batch mate from Penang. He is spot on about the status of medical education and practise of medicine in this country. All of it has been mentioned by myself many times before. With the economic situation as mentioned above, will the government be able to absorb ALL the graduates by 2016, amounting to about 6 – 8 000/year? The income of private doctors has been declining over the years. I just heard an O&G consultant who is only earning less than 10K/month after 2 years being in a private practise! Something that we never heard, 5 -10 years ago.
The government just increased the petrol price by 20cents, which is about 10.5%. This increase will eventually increase everything else that involves transportation. So, your cost of living will increase much more than that. Remember the headline when doctors asked for 30% hike of their fees ? Someone wrote a letter to the newspaper that doctors drive expensive cars but plumbers drive old “retired” cars and thus cannot compare apples and oranges? The person who wrote that got no clue about life in medicine. Unfortunately, what she wrote is exactly what the public perceives. They always tend to forget the cost involved in being a doctor and subsequently a specialist(debt ++), the time taken, the multiple exams that they go through, the risk taken, the quality of life that is lost etc etc. Then, when their child had to work beyond 5pm, they will complain to the hospital’s Pengarah! Their so-called “grown-up” graduated child is still an infant, I guess!
BTW, I know a plumber and an electrician who drives a luxury car and only does supervising work! His workers do all the manual work. They drive the “broken” car to work as they dumb all their instruments and tools into the car! Who wants to do that on a BMW or Benz? I know doctors who drive big cars just for glamour but has a huge amount of debt! So, don’t judge a book by its cover!!…………….
Realities of pursuing medicine
A medical practitioner talks about why students need to think it over before pursuing medicine, and laments over the inadequate training for new doctors and other practices affecting the profession.
By Dr BA KAREEM
IT IS that time of the year again where top scorers from both Sijil Tinggi Persekolahan Malaysia and matriculation courses, slog it out for extremely limited seats in critical courses offered by local universities.
The government of course is unable to provide places for everyone especially with the increasing number of perfect A scorers, every year.
This has led to many unhappy parents taking the issue to politicians, followed by promises by the government to look into the matter. Civil servants and university authorities are usually at the receiving end of an unforgiving public.
Almost all top scorers in the science stream eagerly state their intention to do medicine. The reasons given usually vary from their noble intention of wanting to serve the public, fulfilling their parents’ wishes to job security.
However, the prestige and guaranteed good income are serious considerations which are usually not stated by the students. As a senior doctor in the government service and with exposure teaching medical students, I would like to comment on this puzzling obsession (prestige and guaranteed good income) and perception that students and parents have in pursuing a medical degree.
It is now acknowledged in the medical fraternity that there are too many doctors and about 40 medical schools in the country, producing 5,000 doctors yearly.
Approvals for private and public medical schools contributed to the problem. Many private colleges lack facilities and senior lecturers. They usually take the easy route of “hitchhiking” to a public hospital in the area.
This will save costs as the colleges will usually engage public hospital consultants to carry out the teaching on a part-time basis.
The Health Ministry had recently issued a circular on the matter where doctors are now prohibited from teaching students during office hours.
The Malaysian Medical Association (MMA) in its June newsletter quoting statistics from the ministry which stated that there were 28,309 medical officer postitions available in 2011 of which 21,765 of them were filled.
Therefore, the remaining vacancies must have already been filled considering the annual number of graduating doctors.
These numbers were presented by the MMA President Datuk Dr NKS Tharmaseelan during the association’s 53rd annual general meeting recently. He also stated that there were 130 government hospitals in 2007 and 132 in 2011 — only two hospitals within four years.
The fact is we are not building enough new hospitals to place and train all our new doctors. Thus, job security in the medical field has become a fallacy.
In the near future, doctors will be left on their own to seek jobs while the government only undertakes to provide internship opportunities.
This is already a reality in many developed countries including the United Kingdom, where I was trained. Doctors there have to prove themselves to be capable and pass numerous interviews, coupled with good referee reports before they can get jobs.
I am aware of parents who sell their property so as to enrol their children in medical schools. Let me remind them that job prospects in the profession, is one matter they should give serious consideration.
While the authorities might argue that the situation (a large supply of doctors) is good for the health sector, with only competent doctors being employed, chances are “half-baked” doctors might still end up serving in rural areas where there is less competition for posts.
Ultimately there will be doctors, still unemployed in urban areas. In some departments in the hospital I work at, there are about 40 house doctors, and the head of department is unable to remember their names and faces.
Senior doctors do not even notice when house doctors are absent from work. These house doctors work on shifts which was completely unheard off before. During my training. a 48-hour call duty used to be the norm. They certainly drain you out, but the process makes you a better doctor.
The number of admissions at night are sometimes lower than the number of house doctors on duty. In medicine, you are as good as the number of patients you see and examine daily.
Doctors learn all the time from their patients and seniors. So, questions arise over the quality of training for house doctors before they are allowed to work independently in district hospitals.
For candidates who intend to become specialists, I don’t have much good news either.
According to the MMA president, only 690 medical officers were offered to pursue post graduate medical programmes in local universities in 2011. Masters training positions are very limited as only a few universities with an adequate number of consultants are offering them.
Take note that to train specialists, we need to have senior consultants. A majority of our senior consultants are already in the private sector.
The ministry has set strict conditions where applications are only allowed after a four-year service period, making it a gruelling marathon before a junior doctor can become a specialist.
Having said that, let me point out that I have also come across medical students who don’t want to attend classes that I have, after office hours. This is because of my own hectic schedule. Interestingly, the reasons given range from dinner appointments with parents, evening tennis or swimming lessons.
In situations like this, I wonder if our academic top scorers have the aptitude to study medicine albeit participate in this gruelling race. For those who aim for greener pastures in the private sector, the picture is not rosy either.
The private sector also has too many doctors. Private hospitals which are essentially business entities do not actually employ doctors, but rather hire them on a contractual basis.
This has already resulted in too many doctors trying to meet the needs of a minority group of patients who have insurance coverage or the funding sources to pay for private medical care.
Talentcorp Malaysia has also successfully persuaded Malaysian doctors to return from abroad. These senior doctors are exempted from compulsory government service and are allowed to directly work in the private sector.
Many friends in the private sector actually have difficulty in making ends meet because of the severe competition in treating the dwindling numbers of patients.
Some hospitals actually charge rental for clinic premises and also ask doctors to employ their own clinic assistants.
With increasing overhead costs 1Malaysia clinics are certainly here to stay. It cannot be denied however that they have caused a dent in the practice of general practitioners, especially in urban areas.
On the contrary, remuneration packages and promotional prospects for public sector doctors have improved significantly over the years.
The ministry has to be commended for promoting many senior doctors recently to Superscale C levels.
For the first time, prospects in the public sector do not look so gloomy, but it has to be remembered that vacancies here are running out fast especially with the retirement age extended to 60.
In conclusion, I would ask aspiring doctors to think again. Just because they have the required grades, does not mean that they should be automatically allowed to pursue a medical course.
This article is not meant to dissuade Malaysian students from pursuing medicine. In fact, it is to enable students and their parents to be informed and to consider the issues affecting the profession today. This in turn will help them make the best decision before students pursue their line of study.
Pagalavan's Avatar 
Is the public exam getting easier? How is it possible that the number of perfect straight As keep increasing every year? Maybe it is time to introduce an entrance exam to enter medical course like MCAT (Medical College Admission Test). What is another exam anyway. When one is in medical school, one has to sit for countless exams. Working as a doctor, everyday is an exam. Patients can come in with whatever problem.
you are absolutely correct. The standard of public exams is going down the drain. I heard even 20%, can pass the exam. So, imagine what an “A” mark will be. We have students who got A1 for English but can’t write or read proper English!
http://www.bbc.co.uk/news/world-asia-23841888
http://www.bbc.co.uk/news/world-asia-23925344
The same issue as covered above by BBC will likely affect selection for jobs in future as well. Unlike USA, it’s not how good you are but…
Yes, of course. Preference will be given to local public uni grads and sponsored students, thus you know what is going to happen……….. The last civil service where there are good mixtures of races will eventually become like any other civil service , 80-90% of one race.
Hi dr paga
Im a housemen currently doing my training in one of the klang valley hospital. As for your knowledge my hospital having shortage of HO’s for the past 1 year. Now im in medical posting and we only have 5 housemens the entire department. Yes of course still on shift system working but our work time everyday are extended sometimes up to 5 hours, simply I can say averagely we work 16 hrs per day. We only have 1 to 2 housemens per ward which have around 35 patients. I dont think all other training hospitals having the same dilemma. I write this message just want to inform you that the current housemen ship
Just less than 2 years ago, klang valley hospitals were overloaded with housemen. Thus, MOH issued a circular that all HOs who do housmanship in Klang Valley will be transferred out of Klang Valley after horsemanship. MOH also reduced the number of housemen being sent to Klang valley hospitals. These could be one of the reason why some hospitals may have shortage of housemen aka maldistribution. However, you must understand that the number of housemen in each hospital is limited by the number of consultants in that particular hospital(5 housemen per consultant). Thus, smaller and newer hospitals would not be able to take large number of housemen. From the way you describe, your medical department only has 2 wards! Actually, 2 housemen/ward is enough.
the career talk after spm should really emphasize on this matter.not in a dissuasive way but in a more layman and explanatory both for the parent and the student. i notice that you have roughly the right idea about what’s going on in medical profession but little i’ve heard about any of those ideas being implemented.i believe as a senior you might have more connection than you ever realize and you can surely make a dent.
true.
The career talks are promoting students to take medicine, and the reasons for them to be a doctor is good life and good money…..sigh….
I personally would suggest that all budding doctors to tag along House officers and medical officers 24/7 for at least 1 month and then they would know the reality of being a doctor. Let them notice the bullying even from the MA’s and Staff nurses. They would probably think twice that being a doctor isn’t such a great life after all. Many HOs left the service and joined private as GP (after completing housemanship) or even doing their own business.
There are accountants who completed ACCA within 3-4 years and are working in the big 4 accounting firms with a starting salary of RM3K/month and RM1K increase per year. Not to mention other financial perks. If one were to want good life and good money, there are many other professions rather than being doctors. Sadly these career talks don’t talk about current reality in the world today.
Yes, exactly! I know an accountant who is already running his own firm with his brother. His schoolmate who did medicine is still struggling with his life, doing Masters!!
*completed ACCA in 3-4 years after SPM!
It depends on who is conducting the ‘career talk’. If it is the med schools themselves, then it is more of a sale talk. Especially to the accompanying parents.
Most of the time, it is given by the medical schools. Rarely, they call a third party to give the talk. That’s the reason why education should never be commercialised, especially medicine.
I had given talks for SPM leavers in JB but usually NO medical schools is going to invite people like me! It is a business and they will do whatever it takes, to make profit. Remember, no university promises you a job! And, no matter what you say, people/parents don’t believe in what you are saying. They feel that you are trying to take care of your rice bowl!
While Dr Pag has been for the last few years warning of the over-supply of doctors……the medical schools however have been doing an even better job of promoting their degree programmes. I think Dr Pag’s blog is read more by doctors n medical students…for whom its”too late” to do anything. I think the MMC should play its part….eg have a campaign to inform school leavers on the real situation of oversupply of doctors…..n make them aware of the pros & cons of choosing a medical career. So that potential medical students are well informed b4 making the choice. But knowing the MMC, they care two hoots.
Two hoots would be more credit than the spineless MMC exco deserves.
Actually, I do receive many emails and phone calls from parents and students who are planning to do medicine.
One of the reason I started this blog is to educate the public and I think it did do some good.
Haha..just like doctors, accountants are looked up too much, thinking that they earn big bucks. Now, upon completion of ACCA in 3-4 years time, you’ll need working experience of another 3-4 years before being a registered MIA member (ala MMC registration). After that, then only you can work your way up to being a licensed auditor(ala specialist in medical field). Those days, an accountant working in the audit field calls themselves an audit clerk/audit accountant, nowadays, some even call themselves auditors!
The big four pays a lot, yes, RM3k+ a month, because not many can stand the long working hours. In fact, the work time during peak season for company audit can be as taxing as a doctor! Many did quit along the way, or failed to climb up the ladder for the big 4 company.
Of course, those accountants who worked their way up the commercial field would end up doing non accounting-related managerial stuff and worked their way up like Tony Fernandez.
But do take note that all professional jobs are not as easy as they were back in the olden times. There are successful ones and those who failed. The major difference is, we keep the failures in the medical field in the name of government service and let them kill the patients. Even if they are incompetent, no one can really sack them and they are always in the job. Some of these lazy bums and incompetent doctors are creeping up at all levels, from house officer at the bottom to the specialists above. *sigh*
I have just done my night shift the last two days. spent the day sleeping now awake and written an article on my blog ‘Do we have appetite for another war with Syria?’
have a read if you are interested.
I must agree with ashram. I think you should not be promoting your lifestyle and your blog in my blog. We are discussing serious issues concerning our medical profession here.
Hey Jeffery Luk…..
Dont use Dr Pag’s blog to promote your own blog…ok. With almost every comment u make, u ask readers to read your blog. I have visited it….its of no interest to me for sure…and i think it has no relevance to topics discussed here which are very malaysian. It seems like u are trying to ‘show off’ that u r in UK.
Hi Ashraf,I like your comment on Jeffrey here.Could not agree more.
As for comment from metamorphoses,you have made an accurate description of current situation especially the last paragraph. In every profession there will be some successful ones,the rest remain ordinary,so as medical profession.
I beg to differ– albeit not in an offensive tone— in many developed countries, they have developed their own ways to maintain a certain standards in their professionals, more so on medical doctors who are the last line of defense on a human being’s life. In these places, there will be very good doctors, while the remainder are not as good as those of creme de la creme, they are no ordinary, and certainly not sub-standard.
Key words – “developed countries”.
The subject matter discussed here is income(money)which measures the so called “success”,not about the standard or competency.
I guess you are right ashraf, this blog is very malaysian. and not everyone appreciates somebody talking about their overseas experience. The only common denomination among us is that I am a doctor and I am Malaysian.
And yes, I am very very thankful to Jesus, my Saviour and God that he opens the door for me to come to Britain to study and work.
Many people including Dr. P have made the assumption I come from a rich family. As a matter of fact, I am one of the poorest among my classmates. But by God’s grace, He gave me more than I asked, blessed me more than I could ever hope for. This is the God I serve. I never asked to come overseas, just simply to be a doctor. But guess what, I got a scholarship that tells me to choose any medical school I want to go in the world! Yes, in the world!
I still love my country Malaysia. If God calls me to return I will. At least at the moment, it seems so.
You know despite all these worries about lack of jobs for doctors in the future, I have 1 solution – if your trust in the Lord Jesus Christ, you are secure. cause He will sustain you, protect you. And He has a future and a hope for you. That is what He did to me! My life is the testimony of God’s power and love.
Anyway, I shall bid you all farewell and may the good Lord bless all of you!
So you took a scholarship, with no bond attached to it?
Religion is to many, a personal thing, and this being a mostly Malaysian blog, it is not necessary to go on about your christian faith. You’re coming off sounding like a preacher, young man.
Not to sound offensive, but it does sound like a tiny bit of hypomanic phase. But as they say, a little bit of hypomania can be a driving force to success! 😛
I dont think theres anything wrong about that christian thinggy by jeffery. Just like we saw alot of muslims thinggy everywhere, even on tv break commercials etc etc. Peace.
lolz, we’re only talking about it in the context of this blog, and nobody has said it is wrong, only that it is inappropriate.
Dear Jeffrey,
I admire you your faith, young man. But I would caution you to reign in the outpourings of Christian devotion when you join the medical workforce in future. Your patients will not necessarily share your faith and/or zeal. Some would find it frankly offensive. And you should never use your position as their doctor to impress upon them your Christian teachings. They come for medical treatment, not religious enlightenment.
*BARF*
Good piece of advice not only to Jeffrey but all present and future doctors.
“The president of the United States (George W. Bush at the time) has claimed, on more than one occasion, to be in dialogue with God. Christians love him for this. If he said that he was talking to God through his hairdryer, this would precipitate a national emergency. I fail to see how the addition of a hairdryer makes the claim more ridiculous or offensive.”
– Sam Harris
“I still love my country Malaysia. If God calls me to return I will. At least at the moment, it seems so.” Sounds hypocrite
Hi Dr Paga,
Vikz here (HO), i just want to clarify with you. 2 days ago one of my specialist said he attended a meeting regarding HOship. He broke a bad news saying that starting from 1st January 2014, those finished their HO training after this date required to sit for an MCQ assessment. The passing rate is 60%, if score well, they allowed to continue their civil service, if borderline pass also can continue in civil service but with contract basis and the prolongation depends on SKT, and those who failed the test automatically cannot be a doctor anymore!! Is that true?? and before they implement this test, the government should bring this matter to parliment first, isnt it ? confuse
I have not heard anything yet but something like this is inevitable.
The government would not be able to provide job to everyone. It is a privilege and not a right to become a civil servant.
Parliament has nothing to do with this.
Its a good idea if it is implemented transparently. Can weed out the bad ones and retain the good ones. If the HO is good, would be able to ace the exams. Why need to worry then? But I wonder how transparent would this assessment be?
Usually I would reason out against MCQ as clinical judgment and procedures cant be reflected in the MCQ performance. At least 30% of the doctors in our system are what we called lab technicians, where they can’t piece in and make a clinical diagnosis from whatever they found. Instead, they sometimes rely on a sole lab parameters to guide their management.
But then again, seriously, some graduates can hardly grasp the fundamentals of medical knowledge, and this could weed out at least 20% of them.
Dear Jeffrey,
Yes, please keep your God to yourself. THANK YOU.
Good day doctors
I am pretty much scared to fact of future unemployement of medical doctors. I never miss any issues in this blog and dr.paga really doing great thing in creating awareness.
I’m actually a final year medical student who currently doing clearkship in an unrecognized institution. I chose to study here consciously after knowing all the consequenses and this is because i love medicine profession. I definitely will sit for the MEQ exams and it must be a public university because i dont have money and only have knowledge.
If examination is th only barrier to qualify my self as doctor, then im already facing this barrier ever since UPSR. I keep updating myself with this blog and learned one thing everytime reading through this blog which was about competency and productivity. I’m working on it. I don’t worry about unemployemet and always hoping there will be an examination to screen out the best and im ready to grab any kind of exams.
My prayer is that i want common qualifying exam to be implemented.
thanks.
best of luck
Hi doc. Heard a lot of rumours that there will be some interviews and exams in the future for those HOs. If i am a jpa schorlars, is it means that i am guaranteed a job? or it is the same and I will have to compete with all others HOs? and in the 10 years bond, if we take postgraduation, the remaining bonds will be delay or the postgraduation years are included inside? Thanks a lot for your information.
As a JPA scholar, you are bonded with the government. Thus, the gov must provide you with a job.
Your postgraduate bond will add up to the undergraduate bond.
As I have said before, it is inevitable. The government will NOT be able to provide job to everyone and thus they will have to come up with an assessment.
Hi, medical student.
I don’t think you will guarantee a job. If there is a common exam for all medical graduates, it means even you are a jpa graduate, you will not get a place for HOship if you fail this common exam. It is kind of fair to all medical graduates, regardless of whether they are from overseas-trained, locally trained, public or private, all are treated the same.
Yeah, if there is a common exam criteria to fulfil, I believe even you are a jpa student, you will not get a place if you fail the exam. You will be ‘released’ earlier to find a job yourself.
Sir, is it easy to get a job with bachelor of microbiology , biotechnology biomedicine and biochemist in 2018
Which is the easiest ? Which course is growing?
Jeffrey, that’s your own thing right there for prove dont know which God you likely to hard sell. keep that to yourself, if you say what you wrote are malaysian, then think back what you said, it’s not, as simple that not every malaysian are christ*** and always make everything related to your god, you should preached your religion at religion post, and what we want to see are Dr Pag writting
T….you can kindly just ignore’s jeffrey’s post. Moreover, Dr Paga has to respond to something, otherwise, what you are looking forward to read is Dr Paga’s blog posting and not the comments section.
[…] articles after articles as though the world is coming to an end. I had written about the issue over here and here. Today, the Star had yet again ran an article ( here and here) regarding this issue, […]
With the increasing number of local and private medical school, maybe it is true that one day there will be too many doctors. However i must disagree. If HO training takes 2 years, there’s no way gov could keep the slots empty for 6-8k/year. I’ve worked in ED where sometimes we get only 3 HO per shift (way too little) and sometimes 10 HO per shift (which is a luxury and i don’t complain). And the MO, 3 per shift, 1 in green, 1 in yellow, 1 in red. And for some god knows what reason, patients just love to come at night, not for anything emergency at all. sometimes we had 300 patients per night, and that’s a bit too much even with the number of HO. I had one who came in at 3am with head lice (thus the reason why there are too many patients). Waiting hours in green ranges 4-6 hours from registration, to seeing a doctor. Further waiting period for tests are not accounted. if we have so many doctors, then it is not logical for the waiting time to be that long.
A specialist clinic had to be run by HO and MO because there are not enough specialist. Not exactly a specialist clinic when MO decide on the management. Not enough specialist to oversee these MO. MOs are learning, picking up skills from another MO. This will surely effect the quality of care.
so where are the doctors to cater for all these patient?
Where are all the specialist, consultants? Why are the MO not given opportunity to study?
Why can’t we train more? World’s population are increasing, number of patients are increasing. Some of us just want to serve the people in the country but it’s proving to be very diffilcult nowdays. Soon, disheartened MO who have waited for so long will leave the profession, along with skills and knowledge. I’ve known 2
What you have written is the truth about the “public healthcare system in this country BUT you have forgotten the big picture!!
As you have rightfully pointed out: IT IS MALDISTRIBUTION of doctors that is the problem now. The government is chasing after the ratio of 1: 400 by 2020 but I will bet you that even after they have achieved that, issues as what you had written above will still be happening !! FYI, in Klang valley, the ratio is 1: 450 but why the public hospitals in Klang valley still complaining of shortage of doctors and patients complain about long waiting hours?? BUT, if you include all the private hospital’s number of beds and specialist in private hospitals, do we have enough beds and specialist ? The answer is YES!!
Look at today’s NST. Our deputy Health minister says that we have only 200+ cardiologist in the country when we need 500 BUT ONLY 30 is in government hospitals!! So, you ask why we don’t have enough specialist in the public hospital ?? Almost 60-70% of the specialists are in private sector when 80% of the patients are in government hospitals!! That’s the reason that no matter what is the ratio that the government is talking about, these scenario you described above will continue to occur.
So, you are right. WE DO NOT have enough specialist in PUBLIC hospitals to train the junior doctors.
As for emergency department, we need to educate the patients that emergency is emergency! That’s the reason in some states they have OPD clinics running till 10pm, started in 2008.These issue of unnecessary cases in Emergency has been going to for as long as I can remember!
To solve this problem: we need private-public sector integration with a National Healht Scheme.
We are definitely training more specialists. There is an increase in places for Masters’ programme to exponentially increase specialists by 2020 I presume. I have seen the list and there are many doubtful candidates who I have personally worked with. Not only that, there is a huge question mark on the selection of candidates into the Masters programme. Seems to be over 95% of a particular race. Sometimes, I wonder the impact of quantity over quality even at a specialist level!