I just completed the “Walk a Payung” event for SLE association of Malaysia, Johor chapter this morning. It was the second time we were having this event in JB and we received a wonderful response despite a rainy day. I had a oppurtunity to talk to few people from MOH and a public university academic on few interesting issues.
The issue about medical education and oversupply of doctors has been discussed several times in this blog since 2010. Unfortunately, I still get asked many repeated questions about the situation and some still feel that it will not happen. A few recent comments in this blog said that they are still short of manpower in certain departments in their hospital. I have said it many times before that MALDISTRIBUTION is the main problem. The maldistribution is not only between the departments but also between hospitals and regions. The shortage now is mainly in East Peninsular states and East Malaysia ( compared to the number of post available). In terms of specialist, I do agree that we have severe shortage of specialist in government hospitals. That’s the reason why there are not enough people to train the juniors and the entire system is collapsing when it comes to quality. I was informed today that all the public universities are scaling down their intake. UM has scaled down from 200+ students to 180 this year and subsequently to 150 next year. Unfortunately, the private universities are increasing their intakes to make as much money as possible before the market gets saturated, as what happened to the nurses.
The government is chasing after the ratio of 1: 400 by 2020 which is the reason why they approved too many medical schools. Unfortunately, they have miscalculated as medical education is not like any other field. The training after graduation is very important and we need to have enough consultants to do that. Many people out there still think that post-graduate education in medicine is similar to other courses where they attend a 4 years FULL-TIME course and woolah, they are a specialist! I get asked this question again and again. Let me tell you that post-graduate education in medicine is “FULL TIME” working and “PART TIME” studying. You still need to work as anyone else while studying for your exams and doing your thesis. That’s the reason why you can’t go overseas to do your post-graduate education if your degree is not recognised elsewhere. The Ministry is running out of post and this has been confirmed to me by many MOH officials. New posts are being created but it is unlikely to solve the problem as the numbers will not be enough. The number of Master’s slot is also being increased but again, it is unlikely to cope with the exponential increase in the number of graduates. I was informed by MOH officials that they will soon officially allow doctors to apply for other jobs.
Now, coming back to “chasing after the ratio”, it is not going to make any difference. Klang Valley has a doctor:population ratio of 1: 450 currently but why do the public hospitals still complain of shortage ? This is because, majority of the specialist are in private sector. A report in NST yesterday says that we have 200 gazetted cardiologist in Malaysia BUT only 30 is in government sector. That’s the problem that we are facing. If you include all the private and public hospital’s number of beds and doctors in Klang valley, we have more than enough BUT 80% of patients go to public hospitals when 60-70% of the specialists are in private sector !. So, it is an “artificial ” shortage which will never end. A public -private integration will be needed to solve this problem.
Thus, achieving the ratio is not going to solve any problems. Even after the government had achieved the ratio, similar complains of shortage, long waiting hours for patients and long working hours will still be heard. By being a doctor, you can’t run away from being overworked and working long hours. You are dealing with lives and there is no such thing as “office hour” job. Everyone(including parents) who intend to do medicine must be aware of this before doing medicine for “good life, good money and good future”, a false perception by many. An article written in this blog by a medical officer is a good read for ALL. It tells you a life as a doctor in a government hospital. The situation is unlikely to change even when the government achieves the ratio. The situation is not much of a difference compared to developed countries like US as written over here (see below).
Finally, I received the following SMS few days ago which is self-explanatory:
” Vanakam, we are a medical students placement agency. We are looking for agents. WE pay commision up to RM 5,000 – interested Pls do call xxxxxxxx (Mr XXXX) TQ. www ………………com.my “
When I visited their website it says ” Confirm Seat! “………………….. Gosh, how low the level of medical education has become………………
Anyone wants to make easy money? be an agent !! Recruit 10 students a month and you get RM 50K. No wonder many parents get cheated by the agents.
Long Work Hours Wreak Havoc in MDs’ Personal Lives
All Work, No Play a Recipe for Family Conflict, Depression, and Burnout
Sep 23, 2013
All work and no play is a recipe for family conflict, depression, and burnout in physicians, especially among those who are in dual-career relationships, new research shows.
A survey of some 90,000 US physicians across all specialties and their working partners shows that many respondents report frequent work-home conflicts (WHC) due to the long hours they spend at work, causing them to suffer burnout, depression, and poor quality of life.
“Work-home conflicts are common in physicians and in the partners of physicians,” lead author Liselotte N. Dyrbye, MD, from the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News.
“We found that younger physicians, female physicians, and physicians who work in academic medical centers are the ones who are more likely to have work-home conflicts, and that these conflicts are driven by a lot of work hours,” Dr. Dyrbye said.
“This makes sense, because the more hours you work, the more opportunity there is for work-home conflicts,” she said.
The study was published online September 17 in the Journal of General Internal Medicine.
Choosing Work Over Home
Previous work conducted by this same team of investigators has examined work-home conflicts in US surgeons and academic internal medicine physicians.
The current study extends this research by looking at the issue of work-home conflict in a broader, more diverse group of physicians as well as in their partners.
In the current study, Dr. Dyrbye and her research team surveyed 89,831 physicians from all specialties listed in the Physician Masterfile. Of these, 7288 (27.7%) physicians completed the survey.
Of the physicians who completed the survey, 1644 provided their partner’s contact information.
These partners were in turn surveyed, and 891 (54%) responded.
The median age of the physicians and their partners was 55 years and 51 years, respectively. Most (89.2% of physicians and 86.6% of partners) had children. The majority of physicians were male (75.2%), and most partners were female (73.0%).
Slightly more than half of the partners (n = 503, 56.5%) were employed, reporting a median of 40.0 hours of work per week. Also, most of the employed partners were working in nonmedical professions (58.2%); 40.9% worked in healthcare.
The survey results showed that 44.3% of physicians and 55.7% of employed partners experienced a work-home conflict in the last 3 weeks. Most were able to resolve their conflicts in a way that allowed their home and work responsibilities to be met.
However, physicians tended to choose work responsibilities over home responsibilities, with 28.4% reporting that they resolved their work-home conflict in favour of work, and 10.9% of physicians reporting they resolved the conflict in favor of home.
Compared with physicians, more employed partners tended to put home before work, with fewer (19.7%) choosing to resolve their work-home conflict in favour of work, and 20.1% choosing home.
Dose-Dependent Relationship
The more hours worked, the greater the work-home conflicts. Multivariate analysis showed that for each additional 10 hours per week worked, the odds ratio for a work-home conflict was 1.31 for physicians and 1.23 for their working partners (P < .0001).
Work-home conflicts were also associated with more burnout, depression, and poor quality of life.
Physicians with work-home conflicts were 47.1% more likely to have symptoms of burnout, compared with 26.6% for physicians without work-home conflicts. The trend was similar for the employed partners, with 42.4% having symptoms of burnout if they had work-home conflicts, compared with 23.8% with no work-home conflicts.
Both physicians and their employed partners with a recent work-home conflict were also more likely to have symptoms of depression, substantially lower overall mental and physical quality of life, and worse fatigue. Both groups were also more likely to be less satisfied with their partner and to be considering getting a separation or a divorce.
“These work-home conflicts are very important and have serious ramifications,” Dr. Dyrbye said.
“We hope that our research draws attention to the fact that with more and more dual career relationships, work-home conflicts are something that managers and leaders of organizations need to be aware of and find solutions for, that it’s not just an individual problem, and it can’t just be up to the working spouse to try to figure it out,” she added. “I hope that people can look closely at their policies and the opportunities for dual-career professionals to thrive within the organization.”
A Warning
Commenting on the findings for Medscape Medical News, Michael Myers, MD, professor of clinical psychiatry, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, said that the study is an important warning to young professionals that too much work may be putting their quality of life and their physical and mental health at risk.
“This paper gives us more ammunition to be able to tell our medical students that if you consistently work more than 56 hours…a week, and keep doing it over time, and your spouse is working 40 hours or more a week, you are really putting your conflict level and your relationship at risk, and you are putting yourself at risk for burnout. Perhaps this is an argument for people to cut back on their work hours,” Dr. Myers, who is a coauthor, with Glen Gabbard, MD, of The Physician as Patient: A Clinical Handbook for Mental Health Professionals, said.
“I am very involved in medical education now, and it is good to have this kind of a study and to be able to explain to medical students and to residents that they have got to pay attention to these things, because these stresses are what their fathers and mothers who are a generation older are experiencing,” he added.
The study was funded by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-being. Dr. Dyrbye and Dr. Myers report no relevant financial relationships.
J Gen Intern Med. Published online September 17, 2013. Abstract
Pagalavan's Avatar 
Hi Dr
Since too many medical graduates being produced so far,MOH has run out of posts available for graduates.
Does that mean they are being forced to absorb all graduates?How many post left right now and for Masters program..how many places offered after increment based on the latest news
Why dont they select student from reputable universities only whether from local public universities or abroad?Why need to absorb all of them..
The problem with MOH is that they made it compulsary to absorb all grafuates!!Come on..select the gooD and reliable one
Eliminate those who dont want to become a good doctor
The thing is..MMC need to play their roles..because they are the doctors who are responsible for quality assurance
Come on MMC…..WAKE UP,BE STERN!!!!!
Politically, it will not be possible. The MMC did suggest a common exam for all graduating doctors, but it was turned down by the Cabinet. There will be a political storm if barriers are placed on new doctors, after the parents invested a fortune on their studies.
When a Ukranian Medical school was taken off recognition a few years ago, it was heavily debated in Parliament and parents involved demonstrated.
Politics should play no part in the professional training of doctors, but this is Malaysia where politics is in everything.
what you have just said will come true eventually when all the post are filled but politically it is not right. Our ex, ex Dg did propose a common entry exam but was rejected by cabinet.
MMC’s hands are tight as the chairman is the DG who has to listen to the government of the day.
How many post left : please read my post over here
As for Master’s, the plan is to increase to 1000 by 2015 which includes ALL disciplines. You must also understand that not everyone who goes into Master’s program will graduate. The drop-out rate use to be 50%.
The bubble is about to burst.
Once that happens, med schools would be hit first and hardest. Less well-known med schools would have to roll up their carpets and start something else.
At that time, maybe a carpet-washing venture would seem like a better investment than building med schools.
Disclaimer : Just RM0.02 of my thought.
I have a different opinion. When the bubble burst, well known expensive med schools will be hardest hit. Cheaper, pasar malam med school will still thrive and survive. For instance, Carrefour hypermarket fell out and replaced by Aeon Big now, whereas Tesco and Giant still survive no matter in good or bad times because of their pricing. IMU has already felt the pinch lately and its share of the pie is very much smaller now, whereby a lot of cheaper med school commence business actively. From next year onwards, IMU too will start the one year shortcut foundation in science classes as a preference entry qualification choice and a more or less confirmed place in the MBBS degree course.
I wonder how that will impact on the PMS stream. It is still the most over-subscribed and most difficult to get in medical programme in Malaysian private Medical Schools. And it is a condition of some of the PMS that the students must have done a ‘proper’ pre-U programme, not a foundation.
The most difficult one is Perdana University. None of the local students are self-sponsored because of its exorbitant fee. You have to compete with few thousands applicants vying for the only 100 JPA scholarships every year. For non-bumis JPA scholars under its RCSI programme, you got to be a 4-flat pointer.
Difficulty as in qualifying to get in, not financial. Perdana is a fake system, as it is a graduate entry stream, and then depends on JPA selection, which is NOT purely based on merit.
Ie, it is difficult competitive because it is a lottery to fight for JPA funding, NOT to fight to enter a good university. Without Malaysian gov’t funding, it would have died. How can such a private university exist, if not for political pull at the highest level. Therefore how can such a uni be excellent?
To extend this argument further, if the IMU-PMS programme has the same Santa Claus as Perdana, and all who get accepted into the PMS programme are automatically offered a JPA scholarship, what do you think will happen to that programme?
What about KDUs FIS route to IMU, is it still open?.It is timely I presume to say that time has come for private medical schools to consolidate and perhaps the worst possible outcome besides the prospect of mergers would be to form a conglomerate of sorts to fine tune the ever ill conceived super inflated fees imposed by them and to a reasonable level.I personally think that should they decide on this path, their existence would be assured and many would welcome this!
is it possible for a gov houseman to earn rm6k/month? what does it mean by gaji maksimum? I saw this in pelan gaji starting 2013 while browsing lol.
Nope, the gaji maximum is the maximum salary if you remain in the same scale for certain number of years. Your scale moves up 1 step every year.
As a housemen, your salary is about RM 4k
In Australia, the average pay for a 1st year Intern (houseman) is about AUD 4,620 (equivalent to about RM14,000) but then again dollar to dollar earning and spendingit at the respect country, the gaji is sama sama lah like in Malaysia, so Dr Paga , you are damn right, Medical professions is not well paid but if it is your calling, pay does not matter. As for the future pay no body knows. Like the song sang by Doris Day Que Sera Sera, whatever will be will be, the future is not for us to see.
and mega, please remember in Australia, the tax payable is higher than those working in Malaysia.
Looking forward your comment regarding firing through newspaper among MMC, Doctor and DG!
can’t comment much as no one knows for sure what is happening
Hi Dr. Paga,
is it true that normal GP only earns about RM 8K/month?
Depends. I know many who are struggling with net income of less than RM 10K/ month but I also know many who are successfull. Whatever it is, the competition is getting tougher and the income of many GPs are declining. Most of GPs income nowadays comes from selling medicine. That’s why if the government removes dispensing rights from the doctors, many GPs may need to close shop.
[…] SMS is from the same agency which I wrote in my previous article. From 5K it has become 25K!. It is a business and people are trying to make as much money as […]