It’s December 2013, time flies! By next month, this blog will be 4 years old. From the time I started this blog in January 2010, the number of views has increased tremendously. Currently, I receive almost 1500 views per day with sometimes reaching close to 4-5000 views/day.
Yesterday, I attended a function which was graced by many government doctors and top civil servants. It was also attended by our MMA president Dato Dr K Tharmaseelan. Interesting facts were revealed, which just made whatever I predicted all these years to become a reality soon. Over the last few years, the government was trying to improve the income and working condition of the civil service doctors. The salary was increased with time based promotion and shift duty was introduced for housemanship from September 2011. Whenever something like this is done without proper consultation, setbacks will occur.
The shift duty was introduced not only to reduce the working hours but also to reduce the number of housemen walking around in the ward at any one time. If not, close to 50 housemen will be in each department during office hours. When it was first mooted, I wrote about it over here. As I predicted then, it has happened. Quality of training has deteriorated and patient care has gone down the drain. Many just leave the ward the moment their shift duty finishes without completing their work and promises to the patients. They just don’t bother what happens to the patient till their next shift. They also do not know what is happening to the patients when they come back for their next shift! The situation has caused concerns among the top guys in MOH and thus effective this month, the total working hours for Housemen will be increased from 60 hours with 2 days off to 75 hours with 1 day off !! Will this change anything ? I don’t think so. A better option is to go back to the old system but give them off, based on the total number of hours they have worked. If they have completed the 75 hours for that week, then they should be given the next few days off . This is what practiced in Australia and you can’t run away from your responsibility.
Unemployment of future medical graduates has been written many times in this blog and recently our MMA president voiced it out openly in mainstream newspaper. Public universities have started to cut down their intakes as of this year but private universities have to maintain certain number of students to make profit. Starting from next year, there will ONLY be certain number of intakes into civil service every year. Currently, whenever an application is sent, immediately it is processed and job offer is given within 1-2 months. Starting from next year, the intake dates will be fixed to 2-3 times/year. Whether everyone who applies will get their posting is still a mystery but likely you may need to wait longer. Thus, if you finish your degree in January and the intake is only in July , you need to wait 6 months hoping that enough post is available for all the applicants.
There are also talks at MOH level on giving housemanship on contract basis. It is very likely the time will come for this as the number of post will be limited. The discussion is to offer housemanship on contract basis for 2 years, after which you need to reapply into civil service. How it will be decided on who will receive the job offer is still being determined. Likely an exam plus performance review by HOD will be used. If you do not get a job in civil service, you need to find your own job outside. It also means, you can forget about postgraduate training.
From next year, the 6th posing of housemanship will be done at primary care clinics. I had written about this over here. I do not want to elaborate any further.
The time based promotion has also caused a lot of unhappiness among the senior doctors. When it was introduced in 2010, I wrote this. Whatever I wrote in that article is now becoming a reality. Many senior consultants are still stuck at U54 grade when their previous housemen(who is now a senior MO or junior specialist) are also in the same grade with almost same salary. There is no incentive for any further progress. Thus, why bother doing anything new or challenging when you are going to be paid the same. If you are going to remain in civil service , why even bother doing subspecialty! No new perks or appreciation. Well, didn’t I say that in my article way back in 2010?
Well, enough said in this blog. I will stop here till further information arrives on my table. Sadly, the medical community in Johor lost another great consultant yesterday at a young age. A well-known Consultant Ophthalmologist and a Head of Department who is from a very well-known family in Johor passed away yesterday after battling with a primary brain tumour. God bless him. RIP. Life is always short……………..
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Greetings Dr Paga, may I ask for the future postgrad problem that you have mentioned for several times already, does it apply to the specialities for internal medicine as well? Also, have you recently seen housemen who have graduated from IMU and how are their performance levels because I’m thinking of applying into the university for their partner school programme.
If you get into the PMS stream, your clinical years will be at the respective PMS abroad. You will not be getting an IMU degree, but that of the PMS.
If you are sitting for MRCP then it does not apply unless you can’t get a job.
Generally IMU grads are ok but lately their quality is also deteriorating as mentioned over here
Dear Dr, does it mean that a HO will be paid more since his working hours had adjusted from 60 hrs to 75 hrs with less 1 day off? or it is just increase working hrs but with no extra pay?
No such thing. As a profesional in civil service, you are not entitled for any overtime allowances. This is based on the general order(GO).
That’s why it took MMA almost 15 years to fight for “on call” allowance way back in 1994. Prior to that there were no such thing as “on-call” allowance!!
Still think about money? Not worry about nothing to learn with less working hour?
Of course we have to talk of money to the powers to be!! Because we are not slaves and should not be exploited by the ruling government. We should be treated fairly like other civil servants. After all, it is also our tax payable money, it will motivated us to do our job better if we are treated fairly, rather than the money (supposed to pay us for our extra hours) being siphoning for other purposes/projects to enrich their cronies.
If I am working for a non-profit or NGO based hospital, I will shut-up.
If u r HO…consider yrself lucky to be given the pay u r given now….for merely learning the job. Most of u after yr so called degree, dont even know how to prick the needle to draw blood. Want OT….Ha!
Under the employment act 1955 with ammendmends to the First Schedule in 2012, employees with wage less than RM2000 is entitled for overtime. With doctors earning more than that, you are not entitled since you are not covered by the scope of the act. The same applies for other professionals, where paying more than RM 2000 is not entitled to OT claims although it is up to the discretion of the employer(equating to no OT in reality).
If what Ashraf alleged is true that HOs don’t even know how to prick the needle to draw blood, I would say it is not solely HOs’ fault but it is the fault of the clinical trainings which HOs are going through and being exposed as medical students.
Clinical students may be allowed to do history taking and physical examination freely but always discouraged by MOs. HOs or staff nurses to carry out procedures, even the very minor ones (just allow to observe to avoid untoward incidences happen). So without adequate ‘practise’ on patients during clinical years, how can HOs be competent when starting their HOship? It is during the HOship that the ‘real practice’ start!
That is why it is important to have their own teaching hospital by medical colleges. I started taking blood and setting line when I was a 3rd year medical student. That’s because I studied in a university which has it’s own teaching hospital.
patients are suffering, either from medical students or from HOs………but students are paying the fees, so the MOs, HOs and staff nurses choose to ‘protect’ them to avoid themselves (MOs/HOs/Nurses) from getting the blame, just observation with no practice. As for HOs, they are paid for the job ………..’ so just blame them, blame them. …. who cares whether the system has adequately trained them or not during their clinical years.
Most fresh graduates (either account, banking, engineering or law) are incompetent, when they just join the workforce. All need to be TRAINED!! Regardless of which sectors, those who are smart and willing to learn will pick up faster, those who are slow yet lazy will be underperformed for many years yet get their pay every month , as long as they remained as civil servants.
This is our system.
agreed
Sue wrote: “…Clinical students may be allowed to do history taking and physical examination freely but always discouraged by MOs. HOs or staff nurses to carry out procedures, even the very minor ones…”
Is this the common practice in all medical schools in Malaysia? I know of medical students in the UK who get to practice drawing blood from as early as year 2. They get 2 tries, and if they fail, someone else, (usually a nurse) will do it. History taking is a given.
If the medical school has it’s own teaching hospital, students are allowed to take blood etc like in UH, HUKM and HUSM.
As for private medical schools attached to government hospitals, it is up to the students initiative.
Greeting Dr Paga. Since the over-saturation of housemen is inevitable, will JPA scholarship holder (overseas and Malaysia) able to serve their bond for 10 years ? For those who are bonded to JPA , what would happen once the saturation hits the threshold ? How about those not ?
JPA scholars will be given preference as you are bonded with the government for 10 years
does the standard of overseas grads like those from uk and aus unis deteriorating as well?
Not that I am aware off but their curriculum is based on their healthcare system.
I am sorry, didn’t quite proof read it before asking. What I meant was do malaysians who graduated from overseas unis do well after coming back here when serving the gov?
Clarify by defining “overseas uni”.
The ones from overseas initially would not perform as well as the ones locally as they are not familiar with the local system especially those from the Middle Eastern and Eastern European countries. But with time, everybody will settle down and get the hang of the system, including the loop holes typical of Malaysian civil servants. Lol.
Depends on the university
Hi Dr. Paga, I’m a fourth year med from a college up north and I was wondering what your standards are for a good recently graduated medical student. For descriptive purposes, what is the depth of knowledge pertaining to SLE or RA should a good fifth year know?
I am motivated to be as competent as I should, but unfortunately, between bedside teachings and long cases, I was left to define my own spead of knowledge for honours.
Dr Paga, well done on having prophecized the problems associated with oversupply of doctors. you read the signs early and predicted what the country is facing now.
however, this problem is not new to Malaysia. In fact, the US has been dealing with oversupply for many decades. It actually allows the health system to distribute medical care to areas that need it the most and choose the brightest into the system. standards are in place before allowing anyone to just walk into the medical system.
also oversupply allows you to pick the best of the lot. by virtue of competition, if there is an objective assessment of knowledge/skills, the govt gets to pick the best brains as manpower. gone will be the days the govt is willing and desperate to absorb any candidate that applies for a position
therefore some of the changes the govt is making now is in the right direction.
The way I see it, the problem lies in the fact that the system doesnt know how to make use of this oversupply. This is the best time to work on post graduate medical education such that training is streamlined, coherent and of sound. now there is oversupply, no reason to make a person interested in pathology rotate in gynecology – that has already been done in medical school – if he knows what he wants, no one should waste time unnecessarily.
Also, there seems to be this mentality that many graduating students are either good or not good based on their medical school. those that pass judgement are usually more senior within the system. but lets face it, the ability of a doctor relies just as much, if not more, on post graduate (after medical school) training as it does in medical school. post graduate training is as much a function of proper system and teachers/consultants/specialists as much as it is an individual drive. whether or not a cardiologist or nephrologist is a superb specialist depends a lot on who and how his mentors shaped him to be. thats how you get graduates of university of zimbabwe (not recognized in malaysia) outperforming graduates of harvard and cambridge when put on an equal playing field – we commonly see this in the US.
perhaps the govt shouldnt even bother wondering whether it is worth recognizing university X vs. university Y. if a system that weeds out strong graduates from weak one is in place, it really doesnt matter who graduated from what.
Oversupply has finally given the govt the opportunity to exert standards for employment. revamp post graduate education and redistribute manpower more evenly. the way i see it, its not doom and gloom for both sides, its win-win… if the right thing is done.
Agree. That’s why I said before that maldistribution of doctors will be solved once oversupply hits the market.
The problem in Malaysia is transparency. There are quota’s everywhere and nothing is based on total merit!
The most important thing for a medical graduate to know is to be able to take a detail history, complete physical examination and come to a diagnosis. The you need to know what investigations to order and basic management. Everything else, you will learn along the way.
Thank you, Dr. Paga. Your words are exactly what we were taught here, if not more.
I guess with regards to the 6th posting, it would be choice between emergency medicine, anaesthesiology or primary care medicine then. Tough luck for those who gets primary medicine as their 6th posting and I pity the FMS and MOs who will have to supervise them.
Having 2-3 intakes a year is has it pros and cons. In UK, I believe they only have 2 intakes a year into their foundation programme as places are very well regulated. But, the problem in Malaysia is that, hundreds (probably thousands?) will be joining the civil service at one go if the intake is done 2-3 times a year. These huge numbers joining the service at one go only mean one thing : CHAOS.
Emergency medicine/anaesthesiology should be made compulsary..and primary care should be made as additional posting while waiting for full registration or MO post..
How you going to asses emergency case that sometime pop up at KK.. I knew few M.O at district that run away whenever they saw emergency case coming to Klinik Kesihatan ..and just let PPP handle the case and write referral letter…sigh..
Malaysia boleh mah
Dr paga, I totally agreed. I would like to share my experience with you in Penang GH. My friends grandfather was admitted at a medical neuro ward with iv fluids and iv adrenaline. When i was there, I noticed that the hand which has the iv fluids was swollen ++ when I walked to the counter and told the ho, he came to check and told me that the hand was naturally swollen and walked away. Unsatisfied, i walked to the nephro ward which is beside the neuro ward and told another ho, he came and checked, and walked away then came back and changed a new iv line for him. I am I trying to say here is that sometimes the quality of care depends on the personality of an individual. If the patient was somehow a close relative of that housemen, would he be happy if his relative got treated like that? As a nurse we were told to treat the patients like our family members. That’s how quality healthcare comes from.
hi there..I totally agree that the standards of housemen are dropping and its all because of the lack of meritocracy….but I don’t think increasing the working hours of the housemen is going to change any of it…it all boils down to attitude…mosr housemen nowdays are not DOCTORS but rather “medical practitioners” that lack the care and will to see our patients through to health…I believe some specialists are also like that as I have worked with many of those sort…they practice defensive medicine
Defensive medicine will become a norm eventually as we become a developed nation. This is due to the increasing litigation rate.
As for attitude, that is what I have been saying all these while!!
hi there..I totally agree that the standards of housemen are dropping and its all because of the lack of meritocracy….but I don’t think increasing the working hours of the housemen is going to change any of it…it all boils down to attitude…most housemen nowdays are not DOCTORS but rather “medical practitioners” that lack the care and will to see our patients through to health…I believe some specialists are also like that as I have worked with many of those sort…they practice defensive medicine just to avoid any litigation….I think that we need to set a proper list of criteria and prerequisites before anyone joins the medical workforce….preferably even before they join the med schools….
Defensive medicine is the norm nowadays especially in developed countries and this is becoming more and more obvious in Malaysia. You can’t blame the specialists for practising defensive medicine as patients nowadays are quoting medical information from Wikipedia and what not.
[…] More on that subject here: https://pagalavan.com/2013/12/01/for-future-doctors-the-hurricane-has-arrived/ […]
hi everyone
just wnna tell u smething..this new working hours are not helpful at all.It wont improve the standard by pushing the house officer to work even longer
one case that i know of happen in hospital in selangor area
the house officer there dont even have day off unless they apply officcially for leave
they work continuosly for seven days in a week
u guys need to remember..on paper…the working hour is from 8 am to 5pm
but logically…do you think HO come at 8am??
of course not…they need to come at 6am at least to review all cases by themselves before the MO and specialist arrived
then….do you think the work finishes at 5pm??no such things..because of the workload…all work finished at at least by 8pm or 9pm…
so can u guys calculate…..seven working days with total working hours upto 14-15 days per day??that happen with the so called official 8-5 working hours
nw can u guys calculate what will happen if the so called new working hours being introduced with the reason to improve the stndrd of house officer????
the problem arise from the basis….too many private medical schools….easy to get accepted into these schools,what you need is money..then these schools dont give enough clinical training..they dont even have their own hospital…then do u expect the product to be extremely high in quality??
go to the basic…not to stretch working hours just to improve standard…
leadership should go to the brightest people…..think this deeply
To be frank, there is no such thing as working hours for doctors. I am still working 24hrs a day!
As for your last concerns, I had mentioned many times in this blog.
I do not think you understand the meaning of working hours. Your reply pretty much shows you are trying to avoid his opinion.
For some reason, there is a trend that blame HO for almost everything. I’ve seen countless of good HO around but now all HO are by ‘default’ useless. Raising the working hours (yes, it exist) to 75 hours is nothing when some HO already working up to 90 hours a week. Will ignoring this fact do any good?
Talking to almost-retired doctor. He told me that as a HO, he just followed his timetable (~40-50 hours) without coming too early or going back late like what happened the HO now. Unsurprisingly, he able to use this time to learn minor surgery or others skill with his colleague and have more time to study diseases. He is now a very respected doctor and he contributed most of it to his housemanship days.
Now, I only see an overworked HO without any time to learn. It is pretty common for HO to endure vulgarities being thrown at him even in front of patients.
Been there, done that. I guess the circle of hazing will continue as long as all of us does not appreciate good working environment.
I am not trying to avoid any opinion. I am just stating the fact that there is no such thing as working hours for doctors, anywhere in this world. However, as I have said in my article above, extending the total working hours does not change anything. We should just go back to the previous system and limit the total hours worked/week and take the rest as off day.
And as for your “almost” retired doctor, when was he a housemen? It is probably during the era when there was NO Ct scan, MRI or even any blood test more than the routine ones! That’s why they have a lot of extra time as the demand of patients were very much minimal with nothing much can be done! Even antibiotics can be counted by one hand. Even when I was a housemen, only 1 hospital in each state had a CT Scan! You get what I mean?
Just to further clarify, house officers are not working, they are “training”. That is the official position of housemanship ( pegawai latihan)!
I have not heard of any parents or students complain that they have to study more than 80 hours a week (which is what i assume the average student does whether formally or informally). Is there any restriction on the hours students study? The misconception comes about because of the supposed pay they get which should really be considered an allowance.
Eventually with oversupply and competition, HO’s will be paying to get a training positon in Malaysia….. now that would a paradigm shift and maybe realign attitudes for the better!!!!
Yes the time will come
“they work continuosly for seven days in a week
u guys need to remember..on paper…the working hour is from 8 am to 5pm
but logically…do you think HO come at 8am??”
That has always been how doctors, both HOs and MOs, have been working in the past, before the tsunami arrived and shift work introduced. And for optimal and continuity of patient care, it has to be this way.
It is only in recent years, where we started having mommy’s boys and girls graduating as doctors, and complaining about working conditions.
In the UK, for safe patient care, junior doctors work 60-70hrs a week. That appears to be the sweet spot, allowing adequate continuity of care, and adequate training and experience and rest for doctors. However, to satisfy the EWTD of 48hr week, they work 4 weeks and have 2 weeks off. The 2 weeks off includes a mixture of annual leave and days off.
As the saying goes, if you can’t stand the heat, get out of the kitchen. If you are not willing to put effort and time into your work, expect to work just 8-5, don’t take up medicine.
Finally, the problem of quality with HOs in Malaysia is not about working hours. It’s about the training many got in med schools, and the quality and suitability of students that got in, in the first place.
“I’ve seen countless of good HO around but now all HO are by ‘default’ useless”
MO Tay,
You don’t have to feel bad, it is just the mentality of most Malaysians like to “belittle’ Malaysians, always think that the other sides of the “HOs” are ‘better’ than those in Malaysia. There are many ‘useless’*** HOs at the other sides (UK/Aussie, bla,bla…) of the hospitals but it was the matured attitudes of most of their specialists or consultants that have made the different. They just reprimand the ‘useless HOs’ privately or in a constructive manners, whereas here most of our specialists or consultants will just yell at the top of their voice at MOs or HOs for minor issues just to show that they are the boss!! These arrogant consultants or specialists are disgrace to medical fraternity.
*** Please note ‘useless’ can mean not properly trained, lazy, insubordination, ……
sorry, I mean “made the difference”.
hi dr paga.
imho ,instead of just repeatedly emphasizing on core problem using only words,why dont you kindly insert some chart ,illustration, graph and state reliable source so it is easier for people to trust what you’ve been on about.i heard many people wouldnt believe some article on the internet as there is no proof and some would say it is part of some propaganda.thanks in advance
This has been done with facts and figures many times before. Proofs have been provided in this blog with statistics from the Ministry of Health. BUT no matter what you say, people out there would not believe what you say. I have had chats with some parents and they still do not believe doctors can become jobless and also do not know that it is happening in many other countries.
I am not Doctor but Engineer. Doctors are always kind and helpful person in my eyes. They take pressures and blames and negatives income yet to regenerate into a positive income to well-being and life enjoyment.
All the best, Doctors!
.?? Does anyone understand what he wrote??
I would say he is a nice guy. His message is to encourage all doctors not to feel ‘down’, as there are guys like him have high respect for doctors (though there are pressure and negative opinions on doctros), and he wishes them all the best. Mark Voon, same to you, all the best.
Hi Dr Paga, do you know any microbiologist or biologist of any kind in any hospital? How are they doing with their job? Should be less stressful than doctors right? And do most of them have a Master’s or PhD?
Microbiologist are usually doctors who go on to do Master’s in Pathology(microbiologist). It is a speciality by itself. Office hour job and less stressful.
Dr, can a HO apply for this master’s in pathology (microbiologist) after 1 yr housemanship? Thanks.
Nope
So microbiologists are generally doctors? If not, can i not read medicine but a Biology course then a Master’s degree in microbiology to be a microbiologist? Will the demand for microbiologist increase in the coming years or will it be like doctors? Anyway, if being a doctor first is the only route, does one have to complete housemanship and mrcp first?
Microbiology is a big field that there are many subdivisions like clinical microbiology, research microbiology etc. Generally, those who work in hospitals are clinical microbiologist who are doctors with master’s in pathology(microbiology).
If you are not a doctor based microbiologist, you will be mainly involved in research labs , generally not related to human infections.
Just for information, application for local Masters programme in pre-clinical subjects such as Microbiology, Pharmacology, Anatomy, Pathology does not require completion of housemanship. Of course, that means that if you’re not doing your housemanship, you will not complete your training and you wouldn’t be allowed to practise as a clinical physician and you would be more research-based. Although preferably, clinical training should be made compulsory as this will guide your interpretation of samples as well.
If I am not mistaken, you need to complete housemanship for Master’s in Pathology. Microbiology is a subdivision of Pathology. For the rest, you don’t need to complete housemanship.
I got a microbiologist with me doing corporate services! When her parents found out that she deals with bacteria and viruses, they told her a big NO.
Thank you and Sorry Dr Paga,
was not myself a few days back
what I need to focus is just to get myself better and cured from my disease.
Thanks again.
but I still wish my post not to be shared.
🙂
Dr. Pagal, I just want to share the latest development in JPA PIDN scholarship (Program Ijazah Dalam Negara) for all medical students in local public universities. It’s was used to be a confirmed scholarship for all newly enrolled medical students in local public universities and students has the choice to take it and reject it. But starting this year, if a new medical student in public university wishes to be sponsored by JPA, he or she is required to apply for it as it’s no longer guaranteed. My friend’s son was rejected in his application today even he’s the 1st year medical student in one of the public research universities. As you have said, the hurricane has arrived and our government has now realized that there’re limited public postings for influx of new graduating doctors. By limiting the JPA scholarship, new doctors can be released as soon as their internship and compulsory service are completed.
It is not true that in the past, all local public U medical students used to get a confirmed scholarship from JPA. My friend now a 4th year medical student was rejected 4 years old, However, he managed to secured a Kwok foundation scholarship.
I’m the third year medical student in local public university and all of my classmates in critical courses (medicine, dentisry, phamacy) were automatically offered JPA scholarship in 2011. No application was needed then and all we did was just to print out the offer letter from JPA website. Last year, all 4-pointer students were confirmed JPA scholarship for their first choice of critical course both in public and private local universities. This year, I heard many of my first year juniors in medicine were not successfully in JPA scholarship.
As I said, it has arrived………
No application required previously to apply for JPA scholarship in critical course esp medicine. That was perhaps 7 years ago. I’d even need to sign to inform that I’d reject the scholarship outright. Of course, the scholarship is rejected if you have other pertaining scholarship prior. Tuition fees + accomodation was RM15k for 5 years, so my parents had rather be on their own. I applaud the move as PTPTN is still available for the medical students and I think it is high time that medical students should not take it for granted to be funded for free.
giving HOs extra hours of work will not increase competency if most of the time, we only take blood, set branullas, trace results, sending bloods to lab and doing ECGs – all of which do not require any medical knowledge.
in d ideal world, HOs would definitely love to learn more on management and procedures, but in reality, we spend most of our time doing those above. some MO don’t even let us observe procedures unless we’ve done all of those above. it’s not that we can’t do those above but it’ll be good if that part of the workload can be shared with the nurses too.
in support of quality over quantity.
The MOs cannot allow the workload (take blood, set branullas, trace results, sending bloods to lab and doing ECGs) to be shared with the nurses because they cannot trust the nurses, as they are worse than the HOs!! Unless these nurses are those very well trained or very expereinced ones.
exactly the point. if u wanna improve the health care standard as a whole, everyone needs better training. HOs and nurses in the olden days were both competent, working hand in hand. and nowadays, the nurses only keep ‘doctor, nak branulla. doctor, kena ambil darah.’ kinda irritating, sorry to say that. the same principles apply, if the olden days HOs were good, and so were the nurses, there’s no reason why nurses nowadays can’t be competent too.
Congrats on pointing this out. When I did my housemanship in Ireland, this was exactly the case there as well – in fact they pay you top dollar/euro as a houseman to draw blood. What a waste of brains and time. Its much cheaper to train a lab technician to do this than to waste a doctors time and training on this.
Dr. Pagal, I’d like to highlight the latest development in JPA scholarship for medical students in local public universities. JPA PIDN (Program Izajah Dalam Negara) was used to be guaranteed and offered to all medical students in IPTAs without having to apply and it’s up to the student to accept and reject it. However, starting this year, application is required for all newly enrolled medical students in IPTAs who wish to be sponsored and the approval is no longer automatic. My nephew’s application for PIDN was recently turned down by JPA and he’s the medical student in one of the research IPTAs. As you have said, the hurricane has arrived and our government realises that there’s limited government posts for graduating doctors and by way of limiting sponsorship, government will not be bound to offer job to those bond-free doctors as soon as their intership and compulsory service are completed.
Expected
Hi Dr Paga. I am interested in becoming a doctor in the future but I’m not really sure whether I have the ability to be one. Putting the really long hours of work and the huge load of work to be done, I would like to ask you what will happen to a doctor when he or she forgets some of the medical facts required to help a patient. For example, how can a doctor never forgets the side effects of a medicine out of hundreds of medicines being used in the world. Anyway, I will also like to have a clarification on the differences between an internist and surgeon.
My god! What a childish question you asked! Can a cook forget how to cook in the middle of a wedding ceremony? Can a race car driver forget how to drive just before a big race?! I am sorry but I need to be frank here!
Liang/…dont get upset with Mile for asking a naive question. He is probably a young school leaver. All of u had similar questions then. In hindsight it might sound childish to u.
Unfortunately they do forget. Some did not even learn. Medical is a vast field, hence experience and constant practice are needed. Surgeons do forgot most of their O&G, pediatrics and internal medicine training (for local doctors, while overseas drs may not even learn them in the 1st place) as they are out of practice for the said field. Even a specialist may not be able to insert a branula competently. Common medical side effects are remembered, while the rare ones are often forgotten until they are encountered upon. The key is to keep an open mind in the medical field and continuous learning. Otherwise, even specialists and consultants are liable to mistakes and “forgetfulness”.
Eg: a physician can allow a dengue patient progress to Dengue shock syndrome from day 2 illness in ward up till day 6 where hematocrit rose from 42 to 65 before mortality greets the patient. A pediatrician practising more than 10 years in private practice failed to grasp the concept of hypernatremic dehydration and failed to take necessary baseline blood investigations and cause the patient to go into cerebral edema.
If you can’t put up with long working hours and workload. it is better not to do medicine. You will regret later.
Medicine is a continuos learning process. You learn till you die. Common side effects need to be known by every medical doctor. Uncommon ones, you can check along the way.
Internist and specialist in Internal Medicine.
Surgeons are surgeons.
As MOs, 2 tips, 1) just remember some common medications for common illnesses, those everyone can buy from the pharmacy, 2) just refer the patients to the specialists in that particular filed. MOs do not need to remember all the medications, as it is our systems to refer patients ………the specialists will remember their respective medications and their side effects ……like Dr Paga, he will remember all his medications in rheumatism…
Hi Dr. Pagavalan.
What is your opinion about this Malaysian Medical Licensing Examination? Can MMLE maintain and control the medical graduates standards?
Quote from the article:
“We think there is no choice but to implement the MMLE if the nation is serious about maintaining medical standards.”
http://new.medicine.com.my/2013/12/be-prepared-for-the-mmle/
Thanks
It has to be fair and transparent! Many countries have started these
Just read the article regarding MMLE. Indeed a wake up call for everyone who thinks that anyone can do medicine in Malaysia. It would definitely work out well though without any political interference and I feel similar exams should be administered for chronic MOs not in a training programme for competency reasons. The poor incompetent ones should be booted out and the better ones retained.
Knowing how things work, of course a particular race will be given the upper hand as usual unless everything is done fair and transparently in Malaysia. Then again, since when fairness and transparency ever existed here?
Hello doctor, I have recently attended a talk given by a MO in an edu fair and apparently this MO said that in the future, doctors who finished will be graded and only the best will be selected to be MOs. Have you heard of this news recently? Anyway, I hope those who really want to be doctors due to their own passion could really benefit from this system if this system exists in the future and eliminate those who are under the standard. And hope that it won’t be racially influenced, that is provided it exists in the first place.
Kindly read my article above. It was mentioned!
Good that the best would be selected as MOs but what about the MOs already in the system especially those not in a training programme? Many of the ones in the system are of questionable qualify.
Greetings Dr.Paga, can I get the schedule for HO intake?thank you..
you need to contact SPA
Hi Liang,your comment on Mile’s question is childish too especially ” a cook to cook in the middle of a wedding ceremony”. He/she is just a student aspiring to be a medical student and is asking for clarification.
Some 10 years ago,maybe in 2003/04 a top STPM student in his UPU application stated UM as his only choice to pursue his medical education. He was offered to study at USM and made an outcry on media. His reason: he wanted to be a surgeon and UM confer MBBS whereas USM confer MD. If he were to study at USM he would have to spend his time again to do surgery after graduating. To me this is not only plain childish but arrogant. And he was the top STPM student in the country.
That’s a funny story. Shows the lack of general knowledge of your typical student.
On a side note, I have always wondered how UKM got away with conferring the MD. Being an undergraduate medical degree in a Commonwealth system, they should be conferring MBBS/MBChB or equivalent. An MD in the Commonwealth system is a postgraduate degree equivalent to a PhD, and is usually research-based. It is only the North Americans who confer an MD for their med school degrees because of the postgraduate status (and others with a similar system, e.g. Philippines). I suspect some little Napoleon thought it would be ‘glamour’ to confer an MD instead of an MBBS, because anything is possible in Bolehland. But I am keen to know if anyone here has another explanation.
It doesn’t matter. MD or MBBS gives you the same salary scale, same workload or opportunity for your career development.
I completely understand that it makes no difference in Malaysia. But I still feel that it’s somewhat intellectually dishonest.
Not the fault of any UKM graduates of course, just curious as to whose bright idea it was and why.
It was a one-upmanship over UM. As the second medical school, and one in THE university of Malaysia (hence National University of Malaysia), it was envisaged to be going to be better than UM, and what better way to differentiate it than to use another acronym.
UCSI also confers MD status.
Correct. Because they used the UKM syllabus when they first started offering a full degree.
Hi doctors
I have been a keen reader of Dr Letchumanan’s blog, well i think i will just drop by a few words when i am not busy, my pure intention is good faith and to encourage the doctors out there , not to lose heart , i think it is a pity what Malaysian medical medical system has evolved into such a deplorable state. I think i will just share my experience of becoming a doctor, not with the intention of glorifying myself, but to those who want to give up there is some light at the end of the tunnel.
I am a product of IMU which manage to go overseas to further my study and get my specialist qualification early of next year from a Royal College of NZ (again i do not see the point of saying what i am specializing in as my intention is to build up my peers, not to update my CV) . I went to University of Auckland in early 2000s, sad, dismay but true, about 5 of my colleagues have either need to repeat a year or leave the medical school. This is detrimental to all of us. I personally see my IMU colleague indulged in alcohol to the extend of asking to leave by the medical school.
Starting to work is not any easier, long hours, challenging patients with Mr google as their tutor , law suit/complains, home sick, disruptive patient, cultural shock, limited proficiency in English – is not helping me either, ( I am sure you guy understand), but what i wish to says is , or my gratitude to how medical council and district health board here have been treating us beautifully
1. Most consultant i worked with are encouraging, words like “Rome was not built in a day”, ” what do not kill you make you stronger”, “life is a struggle” are a norm in my meeting with my supervisors during supervision . Yes you do have difficult consultant, but you will know and try to draw a boundary as they always have bad names. Generally we have a friendly and approachable consultant. i go through difficult times, it is a steep learning curve, but it is always the nice consultant that had brought me through 🙂
2. The district health board looks after the RMO well, we are given free specialist training, limited overseas conference/more international conferences if you are a specialist , free meal during duty and salaries is 2-3 x the current rate when you have worked in a public holiday and etc etc…
3. I have consultants coming form Iraq, India or even Bangladesh , they do their NZREX exam. in summary , they work hard and manage to bring their family to this beautiful place.
Sorry guys, i think i will need to pen off now to see a minor with acute bronchiolitis. In summary , for those out there who want to give up, try doing overseas exam, you can earn up to NZ 1000/day for 8 – 10 hours work!!:)) as a locum – even in a junior level (more if you go to Aussie) . You may even get to retire early when you invest in property and a 2 bedroom house in Auckland is rented for NZ 400/week.!!
I think I will qualify your comments by adding that in the early 2000’s, Auckland offered the most spaces for IMU transfers, more than all the UK medical schools combined. 35 students transferred per year in 2001 and 2002. That resulted in a whole range of students going, from those who excelled and got straight A’s right down to those who struggled and a small number who failed and left or repeated a year.
Auckland subsequently raised their fees and increased their intake of their own local students, thereby limiting the number of IMU places on offer.
And in case you haven’t realised, the locum work is drying up (apart from ED registrar jobs, for which there will always be a market I think) because Auckland and Otago have doubled their output of local students from 10 years ago with more increases on the way. Add to that the drop in kiwis who are crossing to the West Island because of the oversupply there, there is going to be a lack of jobs in NZ as well for foreigners.
Getting NZ1000/day for 8-10 hours work is a dream come true for many of us. Sadly, Nav had to bring things to perspective especially in Auckland and Otago. But what about more peripheral areas in which many would not want to go? Are there perks working in these kind of areas then?
I am rather interested in part 2 of the Dr Gratitude’s comment. How far does this apply at this point of time for foreigners passing NZREX starting at a junior level?
As with all shortages, it is the least desirable places that have the most shortages. Demand and supply and all that. Having said that, I quite enjoyed working in the smaller cities in NZ and could have easily settled there permanently, but to each their own.
All of Dr gratitude’s comments for part 2 apply to any junior doctor (non-specialist) working in NZ, whether on work permit or PR. It is part of the employment contract. IMHO, NZ has some of the best perks and working conditions for junior doctors, without compromising on learning.
Hi Dr. Pagal, I always find your blog interesting, especially your insight. As I scrolled down the comments, the first thing that needs changing – mindset. As noble as this profession seems, doctors are only human. Like any other job, it should be an enjoyable one – fairly payed, humane working hours, motivating and competitive colleagues and good teaching environment. Comments like “if you can’t commit 20 hours a day at work and suck it up with the tiny pay, quit medicine” often makes me chuckle. Here are my two cents about a ‘commonly-believed-laid-back’ Aussie intern with my so called ‘so very little training and working hours/workload’:
1. Working hours
I can’t agree more. Working longer hours = counterproductive and not safe! I work 8-10 hours most days with 2-3 hours of overtime a day (and some 18 hour weekends). Continuity of patients’ care is hardly a problem as handover is specifically designed for this. I am still well aware of what happened to my patients overnight. Of course, one has to take initiative to find out themselves, i.e. paper handover sheet or go in half an hour early to do a quick ward round. And often people do it anyway or it would be extremely embarrassing to not know anything when the consultants ask. Mind you, I often hardly find time for a quick bite or even to be excused to the bathroom – just as busy as a Malaysian HO!
2. Life outside medicine!
This is probably the most important. Medicine is not the whole world. A passionate doctor should be a different somebody once outside the hospital. I see many of my Malaysian HO friends having only 3-4 days off a month. It is just wrong. There are so much to care about apart from work. Read a book, self-directed study, do a course, watch a drama, have a drink, hang out with friends, get away etc. A happy doctor is probably more likely to be a good and passionate one. And this, linking to my previous point, can only be achieved by reasonable working hours. I seriously don’t think having more days off make me less of a good doctor, in fact it gives me a broader perspective and chances to think outside the box.
3. Reasonable pay
Oh come on! *rolled eyeballs* No one, including doctors (you, you and you!), likes to or should be underpaid. To those “back in those days, I also get paid so little only la, I also never complained, tsk tsk mummy’s and daddy’s kids these days”, the 5 ringgit that can buy you 10 bowls of noodles then can probably only buy you 1 now – inflation! Plus, it’s not just about money. It’s about being rewarded for your effort, on top of your satisfaction from your jobp, plus doctors need to survive too. To the person who called the HOs lucky to be getting the current pay for he can’t even do a venepuncture, here’s for you: if there is a clerk who can’t type in a company, you don’t go tell the other clerks to shut up for their low pay coz of their crap colleague, you, undoubtedly, will fire the former. Get the point now? It’s the person who hires the low quality doctors to blame because according to the evolution theory, the weak should have already been eliminated over time, should the bias and corrupted system not existed! A decent pay is also useful to fund professional developments like conferences, courses, exams, qualifications etc. Base on my previous two points, takda wang takda masa takda motivation, mana ada improvement?
4. Training
Professional development is a big thing here. Because things are so competitive, having a basic MBBS is not enough anymore. Plus we are always encouraged to take up extra courses to learn skills, or do a diploma to help in research etc. So people automatically wants to be good coz you won’t get a job otherwise. In other words, quota system is anti-competitive and leads to poor quality. You even see juniors who can do echo, or has published many papers etc here or in the US. So an entrance exam to housemanship or contract employment is a brilliant idea. During job application annually, the most common question people ask me is, “what is new on your cv this year?” See? It makes you want to improve.
5. Definition of quality
You often hear senior doctors sigh, “Medical students these days can’t even tell you what murmur is what, can’t even see the wave forms of the JVP anymore yada yada yada.” The truth is, one cannot deny the fact that medicine is moving into a technology era, thus teaching needs to suit practicality. For instance, instead of just teaching about murmurs, some Canadian medical schools are teaching bedside echos – as regardless of the type of murmurs auscultated, an echo is warranted. So these newbies can’t differentiate murmurs, are they of poor quality? No, they can do echos and give you more accurate findings! So what do you mean by quality deteriorating? In what sense, in whose perspective? Of course la am not saying those who try and find a JVP in the leg are reasonable or put a cannula upside down…… Am not implying either that traditional teaching is bad, it’s just not good enough. It needs to be modified to incorporate modern medicine in order to better prepare medical students into the future world of advanced medicine.
Thus all in all, the system needs to change to encourage competition for the better, the mindset of senior doctors needs to change to accommodate for the new era cutting edge medicine, and working environment needs to change for the happier and more motivated junior doctors, the standard of medical school needs to be upheld to only allow the very best to pursue medicine, or everything will continue to fall apart.
All good points. In Malaysia however, the elephant in the room is the system, which lacks inertia for change.
“the standard of medical school needs to be upheld to only allow the very best to pursue medicine”
There lies the root cause of the problems in Malaysia. Part of the difficulty is mediocre bosses trying to handle brilliant juniors. There whole system is just so dysfunctional, which is expected when it is not based on meritocratic principles.
Your points are absolutely correct but the problem in Malaysia is the SYSTEM!!. Until the system changes, there is nothing much that can be done. The dead woods cannot be removed from the system. How many of the Heads of Department even have 1 publications !! So, who cares about CV? As long as you are a government servant, you get paid at the end of the month whether you do anything or not. As long as such system is in place, nothing will change. With the time based promotion, it just made to worst!
It’s the system built, not on professionalism and meritocracy ,but by ruling elites with low or no ethics , in relation to mankind.
Nice insight about somebody working as an intern in Australia. Just to comment on some of your points.
1. Do you get paid the 3 hour overtime you had to do in a day and how about the 18 hour weekends and of course public holidays? I am sure you get extra pay or some sort of hours/day(s) off working on weekends and/or public holidays. This does not apply to house officers in Malaysia.
2. Agreed, but with the current system it would be difficult. In Australia, intern placements are well regulated not like in Malaysia.
3. Agree, but in reality a Malaysian House officer’s pay including allowances comes to approximately RM4500 ++ which is quite a lot for a new graduate. Many will buy flashy cars and stuff. But there are the rare ones who use to fund professional developments like conferences, courses, exams, qualifications etc. I really respect this lot of house officers and unsurprisingly, they come from respected medical schools and were good/excellent students in their undergraduate and pre-uni years.
With regards to low quality doctors, these people are adamant to become doctors despite poor academic qualifications and then go to cheap dubious medical schools (mediated by unscrupulous agents) in Middle East, Indonesia and the famous Eastern European countries, where money rules over standards. The Malaysian Public Service System have to take in all of them as they are qualified doctors from ”recognised universities”. Also unlike in more developed countries, as Dr Paga has pointed out many times, the public servants in Malaysia are permanently employed, so they get cushy with their jobs and time based promotion.
4. Professional development is a joke here. Here after housemanship, most will be just thrown where ever there are vacancies anywhere in Malaysia. Not only that, they may not get into a specialty which they are interested in. Some good House officers tend to finish their part 1 of any exams and then ultimately secure a MO place in the specialty in which they are interested in. Quite a number get cushy with their 8-5pm jobs with lunch breaks etc with no interest in professional development. I know in other countries like Australia, NZ, UK, doctors post-internship are encouraged to go into a professional development programme, with paid membership exams and even attend overseas conference in the US! Why not they turn out to be cool and understanding consultants?
5. Well, if Canadian medical schools are teaching echo to their medical students, kudos to them and unfortunately, Malaysia is probably 100 years behind them. However, on the brigther side, echo is now being frequently used in the larger A&E departments in Malaysia. All this is part of the objective evidence based medicine aka cover backside medicine.
You mentioned that the standard of medical schools should be upheld to allow the best to pursue medicine. Most countries takes in the best to do medicine, but Malaysia, is just the opposite with money and political interference.
It is difficult to change things here but it is possible, and it will take a long time.
Hi Nav, UM was established prior to independence hence adopted the British(English) system,thus conferring MBBS. Universities in Scotland confer MB ChB. When UKM was established it adopted the Indonesian curriculum which essentially is that of the US,therefore conderring MD. Same for USM and UPM.
This is to the best of my knowledge but I could be wrong. Thanks.
That is not quite correct. Quite a few English med schools award MB ChB, eg Birmingham, Manchester, Leeds etc. It is just the Latin version of MB BS.
Dear Dr, I am currently in the final semester of a pre-med prog. While I was doing a short medical work experience in a hospital in Penang, a doctor mentioned to me to read up your blog and to opt for dentistry instead. Do you think it is wise for me to switch to dentistry although I have offered for medicine in RCSI? When it comes to interest, I would say its medicine.
Do what you are interested in. You can read this blog to know the reality of doing medicine and if after that, you are up to the challenge, go ahead.
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I seriously need to find for these hospitals that everyone has ever so openly said are “over-crowded” with HO. up to 50 in a department?.
I’m a ho in HUKM. Surgical department has a total of 13 housemen.
on-call – 3 HO taking care of the whole department.
no shift system. 24hours – 6am till 6am. 1 weekly day off and your postcalls.
I was called to work on my off day. Why? Because one HO took EL and the other was sick and they were short of HO.
I’m not complaining, it’s bloody amazing working in HUKM, but I don’t seem to find someone pointing out the EXACT hospital where there are over-flowing of ho. I have friends in countless number of hospitals. They are worked till their bones.
So, enlighten me someone. Anyone.
Never compare university hospitals to other hospitals. University hospitals limit their housemen intakes. That’s the reason they never implemented shift system. However, MOH hospitals have no luxury of limiting the intake of housemen. They take whatever the MOH has sent them. Come to JB hospital and see for yourself. Most departments are loaded with housemen but maldistribution between departments do occur. That’s the reason sometimes, certain departments may have shortage of housemen. Working till their bones is bread and butter of being a doctor!
Very true, university hosp. do limit their HO intakes. FYI, the no. of HO intake approved for PPUM, HUKM and HUSM in 2010 are only 82, 72 and 63 respectively (i am pretty sure these no. will increase in a yearly basis). And if i am not mistaken, these hosp. will also give preference to their own graduates in terms of HO training. My question is, since UM and UKM are producing more graduates (around 200 students each) than the no. of HO post approved each year, will they not implement the shift system sooner or later (to absorb their own students)? Need clarification.
It does not work that way. It is up to the university hospitals to decide on how many HOs they need. More graduates does not mean they have to take more