My last blog post received almost 27, 000 views in a single day on 5/11/2014. Numerous comments were made. My comment was very simple, a once well-respected and trusted profession to whom the community looked up upon, has gone to a stage where the authorities have to ask sisters/nurses of the ward to monitor their discipline. Some commented that there are only a few bad apples in our profession BUT let me tell you, for those who are not in the system will not know that it is NO MORE a few bad apples. The fact that the Minister has to instruct and give extra job to the sisters to monitor the discipline of house officers is enough to explain the gravity of the situation. BTW, the topic discussed had nothing to do with insulting the nursing profession. It was all about the deteriorating attitude of OUR profession! We brought it to ourselves.
The same situation seems to be happening in smaller district hospitals and Klinik Kesihatans. I am beginning to hear stories that taking MCs, EL and coming late to work is becoming very common nowadays, despite having more MOs. Sometimes I wonder whether it is better to keep less number of doctors than having more as it is easier to monitor. I always believed in quality than quantity. Recently I heard that 4 MOs did not turn up to work in a KK on the first day of the week! 2 decided to take MC, 1 took EL and another claim stuck in traffic jam! Some MOs were found to be taking frequent MCs (must be immunocompromised I guess!), given to each other by themselves! What will MOH do about this ? I am sure sooner or later, another similar circular will be issued to KK sisters to monitor the situation. Few years ago, there was already a circular stating that MOs can only be given MC by a specialist but no one seem to be following this anymore. What impression does the other staffs of the clinic will have on us? An unreliable bunch of ………..?
Every now and then, I hear that HOs and MOs do not turn up to work because they are busy doing locum in 24hr clinics. Some has been caught before. Let me remind those HOs that doing locum before full registration(aka completing housemanship) is ILLEGAL! MOs are allowed to do locum with permission from the Hospital Pengarah. However, the place where you are doing locum must be written in your APC. As a doctor, you can only practise at the places mentioned in your APC. Practise at any other place can be deemed illegal.
All these years, even after locum was legalised in 2006, MOs/Specialists locum incomes are never properly declared to LHDN(IRB). While the clinic may declare the locum fees paid as an expense, I am not sure how many doctors who do locum ever declare their income generated from locum. Remember, every income that you receive are taxable. We all know that the government is running out of money! The last Budget 2015 and the impending GST are clear indications. The drop in oil and oil palm prices in international market will further reduce our country’s income. So, the government has to fall back upon the people to get the money back! Thanks to the 47% who voted in the last election. The toll prices are going up next year, electricity tariffs may go up in June 2015 and petrol/diesel subsidies are being removed effective 1/12/2014. While doctors who are running clinics cannot charge GST to patients (GST exempt), they have to pay and absorb all the GST charged by their vendors on supplying equipment, drugs and clinic rentals. Thus, the overhead cost will definitely increase which in turn reduces your net income further. ON the other hand, an increase in your consultation fee is limited by the government and the patient’s ability to pay! Patient’s cost of living will also increase after GST implementation.
While GST comes under Customs department and follows a completely different set of protocols, income tax comes under LHDN. Doctors in private hospitals who are generally self-employed are still confused about GST. Negotiation and discussions are still going on, between MMA, APHM, Hospital Managements and Customs.
LHDN on the other hand is going around blocking all the loopholes they have, to generate more income for the government. Coming back to the locum incomes mentioned above, LHDN is sending circulars to clinics making it compulsory to declare who their locums are!! The circular (see below) clearly says that, it is needed for LHDN to collect more MONEY! So, for those who thought can do locum and escape without paying tax, please beware. LHDN may come knocking at your doors one of these days. The penalty can be an additional 20% of the tax not paid! Furthermore, you can be barred from leaving the country!
As I wrote in my Part 1 and 1b of the above topic, life is not going to get any easier for doctors. So many rules and regulations are changing nowadays. If the separation of dispensing rights happens in April 2015, income of doctors will further decline. The medico-legal cases and seeking compensation from doctors are also increasing day by day!
Well, it’s time to take another holiday to clear my mind and release my stress. I will be away and may not be able to answer the comments in this blog from 26/11/2014 till 7/12/2014. It’s time for me to go for another round of thrill rides down under!
Good Day mate!
Really Doc…Some of your logic are ars_ logic. So sweet of you to be so thoughful that the government is “running out of money” because locums dont declare.. hence depriving governemnt off tax on their extra income”. If you read Malaysiakini you can see how many BILLIONS are siphoned out via 1MDB.
And dont blow your own trumpet…doctors were never really looked up to as “well respected & trusted profession” as you claim. From my experience the older doctors …even the specialist (except for real sincere ones) are much of ____. It would be disasterous if we rely on the first doctor and dont for for second opinions.
About GST..do you really understand how it works? When it comes to the doctors turn to charge the GST…it has an ADD-ON effect…so its the consumers who bear the brunt of the GST…not the doctors or hospitals
LIfe is not getting easier for everybody…not just doctors. We fully endorse that dispensing rights should be taken away from doctors. Doctors should focus on what they are trained to do….not try to make more money by “running a mini pharmacy”. Talk about that…lots of corrupted doctors who take commission from medical salemen to push their brands.
It is interesting on how you interpret information written in this blog.Sounds like coming from your a**. I never said “government running out of money” because locum don’t declare!! PLEASE read properly before you comment! The government going after everyone because they got no money!! And why they got NO money: everyone knows the answer as you had mentioned!!
Multiple surveys done had shown that Doctors are the most trusted professionals by the public. Please go and find for yourself!
AS for GST, I had clearly SAID that either the doctor had to absorb the GST as they cannot charge GST to patients or increase the fees charged!! Unfortunately, doctors consultation fees are controlled by the government!!
As for dispensing rights, it is something that I had said many times that the separation is unavoidable. Please read my earlier posting before barking over here.
And about corrupted doctors and unethical doctors, please read my posts since 2010!! Everything has been written before !!
Polls also show people distrust politicians.
Which is why Mahatir was in power for so long.
Cuz he was a doctor and a politician.
Because Malaysians are hardcore like that.
dear dr paga, the dr’s fee is exempted (not affected) by gst. But a lot of private doctors had set up a sendirian berhad (that may not be registered as health care provider) to receive payment of fees. The status of these payments (to the sdn bhd) is in dispute.
GST exempted is actually NOT a good thing. It means that whatever GST you pay cannot be claimed, meaning you need to absorb it as operational cost.
Yes, the Sdn Bhd is the confusion
The exempt category is a category where the gov wants to tax the whole chain up to the final consumer, but does not want the consumer to know he is being tax. So the cost of this tax is paid by the consumer, while thinking he is not paying, since at final consumption it is exempt from GST. The GST paid through the supply chain is incorporated into the overall cost of doing business, and reflected in the final price. If the Gov really don’t want to tax, then it is called the zero rated category.
YUP, a political stunt
Why are you reading this blog?
what kind of arse are you? do you know many pharmacist are doing what they are not trained to do: prescribing, that is totally illegal. And you know nuts about GST. A lot of confusion had been created by contradictory guidelines or directives issued by the custom! accountants and legal advisers are still waiting for the clarifications from the custom!
He thinks taking medications from pharmacy is cheaper and better than doctors. Doctors are corrupted for taking commission from drug salesmen but pharmacist don’t??
theoretically you cant prescribe as a pharmacist.but then theoretically u cant dispense as a doctor too! theres difference in theory and real world as u enter working world.change needs to be done for good.
These unscrupulous MOs who frequently take EL,MCs and MIA from work have been doing these all these stuff while since they were house officers. Now they are being a cancer to the healthcare system and nothing can be done about it.
A research should be done on the background of these MOs and HOs who frequently do these and I would not be surprised to see the overall trend.
Most of these MOs and HOs are from Russia and Ukraine. They dont well in SPM and even in their med school. During HOship, they are the lazy ones. I m a specialist in government hospital and even when i want to teach them during CMEs they are ones are usually absent during this CMEs sessions. Please ban these Russian and Ukraine grads…..
OnG Pakar…nice stereotyping and you are a pakar..pathetic..i met local and foreign grads having the same issues that you mention but you mention “most” from there?
I challenge you to do simple study at your hospital. Just take a look at their Pre Uni results. You ll be surprised MOST of ths russian wannabes didnt even attend pre u courses. What more exams like MRCOG and MRCP? Pls stop being a keyboard warrior la
Unfortunately for those Russian graduates, this is true generally for them unless proven otherwise. They are trained under the Russian health system which is incompatible with the British based system here. Most of them don’t even know what are these medical term we used here. They are not stupid but just a defected products from a different system.
There has already been a study on this by the Ministry of Health, although the result has never been revealed. From insider information, while incompetency is found in graduates from many countries/med schools (as is expected), there is a preponderance of such from certain countries/med schools. To any regulatory authority anywhere else, such a result will automatically trigger a review of these med schools. But it will not happen in Malaysia, as it is a political issue, not a profession one!
It is surely not surprising, this phenomena, don’t you all think? There has always been a very strong correlation between the academic ability of students and their subsequent professional competency. Why else would all good med schools be so rigorous in their selection process? Like anything else, rubbish in, rubbish out.
Hi ObGYN pakar
All is not lost if u didn’t make the grade to study medicine in a proper university.
See how this Chinese man who messed up his pre uni get the best gift of his life!
http://www.chinasmack.com/2014/stories/chinese-mans-life-with-beautiful-ukrainian-wife-envied.html
OnG Pakar you are a disgrace to this noble profession stereotyping the russian grads since there are no more ukrainian grads anymore..how can you ban the entire grad just because a handful did not turn up to your boring CME’s?you must be a lousy pakar!!! there are equally lazy ho’s from malaysian universities as well.stop this nonsense of throwing everything on the russian grad..there are some departments in which i work where there are no russian grad but we still see lazy ho’s..
Dr P, I just want to make a suggestion here that you may sign up with some internet advertiser such as Adsense to allow them to put their ads beside your blogs. They will pay you according to the number of clicks on those ads. I did realise that there are hundreds of thousands of viewer on your blogs over the years. You will be surprised that your income through internet could be more than your full time professional income. Nowadays, there are in fact a lot of full time internet marketeer making a living by just staying at home. Some even setting up websites that provide professional consultancy on health and diseases online rather than having had to travel to work everyday through the traffic jams especially with the rising petrol and toll prices. Anyway, I am just giving an opinion out of curiousity because I have come across so many full time internet marketeer in KL and most of them are not from IT background.
u wont get more money from adsense than u earn la..please..
Dr, I m a foreigner waiting for my housemanship call for almost 7 months after passing MQE exam.
There was a issue to undertake and pass BM course.Last week when i called kkm, i was informed that we (foreigners) might likely to pass SPM BM!!!! to work in malaysia…..but not yet confirmed they are withholding the decision….how far this is true dr..?If this rule comes into practice, is this fair ?
Are you married to a Malaysian?
Generally, Malaysia do not provide housemanship to foreigners unless you are married to a Malaysian.
Passing MQE does not mean you will get housemanship post. With the current shortage of housemanship post, it is very unlikely you will get a post. Even locals are taking 6 months to get a posting.
They are just giving you excuses.
Even the msia permanent resident who had graduated locally unable to apply for Hoship as MMC will not process all the non-citizen’s documents.
“Politicians and diapers have one thing in common. They need to be changed often, and for the same reason.” ~ Mark Twain
I really couldn’t understand what’s wrong with our govt docs. Every level from HOs, MOs, sp and consultants nowadays got every serious attitude probs. The news that HOs going MIA and HOs and MOs taking EL and MC is well “published”. What most of us still “unaware” of is the fact that the Sp and consultants are also very good , if not extremely got for going MIA. Check on all of them in every govt hospitals, majority don’t come back to work after lunch. Some do superficial review of patients, expecting the MOs to “pick” and settle all issues. Worst, majority of consultants are no more doing ward rounds. The HODs are now a special breed in service, they won’t do clinical works and more. Some are on holiday in overseas, yet their name are in the oncall list!. The best part is at the end of the month, they can submit their claims for doing calls. I can go on and on abt this. But, nothing will change in the .
It is called ” the government service syndrome”. If you can’t beat them, joint them! As long as the government service remains as it is , where no action is taken, it will only rot away.
..hahaha…
..HOD and government consultant are doing ward round/locum in private hospital la during their normal working hour…some even carried and ‘borrowed’ surgical equipment from government OT as well to perform in private..
They got junior specialist and sub-fellow to cover for them and hospital director just close one eye because she/he also busy giving tender to own crony…
-tuhan tolonglah negara ini-
Yup, it is happening!
govt doc exactly and these are the very same specialist and consultants who sit on their armchairs and write blogs on how incompetent and lazy their junior doctors are..even my hod is on holiday most of the time only thing differs between him and a ho is there is no one to question him.
If you don’t know me and what i have done, refrain yourself from commenting. I have been active in MMA since i was a houseman and the time based promotion that you guys are enjoying now was single handedly written by me!!
Dear Dr Pagalavan, What you mean separation of dispensing rights happens in April 2015?
Is it Medical Doctor can no longer selling drug in their clinic?
Is Pharmacist ONLY allow to sell the drug after then?
Is doctor only allow to diagnose and prescribe type of drug for treatment after then?
Regards, GL
Please read my Part 1 and 1A of these topic
I am NOT muslim male doctor and I want to do Obstetrics and Gynecology postgraduate training in USM. Kelantan is ” a more religious” state than other states. Will I have problem when doing postgraduate in OG because I am NON muslim and a man ?
so far, there is no problem. It will be the same elsewhere as well.
If your car broke down, you have to ask your foreman to buy the spare parts and fix it, even though you already knew that your foreman will mark up the cost of the spare parts on top of charging the normal service and diagnose charge. Similarly, I don’t see the practicality of asking each of the sick patient to look for the medicine elsewhere after the doctor had diagnosed the problem. In some other countries, they have everything under one roof. For instance, in Thailand you don’t see clinics. Every sick person has to go to the hospital for consultancy and get the medicine in a separate pharmacy department. While on my holiday in Bangkok recently, I asked the hotel concierge where is the nearest clinic for me to seek consultation for a slight fever. They told me that there is no clinic in Bangkok and they advise me to go to the central hospital.
Wow that is a terrible model. Most things involve longitudinal care / primary care / ie. the “family doctor” who knows a patient well as a whole over a long period.
Hospitals are for things that cannot be managed in the community.
A lot of time is spent figuring out ways to keep patients out of hospitals – to manage them in the community by their GPs. … and yes, they do a terrific job. Primary care is what really improves DALYs.
Yeah, GP land is a CAT 4 / CAT 5 job…day after day… not much excitement, but they genuinely do prevent true emergencies requiring hospital beds.
Too whiny la doctor… not suited for a pakar. Go into politics la sure you can change whatever you want to change
Hie Dr. Paga,
Dr. Paga, this is not really related to the topic above but I need to show you this.
http://www.attitudetherapy.com.my
The so called prof claims that he is a doctor of complementary medicine but in fact he is talking as if he is practising modern medicine.
A pseudomedicine, rather than complementary medicine. I observe his advice are infact puting people’s lives in potential danger.
Can this matter be brought to MMC/legal attention?
Thank you Dr. Paga.
MMC can only act against medical doctors. However, UKAPS unit of each state can act against complimentary medicine practitioners if they practise modern medicine as well. So, if you think he is practicing modern medicine in the name of complimentary medicine, you can lodge a report to UKAPS unit.
this so called Prof Dr got his so called ‘PhD’ from open university of complementary medicine in colombo, sri lanka – very well known place where bogus PhD and masters degree can be bought through internet easily. He should not be selling those stuff using those credentials in the first place! And he claimed he was a scientist as well??!! Which establisment? Which university?? Any publications under his name??
I pity those consumers who have fallen to his lies and traps. I’m sure those tablets he’s selling are just placebos or steroids pills to reduce inflammation, packed in a nice container with out-of-proportion advertisement and facebook comments.
There are conman everywhere
Hi doctor. I heard that Sg admit Monash Malaysia graduate on a case by case basis. Given that you have taught there before, what do you think about the news? Has any graduate been given a place for housemanship.
I have not heard anything yet. Let me find out first
I checked with Monash staff, they have not heard anything yet. However, there are some students from Monash Australia who came to Malaysia to do 1 year of their program. These students are considered Monash Australia graduates and are given registration in Singapore.
[…] updated my blog as I was very busy. The above topic had 3 parts written before over HERE, HERE and HERE. I discussed how the medical profession is gradually changing with introduction of many new rules […]
Doctor Pagalavan,
It is time of the year to sunmit income tax returns. I have a question on Locum Income. My son does Locum often at a GP’s clinic and he wants to declare the locum income on his tax returns.
But he is not getting a “Form EA Penyata Gaji Perkerja Swasta” from the GP’s Clinic. At the same time the GP told him that he is submiting my son’s name as one of the Locums working in the Clinic.
Is the GP’s Clinic obliged to give me the Form EA for the Locum fees I have received for the Tax Year?.
In the absence of a Form EA in black & white, I cannot be “cooking up” some Income on my Tax Returns…right.
I think the best person to answer this question is an accountant or tax consultant. As far as I know, form EA is only given to those who are legally employed. Locums are not legally employed aka has a formal agreement. Obviously, the GP clinic will submit the Locum names to LHDN as the amount paid is tax deductible for them. On your side, you just have to declare the amount that you had received from the GP which your son should have some form of tax invoice when he receives his Locum payment.