It has been almost 3 weeks since I last 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 and regulations. A recent meeting between MMA president and Ministry of Education had yet again confirmed the fact that we are heading towards oversupply of doctors and unemployment (Berita MMA January 2015). The Ministry officials admitted the fact and are considering to increase the entry requirement to 5As in SPM. I will not elaborate any further as I had written enough.
In July 2014, I wrote the 1st part of the above topic. One of the issues discussed was about dispensing separation (DS). It was announced that the dispensing separation would begin in April 2015. Over the last few weeks, this is the hottest topic being discussed among the medical fraternity, especially among the GPs. It was informed that the Pharmacy Bill would be tabled in Parliament this March, which suppose to move the dispensing rights from doctors to pharmacist. This will have great impact to the GPs. As I had written before, most GP’s income comes from the sale of medications. If they were to survive by just charging consultation fee, most GPs may not earn enough to even maintain their clinic. They may have no choice but to increase their consultation fees, which in turn will increase the overall cost of medical care and chase away their patients.
I must agree that in most developed countries, doctors are not allowed to dispense their own medicines. However, are we ready for such practice over here? The best people to answer this question will be the public themselves. Is the public ready to pay consultation fee to the doctors and then go to the nearest pharmacy to collect their medications? I am sure the one stop center that is currently being practiced is a much better option. However, the patients have every right to request to buy their medications from elsewhere. We cannot deny that fact. The patients also have every right to know what medications they are taking, aka name of medicines. No doctors can refuse to inform the name of medications to the patients. In fact, under PHFSA, all medicines must be labeled.
Over the last 1-2 months, multiple letters were published in newspapers, even RTM had invited a pharmacist representative to talk about it, and last week, most major newspaper carried topics regarding dispensing separations. One issue that I noticed during these few months is the fact that the pharmacists are more united in supporting this change. What happen to the doctors? Sorry to say, we are the most disunited profession in this country! We had MMA as the sole representative of doctors in this country till a few years ago. MMA is the only body that the government communicates with, officially. Some felt that MMA is not representing them enough and not vocal enough. MMA, as a professional body and not a union will have to settle any issues with the government via diplomatic way. Unfortunately, many out there, who are NOT even a member of MMA and do not even know what MMA is doing, will only know how to complain without contributing anything.
Few years ago, social media aka Facebook was used to start a new organization known as Malaysian Primary Care Network aka MPCN. The main agenda is to unite all doctors. The group grew in size and subsequently registered as an organization. I am also a member of this Facebook group and supported the call for unity. I have been a member of MMA since I was a houseman and had been active with MMA since then. I have been a committee member of MMA Johor since 2000, SCHOMOS Chairman of Johor for 3 years and National SCHOMOS Treasurer for 2 years. Currently I am the CME Chairman since 2013. While I support MPCN’s call for unity, I always felt that they should work with MMA and all their members should also become MMA members. Only with total strength we can fight.
Unfortunately, doctors are far more divided than before. Not only we have MPCN, we also have GPs united and don’t forget the race and religion based association such as Persatuan Doktor Islam Malaysia (PERDIM), Muslim GPs united and even Kumpulan GP Melayu etc etc. IT is very sad to see that after almost 60 years of achieving independence, we still want to fight a course by differentiating ourselves along racial and religious lines. While all of us are doctors through western education and sworn to help human beings irrespective of who they are, I wonder how differentiating ourselves along racial and religious line will help mankind. These include backstabbing each other etc.
We must not forget that we are all in the same ship. We leave in symbiosis. If one falls, everyone falls. Frankly, our ship is sinking! Politicians will find whatever way to keep their power and thus, the increasing rhetoric on protecting race and religion. We, the so-called most educated people in this country should be the uniting factor. Unfortunately, day-by-day, I see the most educated people believing in conspiracy theories and prefer to hold on to their race and religion cards. Sad indeed.
I see each of these groups organising separate forums and agendas to fight the dispensing separation (DS). The only unity I see is the fight against DS. Why not we merge into a single group and fight the battle together? Why must we fight separately? Is it because, everyone wants to become a hero of their own group? I see sincerity in MPCN’s boss Jim Loi. Being in an organisation for almost 17 years thought me one thing: backstabbing is common. There are many armchair critics and keyboard warriors who will only talk but will never help you when the need arises. There will be many who may be nice to you but will say the opposite behind your back. I have seen and heard enough. A person who you thought is your best friend may have a totally different agenda behind your back. This is becoming more common as our politicians use race and religion to their benefit. Many minds are being polluted with multiple conspiracy theories. Even a sincere help is considered as a conspiracy to “take over” the country, convert people etc etc!
Well, enough of my rant. Coming back to the DS story, our “MIC troubled” Minister issued a statement yesterday that DS is still in discussion stage and the government has not decided anything yet! Hah? There will never be smoke without fire !. Remember PHFSA in 1998? Before we knew, it was tabled in Parliament and passed!
Somehow I feel DS is inevitable as the government prepares for the next major restructuring after GST. It will be the health care system. The government will never be able to sustain the current public healthcare system. It will have no choice but to introduce a National Healthcare Financing Scheme. Whether it is for good or bad, we must be prepared for it. The future landscape for doctors will change. The only people who can challenge this will be the public……………
Gong Xi Fa Chai…………………. May the year of Goat bring us good luck.
Doctors meet to diagnose ailing industry
By Haresh Deol
Published: February 6, 2015 07:05 AM
KUALA LUMPUR, Feb 6 — As the debate for separation of the roles of doctors and pharmacists lingers, general practitioners (GPs) are racing to safeguard their interests in the wake of impending losses and additional costs imposed on them.
More than 50 doctors will gather in a closed-door meeting in Kuantan tomorrow to discuss the implications of:
• Separating roles of doctors and pharmacies;
• Implementation of the goods and services (GST) tax;
• Upgrading equipment involved in treating foreign workers;
• Growing number of clinics folding up;
• Over 4,000 private doctors who have quit in 2013 alone, mostly due to losses.
The disgruntled doctors insist these factors will impact their practice come April 1, leaving them little choice but to charge their patients more.
They cited rising cost of living and “bullying tactics” adopted by third party administrators as among the reasons for closure of more than 500 clinics between 2012 and last year.
But Health Ministry insiders claim, while nothing has been confirmed, the doctors are kicking up a fuss as they stand to lose their side-incomes from selling drugs.
“Dispensing separation will hurt the people not only in terms of more financial burden but other things like waiting time and other inconveniences,” said Medical Practitioners Coalition Association of Malaysia president Dr Jim Loi Duan Kong.
“The inconvenience of driving around for another parking space and paying for another parking coupon … that will happen if clinics no longer dispense medicine. What about the elderly? It’s just more troublesome for the man on the street. We’re not ready for it.”
Dr Loi admitted doctors would be able to “cut corners” if they continued to buy and dispense medicine.
“It has nothing to do with GPs enjoying kickbacks. It’s pure economics as doctors get to balance their accounts. We don’t dare to charge more than RM25 for consultation for a common flu or fever. We can’t hike prices of medicine as people know how much a strip of paracetamol cost. But many members insisted if the dispensing of medicine is taken away, then they would be forced to charge higher consultation fees.”
When told talk of dispensing separation has made its rounds since last year, he insisted: “This time it’s going to happen and it’s going to start in April.
“Right now will be what has been termed as the hybrid period where patients will be allowed to choose to either buy from the clinics or pharmacy. The dispensing of medicine will be phased out by April next year,” he said.
He has also received complains members have not received their dues from third party administrators on time.
“According to our statistics, there were 11,240 private doctors in 2012. The number dropped to 6,675 in 2013. In 2014 there were 6,865 private doctors nationwide. So many have quit as they cannot sustain.”
Another doctor from Jerantut, who declined to be named, said the introduction of dispensing separation will kick-start the 1Care for 1Malaysia health transformation plan — which mirrors the national health care service of developed nations including US and UK.
“But if you study the US and UK health care service, they have plenty of woes. It is not perfect. It is now even a top issue in Britain ahead of the May elections,” he said.
He said the rental of clinics and other administrative and operating matters were not exempted of the GST.
A Malaysian Medical Association top official said they have received numerous queries pertaining to the issues.
“There’s just so many elements disrupting doctors, especially those running their own clinics. Yes, many had quit and intend to quit. Some thought they could earn a steady income by becoming associated with companies through third party administrators but have instead been incurring losses. They also worry of the GST.
“But the dispensing of medicine is the final straw. It will be difficult for both doctors and patients. Let’s be logical, you’re already sick and the last thing you would want to do is to go in circles finding a pharmacy to buy medicine. Doctors will eventually hike their consultation fee as the current regulation states GPs can charge consultation fee of not more than RM120. So if a doctor used to charge RM25, if the dispensing separation kicks in, he or she could now charge RM35 or RM40.”
“Doctors face many woes and often suffer the end rot of it.”
– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-meet-to-diagnose-ailing-industry#sthash.vdpE6cZW.dpuf
Pharmacies to dispense medicines if proposal accepted
BY CHRISTINA CHIN
PETALING JAYA: Instead of getting their medicine from private clinics, patients will have to obtain it from pharmacies if the Health Ministry accepts the proposed “Doctors diagnose, pharmacists dispense” system.
While the system may cause some inconvenience to patients, pharmacists say it will help bring down the prices of medicine and give doctors access to many more drugs to prescribe.
It is learnt that doctors and pharmacists have held several discussions on the issue over the last year and they plan to meet the Health Minister soon.
They are represented by the Malaysian Medical Association (MMA), Medical Practitioners Coalition Association of Malaysia, Islamic Medical Association of Malaysia, Malaysian Pharmaceutical Society (MPS) and Malaysian Community Pharmacy Guild (MCPG).
According to MCPG president Wong Sie Sing, the five organisations had, at their last meeting on Nov 8, agreed in principle that dispensing be left to pharmacists.
Representatives of pharmacists later met Health Ministry director-general Datuk Dr Noor Hisham Abdullah on Nov 26.
He said the two professions met to work out a timeframe to introduce the new system, adding: “I hope we can implement it by April.” Debate on the issue has been going on from as far back as 2008.
“If pharmacists are allowed to dispense, doctors would have access to 10 times more drugs to prescribe than what they have in stock. This will benefit the patients,” Wong said.
MCPG represents more than 2,000 community pharmacies employing some 2,500 pharmacists.
MPS president Datuk Nancy Ho said patients would receive further counselling from another group of well-trained healthcare professionals if pharmacists were to dispense medication.
“The check-and-balance reduces prescription and dispensing errors. Dispensing separation is about professional medication management and only pharmacists are trained in this specialised practice. We know everything about a drug’s healing value and possible harm,” she said.
MMA president Dr H. Krishna Kumar confirmed that the associations had met on the proposed new system but said nothing had been agreed on yet.
Dr Noor Hisham confirmed meeting representatives of pharmacists, and said they discussed about integrating and consolidating the Pharmacy Act.
Stating that nothing had been decided on, he stressed that the ministry’s main priority was to ensure quality and safety.
Universiti Sains Malaysia (School of Pharmaceutical Sciences) Assoc Prof Mohamed Azmi Ahmad Hasalli said a 2013 study of 40 clinics and 100 pharmacies in Penang found that doctors dispensed more medicine and antibiotics and charged more than pharmacists.
Pagalavan's Avatar 
Dear Dr Paga,
This statement is not accurate and misleading: “A recent meeting between MMA president and Ministry of Education had yet again confirmed the fact that we are heading towards oversupply of doctors and unemployment”.
Either MOE said it wrongly, or MMA President heard him wrongly. Its actually oversupply of medical graduates against the housemanship job post.It bottlenecks at housemanship. You’ve discussed this in your blog previously. In fact, Malaysia are still short of doctors.
Secondly, raising entry requirement to 5A is not as quantity control measure, but quality control measure. Similar to proposed MQE for all medical graduates. Its sieves them at different level.
Not really. We have achieved a ratio of 1:600 in 2013. At the current production rate, we will have surplus production by 2017. We are not short of doctors but maldistribution of doctors
THANKS
For?
In any policy implemented, there will always be some people losing out, and others gaining from the game. With the glut of doctors being churned out year after year, it is inevitable that the job in the market gets saturated and oversupplied. When this happens, it becomes a norm that either the selection of doctors into the field becomes very tough (and hence many doctors who do not make the cut will be jobless); or the competition becomes so stiff that price war, salary reduction and under-cut practice will be happening more than ever before.
I always think that we are only looking from the angle of the more established doctors whenever the discussion in MPCN or other similar platforms. Those doctors are normally having 30-50 patients steadily per day, and hence the income from the medicine profit alone will achieve a good revenue for the clinic. But many forget that out there, and in near future, there will be a LOT more younger doctors, who are not doing well, especially in new GP clinics. To add salt to wound, patients able to see specialists (using insurance card) without going through the gate keeper (ie GP), will cause another blow and huge loss in income. Therefore these are the doctors who definitely will agree to the national healthcare scheme – which promises the GP a fixed income for each consultation, and also a promise of a certain number of registered patients under their care (it was rumoured to be RM30 per consultation, and min 20 patients a day, hence if work 22 days, one GP already getting RM13200/month, without needing to stock up and dispense medicine!). And because the nurses are also in surplus figure, the rumour also indicated that all 1Care clinics will be supplied with nurses (not just SPM leavers as clinic assistants), and they will work out a pay scheme between the doctor and the govt (still unclear). And becoz the rental is high, it is also rumoured that pharmacist co-rent a shop with GP, each taking half of the premise, and this not only cut down rental expenses and electricity bill (from aircond); but also fulfilling the dispensing separation dream of the govt and pharmacists – they get to now dispense! And at the same time, for the patients (or publics) there is no excuse of “walking far away to get medicine” – coz it’s just next door!
Although we hope for total unity among the doctors, at this moment, it is hard. Every doctor is more concerned of their own rice bowl, which is not wrong at all. It will be more united, when the national healthcare scheme comes in play, and every doctor is REALLY in the same boat once and for all. Currently every GP in their own clinic is running the show separately, and stiff competition getting patients within the community is happening. And with giant players like BP Healthcare coming forcefully, the GP’s are even more cornered. And hence, those younger GP’s will even suffer more blow to their rice bowl, and at the end, many if not all, will just give in, and opt for the “best” solution offered – ie “steady income” from the healthcare scheme. And I think many of us also realise the DFM program offered by AFPM is not there without a reason – it is also rumoured that DFM will become a pre-requisite for any GP to be enrolled under the healthcare scheme once implemented – ie if you do not have at least a DFM, then your clinic cannot see those “20 patients” (mentioned above); and therefore you can only rely on walk-in patients. Simple logic applies – if the govt forcefully implement a healthcare contribution from the rakyat, do you think the rakyat will still fork out money and be your walk in patient? Or do you think they will use their card to go to the GP with DFM to get their “free” consultation? Hence by then, many GP’s who are not willing to take up the DFM will ultimately lose out – though many of them at the moment, are doing well – but do not forget those younger newer GP’s are coming out, probably jobless, and in order to protect their rice bowls, they will not hesitate to join force with the ministry for the “stead income”.
Yup, agreed.
How abt the doctor sitting in klinik kesihatan when 1 care system come into effect? Are they still gov servant getting salary fr gov or have to follow the 1 care system as well?
Initially yes but they may corporatised the healthcare few years down the line, which basically means you will be working under contract with a private entity
Yup. All will be under 1 entity.
Hi, Dr. Paga.
I would like to ask for your opinion on my further studies in medicine.
I’ve read through most of your posts in the series “For future doctors” and I’m well aware of all the issues that may arise in the future.
I’m an A-levels student, my first option is to apply for imu PMS programme since I wanted to work overseas, but the thing is, do I need to pass any licensing exam in australia or nz? for example if I graduated from UK or ireland medical school twinned from imu. And vice versa, if i graduated from Aus or ireland med school, do i need to take PLAB in order to do housemanship in UK?
If the thing really goes like this, why would I bother to pursue a UK or ireland or Australia medical degree because of the fact that I still need to take the licensing exam just like the graduates from any medical school listed in avienna, that makes me no prior advantage than them.
However, I know that if I graduated from Ireland med school i may have a chance to do the housemanship there. Same thing goes to UK.
Hope to get your reply soon.
Nope, if you graduate from the medical school overseas(where you do your clinical years), you don’t need to seat for any entrance/licensing exams.
Yes you do. If you graduate let’s say from the UK and intend to practice in Aus you need to take the AMC exam if you intend to practice in aus immediately post graduation. The same applies vice versa : if you graduate from aus and intends to practice in UK, you’d need to do the PLAB exam.
You do not need to take the licensing exam from the country you graduate from if you practice there post graduation.
For those UK Grads who wants to go work in UK, you don’t need to sit for any exams. Read up on the Competent Authority Pathway. All you need is complete F1 and get full GMC registration.
The reverse
appears not possible. But then, few international graduates from Australia want to move to the UK anyway. However, for those undergoing postgraduate training in Oz, many do go spend a time in UK, through arrangements via the respective specialist bodies.
For those of you young doctors who want a simple solution to the worry over loss of profit with the removal of dispensing rights of doctors, it exists. Choose a career in a surgical discipline and make your living from operation fees rather than medical consultations and selling of drugs.
Not all cam become a surgeon. Furthermore, many do medicine with the intention of opening a clinic: claim easy life!
Hello DR!
I’ve been reading your blog since I was in 2nd year med school.
I’ve just completed 5+ 1 yrs (internship ) in India under JPA scholarship and I am waiting for my posting in Malaysia.
I am curious about
1) the rush for completing MRCP ( even my Indian lecturers suggested it)
2) What are your thoughts on clinical hypnosis and hypnotherapy as I am being introduced to such courses- I am interested in Neurology and Geriatric Medicine
3) MRCP vs AFPM s -Dip in Family Medicine for GPs vs Post grad courses (health and medicine related) offered in local uni – noting that I am bonded for 10 years
1) why the rush? do you want to be a good clinician or just want to pass the exam?
2) it is considered a complimentary medicine
3) depends on what you want to do
Pathmadevi. Dont be so kiasu la. Finish ur internship in KMC mangalore 1st.Why so kiasu la.. So typical of JPA laaa. I m also JPA. Chillout la…Haiyooo
Here’s an idea.
How about ACTUALLY practicing good primary care medicine?
The problem is highly profitable clinics and good primary care clinics may not necessarily be the same entities. How a clinic delivers high quality family medicine and how a clinic sustains a high profit margin is sometimes on the opposite end.
And therein lies the problem. What unity are we talking about? MPCNs (and various similarly themed groups) call for unity is flawed. Its essentially a call for clinics with good business and profits to unite and protect status quo. I don’t think MPCN cares about protecting the growth and delivery of primary in this country. Most doctors should see right through this whether they are GPs or not.
AFPM organizes the RM 16k DFM program and has their RM20k ATP program going for some time. Its a noble call to provide an alternative to the Master Fam Med program especially for busy practitioners. However, John Doe’s assertion that the future National Healthcare Financing Scheme/1Care will make it mandatory for doctors to must have minimum DFM to participate will be economically disastrous.
Don’t forget, MMA/AFPM or KKM don’t call the shots here. Its the all mighty Economic Council. And it has to make economic “sense” for the countrys greater agenda. Its the very same reason medical surveillance is not limited to Public Health specialists in this country (if you know what im talking about).
I don’t think anything is set in stone, but its probably going to be like this. All GPs can enroll in the program. First of all, its not going to be a walk in the park. Credentialling the clinic will/can be hell. Apart from regular CPD points by the principal practitioner, your clinic needs to be set-up properly as per regulations, and you probably need a qualified nurse to run the practice.
As the system starts to stabilize and enough clinics exist in the vicinity or the “zone”, then slowly only specialist doctors will be allowed to open practices in certain areas while incentives should be given for doctors to open in underserved rural areas.
While I am not an insider who knows whats going on, I have studied various implementations of primary care in developed countries; unfortunately this is where the country is headed. If they want to reach certain development parameters, they have no choice but to integrate the public-private dichotomy no matter how ‘effective’ the present treat-patients-after-they-get-sick model is in this country.
yup, agreed.
sir, for those who r admitted for clinical postgraduate course in public universities, would they be paid salary for their works?
Your salary from KKM continues with some reduction in allowances, if I am not mistaken.
Hi sir,
Should I be offered both Penang Medical College MBBS and NUS Systems Engineering? which one should I choose? What is the prospect in terms of career and postgraduate studies since the clinical years are done Penang (the last 2.5 years)? I intend to work overseas. Thank you.
PMC degree is not recognised elsewhere except in ireland.
The basic guideline is, if you intend to work outside Malaysia, do not do medicine in a Malaysia based University where the clinical component is in Malaysia. Specifically for PMC, I don’t think it is possible any more to get a Housemanship job in Ireland for PMC graduates, even though the degree is recognised. Always remember, having a recognised qualification does not mean ability to work, two other factors needs to also be recognised: availability of jobs, and ability to get a work visa. This applies in all countries.
Hello doctor. May I ask : The MRCP (UK) – Internal Medicine is an exam to become a specialist?
Is the residency in Singapore considered as master program?
MRCP can make you a specialist in malaysia but not anywhere else. Residency is residency program
residency program in the states leads you to attending position..
singapore adapted this system from the us back in 2009 by collaborating with ACGME and formed ACGME-i (i for international, because those who completed residency outside us can never sign up for the board exam or practice in the states, at least for now), after that abu dhabi was accredited and followed by hamad medical corporation in qatar.
in middle east, they consider the attending doctors as specialist. and those who completed the residency program and pass the arab board exams will be gazetted as specialist.
residency and mater program are two diff programs but what i see the stucture and objective are the same, to train and produce specialized doctors in specific specialty with continuous assessments.