So, after 5 years of me starting this blog and almost 10 years of voicing out my concerns, finally the government has acknowledged the situation. Almost all that I had said in this blog over the last 5 years were clearly mentioned in today’s Star headline. The time has come for the government to admit the mistakes that they had committed. Unfortunately, do they have the political will to change the situation?
As a country with the highest number of medical school per capita population in the world, in a truly Malaysia Boleh spirit, we had allowed countless number of shop-lot medical schools to flourish. Thousands more go to overseas universities either sponsored or self sponsored. We are creating a generation of people who are going to be in debts for years to come. I had always said that you should not take huge loans to do medicine. It does not make any economic sense and do not forget the many more debts that will come along away. Basically, you are starting your life with a RM 500K debt which will only accumulate further.
Today’s Star’s headline discussed several issues. Debts to be paid and huge investments that are going to waste, as the country is unable to provide housemanship post for at least 6 months to a year upon graduating. This waiting period will increase further when all the remaining medical schools (50% of them) start to produce doctors at their maximum capacity from next year onwards. I understand that they have started the e-housemen website.
Another issue was the issue of quality which I had written several times before. The figure that 1 in 5 housemen are quitting their job was rather surprising to me as I had expected a much lower figure. As the Deputy DG said, most of them just go missing in action(MIA) without any resignation letter. In government service, if you leave without a resignation letter, it will take almost a year for disciplinary action to be taken to remove you from the service. During this time, no one can occupy your post! THUS, for those who intend to leave, please put in your resignation letter. This will benefit the newly graduating doctors in reducing their waiting time. I have said many times before, being a doctor involves hard work and lost of social life. Working long hours is a norm in many countries including in many developed countries. It’s the healthcare system that wary. Each country will have their own problems. In Malaysia, the public healthcare system is as such that working long hours is sometimes inevitable. WE need an integrated healthcare to improve this. Being part of civil service, it is very difficult to take disciplinary action against a civil servant. That’s the reason why you may see a lot of deadwood doctors in civil service. That is also the reason why bullying and intimidation will never stop!
There were again suggestion to introduce a common entry exam/MQE. The last time I spoke to a senior MMC member early this year, the obstacles to this idea are the politicians and local public universities. My question is, if you think you are producing competent doctors, why worry about the exam? I am all for a common entry exam. It is the only way forward to maintain the standards. It is impossible for MMC to monitor all the medical schools locally and overseas. That’s the reason why many countries switched to a common entry exams. I hope the politicians and local public universities will lower their ego for the betterment of the future generations and the country.However, I am sure you know the answer!
So, for future doctors and for those who made insulting remarks over the last 5 years in this blog, the time has come to wake up and face the reality. Never do medicine for wrong reasons and I will also add, never do medicine if your intention is to migrate. It takes great passion to overcome the obstacles that you will face as a doctor. Do not forget the numerous laws and regulations that you need to abide to. We have Medical Act, PHFSA, Poison’s Act, Dangerous Drug Act etc. A traditional medicine seller has very much less rules and regulations to follow! The complementary medicine practitioners are laughing to the banks but we doctors are fighting tooth and nail to prevent dispensing separation. Oh, and not to forget the GST which doctors are supposed to absorb in the name of “untuk rakyat”.
On the other hand, we are facing more and more demanding patients. Medico-legal cases are increasing by leaps and bounds. Just recently, a patient sued a government hospital and was awarded RM 3 million in damages. Not to forget a male doctor being charged for molesting a male patient! These are some of the frustration that doctors are facing day by day. The younger generations are still leaving in their past. I attach 3 out of 4 articles that appeared in the Star today.
Housemen do not complete training stint for various reasons
PETALING JAYA: One in every five doctors undergoing training as houseman in Malaysia quit each year, an alarming rate of drop out, considering the high cost of studying medicine.
It may cost up to RM500,000 to study medicine in Malaysia and up to RM1mil if it is completed abroad.
Many newly qualified doctors also quit because of the longer wait to be posted as housemen.
Those who left abruptly have been found working as waiters and even running pasar malam stalls and there has also been a case of a trainee doctor taking up a job as an air stewardess.
Deputy Health director-general Datuk Dr S. Jeyaindran said about 1,000 of the 5,000 housemen employed each year do not complete the two-year training stint.
Among the reasons for housemen to leave the service include unsuitability for the profession as they were pressured to study medicine by their parents.
Having a totally different perception of a doctor’s life, inability to work long hours and suffering from burnouts are the other causes.
He said the rise in numbers of housemen quitting had been growing over the past three years.
Dr Jeyaindran said as housemen were hired by the Public Services Department (PSD), the termination process was tedious and could take up to several months to more than a year.
“Until the person’s service is terminated, the vacancy cannot be filled and those who replace them have to wait for their turn to start,” he said in reply to questions submitted by The Star.
He said many of the housemen who left did not tender official resignation letters.
The large number of medical students graduating each year is another reason for the long wait for postings as a houseman, especially under the new e-houseman system, which allows for newly qualified doctors to choose the place of their posting.
While the average waiting time is about six months, it can be longer for the more popular postings in urban hospitals including the Kuala Lumpur Hospital.
“With 10,000 housemen in all the 45 training hospitals nationwide, these hospitals have varying degrees of waiting periods except for hospitals in Sabah, Sarawak, Kelantan and Terengganu,” Dr Jeyaindran said.
He said the ministry must explore other ways that allow for greater flexibility in employing housemen to replace those who had left.
He said the proposal to have a common entry or fitness to practice examination as proposed by the Malaysian Medical Association (MMA) was among the steps being considered.
Another was a longer induction period for housemen to have better understanding of their work.
“It is not to control numbers as proposed by MMA, but to ensure a minimum standard of competence. The common entry examination is already in place in some Asian countries, the United States and Australia and it might become necessary to ensure safe medical practice especially once there is a liberalisation of trades and services,” he said.
He said a houseman’s workload in Malaysia was lighter than those in other countries, adding that on average, housemen in Malaysia took charge of between four and six patients in a ward compared with eight to 12 in Singapore, Australia and the United States.
“Moreover, house officers in these countries work an average of 80 hours compared with the average of between 65 and 72 hours for Malaysian housemen,” he added.
New docs may have to wait a year for housemanship
PETALING JAYA: Newly qualified doctors must now wait longer – up to a year after their graduation – to take up their stints as housemen at certain training hospitals instead of the previous period of six months.
Malaysian Medical Association (MMA) president Dr Krishna Kumar said that with medical graduates now being given the choice to choose the hospitals to be trained in under the e-houseman system and the long waiting lists in some hospitals, the waiting time could be longer.
Prior to the e-houseman system, which was introduced this year, the average waiting time was about six months.
“The waiting time is getting longer and longer, especially in the more popular urban hospitals, including the Kuala Lumpur Hospital.
“We must have an entrance examination to screen medical graduates for the best candidates,” he said, adding that the bottle neck was reaching a “critical stage”.
Last month, Deputy Health Minister Datuk Seri Dr Hilmi Yahya announced that housemen could choose the hospitals for their internships through the new system.
Dr Krishna said with one in five applicants requesting for specific postings, the ministry decided to let the applicants see the limited spots available for themselves.
He said at the current rate of 5,500 medical students graduating each year, all 45 training hospitals in the country had difficulties in coping with the numbers.
Dr Krishna cited two hospitals as an example. At the obstetric and gynaecology (O&G) department in Seremban Hospital 65 housemen have come under the supervision of two consultants and five specialists while the Kuala Pilah Hospital O&G unit only had one obstetrician overseeing about 30 housemen.
“We are a small nation but we are generating so many doctors and causing a bottle neck in training hospitals,” he said.
He also expressed concern that some might not get postings as medical officers in the future, adding that their career path too would be limited because scholarships for Masters programme were only offered to between 800 and 1,000 medical officers each year.
Five years ago, The Star highlighted the massive number of medical students graduating each year, putting pressures on the limited number of training hospitals. The problem has since worsened.
Dr Krishna attributed this to the lack of political will to resolve the issue and urged the Higher Education Ministry’s moratorium on new medical programmes be maintained and the brain drain among specialists be addressed as it was difficult for a small number of senior doctors to keep tabs on housemen.
Universiti Malaya medical faculty dean Prof Dr Adeeba Kamarulzaman said that there was no waiting list at the Universiti Malaya Medical Centre for housemen but the entry level for medicine course at UM had been raised to 5As for Sijil Pelajaran Malaysia results.
Deputy Education Minister P. Kamalanathan said the five-year moratorium imposed on new medical programmes in 2010 would remain.
Long hours and lack of work-life balance prompt one doc to quit
PETALING JAYA: One doctor decided to opt out of her housemanship training after realising that it was not the life she wanted.
The 32-year-old woman, who only wished to be known as Dr MH, said she decided to stop her housemanship after 14 months of training because the long hours were stressful and there was no work-life balance.
“I was on-call every other day and I realised that even after becoming a medical officer or specialist, the schedule would still be heavy. I didn’t want that kind of lifestyle,” she said.
Dr MH, who is now a medical adviser for a pharmaceutical company, said as a houseman in a training hospital in the Klang Valley then, she worked from 7am to 5pm and would be on-call duty from 6pm to 7am the following morning before continuing with the normal working hours the next day.
“During on-call duty, there are usually patients to attend to. We get little sleep in between and have to wake up at 5am to take blood samples of patients before the senior doctors come in,” she said.
She said her late father was horrified when she resigned and even asked relatives to persuade her to change her mind.
She admitted that her father had wanted her to do medicine although she had wanted to do actuarial science.
“Money was not a factor for leaving the profession even though pharmaceutical companies pay better. I am more satisfied with the stable working hours,” she said.
Asked what advice she would give to students wanting to pursue medicine, she said they must have the passion and good grades because the course was intensive and the work demanding.
“They should not be influenced by their peers or their parents for choosing medicine,” she said.
Pagalavan's Avatar 
Hello sir
Greetings I been your follower last few years.Like you said we shouldn’t do medicine for wrong reason. I completed my medicine due to my parents interest. Once I started my housemenship I realize medicine not my field of interest. After my housemenship I join as MO at KK and started my own poultry farm. Its tough but I’m happy with my poultry farm. I get my job satisfaction. I learn chicken rearing with help of veterinarians and senior farmers.Currently I’m progressing well in my choice of interest.
Let parents focus on their children field of interest not theirs!
Thank you sir
Best regards
Dr R
Sent from my iPhone
Good Luck
There is no political will to solve this problem. It will have to come to a crisis first, before the gov wants to react, and be politically seen to be ‘correct’ in reacting. So we wait a few more years for the actual crisis to come first.
not only HO, noe even MO are overleaded. mo are being sent to klinik 1msia bcz no wher else to be placed. small hosp ETD has 20mos. most are jobless. got to brace ourself, all going down into deep shit!!
Expected
Just when exactly is the moh going to increase the min.requirement for entry?this was spoken about in 2013 by Moh but till date nothing was even mentioned or spoken about since!
I think MOH has always been on the receiving end and has not much say in it. Its actually MMC and Ministry of Education who should be answering that question. I sense a very weak MMC who is beating around the bushes. I say take the bull by its horn and seriously do something! Raise the medical school entrance criteria, quickly start the common entrance exam. It will ensure quality and the same time will bring down the numbers. Its been said many times before, even Dr Paga might get carpal tunnel syndrome soon for writing about this again and again (God forbid).
I do have carpal tunnel syndrome of my RT hand! Much better after few months of metylcobal. Haha
Politics!
As a fresh graduate who got posted in just 3 months, I am grateful. However, it’s hard to put on a brave face when there is so much negative publicity about the job I am about to have.
I wish the star newspaper article quoted a more holistic statistic instead of only using the hospital that the doctor in question works in.
Perhaps further researching into where exactly these doctors who left housemanship ended up in. Personally I can name a number who hold very good positions in pharmaceutical companies and other companies.
What happened to thorough research with airtight evidence? Instead of quoting people you may or may not have spoken to, perhaps one good fool proof article with adequate evidence and information on the houseman issue should be published?
I feel like I’m listening to a friend whispering a rumour in my right ear.
Actually I have seen and advised many who are just sitting at home doing nothing. Pharma companies take very few doctors and they need you to have full MMC registration which can only be obtained after housemanship. I know quite a number working in insurance companies as underwriters. And I also know a few who just continued their parent’s business.
You have missed my point sir … The Star article and you yourself have made it look like most of these people (not all) who left housemanship lead terrible lives after leaving the service.
I feel that at the end of the day you have to do what makes you happy.
I am so happy that I’ve graduated.
I am so excited to start work. It may be tough but I am praying for the strength do go through it and come out the best doctor I can be.
I wish more senior doctors would come out and give more constructive advice to houseman rather than constantly beating their spirits down.
I think you are not getting the point. The Star newspaper is very clear on what they wrote and it is the reality. They are simply saying that many who left or waiting to get a posting is doing multiple other jobs. This is very true as some of these graduates have to pay back their loan.
What we are giving is constructive criticism. Why are we in in this state at the moment. Because no one listens to criticism. The reality out there is what is being written in this blog. But many refuse to believe and think that everything is well and good out there.You will know what i ma taking about once you join the service.
For the sake of future medical students,your internship waiting period is short but what I like to know n most of us is to which state r u posted to?.tq
Oops sorry,this message is in reply to Amy’s post.tq
Good day, Sir
I’ve been following your blog for quite sometime now. As a medical student, these issues about the fate of future doctors have been bothering me. I’ve always thought of a backup plan, e.g furthering studies in other courses, etc. My question is, is it possible to do that without going through housemanship? What are the options for those who are stuck in medical schools, if they don’t want to become a doctor for whatever reasons? I know that people should think thoroughly before taking medicine, but well, things happen… And changing course would be the last thing to do if you are in 5th year, for example. IMO some of those crappy, unhappy doctors become what they are because they didn’t know what to do with their MDs or MBBSs apart from, well, being a doctor… I would be really glad for your/anyone’s guidance in this matter:) maybe you can make a post about it? Perhaps it can contribute in reducing the number of incompetent doctors in the future.
Thank you
Razzz
I had written about this before. See the topic ‘what if…….’
I’m a fresh graduate and was posted within 3 months thanks to e-houseman. It was introduced on 16th of March and only took me 20 mins to fill the form up n my posting was given instantly. You can even see the number of places left. However, 2014 grads waited for a long time before being posted.
Yes, that’s why I feel the e-housemen is actually a good thing to do. How long you want to wait depends on where you want to do your housemanship. However, i hope the system will be regularly updated.
Hi Amy, congratulation on getting your posting! May I know what is the availability now for major city like KL, Ipoh, Seremban, as well as Sarawak? I will be graduating in June and hopefully can get a place that I want! Thank you!
It is shocking to learn that JPA takes a year to remove the service of those HOs that go MIA. Do they get paid during this period?
And it is hard to believe that the workload of our HO is lighter than that of Singapore, US and Australia.
One of the obstacles to common qualifying exam is objection from public medical schools. This clearly shows that they do not have confidence in their graduates, at least some of them. What’s the point of raising the entry requirement in SPM to 5As when the standard has deteriorated, and in addition the public medical schools take in applicants with matriculation and STPM qualifications which are not of equal standard.
Lastly, we have to thank the former minister of higher education for the present state of having the highest number of medical schools per capital population in the world. At least we hold a world record?
Yes, that is how civil service works. It will take a long time for someone to be removed. I know cases that even after 4 years, his name is still in the hospital. Now you know why civil service is rotting away. Usually their pay will be stopped after 2 months
i just completed my housemanship a few months ago at one of the tertiary hospitals in peninsular malaysia and I’m applying for my placement for mo-ship,I was told that most of the mo posting in peninsular hospitals or even kk are already filled up.i was then being posted in Sarawak now,and I consider myself lucky to get a place in another tertiary centre in Sarawak and the department that I like and the process only take 1-2 months to get my posting. But some of my colleagues and housemen ain’t that lucky. And nowadays,a lot of them who completed their housemanship have to wait for 2 or sometimes 3 months to get their posting and those who get places like kelantan and terrengganu are consider lucky. Well, maybe in the near future, I guess it will become like those who get a job are those lucky ones…
you need to use proper tenses, it was difficult to understand your comment at the beginning
During the 2-3 month waiting, do they earn money?
Nope
yup eventually, not everyone will be given a job
Well written, doctor. I have 2 points:-
On a personal capacity, it is a sad to hear someone claim that they chose medicine for their parent’s sake. Even more sad, is to see 5 years of hardship and struggle go to waste.
Every teenager must realize that they have a choice in deciding what they want to do. Your parents will always want the best for you. But, you must counter argue your POV and stand your ground in telling them what you want to do for a career !. I encouraged my son to do engineering and he got a scholarship at UCSI. But, I later found out he liked to study medicine. I financially supported him and he graduates from AIMST, this year. The debt is worth it, if the chosen path is the true calling and every bit enjoyable. Parents only want what’s best to see their kids succeed in life. In present times, information is easily accessible, hence, a child should what to chose for a career. Talent & passion, not glamour & money, should be the motivation.
On a professional note, it’s sad to see what is happening to a profession entrusted with god’s work. I wonder what Pemandu, MOH and MMC have to say on this malady. The person I hold accountable is the MOH and who is leading it? – A doctor !!. I suppose he is too busy fighting his political battles than to improve the medical vocation, where he came from. How can we expect “political will” to save the day?.
There is money to be made in so many areas. Do they care about uplifting the medical standards and professionalism in this country?. We have a blueprint for education but is there one for Health & Medical. You can’t just focus on technology without developing the very people who operate them. Robots can’t replace doctors ! How does this fit into the nation’s developed status?
I feel it is time for doctors to speak up and out. You are too important to be left out of the mainstream development because you are critical to the health and well being of citizens. It’s not enough to just complaint and do nothing. Take it up with MOH and MMC as a intellectual discourse for effective remedies. Demand that they do something or ask them to make way for someone who can champion the cause. Write a petition and take it up to our good friend Mr Subra.
Do this, not for yourself, but for your future children.
Actually it is not an MOH problem. The approval to start a medical program comes from MOE. MOH is at the receiving end. Unfortunately, MMC which suppose to maintain the standards of doctors is a branch of MOH where the DG automatically becomes the Chairman! How can a civil servant go against the policy of the government? That is the problem! The past president of MMA raised this issue 2 years ago but no one bothered. Infact until 2013, even the Minister of Health denied that we are heading towards oversupply of doctors. Only last year he admitted the reality.
The MOH is not the cause of the problem, but is saddled with it. The fault lies with the MOHE in the past, who granted too many licenses for Medical School. But MOH does add to the problem by being unable to clean up the system.
The MMC is a somewhat divided body, with appointed members pulling often in different direction from the elected members. In addition, it actually has little power, as it only advises and it is up to the Chairman to carry it out recommendations. Like Paga said above, that is the DG, who has his own agenda. Finally, the cabinet micro-manage decisions as well, and that was how the proposed common qualification exam was shot down.
In summary, politics permeates through what should be a professional area. And as politics will inevitably do, it messes every thing up.
My case however is different
Imagine a student who is not able to read, the teacher called him stup#d, for not able to read. His friend always discriminate him for not able to read and so as the result he feel he is useless. He lost his self esteem. But one day, however a doctor meet him and found out that hes suffering dyslexia
Thats what i encountered in my life as a doc. WIthout knowing that im suffering central auditory process disorder, i encountered several difficulty that compromise my job. The diagnosis only known just before i end my houseman ship and was confirmed by 2 senior audilogist who expert in this condition
1/ Ive difficulty to understand speech / communication in noisy enviroment, esp in ward round, or grand round. I often get clueless of what that being discussed
2/ I have difficulty to differentiate word that sounds similar, ex like goat vs god, vac (vaccum) dressing vs wet dressing, thirteen vs thirty, Sometimes my senior doc instructed me to give drug A .10 mg, but i missed the “.” and heared 10 mg instead 0.10 mg
3/ Loss of short term memory, example my boss asked me to send patient to OT, but when there is sound distraction , i suddenly forget everything. This is also leads to difficutly in my ward round since i cant recall the case that ive clerk or patient that im in charge. Normal people usually can remember average 7 items list. But i only can remember 3.
4/ Poor secondary language acquisition
5/ Poor word retrieval or expression…i find difficulty to find words that im trying to say or to express my self. Sometimes i know what to say, but it seems however i lost the word. So such behaviour gives bad impression on others
6/ In order to compensate the difficulty of understand speech, i used more energy to focus . In other word, my brain works harder as compared to normal people. Therefore i tired easily…and when i grow tired, the symptoms are worsening
The audilogist told me that they can train my brain through brain exercise. Unfortunately, they dont have the exact program for adult since central auditory processing disorer is still new in malaysia. SO they suggest me to train myself, through a unique computer game in internet that can train my memory, focus and other aspect of the brain. However…the progression can be very slow. Time goes fast and i understand many MO already competing each other to do their master program and i lost that opportunity as time flies. I am still lost confidence in doing any mastership, in view of bad experience of being label as “clumsy doc” from my previous HO and early MO life. Im doing fine in quiet and calm clinic. Im thought im gonna take family medicine, but in the program required a clinical rotation in ward. I cant afford to work in noisy and hectic enviroment esp in ward due to limitation i mentioned above. I try doing pathology, but the life, sitting still on the bench is boring. I know that i am very ambitious people….I dont want to give up.
When i tell this to my friends….they ask me, how come u can be a doctor? Maybe because i am not that person that easily give up and continuing struggling. When i ponder of my past….i realized i had already have similar problem when i was primary school and secondary school. But i am able to compensate my weakness by being hardworking and reading lot book. But when the moment i start working , i start to see my real problem that was once never been diagnosed. I always wish that i know my problem before i choose to be medical student, so that i can choose different path. I understand people who have central auditory processing disorder are good in computer, arts and music. I thought of doing a movie director and i am good in those. But at the age of 31, do i have opportunity to excel study in different course….esp thinking how much money that i had spend in my medical school. I dont want to waste my money….i already ends up something that i am not supposed to be. I am still clueless….i have not yet discovered any doctor that have similar problem as me to share or a role model. Ive been continue looking for answer…..and every question is a disappointment. When i post this story here….maybe im expect a miracle answer. Who know….this time god wanna help me. I want to do something different than others….expertise in medical history, medical journalism , but the course still not available in malaysia
You are still young and can do a lot of other courses if you think you can be more successfull. Medicine may be difficult for you.
My case however is different
Imagine a student who is not able to read, the teacher called him stup#d, for not able to read. His friend always discriminate him for not able to read and so as the result he feel he is useless. He lost his self esteem. But one day, however a doctor meet him and found out that hes suffering dyslexia
Thats what i encountered in my life as a doc. WIthout knowing that im suffering central auditory process disorder, i encountered several difficulty that compromise my job. The diagnosis only known just before i end my houseman ship and was confirmed by 2 senior audilogist who expert in this condition
1/ Ive difficulty to understand speech / communication in noisy enviroment, esp in ward round, or grand round. I often get clueless of what that being discussed
2/ I have difficulty to differentiate word that sounds similar, ex like goat vs god, vac (vaccum) dressing vs wet dressing, thirteen vs thirty, Sometimes my senior doc instructed me to give drug A .10 mg, but i missed the “.” and heared 10 mg instead 0.10 mg
3/ Loss of short term memory, example my boss asked me to send patient to OT, but when there is sound distraction , i suddenly forget everything. This is also leads to difficutly in my ward round since i cant recall the case that ive clerk or patient that im in charge. Normal people usually can remember average 7 items list. But i only can remember 3.
4/ Poor secondary language acquisition
5/ Poor word retrieval or expression…i find difficulty to find words that im trying to say or to express my self. Sometimes i know what to say, but it seems however i lost the word. So such behaviour gives bad impression on others
6/ In order to compensate the difficulty of understand speech, i used more energy to focus . In other word, my brain works harder as compared to normal people. Therefore i tired easily…and when i grow tired, the symptoms are worsening
The audilogist told me that they can train my brain through brain exercise. Unfortunately, they dont have the exact program for adult since central auditory processing disorer is still new in malaysia. SO they suggest me to train myself, through a unique computer game in internet that can train my memory, focus and other aspect of the brain. However…the progression can be very slow. Time goes fast and i understand many MO already competing each other to do their master program and i lost that opportunity as time flies. I am still lost confidence in doing any mastership, in view of bad experience of being label as “clumsy doc” from my previous HO and early MO life. Im doing fine in quiet and calm clinic. Im thought im gonna take family medicine, but in the program required a clinical rotation in ward. I cant afford to work in noisy and hectic enviroment esp in ward due to limitation i mentioned above. I try doing pathology, but the life, sitting still on the bench is boring. I know that i am very ambitious people….I dont want to give up.
When i tell this to my friends….they ask me, how come u can be a doctor?
Maybe because i am not that person that easily give up and continuing struggling. When i ponder of my past….i realized i had already have similar problem when i was primary school and secondary school. But i am able to compensate my weakness by being hardworking and reading lot book. But when the moment i start working , i start to see my real problem that was once never been diagnosed. I always wish that i know my problem before i choose to be medical student, so that i can choose different path. I understand people who have central auditory processing disorder are good in computer, arts and music. I thought of doing a movie director and i am good in those. But at the age of 31, do i have opportunity to excel study in different course….esp thinking how much money that i had spend in my medical school. I dont want to waste my money….i already ends up something that i am not supposed to be. I am still clueless….i have not yet discovered any doctor that have similar problem as me to share or a role model. Ive been continue looking for answer…..and every question is a disappointment. When i post this story here….maybe im expect a miracle answer. Who know….this time god wanna help me. I want to do something different than others….expertise in medical history, medical journalism , but the course still not available in malaysia
I’m a Malaysian doctor but working in the UK after completing my housemanship in Sarawak some 10 years ago. I left not because of the working hours or the difficulty of the job – but simply because of a quota system I was tired of living with. There are a lot of solutions to the problems highlighted in the press. I did medicine as a postgraduate degree and it is certainly something that Malaysia should consider because you get a different perspective of things when you enter as a ‘mature’ student. Entrance criteria need to be made more robust, regulation of training through a training board scheme which exists in the UK (that also allows for a more equal distribution of doctors), efficiency in processing resignations, regulation of standards though the MOH/ MMC are just some of the steps that will help the problem. Question is who will be willing to make these hard but crucial decisions? And please don’t penalise or condemn people who go abroad – I was desperate to stay in a country I was born it, but the ‘system’ did not recognise my contribution. So I sought greener pastures where opportunity is given to people based on merit, something our country needs to understand if we are going to reach a developed nation status.
In Bolehland, whatever you said is either sounds Greek or seditious!
Are you the same person who was in IMU? Probably in my sister’s batch, similar name as mine? 😉
But yes, agree with your sentiments, especially the criteria for ‘mature’ students in a society that decrees that fasted is best.
Hi Dr. Paga,
Thank you for your informative blog entry. I believe our housemen training are set to fail the young doctors; not only physically or mentally “weak” candidate but also those who can’t play the ‘game’ as a civil servant. That is not supposed to be if the training is a good one, with the intention to strengthen the healthcare system. 1 in 5 dropouts is an alarming statistic. It shows the training system has failed, not just to blame the young doctors.
When I entered the training as a young houseman years ago, I was so shocked with the system. I entered a medical school in India with my 10A1 SPM result, graduated first class so I was entitled to pay only 1% of my student loan. I endured the training despite all the negative discoveries while saving my salary every month. I did not even buy a car. When I was in my 6th posting, I resigned from the system. It happened after I tried to report a case of a senior surgeon who tried to molest my fellow houseman. The surgeon repeatedly forced the HO leader to put the pretty HOs while he’s on duty. One day after a long OT day, my friend came to me sobbing. She told me that the surgeon tried to groped her in the lift. It was a Sunday so the hospital was quite empty. I wrote a complaint straight to the hospital director. I met the director personally and he gave assurance that the issue will be investigated. However, no action taken to the surgeon but my life was miserable after that. I was being attacked for so many ridiculous accusations. The surgeon told my supervisor to extend me. The system in Malaysia shield the superior. With all the savings that I have, I migrated to Australia. I took Master in Health Economics while completing my AMC. After a year, I graduated with a master and passed my AMC exams. While waiting for the internship, I worked as a research assistant with a professor in cancer study. It was 5 years ago, currently I am just entering GP training. Life is very good here. To get a position as an IMG intern is difficult but if you are good and you have a strong determination, nothing is impossible.
I am writing this to make you aware that not all who quit are the bad apples. I know few friends who quit because the don’t have faith in our system any more. Not because they are ‘weak’. If the system is very good, why our Health Minister’s daughter quit her MO KK job and move to Melbourne recently without completing her compulsory service?
The comment made by Dato Jeya about Malaysian HOs working less hours than UK & Australian interns are *bullshit* (excuse my laguage). Malaysian HOs are overworked and underpaid. There are various reasons why a HO quit. Ask the MOH to reveal the truth. More HOs nowadays quit because they are more prepared to leave the profession. With a blogger like you Dr Paga, we can gain information to plan what to do next. You are a very honest person.
DrM
As i have said many times in this blog, it is the SYSTEM! As long as we remain with the current system, nothing will change.
I agree the system is a faulty.
But at the same times, in a different view, there are too much demand from public as well.
Parent will complained my son got 10 A in spm but couldnt get into medicine!!!
How would goverment responded to this?
Some doctors however refused to be transfered to sabah and sarawak…too much complaint letter comes out.
I think there are also need to look into considerarion the complaint that goverment has to face
The government should not compromise quality to quantity. The problem in Malaysia is the fact that nothing is transparent, not to forget the race based policies. Thus, when a person is not selected, parents will complain. If it is transparent like in many other countries, no one will complain if they are not selected. Results alone is not good enough to enter medical schools. The government should limit the type of pre-u courses that can be used to enter medical school. SPM does not mean anything!
The issue of transfers is nothing new. Why should the government entertain in the first place?. You are an employee!This is again a problem within a civil service. Nothing can be done if they don’t want to go. However, this issue will be solved when there are no more post available. Doctors have to go where they are posted if they want a job.
“More HOs nowadays quit because they are more prepared to leave the profession.”
I think you are right DrM. During my time, like it or not we have to keep going. Some survive, some find peace by just accepting the fact that we have to do it. Medical profession, like other jobs on earth, if you hate it leave it. Every 25 y/o mature house officer should decide by themselves what kind of life they want to lead. Why the news make it looks so bad if the doctors quit? My only concern is those young doctors are the bright ones. The country should utilize them to be the thinkers. Hire them as researchers. Do not let them be a pasar malam boy or stewardess or salesman.
As i have said many times before, many quit because they never thought that doctor’s life was like this. When they face the reality, they realise that it is not for them
It is very expensive to train a doctor. If a doctor give up practices, it is wasted resources. That is why all properly managed countries manage this very carefully, since they are mostly public funded. The proper numbers are trained, the correct candidates carefully chosen, to minimise attrition from whatever reasons and avoid joblessness.
Just because in Msia, most are privately funded does not mean the same care need not be taken.But unfortunately, politics interfere in cohorts with businessman, and it becomes not an issue of managing healthcare needs, but maximising potential profits. A ready market feeds this, with parents clamouring each other to enrol their children. Unlike other countries where only the creme de la creme and the most keen ever considered the career, excess capacity means ‘everybody can be a doctor’. One recruitment agency went as far as using this tag: ‘a doctor in every family’!
There are many jobs a graduate doctor can do outside clinical medicine. However, then too many quit, it wastes resources, and indicates something is VERY wrong in the system.
Our country has lost one precious gem, DrM. I believe this brain drain thingy should be curbed ASAP or our country will be the laughing stock of even a small country like Timor Timor.
The problem in our medical training system actually occurs at the lowest and most fundamental level;medical education itself. Tun M once said that meritocracy shall be the basis of selecting people for jobs and educational opportunities so that only the brightest and ablest will be the stewards of this country in the future. But as one of those who have been serving in the public university for a few years, meritocracy is completely nonexistent. As I have posted in the previous article by Dr P, even a candidate with a CGPA 2.70 was selected and sent abroad for further training under the trainee lecturer training scheme of our public university (SLAB/RLKA) and this will create nothing but further deterioration in our current medical education system since future generation of doctors will be trained by a sub-par lecturer (third-rate students will create abysmal lecturers). Besides, I totally concur that the brightest and ablest house officers are the ones that quite prematurely from the service since no room is given to them to hone their skills and independent thinking skills during their professional career. What they really need is a good mentor who will polish their shining quality that they already possess, somebody that they can look up to. But as you can see, only those who always kowtow to their bosses will be the ones who survive the training (it seems ingrained in our Malaysian mentality not to encourage people to think independently since we are more interested in producing apple polishers and bootlickers).
And again I concur with what TonyC said in his posts, we should try to encourage these gems from quitting the medical profession by opening up more career opportunities in research. I have seen too many good house officers who eventually ended up as medical underwriters and waiters/waitresses in fast food outlets whilst I ended up with a bunch of staff in the departments with annual practicing certificates (APC) but couldn’t even solve simple problems on research design or statistical analyses. I wish I could trade off all these losers with one of those bright “overqualified waiters/medical underwriters” since they will serve our department and research endeavors better than those bunch APC-flaunting doctors. But again, as DrP once said, our system is rotten enough that even a mere suggestion that a doctor without an APC should be allowed to be a trainee research lecturer in any of the basic medical science areas (immunology, physiology etc) is already considered as something contemptible and loathsome. In the country where I underwent my training (undergrad and postgrad) I have seen so many intelligent students who didn’t do their housemanship (foundation years) at all but ended up making tremendous groundbreaking discoveries in medical research. Perhaps, if we can create an avenue for these poor and misguided souls, we can tap into their potential for the benefit of our medical progress. What is better than a homegrown talent.
Just to satisfy one’s curiosity, I am a Bumiputera. The brain drain is no longer the issue of non-Bumi. The tsunami of professionals leaving Malaysia will become worst. When I first came to Australia, I believe I won’t be able to practice as a clinician. I took Health Economics which is a speciality under Master of Public Health. I enjoyed Epidemiology & Statistics tremendously. My proficiency with SPSS and SAS helped me to get through research job and eventually a post as an intern. Here, people recognize talent. I am still very much interested with research field. Being a GP with research abilities is an added advantage. I thank Australia for the unbiased opportunity, even for a Muslim like me.
Have a good day.
DrM
From your first comment a day ago, I know you are a bumi when you mentioned about the 1% payback. Only MARA does that!
The feeling you got in Australia of being unbiased etc is not the feeling that Non-Bumis get in this country, despite being a citizen. We are forever known as pendatangs who must not question anything as the country do not belong to us.Almost every non-bumi that I talk to has plans to migrate.
While I agree with all your statements, I disagree with one statement. It is about Tun M and meritocracy. Tun M is the very person who destroyed meritocracy.He was the one who only wanted one race to dominate everything and created all the mess that we are in now. While he developed the country physically, he destroyed racial harmony and created a society which is only interested in rent seeking. Our civil service went down the drain because of his “1”race civil service policy. Thus, meritocracy was thrown out of the window. Then at the time he was about to retire , he “so called introduced meritocracy” in university entrance, very well knowing that matriculation is not the same as STPM and major bulk of students entering university were from matriculation. Then he created private medical institutions for the non-Bumis so that they will not disturb the public universities.
Dear Dr. Pagalavan,
Good evening doctor. Thank you for your informative blog which give me a closer look on a doctor’s real life. I would like to ask Dr. a few questions regarding medical course. Beside the famous research university, which comprehensive university is better? Are they all the same(for universities which teach medicine), from their teaching method to the textbook? Secondly, between UPNM and UniSZA which university is better in medical? Thirdly, I would like to know is all the MO and houseman position in Sarawak fully filled? Will there be a very high chances for me to be jobless when it is 2020?
Thank you.
No 2 universities are the same. They use different curriculum and teaching methods. Both UPNM and UNISZA are relatively new, can’t comment.
At the moment, Sabah and sarawak is still OK. However, post in peninsular malaysia is almost full.
Hello Dr Paga. I ve completed Part 2 Mrcp and vying to sit for PACES soon. I want to be an immunologist. What is the pathway? Is it PhD or rheumatology subspeciality training?
Thank you
Frankly, there is no clinical specialist in immunology. It is under research category. There are some Rheumatologist(already a sub specialist) or even haematologist who does PhD or some attachment in basic immunology. Immunologist is mainly reserved for basic science researchers in immunology.
Immunologist is under subspecialty of microbiology
The solution to all these so called problems by HO is easy…increase the salary. Once this happen, there will b no more complaining long hours bla bla bla as the salary is worth it. Why they dont think of this or fight for this instead of fighting to reducee time of working? Hehe
Nope, that will not solve the problem. The salary of doctors doubled since 2009 but complains have increased!!
I dun think its doubled. Last time ho used to get on call allowance. Ho in sabah can earn up to 6-7k per month. Lol
HO salary before 2008 was only RM 2000+ compared to RM 4K now. HO in east Malaysia get additional Elaun wilayah which they still get till today.
Increasing salaries will not solve the problem, since the problem is NOT low salary. Trust me, money cannot solve ALL problems, unlike what some may like to think.
In fact, there was a time when junior doctors were paid less than drain cleaners, on an hourly basis, yet, there was less of this sort of issues.
On hourly basis they earn less…but try to increase the income to 6k instead at least
No they don’t earn less. HOs are working on shift duty now unlike before 2011 where they even work 48 hours straight!
Why not having a more ‘standard’ common entry exam before get admitted into med school?
Or why not just reduce/limit the intake of med school-for goodness sake!
Instead of wanting them to complete a 5 year course(after all cash in investor’s pocket) and then another common entry exam. In this case, i can take law degree and if i am smart enough to self study medicine, thus able to clear the exam even without cleaning med school, becoming a doctor and work in a hospital.
Politically not acceptable. Vested interests in IPTS want to make money, cannot restrict.
I am an MO at KK in Kelantan. Strange but most of my peers who quit the job as a house officer are the good students. They got good SPM result and passed med school with good grades. So it is difficult to link the competency issues with high HO dropouts. Usually those bad ones who cannot even read proper ECG will still become an MO. HOD wont keep them in the department. Sad to say but in reality it is a waste of talent as most HOs who quit are actually the good ones with bright potential. Reasons why they quit varies. MOH needs to take this matter seriously. Stop blaming the HOs just to hide the bad training system.
Having a good result does not mean they can take the stress. Furthermore with the current education system where everything is spoonfed, many of the younger generations can’t handle stress. It is the same in all other field as well.
That’s why I started this blog to let these young budding doctors to know what being a doctor is all about. If they think they can face the challenge, then go ahead
If the problem is the stress, we need to help on that problem. I think that is what DrM tried to convey with his/her opinion that the training is set to fail the young doctors. Instead of blaming the young doctors cannot handle the stress, we admit the problem and improve it. Inarguably, most of them are brilliant (if not they won’t pass med school). They have the brain but not the courage. We need to mould them, like a guru with his apprentice. It seems like the supervisors are not doing their job well. But to blame them is also not fair. HOs supervisors are clinical specialists who do the training without extra salary for the role. They are already overwork. This is what happened when the govt try to reduce healthcare cost by using the doctors and other healthcare staffs to do more work. Everybody in healthcare will burn out eventually. Maybe GST can help, maybe. Or perhaps Najib’s menantu can help.
Passing med schools is not as tough as it use to be. The failure rate of our local medical schools are almost 0%! Have you heard of anyone failing?
The entire healthcare system has to change. Until we have an integrated healthcare system under one scheme, it will NEVER change.
Being a doctor is stressful. I still work 24hrs a day 7 days a week. I was incharge of housemen for almost 7 years before. Even then we had similar problems of Ho quitting and MIA but to a lesser extent. When I sit with them and talk to them, the answer has always been the same: I was forced by parents, I never thought being a doctor is like this, I thought being a doctor is just sitting in a clinic and seeing patients etc etc. That’s the reason I started this blog in 2010. Being part of civil service also does not help as the deadwood doctors will remain in the system doing nothing!
Medicine cannot be done as part time or online! Yes, i agree that there must be a standardised pre-U course to enter medicine like in developed countries. We should throw out all those foundation courses out there.
saya seorang doktor, habis housemanship 2014, jangan risau pada adik2 ho atau medical student y lain, kenapa kita berada di bidang ini kerana tuhan tahu kita mampu, saya ho di hosp batu pahat, antara pengalaman yang saya tidak dapat lupakan adalah sewaktu di bahagian perubatan, dimana satu-satu department yang tidak mahu gunakan shift system, saya masuk kerja pukul 2 pagi untuk review 24 patient before morning round by fierce specialist dan ada satu waktu disaat dikatakan lambakan ho dimalaysia oleh media dan blog2 begini kami di batu pahat sebaliknya 2 ho kena jaga satu ward perubatan yang jumlah patient 40-42 patient, bayangkan di wad perubatan dengan review dan prosedurnya, jadi apakah benar apa yang diberitahu oleh media kerana ada hospital yang tidak cukup ho seperti dihospital saya atau disabah sarawak dan ramai ho y quit kebanyakan yang saya lihat akibat tekanan ditempat kerja oleh senior(mo, specialist dll), so jangan peduli dengan media dan blog2 sperti ini, ikhlas da kuatkan hati anda
I have proven many critics wrong. Firstly you must understand that the number of housemen in each hospital is determined by the number of specialist in the particular hospital. Secondly maldistribution of doctors occurs everywhere. That’s why the shift system does not work in every hospital.
So please read this blog from a to z before making a comment
Dr Paga, I hope Dr Hisham the DG read your blog. This issue needs a serious intervention. If more young doctors continue to quit, our generation fails them. Hisham seems like a reasonable man, at least more proactive than our Health Minister.
Yes, I know he reads this blog. Infact, he even shared one article I wrote before in his Facebook!
Sometimes i wonder dr paga….
i cant deny the truth that u mentioned in this blog
But despite the condemn and critic, where are u in kkm fixing this thing into the correct path?
If all good doc like u run into private…than how the goverment system will works better?
I was in KKM and was in national SCHOMOS for 3 years. I must admit that i gave up as the administrators are not people who will listen to you. FYI, the time based salary scheme enjoyed by many now was single handedly written by me in 2006 after a SCHOMOS workshop before submission to minister. So, i have done my part but as long as the government do not listen, nothing can be done.
That is the problem with our system which also can be seen in our education system. Most good apple in SPM will choose to be a doctor, pharmacy, dentist. However the remaining average or poor apple will choose the other remaining field and than they cause problem within that field
Even in medical profession, we see many good and excellent doctor do a lot of clinical work, n the remaining those who fail to excel in clinical will do the admin. Only few excellent doc doing the admin
I am sure you would have heard of “A grade students work for C grade students”?
Hi everyone. Thanks to Dr. Pagalavan for sharing info and experience about the doctor’s life. I am currently studying at foundation level in one of the IPTA.I really need help from the experts as well as advice and also motivation. About GMC, do GMC recognise the medical degree of IPTA here? Sincerely, I am really determined to further my clinical masters at UK and then become a cardiothoracic sugeon. Among IPTA, NUMED and IMU, which one is preferable for me to pursue my undergraduate studies in medicine so that I can continue to take clinical masters at UK? Please help me. Thank you so much for your concern
None of the degrees in Malaysia except NuMed, is recognised by GMC. However, in order to be registrable in UK, you need to do internship in UK where the chances are almost NIL. So, if you can’t get a job in UK, you will not be able to do any postgraduate education in UK. However, you can do some attachment as part of your local training program in Malaysia. Please read all my other blog entries, the answers are ALL there.
Snd also read my blog entry on cardiothoracic surgery
IMU is also not recognised by GMC?
Nope unless you do their twinning program in UK
IMU MBBS is not recognised by UK. Why would you think it is? However, students in the PMS stream, and matched to a UK med school for Phase 2 will graduate with the degree of that matched Uni, and will thus have a degree registrable with GMC, subjected to completing F1.
Haha…u reminds me the day when i was young as medical student. When asked, what do you want to be..most will say they want to be cardiologist, cardiothoracic, surgeon. But after they completed their housemen…everyone changes their interest. Believe me…. Each specialty has its own personality. U will know once u undergo each specialty. For exanple anaesthiology is good for those perfectionist
and some will quit all together!
just to leave my 2 cents here. I’ve been following this blog for some time; the message here is timeless and intended well. If you feel angry with the author of the blog, it means ur not tough enough to survive the profession in this country. If these words hurt your ego so much that you feel the author of this blog is doing a disservice to the medical practitioners of this country, then you still need to makan more “asam and garam”.
The advice in this blog is like all good medicine, it may not taste well; but it will certainly do you some good.
Monash do fail their students.
Yes, what percentage?. I was with Monash before. Some will resit the exam and pass, and some will repeat the year. How many really quit?
MSU University is one that expels underperforming medical students.I have seen it for myself!
Yup, what percentage?
Regarding moral harassment to the interns by their superiors, is there any law in Malaysia to prevent it? I am surprised to read the comments from your previous post that the young house officers are supposed to toughen up and accept scoldings. That is not how professionals do their job.
Scolding for serious mistakes and harassment are 2 different issues. There are no laws to prevent harassment. Furthermore you are talking about our civil service where no actions can be taken!
My experience….
Because i dont understand what the paeditrian told me.
She told me to balik indon
Hi, I am a SPM graduate and I am interested to study the field of neuroscience and become a neuroscientist, especially in the field of cognitive neuroscience or neuropsychology if possible. I was told that medicine is the pathway that leads to that particular field although psychology is one way to go, but I am afraid the chances of me looking for a job will be low. I have understand that the doctors in Malaysia are overflowing and that the life whether during study or work will be tough. My question is, is there any other pathway for me besides medicine to be able to study and research on neuroscience?
Becoming a neuroscientist need not necessarily be via medicine. It is a research field and not a clinical field. However, being a doctor and venturing into pure research gives you a better understanding of what people want. However, becoming a doctor and then going into this, is a very long pathway. Secondly, research is very much underdeveloped and underfunded in Malaysia. You can also become a neuroscientist via pharamcy, biomedical, biochemist etc.
I have considered biomedical science and biochemistry but I am afraid that the career prospects in Malaysia after graduate is not as good as a doctor. For example, biomedical sciences graduates would only work in a hospital involving in tasks like analyzing blood samples etc. The opportunity to involve in research related fields is scarce plus it is not a hot subject yet in Malaysia. If I study Masters in either biomedical or biochemist, would I have more options in looking for a more promising career?
Actually Biomedical is more than that, there are many fields that you can work in. If you are interested in research only, doing medicine is a not a good idea. Almost all doctors do not do basic science research. They do clinical research. If you intend to do basic science research after MBBS, you need to Masters in basic science after completing your housemanship/MOship. It is a long journey. The other option is to do basic science course and then go on to do Master’s in basic science.
Hi Bryie12,
To become a neuroscientist, you can take Bachelor of Advanced Science with a major in neuroscience. You can take your Honours year after that and continue with phd (usually by joining a research team as a research assistant/associate). You may find this website helpful to answer your questions https://www.neura.edu.au/
DrM
Thank you