In 2012, I wrote 3 parts of the said topic above. The first was on criminal accusation of doctors and the second was on medical negligence. It looks like, the issue that I wrote in my 2nd part is being revisited by the Star today.As I said in my previous article, the current generation of patients are different compared to 20 years ago. They are more demanding, disrespectful and ever ready to sue doctors when something happens. This is something that the budding doctors should realise before doing medicine. The ” I want to help people” rhetoric is not the same as before. You can “help” thousands of patients but a single error will make you to quit medicine all together, not to mention the huge debt that our current generation of students are graduating with. Interestingly, it is the same Generation Y who are becoming doctors and complaining about the working environment/hours. Imagine your own generation will be the ones who will be suing you.
Today’s Star (see below) reported that many private obstetricians are quitting practise due to increasing litigation rate and high indemnity insurance. Well, that is a fact. The number of legal suits is increasing year by year. As our DG mentioned in his reply, the number of O&G suits for MOH last year was 18, an increase by 10 compared to the year before. That is more than 100% increase. As more and more “successful” stories begin to appear in newspaper, more people/lawyers will be going after the doctors. Recently, the court also awarded RM 6million for a spine case in Penang. The name of 3 doctors were clearly mentioned by the news.
With the increasing litigation rate, many O&G specialist are finding it difficult to cope. Their stress level is very high and they can’t afford to make any mistakes. This has resulted in many private O&G consultants pushing away high risk cases to government hospitals. Some have stopped practising Obstetrics and some only does Caesarean sections. I remember when I asked many budding O&G specialist, why they want to do O&G, the answer use to be “ I am dealing with 2 lives and I am happy to deliver a new life to the world“. Well, that was the noble intention. However, this nobel intention is not nobel anymore in this capitalist world. Very few appreciates what we do. In private sector, the word is ” I pay you to deliver my wife. So, no mistakes please!”
The last Cerebral Palsy case was awarded about RM 7 million. I know few more cases pending in high court and one of it is standing at RM 10 million. Due to this increasing amount of awards, almost all indemnity insurance companies had increased their premium since the last 2 years. MMI has increased their premium for Obstetrics by almost 100% with maximum coverage of about RM 5 million. So, if you get sued more than that, you need to pay out of your own pocket. The premium for the RM 5 million coverage is RM 35 000/year. MPS (Medical Protection Society) which is an international organisation and the oldest indemnity insurance scheme, use to cover unlimited amount with occurrence-based coverage. However, starting this year, they have made some adjustment for Obstetrics. They had reduced their premium from about RM 70K+ to about RM 45K. Unfortunately, the maximum coverage in only RM 10 million in aggregate (pending MPS council approval) and it is “claim-based coverage“. This basically means that you may end up paying out of your own pocket if the council decide to cover only certain percentage of the amount. Furthermore, you must continue paying for years after you stop delivering babies as you must be a member of MPS at the time the legal suit is filed. Legal suits in O&G can appear at your doorsteps 5-10 years after you delivered the baby! Meanwhile, the consultation fees are regulated and limited by the government. So, the consultants can’t charge as they like to support the increasing cost.
This phenomenon will in turn increase the number of patients delivering in government hospitals. At this point, government doctors are indemnified by the government. While I do not know how long this will last, the workload and stress level in government sector will continue to increase. Remember what I said in my previous article? No matter how many doctors we have in government sector, the workload will never reduce as more and more patients are becoming ever more demanding! There is no such thing as easy life, easy money and good future in medicine anymore. Everything that I have been saying in this blog over the last 5 years is slowly appearing in mainstream news. Only those who can handle the tremendous amount of stress and true passion can endeavour. Unfortunately, even then, many will quit.
Unless, the entire healthcare system in this country changes, the situation will not get any better. With the increasing cost and litigation rate in private sector, there will come a time where the private sector will collapse. The government must come up with a Healthcare financing system to address this problem.
Obstetricians are quitting
BY TASHNY SUKUMARAN
PETALING JAYA: Senior obstetricians in private practice in the country are opting out of delivering babies as a result of changes in their professional indemnity coverage.
The shortfall of these specialists is expected to create a rise in the workload in government hospitals, increasing the possibility of sub-standards or delays in maternity care.
The Medical Protection Society (MPS), the world’s leading indemnifier of health professionals, changed its policy for obstetricians and gynaecologists this year – from occurrence-based protection to claims-based coverage, under which these doctors have to pay annual premiums for 25 years.
This means if a doctor retires at 60 after delivering a baby, he or she must continue to pay for the coverage until the age of 85.
According to the MPS, the changes were made because of global challenges and risks associated with obstetric claims and litigation.
In Malaysia, the highest protection coverage is taken up by obstetricians, who used to pay more than RM70,000 a year for unlimited indemnity.
Under the claims-based coverage, the amount to be paid annually is lower but the time frame is longer.
More than 500 obstetricians and gynaecologists are covered under MPS, which has over 4,000 members in Malaysia.
MPS has more than 300,000 doctors, dentists and medical students as members worldwide.
Dr Tang Boon Nee of Subang Jaya Medical Centre said many of her colleagues had decided to stop delivering babies as a result of the change in policy.
“As we are liable for up to 25 years after delivering a child, many of us who are older obstetricians will have to pay for coverage well after retirement,” she said.
Dr Tang, who has been an obstetrician for 20 years, said “phenomenally high” damages had been paid out in obstetric claims.
“There was a case last year in which the amount awarded was RM6.9mil. To protect ourselves, we will have to continue paying MPS well into our retirement because of the claims-based system.
“It is not fair as many of us will not be making that much money,” she said.
KPJ Damansara Specialist Hospital’s Dr Gunasegaran Rajan said the occurrence-based indemnity had no ceiling on coverage, but claims-based was capped at RM10mil.
“Recent payouts have already touched RM7mil, and this can only increase. I would have to pay out my of own pocket if the damages awarded are above RM10mil.”
He said that his best option was to stop practicing obstetrics as the future left him vulnerable.
“It is a great shame that the skills and knowledge many obstetricians have acquired over the past 25 years cannot be used to help Malaysian women’s maternal health due to this policy,” he said.
Another obstetrician and gynaecologist, Dr S. Shankar, said doctors could not run the risk of not being covered.
“We don’t have much choice. Our legislation should come up with a better system, like New Zealand which has a no-fault compensation scheme. Personally I will get out of obstetrics as fast as I can.”
In a statement to The Star, MPS defended its policy change, saying that claims-made protection was the more common form of coverage for obstetricians in many countries.
“Claims-made protection requires members to be in continuous membership both at the time an adverse incident takes place and when it is reported to MPS to make a claim.
“It was introduced to price subscriptions for obstetric risks more accurately and fairly as it can be difficult to predict long-term risks.
“This is because obstetric claims can often arise many years or even decades later,” it said.
MPS assured members that even with the new system they would continue to receive high-quality service and support.
Substandard maternity care possible, warns Health D-G
PETALING JAYA: Health Ministry director-general Datuk Dr Noor Hisham Abdullah said there would be an increase in workload in government hospitals and risk of substandard maternity care if the private sector loses its obstetricians.
“With the obstetrics and gynaecology specialists almost equal in numbers in both sectors, there is definitely going to be increased demand. We will not face a shortage of O&G specialists but rather a mismatch in the distribution and the corresponding workload.”
“It is also important to note that there will be a definite spill-over effect to the neonatal and the anaesthetic services. With this scenario, there will be an increased chance for delayed or substandard care,” he said.
Dr Noor Hisham said the excessive court awards and punitive damages used to penalise doctors would negatively impact doctor-patient relationships.
For the public sector, all negligence claims costs are borne by the Government.
Last year, 18 cases involving obstetric cases were filed against the Ministry of Health, 10 more from the eight recorded in 2013.
A total of 462,626 babies were delivered in both private and public hospitals as well as by private midwives, alternative birthing centres and estate hospitals.
Out of the number, 63,063 were delivered at private hospitals while the most, or 83.9%, were still delivered in public hospitals and clinics.
Meanwhile a medical law lecturer has called for research on the effects of changes to indemnity protection for obstetricians and gynaecologists.
Dr Sharon Kaur of Universiti Malaya said the authorities should look at court decisions, amounts awarded and gauge if the changes in policy could have a knock-on effect.
“If private healthcare services are cut, the burden will fall on public services,” she said.
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Many private Obstetrician and Gynaecologist are doing Gynaecology alone If they see below22 weeks of pregnancy or only gynaecology then insurance are much lower There’s a fear that ultimately it will be government based care One suggestion is to cap claims like in Singapore or C Section for all as in Brazil or Government based care as in Ireland
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yes, indeed.
So the pattern now will be to have all Obstetricians with Public Hospitals . That would indeed be a blessing in disguise ! We could have Heli landing too !
I reckon things have to be put into perspective. Firstly having read a few of the large award judgements ( Samantha vs Gleneagles/Jimmy Tang, Sa-Art vs Dr.Noor AIni) – none of the claims were for punitive damages – in lay man speak – the plaintiff never asked for any damages in order to punish or penalise the doctor. The awards were all compensatory in nature only. Bulk of the award was for future care. I reckon with the advancement of medical science and coupled by the fact that society at large have higher and better expectations of life – the future awards may appear to be high but in reality is reflective of todays cost of living.
Again comprehensive study has to be done to determine if the indeed the rate of litigation has increased. We must bear in mind that the number of doctors have grown exponentially over the past 10 years.
In respect of the available medical indemnity in Malaysia – well there is a Malaysian mutual – http://www.mdm.org.my who offer occurrence based indemnity similar to what MPS used to offer in the past for O&G’s and Lonpac Insurance Berhad now also has a tailored made cover for Obstetricians for Limits of upto RM 30 Million. Further Lonpac rewards members with no claims with upto 20% No Claim Discount.
The award would not be given if there is no medical negligence. While the award is to cover the medical cost for the patients, it is a punitive action as the doctor has been found negligent. The payment comes from the doctor and some from the hospital. It is the doctors who are in the centre of the trial.
Each indemnity insurance have their pros and cons.
I wonder if bringing in the national healthcare insurance will be a better move in the long run, like what the DG claimed. Firstly, there will be less of “I pay you so make no mistake” kind of threats to the doctors; and secondly, a more sustainable healthcare coffer for the nation; and thirdly, a better prospect for the GP’s (who are in the sunset industry due to sheer amount of competition from med graduates and the pharmacists). What do you think, Paga?
As I said, the entire healthcare structure must change. Only then the government will be able to control it. At the moment, the government will care less about private sector.
Shifting the Obstetrics care to Government hospitals just shift the risk of litigation to the Govt, it will not lessen it. The figures Dr. Hisham quoted shows the rise in litigation is across the board, not just in the private sector.
This is not a new phenomena. Most of the developed countries have gone through the same before. We just need to look at their experiences and solutions, and adapt it to our setting.
The basic change needed is tote reform on award size and eligibility for litigation, and a realignment of expectations by the population. Or simply, a no fault compensation like NZ. Each “solution” brings with it, another set of problems.
It’s not that the ‘quality’ of the doctor has fallen, but the ‘illiteracy’ rate has been improved. Our society is getting smarter day by day. Admit that you too did at least 1 mistake during your internship year Dr.Paga, and that you too had at least once lied to cover up your mistake.
Dr.Mahathir can sack 3 of his DPM during his time without any uproar of the public. See what’s going on with our current PM? People get smarter.
It’s both! The quality of doctors has definitely gone down. And as i said above, the society has also changed. That is a well known fact. Being a doctor, you can’t run away from mistakes as we are just humans. It is the type of mistakes that matter.
MMA had proposed a new structured fee schedule that takes into account the annual changes in cost of practice, consumer price index and the changes to medical indemnity premiums to the various specialist societies. Unfortunately, a few of them rejected this new system and now they have no means of adjusting their fees. The MOH was and still is willing to consider the MMA’s proposal if all the specialist societies will unite and accept this proposal.
It is easy to commit mistakes in medicine rather than save lives/help people. Many failed to realize that.
One day , A neurosurgeon asked us about the reason of taking medicine, One of my classmate answered , ” because I want to help people”
“help people ? You don’t know how many people we have killed ! “
that must be the most sarcastic neurosurgeon in the world
the neurosurgeon should have said,” you don’t know how many people we CAN’T help”
soon malaysia will become like some other countries, obgyn doctor set up private clinics for prenatal/uss check up only, no delivery. once it gets closer to full term, pt will be referred to / go to government hospital / or bigger private hospitals that handle deliveries
Where the risk of high potential loss is greater, the more doctors will need to seek the services of Accountants and tax agents to minimize exposure to potential threats. One of the many reasons why doctors are advised to incorporate limited companies to run their operations and structured in such a way that they are in employment and not the risk the exposure of their hard earned wealth.
It does not work that way. The hospital’s agreement is with the doctor and not the company.
The law as it stands at the moment, does NOT allow doctors to hide personal liability behind a limited liability company. When people sues, they will sue the doctor as a person, NOT his company.
Dear Dr,
I was a top student back in school and wanted to do medicine. However, failed to obtain any scholarship at spm level and did not get into any med courses in public uni despite having CGPA 0f 4 in STPM back in 2008. I was given an engineering course which i proceeded to complete and am now currently working as an engineer in a small company.
Problem is i hate the job. Feel no sense of attachment to it. Working only to pay off my bills and i do not know how much longer i cn endure this torture. Medicine has been lingering in mind for a very long time. However, i do not come from a well to do family nor do i hav the resources to do medicine as a second degree. I know that Perdana university offers graduate medical program. but what are the chances of getting in? Financial assistance given?
Also, lets say i managed to get into a medical course, in 5 years time, what are my chances of obtaining a spot for housemanship? at age of lets say, 32? I follow your blog regularly and have been quite worried with the issues you have mentioned regarding over supply of doctors. Any input from other doctors are very much welcomed too. Thanks
I am surprised that you could not get into a public university medicinewith your results but that is Malaysia!
Every job is to pay your bills. That is why you work and get employment. If you are not interested in your job, there are many other things you can do with your engineering degree. You can jump onto another multinational company, work overseas or even go into teaching/academic life.
I know many who did medicine with great passion but ended up saying the same : I hate the job!You will not know the problems till you work.
Perdana students use to get full JPA scholarship but I heard the number of scholarship has been gradually reduced. You need to check with them. However I must warn you that Perdana is having some problem with MMC at this moment. I will not reveal much.
Yes, in 5 years time, aka 2020, the government would have achieved their “great” ratio of 1: 400 doctors! So, the waiting time will be long and whether you will get a job or not depends on our economic situation at that time. Life in medicine do not end with MBBS. It goes further. So, if you are going to do housemanship at age 32, at what age are you going to do your post graduate? What about married life etc. While age does not matter but life is.
Think carefully and decide.
i just started working as a doctor. i can tell you i hate my job as a dr. long working hours and patients complaining nonstop. high expectation from d patient;s family. d nurses make fun of u, colleagues leaving u alone in wards while they went back home to rest.
job is a job, it is never fun until u can make d fun out of it.
I sympathise with you, unfortunately you live is a country which discriminates, and while you had done your best and obtained the highest grades possible, the rules unfortunately is unfair to you.
However, going forward, it is not a good time to be a doctor in Malaysia. There will be too many, joblessness becomes a real possibility for the first time in our history, and you face the same frustration of people with lesser qualification getting ahead of you in the same non-merit based system. While in the past, the remuneration may compensate, this is also under stress, as income gets diluted by numbers. And condition of practice deteriorates as patients have higher expectations and litigation and cost of litigation avoidance increases.
However, we will still always need good doctors, so if you really really want to do it, go for it. It is quite common in developed countries to find mature students in Medicine.
Forget about the PUGSOM, John Hopkins has already left the collaboration and it is in some trouble.
Getting into any IPTS med school is VERY easy, so that is not an issue. Funding is more problematic, and NEVER get into a big debt for this.
It is sad to hear that students with stpm 4.00 cannot secure a place in ipta medicine.. Dont study medicine and leaving yourself with huge debts after grad.. the job is not secured anymore like last time.. think carefully before you decide…
I am not a doctor, but I would like to give you input as an engineer. i was exactly in your situation before, thinking of going back to school to do medicine when I started my engineering job as engineering was not my choice at the first place. But then I didn’t have much resource to do it, and I needed the monthly paycheck.
If you were to do medicine, you will need to wait another 5-6 years in order to get a steady income again. And if you plan to do it abroad, some countries pay very little or no pay at all for intern. the competition to get mo / residency position is high and will be high in malaysia. and there are not many medical scholarships around.
If you are a good engineer, try to get job in multinational comp. if you like adventurous/ challenging work, try oil and gas companies like schlumberger/ baker/ Halliburton/ exxon/ shell etc. Even if you feel no attachment to the job, the remuneration makes you think twice before you decide to switch career. Doesn’t matter which engineering discipline you come from, they take ppl from diff engineering backgrounds and give training. But with the current oil price, it is tough to get a new job now.
Another option is, like many other ppl from diff part of the world have been doing, try to get scholarship for master degree in the states, as not many school offering scholarship for foreigners in the UK, and get a job there after you graduate (or somewhere else). Hopefully by the time you graduate, the job market (especially in oil n gas) will be better. Rather than keep on doing the same job you dont like, better do something like GRE right?
this feeling of doing thing that you wanted to do always comes when you are not in the right situation. i also had a friend, while we were busy doing our group project in MSc, he was busy looking for options in graduate medical school. but now he seems enjoying his job in the wild world offshore.
engineering degree also doesnt stop you to go into finance. there are many engineers in financial sector now making loads of money
Looking at the way things are, I am certain that I may never get to pursue medicine as i simply do not have the finances to pay for another degree. Have to face this reality. Sigh
Since you too have had similar thoughts, could you kindly shed some info on how you handled it? Did you go into oil and gas? Or another field? What are you currently doing?
I am a chemical engineering graduate and have been thinking on venturing to oil and gas or something interesting. I attached to a ceramic manufacturing company and work is just mundane.
Could really use the input from another engineer. Thank you for your time.
im googling something else and landed here. http://tcm.moh.gov.my/v4/modules/mastop_publish/?tac=35 is this for real? ur thought on this?
(i) Bachelor of Ayurveda Medicine & Surgery (BAMS) [5 ½ years] – 11 seats
(ii) Bachelor of Siddha Medicine & Sciences (BSMS) [5 ½ years] – 5 seats
(iii) Bachelor of Unani Medicine & Surgery (BUMS) [5 ½ years] – 2 seats
(iv) Bachelor of Homeopathy Medicine & Surgery (BHMS) [5 ½ years] – 2 seats
http://www.indianhighcommission.com.my/ayush_scholarship.html
This is the MoH attempting to regulate a mostly unregulated and unregulatable industry. No matter what we say, the alternative medicine industry will continue, and remain highly attractive to a big segment of society. Through the TCM Act, it is hope that some semblance of control over this industry can be achieved. The aim is just to hopefully reduce harm arising from this industry via means to punish such practitioners. At the moment, the Medical Act does NOT extend to them at all.
it’s not about the Gen Y stuff with all the suing. it’s about people getting smarter. back then people don’t know what to do when cases like this happen. now, people are educated and know what action they can take.
people been going around saying that doctor is a more noble job compared to others. well. i disagree with that. a job is a job. do it nicely then its job well done. screw it up and off you go. other profession also suffer the same action. can’t take the heat of work environment? write a resignation letter and sit down quitely under mama’s armpit.
stop blaming gen Y. they wouldn’t have become spoiled brats if it’s not the work of generation before them which is gen X. they(papa and mama from GENERATION X) are the one responsible for this thing to happen. 18 years of spoiling for sure got embedded in someone personality. they’ve been programmed that way. only few of them manage to rise up on their own.
Hi Reena, there is a blog by Dr Simon Sim who was in a similar situation as yours before. I think he is now a neurosurgeon. If interested to read his blog just google it. He could be an inspiration to you.You decide your future,not others.
Yes and he is also still single. If you don’t intend to get married and have children, you can go ahead and do anything in life. During his time there was also no such thing as waiting period for housemen etc. He did his medical in RCMP which was offering UM degree then. He did the Master’s in neurosurgery in USM, would have just completed.
[…] that more and more patients are heading to government clinics for treatment. Due to increasing litigation rate in the field of O&G, the Ministry of Health had recently, in a letter dated 10/09/2015 increased the fee for O&G […]