Malaysia has become a laughing-stock of the world over the last few weeks. While TM Net still has not restored my home internet service since the last 2 weeks, luckily I have an alternative internet service to be able to write this blog. ON 8th August 2015, our DG gave an interesting speech at a conference in Port Dickson. The text of the speech can also be read below. From his speech, once again it is beyond doubt that we are running short of post for both Housemen and Medical officer. While HO post are rolling post, where only the waiting period will get longer, the MO post are permanent post. According to DG, MO post are almost 95% full with certain states being over subscribed (borrowed post). I know many who had completed HO this year being posted to East Malaysia.
According to DG, the government need to create about 4 000 new MO post per year for the next 5 years to achieve the desired number of doctors needed (20 000 new post). Do the government has the financial means to do it? Assuming average salary of a MO is RM 6K/month including “On Call”allowance (U44), we need RM 288 million/year for 4000 new MO post. So, 20 000 post will cost RM 1.4 billion in total, not including the rolling salary of the earlier created post ( the actual amount will be much more, cumulatively). I assume we can request for some tax free donation. It is still less than RM 2.6 billion!
The DG has also mentioned something about HO assessment/completion report(CCHT) etc. I am also hearing rumours that the Malaysian Healthcare restructuring is in final stages. The doctor: population ratio has already hit 1: 661 as of 2014, the initial target for 2016! We are 2 years ahead. There are also rumours that HO post will be eventually given on contract basis and subsequent application to MO post will be necessary. Thus CCHT may become important in your MO application process. IT also means that not all those who are completing HO will get their MOship. It is the same in most other countries as well. DG has also mentioned about shift duty for MO which is not applicable at the moment.
Our DG has also been conducting discussion with the Royal Colleges in UK to bring back FRCS program to Malaysia. I hope it will materialise with a proper structured program in Malaysia. It will give an alternative pathway for surgeons wannabe.
Full Text of DG of Health’s Keynote Address: ‘Optimising Human Capital And Enhancing Specialist Services’ at the Medical Program Specialists’ Conference 2015
Posted on August 8, 2015 by DG of Health
KEYNOTE ADDRESS
BY DIRECTOR-GENERAL OF HEALTH MALAYSIA
PERSIDANGAN PAKAR PROGRAM PERUBATAN KKM 2015
‘OPTIMISING HUMAN CAPITAL AND ENHANCING SPECIALIST SERVICES’
THISTLE PORT DICKSON RESORT
8th AUGUST 2015
Thank you Mr/Ms Chairperson,
i) Y.Bhg. Datuk Dr. Jeyaindran Tan Sri Sinnadurai
Deputy Director General of Health (Medical)
ii) YBhg. Dato’ Dr.Hj. Azman Bin Abu Bakar
Director of Medical Development
iii) Dr. Abdul Rahim Bin Abdullah
State Health Director of Negeri Sembilan
Hospital directors, Profession & Department Heads, Consultants & Specialists, Ladies & Gentlemen,
Assalamua’laikum wbt, and A Very Good Morning.
Firstly, I would like to thank the organising committee for their effort in ensuring the success of this biennial event. It is my pleasure to welcome all of you to the Medical Program Specialists’ Conference 2015 here in Port Dickson. As we are still in the Aidilfitri mood, I wish all Muslims here ‘Selamat Hari Raya Aidil Fitri’.
It has been two years since our last meeting in Melaka. This biennial event is an important forum for us to interact and keep abreast with current issues and knowledge towards achieving an excellent medical and specialists care delivery system.
All organisations require human capital to function and accomplish their goals. Human Capital is defined by the Oxford Dictionary as ‘the skills, knowledge, and experience possessed by an individual or population, viewed in terms of their value or cost to an organisation or country’. Managing patient care requires a multidisciplinary team approach, and doctors comprising of housemen (HOs), medical officers (MOs) and specialists alike are the most essential members of the team.
Thus the theme of our conference today, ‘Optimising Human Capital and Enhancing Specialist Services’ is pertinent and significant considering that Human Capital is an important component in delivering quality healthcare, particularly specialists.
HOUSEMEN
The number of housemen has increased tremendously from 1,059 in 2006, to 2,319 in 2008 and subsequently 4,991 in 2013. As of March 2015 there are 9,502 HOs in the programme. Currently, there are 10,803 HO posts available in the accredited government houseman training hospitals. With the large number of HOs, specialists need to re-engineer their approach to training with existing resources in order to achieve the objective and maintain the quality of the housemanship programme. Staggered appointment of Housemen has been introduced since August 2014 with the intake currently done every two months. In the meantime, the online system e-housemen has been implemented since March 2015.
MOH has proposed the introduction of a generic logbook and Certificate of Completion of Housemanship Training (CCHT), which is awarded upon completion of the housemanship training. It is hoped that CCHT can be used to determine the ‘level’ of competency of HOs and in pursuant of future specialist training. Meanwhile, the generic logbook is designed to document common procedures that can be done in any discipline. I was made to understand that these two topics have been discussed in the workshops last night and hope there will be a fruitful outcome.
The Honourable Minister of Health is also concerned about the quality of HOs these days, and thus mooted the idea of introducing theoretical assessment during the Induction Course to determine the level of knowledge before the commencement of housemanship training. In addition, to ensure the quality of HOs, MOH has recommended that the minimum requirement to enter medical school be increased from 5Bs to higher grades gradually.
MEDICAL OFFICERS
Similar to HOs, the number of medical officers has also increased from year to year. As of 30th June 2015, there are 15,388 of MOs serving in the MOH. This accounted for 94% of MO posts being filled as compared to the total number of posts available. Although there are about 900 vacant posts currently, the numbers of MOs in certain states like Johor, Perak, Pahang, Kelantan and Melaka however have exceeded their allocated posts.
As we know, more posts are required to cater for the expansion of new facilities, new services and additional workload due to increase of diseases burden, increase in population and demographic changes. The doctor to population ratio in 2014 was 1:661 (inclusive of HOs). However, the doctor to population ratio based on the number of Annual Practising Certificates (APC) was 1:904. In Singapore, the ratio was 1:513 (2014). The ratio in other countries like New Zealand, UK and Korea was 1:365, 1:356 and 1:467 respectively.
The five-year 11th Malaysia Plan also projects the upgrading of selected clinics into advanced clinics that provide a full range of multi-disciplinary services to enhance and support primary healthcare teams. Read more here
On 14th July 2010, YAB Prime Minister announced that to be on par with other developed nations, Malaysia has set a target to achieve a doctor to population ratio of 1: 400 in 2020. Based on this, Malaysia requires about 87,000 doctors with the estimated proportion of 60% and 40% respectively in the government and the private sector. In the government sector, as 90% are serving in MOH, that will account for 47,075 doctors. As currently there are 26,924 posts, therefore MOH will require 20,151 additional posts in 2020. With the ample number of MOs, there is a need to relook at the ‘work processes’ in every department to optimise the resources.
Although postgraduate training focuses on specialist training, MOH also needs to pay more attention to the training of MOs who have been described as ‘the lost tribes of medicine’. Being seniors, specialists should encourage these doctors to enhance their skills and knowledge by attending courses or workshops and guide them to plan their career development.
All junior MOs are encouraged to indicate their interests in the field of choice so as to facilitate them to pursue postgraduate training in that area. Those who have passed MRCP/MRCPCH Part 1/Part A must register to the Medical Development Division for appropriate postings, including rotation in selected subspecialty areas. I also urge all senior specialists to inform their junior doctors who have passed the membership exams to immediately report to Medical Development Division; otherwise their gazettement will not commence. It is worth mentioning here that gazettment of specialists will be based on knowledge, skills and competency as well as appropriate exposure, and not merely time based.
SPECIALISTS: LOCAL MASTERS PROGRAMME & PARALLEL PATHWAY
Specialist and sub-specialist training in various clinical disciplines will continue to be a major concern in order for us to ensure that our nation has the needed numbers to deliver high quality care for individuals as well as population. Currently, there are approximately 9055 specialists in Malaysia, out of which 52% (4698) are serving in MOH. Despite notable achievements of the Masters Programme conducted by local universities, the country is still facing a shortage of specialists to meet requirements of our healthcare facilities.
Local Masters Programme
The Ministry and the universities face many challenges to ensure the smooth running of the Masters programmes. One of the issues is the low passing rate in some of the specialties. This might be related to the capability of candidates as well as to the very nature of specialist training i.e. the standards are very high and only the best and most determined to sacrifice will make it. Therefore, the selection of suitable candidates who are highly committed and motivated to complete their postgraduate training is of utmost importance.
It is important to emphasise on the supervision and monitoring of the trainees to ensure they are equipped with knowledge and skill that befit the specialist. For your information, there are cases of master graduates that need extension in their gazettment period due to competency issues and so far there was one that has failed to be gazetted.
The Health Ministry is committed to meeting the pressing need for more specialists. It is offering more local Master’s scholarships and opening up alternate pathways. Read more here
Parallel Pathway
In order to increase the number of specialists, MOH encourages MOs to pursue postgraduate training program via various parallel pathways such as the membership program. MOH is in the process of strengthening the parallel pathway to make it more structured. YAB Prime Minister, during the PM-Minister Mid Year Review 2014 on 20th August 2014 made the decision that MOH should include the budget or funding in 11th MP for the Parallel System. Through this system, while working with MOH, these doctors can sit for the relevant British qualification/exam for specialist training.
The governance of the Postgraduate Medical Specialist and Subspecialist is needed. In the near future, it is hoped that the newly set up dedicated unit of Postgraduate Medical Specialist and Subspecialist (Deanery) under the Medical Development Division of the Ministry will be able to specifically focus on the planning, implementation, promoting, recruitment, monitoring and accreditation of the programmes for clinical specialists. Subsequently, for more effective management of postgraduate training, units could also be set up at the level of the respective state health departments, hospitals and district health offices.
As you all may know, YB Minister of Health and I had recently visited several colleges in London, Edinburgh and Glasgow where they have agreed in principle to train the trainers, accredit our training centres and conduct membership exams in Malaysia. In addition, several MOUs have been signed between the Royal Colleges of Physicians and Surgeons and Academy of Medicine in the field of Cardiothoracic Surgery, Plastic Surgery, Orthopedics and Family Medicine.
SUBSPECIALISTS
There are currently 1,415 subspecialists including trainees in MOH. This number accounts for 35% of the specialists’ workforce. With the shortage of generalist, subspecialists working in the bigger hospitals are expected to provide general medical or surgical services. To optimise resources, subspecialists should not confine themselves to their subspecialty area unless the hospital is a designated tertiary centre.
In addition, among the existing pool of sub-specialists, a number will resign after completion of their training to work in the more lucrative private sector and this is definitely a great loss for us. On average there are about 150 specialists who leave MOH annually. As of May 2015, there were 95 specialists that have resigned, out of which 25% are subspecialists.
Notably in the 11th Malaysia Plan following the amendments to the Medical Act 1971, all specialists are required to be registered with the National Specialist Registry in order to practice as a specialist in that particular specialty. They have to gain certain years of experience before they can be registered in the NSR, thus it is hoped that the number of resignation will be reduced once this Act is being implemented.
The subspecialty-training programme needs to be enhanced. Subspecialty training should be structured, monitored and adequately supervised with the possibility of an exit assessment for all areas. While there is no denying the importance of developing subspecialist services to enable us to handle the small percentage of highly complex cases but it is crucial to strike a balanced mix of generalists and subspecialists. The trend in developed countries is to train generalists with subspecialty interests. At best, subspecialty care only offers organ-specific, intermittent and episodic care. On the other hand, the vast majority of patients need general and continuous care, which can only be provided by “generalists”.
ROLES AND RESPONSIBILITIES OF SPECIALISTS
Specialists including subspecialists play an important role in ensuring the quality of medical services provided by MOH. Thus, specialists should place quality of services and safety of the patients as the highest priority. Senior specialists also need to focus more on patient care and not only administrative issues. Never neglect your patients and let the juniors manage the patients on their own without direct supervision.
I would like to see our specialists be the benchmark for other categories of staff such as house officers, medical officers, nurses and others in providing clinical services to the patients so that we are able to create an effective clinical team. As a specialist, it is important for you to be a team leader and provide leadership in order to ensure effective clinical governance with the emphasis on quality of services and patient safety. This includes good medical practice; evidence-based clinical practice; continuing professional development; and patient, family or community participation in decision-making.
All of you need to play your role as specialists to ensure patient management is being carried out effectively. This will include doing daily, teaching and grand ward rounds to review complicated cases and new cases especially during on calls. Apart from the above tasks, specialists are also required to conduct research and be actively involved in training of junior doctors including HOs and Allied Health Professional.
ON-CALL
In-patient services requires the 24 hours management of patient care by healthcare providers particularly specialists as a team leader, thus the need for specialist to be on-call. For a department that has more than one specialist, the specialists including the Head of Department (HOD) have to do calls on rotation basis. There will be only two tiers of on-call practiced for these departments i.e. specialist and consultant, hence there is no specific HOD call. Likewise for a department that only has a single specialist; he or she has to be on-call daily, which is usually a passive call.
It is crucial that the on-call system be managed with integrity to ensure patient safety. There should not be too many tiers and for each tier the number of specialist on-call must be in accordance with the need and workload. Some departments do not require active calls. Some subspecialty services in smaller hospitals do not require a dedicated subspecialty calls.
Many have suggested that we should relook at our on-call system, working hours and so on. I am open to any constructive suggestions that may help to improve the life of doctors and others in the healthcare profession.
Some have suggested that MOs also work on flexi hours. However if we were to implement this, we will need more MO posts and the on call allowance will be removed. I believe that many hospitals allow post calls off for medical officers as soon as they finish their passing over.
We might consider call sharing where 2 MOs share their calls and each does half of the call every time they are put on the roster. This concept has been implemented in Australia and we need to explore the possibility in doing it here. For those who are on call, make sure you are in hospital and actively review patients and not giving consultations from home.
PROMOTION TO GRED KHAS
Currently there are 953 (23%) specialists who have been promoted to Gred Khas with 48 on Gred Khas A, 140 and 765 respectively in B and C (inclusive of those appointed on contract basis). The promotion exercise will take place when there are vacancies and the posts are very much limited.
There are various criteria that have been identified for the promotion to Gred Khas and not merely the seniority or time based. Other important factors that are being taken into consideration include those who have shown exemplified excellence, those serving the periphery of Sabah and Sarawak and also those with critical specialty and subspecialty. In addition, we also need specialists who are not only good at local level but also recognised at the international level.
It is hoped that MOH can promote those who are well deserved but looking at our current situation; it might be a bit difficult. I understand the frustrations, as it was a long wait for some of you. Due to constraints on promotional posts, MOH has proposed to JPA to consider giving some perks to senior specialists particularly to those on Grade UD53/54.
Great efforts have been made to provide better service schemes and remunerations to encourage doctors to continue serving with the government. Year after year MOH has strived to offer better career pathways for doctors and specialists including faster promotion, increment of specialist and on-call allowances, full paying patient, Saturday elective surgery, privilege to do locum etc. Consequently, it is hoped that all these advantages would encourage the specialists to work harder and give better services to the patients as well as better guidance to the juniors.
INTEGRITY
As the medical practice has become more complex, doctors’ attitudes are also changing. Doctors remain ‘professionals’ but the traditional image of what this means in practice – a selfless clinician, motivated by a strong ethos of service, caring and compassionate is increasingly eroded. Doctors are perceived to be pursuing their own financial interests, and fail to self regulate in a way that guarantees professional competence. There has also been a disturbing change in the attitude among doctors, relating to ethical integrity, professional values and behaviour causing not only serious medico legal problems but also disrepute to the profession.
Doctors are not only required to be technically competent and knowledgeable in the field, but they are also required to embrace the appropriate ethical beliefs and act in a professional manner.
DELIVERY OF SPECIALIST AND SUBSPECIALITY
MOH has produced a Specialty and Sub-specialty Services Framework, which serves as a key driver in leading the path for infrastructure development as well as resource management and allocation.
The target is to provide 10 basic specialty services in minor specialist hospitals, 20 specialties in major specialist hospitals and 45 specialties and sub-specialties in the state hospitals and also 26 specific subspecialty services in each of the 6 zones in Malaysia. So far, only 74.4% of the regional centres have achieved the target of providing the 26 subspecialty services listed in the framework while 79% of the state hospitals are providing the 45 specialties and subspecialties listed. However, only 65.7% of major specialist hospitals and a mere 31.85% of minor specialist hospitals have managed to reach the set target.
MOH also plans to upgrade 4 services such as geriatrics, neurology, palliative care and uro-gynaecology from regional services to be provided at state hospital levels to meet the demands of the ageing population. We have also planned to establish the National Centre of Excellence for Specialised Clinical Skills to enhance the clinical skills of health personnel.
In order to face the challenges in optimising resources, the cluster hospital concept has been introduced in 3 states – namely Melaka, Pahang and Sabah. It has been proven to show positive results; hence the decision to expand the project on a national scale. Clinical leadership at non-specialist hospitals will be strengthened through the hospital cluster concept whereby hospitals within the same geographical location will work together as a unit, share common resources such as assets, amenities and personnel for betterment of patient flow and reduce waiting time for specialist treatment.
Some of the factors that limit the development of specialist services include budget constraints especially in procurement of expensive equipment and facilities as well as support team. There are also shortage of specialists in certain hospitals and specialties due to maldistribution because many refuse to serve in remote areas.
CASEMIX
We have to realise that not only the clinical care of patients is important, but ensuring accuracy and completeness of the clinical documentations are equally essential too as it is also a medico-legal requirement.
Efforts are also being initiated to include or consider Percent (%) Accuracy of Clinical Discharge Documentation, which the Casemix Unit in Medical Development Division will monitor regularly and any recurrence on shortfall should be followed up with Root Cause Analysis. All Heads of Departments and Hospital Directors must play their role. Any national issues must be discussed further with the Medical Development Division.
I also would like to inform that the audit on the clinical documentation accuracy is under the realm of the Hospital Director, as well as all the Heads of Clinical Departments. To make the effort a rewarding activity, the audit activity has to be conducted at a regular interval, at least twice a year and will be followed up by the Casemix Unit.
I urge that all of us, the Senior Doctors, to accomplish our obligation in patient care by monitoring (keep in check) the level of accuracy on the discharge clinical documentation, so as it will attain an overall achievement of more than 70% for every clinical department. I am pleased to note that one session at this conference has been dedicated to the discussion on casemix.
CONCLUSION
Human Capital is an important component in delivering quality healthcare, particularly specialists. As we aspire to become a high-income nation in 2020, our healthcare system needs a medical workforce capable of adapting to change in service needs and the future generations of doctors must have greater understanding of the aspirations and expectations of rakyat.
Doctors must therefore be competent with the relevant knowledge and skills, in addition to the right attitude as well as capability to work as a team. Optimising human capital must be implemented through various strategies, among others through training, delivery of quality service including casemix, innovations such as lean management, cluster hospital concept, NBOS, research, and with good leadership and integrity.
On this note and with Bismillahhirahmannirrahim, it is my great pleasure to declare the Persidangan Pakar Program Perubatan KKM 2015, open. I am sure your participation in this conference will be both useful and rewarding.
Thank you.
Datuk Dr Noor Hisham Abdullah
Director General of Health Malaysia
8th August 2015
Pagalavan's Avatar 
Dr Pagalavan, like u said, its only rumours that HO will be employed as contract officer and subsequent application to MO post will be necessary, which might be related to CCHT..but this is mere speculation right? maybe you can share with us your source? Transparency is the buzz-word nowadays..Otherwise don’t blame people it they start labeling you..
As i said, it is rumours and it is also not a new rumour! It has been discussed many times in many of the MMA and MOH meetings. The issue of an exit exam for housemen was discussed almost 2 years ago
Yes, its not a new rumour..but still, it’s a rumour..Then why do you need to assist spreading this rumour? The first time we heard about this CCHT is in DG’s speech at PD..that too only after he upload it in his FB..suddenly you already know that ‘actual’ purpose of CCHT? Interesting indeed…it almost felt like reading Raja Petra’s piece in Malaysia Today!
An exit exam for housemen was proposed almost 2 years ago in MOH. It is nothing new. It is just appearing by another name. Haha, how many of such ‘rumours’ has come true indeed? Eventually, the government will have to introduce a filtering mechanism to decide who they will employ. Since unlikely a common entrance exam will be introduced due to political reasons, the exit exam is likely the way to go about.
Dear Dr Pagalavan,
First of all, I must congratulate and thank you for educating our future colleagues on the changes in the medical career especially in Malaysia.
With regrards to British membership exams, these qualifications are now not even considered as a specialist qualification anymore in UK, Singapore, Hong Kong, Australia and New Zealand. These qualifications mean that one can be considered for specialist training. The same applies for other local qualificationss eg Masters in Singapore. As far as in UK, even after being conferred a Fellow of a Royal College, does not mean one is a specialist.
To become a Specialist, one need to apply for a training specialist programme, where one’s soft skills are tested and assessed in an interview (besides a generic specialist knowledge, which is anticipated that every one would passed) During training, specialist and soft skills are assessed annually by various people, including patients and hospital attendants!
There are plans to introduce this sort of training in Malaysia – as I was told by Bahagian Latihan, but at the moment, there are opposition from local universities.
Yes, potential doctors must realised, their MBBS, Masters or even membership/fellowship of the Royal Colleges would be pretty much useless in the future. I forsee in Malaysia, to become even a GP, one would need MRCGP / Master Family Medicine, board/council certified (post training) before one can buka kedai!
On the last note, the Royal College of Surgeons do not conferred FRCS anymore after their exams. It is now MRCS. The fellowship is to be conferred after a long training period., 7 years!
“I forsee in Malaysia, to become even a GP, one would need MRCGP / Master Family Medicine, board/council certified (post training) before one can buka kedai!” ~~ I agree with you 101%. It has been discussed even in the initial stage of 1Care, for a different tier payment systems; more for those with postgrad degrees, and less for those MBBS holders. But many of the existing GPs opposed strongly, and they shifted the rakyat/clients’ view towards the govt’s “incompetency” in handling the coffer of money; but many of us know that one of the real reasons is that the move would hit their rice bowl indefinitely, as more and more junior doctors are holding postgrad degree even for fam med.
One can still implement the 2 tier system of payment for GP, provided the classification of payment is not made retrospectively. Then, current batch of GPs would have no reason to object as it does affect them at all!
i am just curious, upon completion of cct after 7 years of training in the uk, does the doctor become a specialist or a consultant?
and if doctors in malaysia complete mrcpch / mrcog (which normally taken after 4 yrs of specialty training/mo-ship + 2 yrs of fy/ho training), with enough skills + knowledge, cant they be promoted to specialist position.. because to become a consultant in malaysia will take more years after becoming a specialist?
Frankly, there is no difference between a specialist and a consultant in MOH. The salary is the same. It used to be said that after 7 years of being a specialist, you can be considered as a consultant. BUT there is no such thing as formal promotion to consultant. After passing MRCP etc, you will have to undergo 18 months of post MRCP training before being promoted as a specialist. The only difference in salary is the Elaun Pakar which you will only receive after gazettement as a specialist.Elaun Pakar is tied to your salary grade and not your years of service.
The term specialist is used rather loosely in Malaysia.
In the UK, even after completing specialist training with a certificate of completion of training (CCT), one does not automatically become a consultant. With a CCT in the relevant speciality, you can apply for Specialist Registration with the GMC (ie equivalent to being on the NSR in Malaysia) but this does not mean you are a consultant. To become a consultant, one has to apply for a job (where a vacancy exists), pass a competitive interview before being allowed to practice as an independent ‘specialist’ clinician.
There is generally no ‘continuous’ pathway to a job as a consultant… there is a lot of competition along the way.
In your blog, you have raised many pertinent question and argued issues with strong justification and point..making it a platform for many to seek info about postgrad medical training and education in Malaysia..which I must say, is very impressive..but with great power comes great responsibilities! I just felt that at times you need to rethink what you plan to write as the implication is quite big..people pass information irresponsibly and the story get twisted along the way..having said that, thank you for all your articles..many are spot-on, informative and honest..but this piece is not one of them.
Thank you but we shall wait and see! Remember, 5 years ago, people said the same thing when i predicted about doctors future. Either an entry or exit exam is imminent . Government will not be able to absorb all. Either the entire healthcare system need to change or an exit exam is unavoidable.
Can those with MRCP Part 1 / MRCPH Part 1 STILL apply for the local Masters programme even after registering to the Medical Development Division?
Yes, they can still apply to Masters programme. In fact, it would count as bonus/extra point as compared to those without Part I. Similarly, those served in Sabah/Sarawak get bonus point in their application. Registering with Bhg Perkembangan is important as reasons mentioned by DG in his keynote..this parallel pathway complement Masters programme, it does not work against it. Excellent Masters candidate even continue to complete their part II, PACES, etc during/after their Masters..
Yes, you can
The Umno putras and their running dogs mca and mic have managed to destroy our education, economics and now health care. It seems to me we would be better off under british colonial rule. At least we would still have world class education and a healthcare system to be proud of.
To the people who voted bn for pathetic reason of preserving racial rights you deserve this.
For those who were enlightened enough to see the bn government as a complete farce, unfortunately yous would still have to suffer because in a flawed democracy idiots lead the way.
I pray hard for malaysia, its economy and healthcare, but not the politicians that are screwing us up and may the devil piss on their graves, the sooner the better
Filtering of doctors needs to be done somewhere. Unlike other professions, it is not acceptable even if one incompetent/unsuitable doctor is let loose on the population.
Different countries do it differently. In Australia and UK, filtering is done at entry into Med schools. Further filtering is done during the course, some med schools have significant attrition rates. But once you graduate, you are through.
In the USA, in addition to entry filtering, they filter further at graduation, via a common exam, the UMSLE Step2.
In Malaysia we have no filtering at all. It is insanely easy to get into med schools, almost nobody fails, everybody gets a HO post, and flows through into MOs. That is the reason why 15% of HOs were found incompetent. And as many as 20% of HO do not complete their 2 years.
To filter AFTER HO is madness. It is very expensive to train a doctor, and after 5-6 years, and 2 years HO, suddenly you tell them they are incompetent and cannot work as a doctor?
Filtering should be done at the basic level, at entry into Med schools. But Malaysia politics decides otherwise.
Madness.
To Pagalavan, the oversupply of young housemen are due to, everyone can study medicine in Russia. so, when will this so called exit oe entrance exam gonna be implement ?
to Peter C,
From your statement, you sound like a doctor too as you able to mention MRCP, ETC, but, you seem do not have much clues how specialty in malaysia work.
When u passed all 3 parts of MRCP, u are being called physician, in all teaching hospitals, nobody will look at u or called you specialist. in malaysia, mrcp is just another express way to get yourself enrolled into sub specialty, such as nephro.
for my experience, my specialist training of 3 years locally and 1 year abroad never get myself assessed by hospital attendants or patients. so, which part of trainning hospital u refer to ?
Wah Lobak you sure you are specialist Uh? Your English need some improvement leh. How do you read and write papers in journals etc. or present a case to your colleagues? In Hokkien uh? (Judging from your love of Lobak)
Sorry for being harsh, if your identity were exposed I would give you face. But since this blog is anonymous then ok la free for all… no hard feelings.
Once again proving the point of JKL… we need some filtering.
Entrance exam was deemed not applicable by our cabinet. It is a political decision. Exit exam is still a proposal.
Nowadays, this situation always happen. I guess some of you are familiar with it. I always wonder do they really know what studying medicine is all about. Hopefully they do. All the best for them.
I:”Nak apply study apa?”
Student:”Entah, medic kot, under mara”
Our education system creates parrots!
Lobak,
I agree with Sarcastic! Are you sure you are a specialist? If you are, how come you are not aware of tools of assessments of training, such as work based assessment, 360 degree assessment, OSATs, etc.?
You must be a traditional medicine specialist, or dukun specialist!!!
Yes, I am a consultant, registered under the Specialist Register in the UK General Medicine Council, and an honorary senior lecturer with King’s College Schhol of Medicine, London. I was also a Pegawai Perubatan in Malaysia, being in various clinical rotation, and spent a few years as Pegawai Perubatan (Pentadbiran), and so, I know, more or less what is happening in medical circle in Malaysia. And yes, an ex- Medical DG was a like a big brother to me.
In my long years of training in further training in UK, I have taken recognised short breaks to work in Hong Kong. In the various scientific meetings which I attended as speaker or just a normal delegate, I have rubbed shoulders with trainees and Consultants from various countries in the world. So, I am qualified to speak on issues on training of future doctors / specialists.
For your information also, I am still a member of a Royal College, as becoming a Fellow is time based. And in my team, I have Fellows, ie doctors who are very senior to me, working as registrars under me!
Thus, the response I have written earlier would the be direction, future medical training is heading . Malaysian medical training is still behind time, but will eventually be adopted if Bahagian Latihan has its way. In short, get MBBS, get into a training programme by interview or passed membership / masters programme, training being assessed from speciality and soft skill aspects from non medical to medical persons, annual appraisal and finally Speciality board / Medical Council certified as a specialist or associate consultant. To become a consultant, needs another round of interview and also annual appraisals! To become a GP, training would be shorter, and the pathway is still the same. Therefore, as per my earlier response, to buka your own GP Kedai, one would need to have, in the future, MBBS, Masters (family medicine) or MRCGP or equaivalent, AND Board / Council certified!!!
And judging from your response, Lobak, you would have failed miserably, because of your attitude ( a soft skill).
Dear Honorary Dr Peter C (sorry if I miss out any titles e.g. Lord/Sir/Tan Sri/Datuk etc.),
With all due respect, please don’t make this as **** measuring competition, whether yours or Lobak is bigger. Maybe you are overly qualified to comment on issues related to postgraduate medical education and training. But if we were to conduct a 360 degree assessment on you based on your comment, I’m not sure you will get far either.
In some regards, what Lobak said has some merit. Maybe with your vast experience abroad you have slightly lost touch of what is happening in Malaysia, although ex-DG is like your brother. With regard to specialty training, Bahagian Latihan is only involved in the selection/financing of doctors into masters programme. They are not bothered with content/structure/curriculum of training, career pathway, credentialing, CPD, etc.
Yes, medical training is still lagging behind in Malaysia. Work based assessment is already in practice for HOs, but senior clinicians are still not very keen on 360 degree assessment. Appraisal is only one way: top down. Annual appraisal is still in the form of SKT/LNPT where almost everyone will get good marks, as giving too low marks will lead to surat tunjuk sebab and no anjakan gaji tahunan for the affected officer. Soft skills is not yet a priority. Undermining, bullying, blaming cultures are still rampant.
The list goes on and on…surely we can only improve. Resistance to change is our biggest challenge, not just politics as many would say. You have experienced of what is regarded as the ‘way forward’ in undergraduate/postgraduate medical education and training with your extensive experience in UK and other countries. I am certain you can contribute to Malaysian system by sharing your experience and best practice from UK, or even conduct some kind of study/project with Medical Development Division of MOH Malaysia. Writing to the current DG would be a start.
Dear Peter C,
seems like you are a very experienced consultant, but i highly doubt. the reason is simple, an honorable consultant will not be this naive as you to tell others where you teach, especially in kings college. kings college is a place of richest on the earth. kekekeek. u sure, mr peter c?
do u know exactly what is bahagian latihan in malaysia ? u sure u are the abang adik of dg and bahagian latihan ? dont be kidding la bro, bahagian latihan main and the only job is to provide scholarship to the eligible master students. all other assessments, thesis, are assessed by the consultants.
what do u mean by YOU ARE STILL A MEMBER OF ROYAL COLLEGE ? come on la MR PETER C, in malaysia, we do not worship mrcp, we take mrcp because we want to be sub specialist as soon as possible, instead of 4 years master programme in internal medicine.
mr PETER C, come la, reveal yourself, who you are, make us, malaysian proud to have a lecturer in kings college. for your information, i only graduated from the UM, maybe to u, UM, too low standard compare to your KINGS COLLEGE.
Come, reveal yourself, who you are or what your specialty is……..
Perhaps, you might just a chronic GP in UK, worked like most other asian doctors in UK.
Wah lim77 I suspect you are must be lobak because your English as good as lobak. Is this really how you write in real life?
If you are a specialist and UM medical grad then you are painting a bleak picture of medical training in this country.
I never went to UM but have always held a high regard for doctors graduating from UM. They (Used to be) the best STPM students, students who I would expect to be able to defend themselves and argue their points eloquently on a blog like this. If you got into UM with your standard of English and communication skills then I suspect UM grads aint the way they used to make them. My bet is you got in the short cut way ie matriculation. And how you managed to be a specialist amuses me. We need some filtering, not just for housemanship, but also for specialists.
Your arguments have no basis, or maybe I can’t understand your points because of poor English.
MRCP UK is not meant to be worshipped in the first place. It is meant to be a pathway for doctor in Malaysia to become physicians. Masters of Medicine is an equally viable pathway but is it based on merit when selecting candidates?. I challenge the Masters program to make it compulsory for all their trainees to do the MRCP and see how many of them will pass in a blinded, nonbiased exam. My bet is there are a lot of undeserving people in the masters program because it is not based on merit, and the mrcp will weed them out. lim77 might not pass because he can’t understand half the questions in the written exam, not to mention presenting a good case history in the vivas.
Peter C’s story seems very plausible, and reflects a Doctor who is bright and worked extremely hard to get to where he is today. You on the other hand made baseless and sweeping statements that will only incur the wrath of doctors working abroad. No most Asian doctors in the uk/Ire aren’t GPs, there are many who are head of departments in world class hospitals that would put UHKL to shame, or consultants who are thought leaders in their field, with massive number of publications. GP’s in UK have respectable degrees and are good at family medicine. It is not a downgrade to be a GP in the Uk, in fact getting into a GP scheme is highly competitive in the UK/Ire
Maybe Peter C could reveal himself if lim77 aka lobak does so too. Humour me for who this clown of a lim77 aka lobak is
im not sure bout whether mrcp may prove as a hurdle to md or ms in local uni.
but i certainly hold high regard for d former more. i dun really trust d exams system in malaysia. its too easy to score an ‘A’ and too easy to get into medical schools. those who get medical seats in public uni may not be d brightest in their schools.
though i may not have worked with my ex schoolmates, but with their above average SPM results, i highly doubt how they pass their medical exams.
back to d topic, d thing is d environment in malaysian gov hospital is not conducive for preparation of professional exams. i once asked a senior dr, how did u manage to pass MRCP, how could u squeeze time to study?
he said ‘ its all a MYSTERY.’
Hi, Doctor. Are IPTA and government sponsored medical students gonna be given preference when it comes to MO, HO or Master spots in the future (2020 and beyond since that is when I would probably graduate) as compared to IPTS and self-sponsored students? I am having a hard time deciding between IPTA and IPTS as I got offered a place in both institutions. Financially, I think my family would still be able to afford it with the partial scholarship the IPTS has given whereas the IPTA I was given a spot in is quite far away (East Malaysia). Hope to hear your opinion, doctor. Thanks in advance.
No one knows for sure but bonded students will definitely be given preference as they are bonded with the government/job guaranteed.
At this point in time, i would prefer IPTA looking at the future prospect.
My humble opinion: Wat ipts is it? If its local or even twinning i would go ipta. All same quality (mediocre) just different price. If however you can afford to go to an english speaking commonwealth country ( non twinning) or go the long mile for an american md after a first basic degree i would choose that. If locally rather save money and go to ipta as many ipts are of questionable quality. Would be good to know which ipts / ipta you are offered
Hi. I’m a student in the East Malaysia IPTA. I had the same dilemma as you too. But I think it’s not the place that matters. after all, the things that you will be able to learn is almost the same, especially with all the internet access. Furthermore, it is better to be exposed to the Malaysia setting in ipta for you will be working in M’sia. (unless you don’t plan to return upon graduating) I have seen HO returning from overseas but were not used to our setting, thus having a hard time. But, this can be settled with a lil bit of time getting used to it. anyhow, the subject matter is still the same. I personally feel it’s better to save the money for further use after graduating in furthering your studies.
We do have very experience lecturers here too during our clinical years from public hospitals to teach us. Thus, it is a matter of how we, as students are able to perceive and correlate the knowledge into clinical practice.
Just my humble opinion. =)
really enjoyed your thought..love reading your blog..@kipidab
these number really not right and frightening..
10803 HO post and 15338+900 MO post.. wonder where all those houseman are going to work with current situation.. no more new post created and only few from those MO will go up another level to become specialist or resign…
Thats why a filter should exist before one is allowed to become a MO
A filter at that point is way too late! If we assume that the MoH really select the BEST from the completing HO, there will be thousands of new less qualified/competent doctors who will get their full licence to kill, and enter the private sector, where it is notoriously poorly supervised environment.
That would be exactly the WRONG think to do. The less competent doctors should actually be kept in the MoH, where there is much more supervision, due to the inherent existing hierarchy of medical staffs.
Madness.
Then the ministry will be flooded with less competent doctors…
Common entry exam like usmle should be introduced so that the less competent one will not enter the field…
Again, it is madness to not allow a grad to work after spending so much time and money for medical degree…
This is not rocket science. The main filter should be at entry into Med School. Of course you will not get it right all the time, hence additional filters along the way, and finally a last filter before granting any kind of license to practice.
i think the MLME exam may come happen this year
There must be a political will to do that
http://www.therakyatpost.com/news/2015/08/24/picture-in-labour-room-triggers-netizens-outrage/
Malaysians hahahaha
20 years back, there was only 3 medical schools, so to enter the school, competition was stiff…Now we have so many medical schools but limited post for HO, MO… the competition isn’t stiff right, plus after 5 years of study, no job is available??
Hi Dr,
I’m starting my housemanship soon. However, I have started to feel that I am having burning out syndrome. My passion in medicine has been diminishing and the work and working environment add to the pressure. I miss the positivity and being happy.
Is there any other pathway I could do right after my 2 years housemanship?
Could you give me a direct link if you have written on this before? I couldnt find the page.
Looking forward.
I thought you haven’t started housemanship yet? How come you are burnt out already?
You can read THIS
You can also read THIS
Hi Dr,
I heard that IMU local programme currently was recognize by GMC like Newcastle University Malaysia Campus. IMU local graduate now can train in few hospital that appointed by GMC as houseman and can registered under GMC once they finish the training. Is it true or just a rumor?
Thank you.
I was just thinking of writing something about this.
Yes, for NuMed, under their own supervision, housemanship in 5 hospitals in Malaysia is recognised for full GMC registration.
As for IMU, it is only applicable for those who does twinning program with UK university and graduate from the UK university. They can return to Malaysia and do their housemanship. This is due to lack of FY1 post in UK. I am not sure which hospitals they had made arrangement with. I have not heard anything about their local programme as it has nothing to do with UK.
Whatever said, getting a full GMC registration may not mean anything as you will still not a job in UK due to immigration laws. However, whether Australia will recognised this type of full GMC registration depends on their medical council.
In your honest opinion , doctor , are there really any substantial differences between graduates of IPTS and IPTA medical schools in terms of knowledge,skills, attitude and etc. ? Especially nowadays where the quality of IPTA have somewhat deteriorated and a few IPTS being able to hire some of the more experienced lecturers to teach at their faculties. And in terms of teaching hospitals, what kind of advantage do medical students at UM,UKM and USM get from having their own teaching hospitals? Do they receive more training and attention than medical students who need to do their clinical years at MOH hospitals? I am just a curious pre-university student who may or may not study medicine in the future, by the way.
Of course, if you are a student in university hospital, you will be given a chance to do a lot of procedures compared to those in KKM hospitals where they are not allowed or not given a chance to do basic procedures. Definitely, when working, the one can do basic procedures is much better than those who never did it.
Yes, definitely there are significant differences in IPTS and IPTA medical schools. For IPTA medical schools, their training during clinical years is limited to one hospital, that means you walk in and out at the same familiar hospital throughout the duration of your course of studies. However, for IPTS medical universities, you are trained in at least a minimum of 2
Yes, definitely there are significant differences in IPTS and IPTA medical schools. For IPTA medical schools, their training during clinical years is limited to one hospital, that means you walk in and out at the same familiar hospital throughout the duration of your course of studies. However, for IPTS medical universities, you are trained in at least a minimum of 2 MOH hospitals. Some IPTS universities, for instance, AIMST University’s student train in between 5-10 hospitals during their clinical years’ training, namely, Hospital Sultan Abdul Halim Sungai Petani (1 year), Hospital Sultanah Bahiyah Alor Setar (1 year), Hospital Seberang Jaya (2 mths), Hospital Kulim (3 mths), Hospital Yan (3 mths), Tanjung Rambutan Mental Hospital (1 mth), Hospital Baling (2 mths), Hospital Bersalin Jitra and also some clinics in the kampungs. You need to have a car or your group friends to car pool during your course of studies. Of course if you can get a place in IPTS, you save a lot of money especially transport cost.
Firstly, it all depends on student’s attitude. If you want to learn and really interested in medicine, you will do well no matter where you are. However having own teaching hospital do make a difference as the environment is totally different. Teaching hospitals do give a more conducive environment for teaching and studying. Less obstruction and bureaucracy. Everyone teaches you during rounds etc. It is not the same with MOH hospitals especially if you are from a private university. If you don’t pay the MOH consultant, they won’t bother to teach you anything. A lot of politics internally. In medicine, having more experienced teachers alone is not good enough. Practical training is more important than lectures!
Agreed. Attitude is the most important. I don’t think students are not allowed to do simple procedures in MOH hospitals like what AL said. If they show the right attitude and enthusiasm, MOH doctors will definitely allow them to observe and perform many procedures. From my observation in Malaysia, sadly many students just want to attend bedside teaching and attend lectures. They never bother to try to be part of the team. This includes the top medical school students like UKM, UM, IMU, etc…When asked to take history from the patient, 3-4 of them will ‘interrogate’ the patient simultaneously. It was jaw-dropping!
I still remembered my training during clinical years, where we medical students were considered as part of the team. We clerk the new cases, perform simple procedures, prepare for ward rounds, present cases, assist in OTs, attend MDT meeting and radiology/pathology/haematology meeting/teaching session, shadow the HO during on-call and basically does some of HOs works. This is rather traditional, but many medical school and teaching hospital in UK still does this, and I sincerely believe this is the right way how it should be done.
Contrary to what 1MDB said, not all IPTA send their student to just their university hospitals. Some has collaboration with MOH where they do attachment in MOH hospitals, including minor specialist hospital.
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