Year-end is always a busy time for me. Accounts to settle, children’s exams, meetings and holidays. Over the last few months, I have been writing about debts, UK crisis and job opportunities. Interestingly, there have been reports in news portals regarding debts that Malaysian students are collecting. In my last article, I attached a report stating that Malaysia’s Gen Y are living on the edge due to debts. Subsequently, few more reports emerged over the past few weeks.
Malaysian Insider quoted report from Asia One that Malaysia is the 5th most expensive country to do a degree program, in relation to household income. This is not surprising at all. That’s what happens when you commercialised education. It seems Malaysian parents spend 55% of their pay in allowing their child to finish university. The average tuition fee quoted was RM 77K. This is way below any medical course tuition fee, which can reach close to a minimum of 300K. Imagine the amount of debt if you do not get any scholarship. As one of my colleague said, medicine is only for the rich and for those who receive scholarship. Taking huge loans to do medicine is not worth it! Just few days ago there were some interesting advertisement about loan for wedding (nothing new actually)! We are really creating generation in debt! From study loans to car loan to wedding loan and house loan! Do we have anything left to feed ourselves!
It is also interesting to know that unemployment is higher among the highly educated people in Malaysia. This is also nothing unexpected. The higher you are educated, the choosier you become. Imagine, once jobless scenario hits the medical field, how many of these graduates will be willing to work in another field? Everyone will be blaming the government and colleges. There was an interesting write-up in Medical Journal of Australia (MJA) (see below) regarding job opportunities for doctors who can’t get a job or training post. This was a follow-up article to this article (see below) which confirms that Australia is facing the same crisis as any other country. Doctors are finding it difficult to get a permanent job and training post. He has given some suggestions, which I don’t think many would be interested (see the comments as well). At the same time, he also feels that the situation may get better later, when people stop doing medicine. The cycle repeats itself but it definitely does not console those who are already in the situation now. Trust me, there is NO job security anymore for doctors. Parents and students should remove that from their perception and just consider medicine as another job where nothing is guaranteed. The only setback in medicine is the fact that you would have spent huge amount of money (if not sponsored) and would never be able to practise as a doctor without completing housemanship. No training post means, no hope for further advancement.
IN the UK, as I had written on 2/10/2015, doctors took to the streets to protest against the change of working hours and income. Another protest was conducted on 18/10/2015. The UK crisis once again proved to us that at the end of the day, what matters is your income and how you are going to live a life. No matter how much passion you have, living a life is another story all together. Most of the cries of UK doctors were based on their income and survival. How they are going to feed their children, how they are going to lose their family time and how are they going to settle their debts etc? As I had always said, in the end, it is just another job to earn a living. Whatever passion you presumed you had will be thrown out of the window. Only real passion can pull you through. The Health secretary of UK has finally took back some of the statements he made regarding working hours. However, change is definitely coming to NHS. You can read the other articles in The Guardian news.
The world of medicine is not the same anymore. Patient’s demands are high, huge debts to become a doctor, increasing litigations and increasing risk of being unemployed. Not enough with these issues, we now have to compete with traditional healers, anti vaccine movements, home births, religious and non-religious supplements etc. Patients rather trust these guys than us, who had spent years studying evidence based medicine. Below I attach a Facebook post of a “crying” doctor:
It is the same thoughts that run through my mind. Over the last 20 years since I started my medical career, I am seeing increasing number of patients who trust all these “non-western and natural ” based treatment. No matter what you tell a patient, he will always consider you as a person who is making money by selling drugs/chemicals for profit-making pharmaceutical companies. Patients rather spend thousands of ringgit buying a product that supposedly can cure Diabetes and Hypertension. But, do they sue the seller if it does not work? The answer is NO, because you bought the product voluntarily and there is no written agreement between you and the seller on what he had promised. We have various magic drugs being promoted in Internet and even at roadsides, which can cure your Gout, Body aches and Joint pains. Almost all of these pills contain high dose steroids. Instant cure and pain relief is definite. Who are you to say it does not work? Most patients get a shock when I asked them how long have they been taking traditional medicines whenever they walk into my room. The first question they ask “ How do you know?” The answer is right on their face: “Cushingoid” facies!
15-20 years ago, I hardly hear anyone rejecting vaccination. Only a small group of people belonging to a certain religious sect refuses vaccination. Now, we have groups of people who openly rejecting vaccination claiming it is a Jewish plot, causes brain damage etc. We even hear stories that it is a Jewish and Christian plot to poison the Muslim community! Sometimes I do not know whether to laugh or cry but what shocks me further is the fact that there are people who actually believe all these nonsense, even the educated ones. Now, we are beginning to hear cases of Diphteria, Measles and Pertusis increasing day by day. TB will be the next epidemic. Parents are putting their child in danger. Should we create a law to punish these parents? While it is their right to take whatever treatment offered, spreading infectious disease can also be considered as a crime! Some countries have started to remove certain benefits from unvaccinated parents such as reducing tax relief, isolating them in schools etc. Proponents of home birth are another group that is increasing day by day. I had talked about it before.
Frankly, day-by-day I am losing interest in treating patients. The art of medicine is dying. Almost 5 out of 10 patients do not take your advice nor compliant to your medications. We are seeing younger and younger Diabetics and Hypertensives but do they care? WE will be seeing more and more complications from these diseases in years to come. We hoped that as the population gets more educated, we should be seeing fewer complications of chronic diseases but it’s the opposite that we are seeing. Patient feel that it is their right to do what they want as it is their life and body. Who are you to tell them to take medicine? Gone are the days when the community regarded doctors’ advise as golden! This write up from a Malaysian doctor in US is worth reading. That’s exactly what is happening over here as well.
Patients demand that investigations must be done to prove their diagnosis. Do we have test to prove everything in medicine? That’s where clinical skills come into the picture. A good clinician can diagnose a condition from history and examination alone. But patient will never trust you as long as you can’t provide a proof of your diagnosis. Tell them it’s Viral fever and they would want you to show the proof of the type of virus that infected them! These are the type of patients you are seeing nowadays. Tell them the liver derangement is caused by Dengue Fever and they will demand an answer why the liver enzymes are going up despite taking treatment from you! For those who think can do wonders by being a doctor, please understand that doctors don’t cure anything. We are just supporting the body to heal itself. Most of the time we are just buying time. The body will decide which way it’s going to go: recover or succumb! No surgeries are without complications but most patients nowadays do not except that fact either!
The comment below which appeared in my blog few days ago is worth reading:
“Interesting read Dr Paga.
I am amazed by your patience in answering questions here. I think you must be a good and patient doctor!
Anyway, when I was in medical school many years ago, I was already worried about job security and it was not like we have over 30 medical schools in Malaysia back then as it is now.
I think young people will need to look at themselves honestly and not just jump on the bandwagon and try to do medicine just because everybody think it is the right think to do and it is best way to earn money.
If you do something passionately, very likely you will succeed no matter what profession. Need not be medicine.
I used to be a top student in my school and naturally I studied medicine (because I thought that was the best thing to do!). My brother never understood science and he did law. My sister was an average student and did finance. Both of them are far more successful financially than me. Fortunately I have no aspirations to be a very rich man but I do enjoy what I do.
If you want to be rich and successful, you may be disappointed if you think medicine is the answer. Malaysia has very little control system and they allow all sorts of medical schools to sprout out.
UK has twice the number of people as Malaysia and is a far richer country and yet we have more medical schools than them. Something is not quite right.
So my advice is, if your real passion is to be a doctor, to be sensitive and compassionate with people, please go ahead and try your best if you have the means. Going to a good and well-recognized medical school is important. After leaving medical school for over 15 years now, I can still remember the basic medical science taught well to me but many housemen, fresh out of uni, can’t remember a thing!
If you need your dad to sell the house and car for you to realize this dream, you may need to think twice, because you will not necessary return a multi-millionaire to repay him.
If you want to become a doctor because other people tell you it is good, you also need to think twice. Life of a doctor is not for everyone and not everyone will be successful. You may see some successful ones but many are struggling too.
I always like to bring my brother as an example. He is hopeless in studies but can talk and argue really well. Today he is a very successful lawyer, earns easily 5 times more than me !!”
Well, it is time for me to take another break to release my stress. This would be the only article I will likely write for this month. I will be away next week with my parents for Deepavali. A week after that I will be exploring Middle Earth for 2 weeks. Hopefully, when I return early December, my mind will be fresh to start the cycle all over again!
Happy Deepavali to everyone………………..
Simon Hendel: Job opportunities
Simon Hendel
Monday, 2 November, 2015
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MORALE is low and burnout across medical specialties is high. In part, this is fuelled by the constant worry about job security for junior doctors. Some doctors who complete their training struggle to find regular work in the public sector for reasons too complex to detail in this short article. As discussed in MJA InSight last week, many junior doctors might not be able to even get a training place. However, the lack of job security for junior doctors is likely to be part of normal cyclical workforce patterns, which indicates we shouldn’t be too worried. However, that offers little consolation to new practitioners who can’t find work now. Doctors looking for work and those feeling uncertain about their job security often fear that if they deviate from the “normal” training conveyer belt they will be further disadvantaged and passed over in the competitive workplace. I would like to challenge that notion. Medicine as a profession is always changing. New evidence is regularly discovered that informs and changes the way we all practice. These changes are vigorously and appropriately debated. There is no reason to think that significant changes in our workforce should be met with any less critical debate. In that debate, one thing that all practising doctors can be sure of is that workforce changes, like changes in practice, are inevitable. And that change is hard. No other professional graduates have job certainty and few other professions ever have the job security that we have enjoyed. Yet medicine also requires a level of personal sacrifice that is quite different to most other professions. So it’s understandable that this change to a less certain job future is a bitter pill for us to collectively swallow. But it doesn’t have to be. Amid change there is opportunity. Junior doctors now have more opportunities than their predecessors to shape the way they balance their life with work. And this is the real elephant in the room. There is more to life than medicine. Having just spent the better part of 15 years learning how not to have a life, but at least being assured of employment, that can be hard to remember and even harder to believe. Studying and specialising in medicine teaches us to sacrifice other parts of our life rather than nurture them. So when we reach the end of the study and training road to find our future job prospects are not as certain as we expected, it can be very daunting. But this is where the opportunity lies. For doctors still in training there is opportunity to gain experiences out of the ordinary through locum work, travel or volunteering abroad, or practise in an entirely new setting like the military, or accept an overseas fellowship, or even work as a doctor in Antarctica. I’m willing to bet that doctors with this broader experience will be more marketable in a competitive job market than those with a generic ticket who are the same as the next applicant. And for those of us recently qualified? This is our opportunity too. This might be our only chance to really think about how we want to work — or perhaps how we don’t want to work. Is it time to do part-time clinical work so we can learn other skills we always wanted but never thought there would be time to achieve? Or time to be home for dinner and our children’s bath time? Or time to build a successful private practice? Whatever we choose to do with our time, we have a choice to use it as an opportunity or waste it wishing things were how they used to be. Before we know it there might be too many jobs again and we’ll wish we’d taken the chance when we had it. Dr Simon Hendel is a Melbourne based anaesthetist.
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Pagalavan's Avatar 
its tough to be a doctor nowadays!
Have a great holiday, Dr Paga 🙂 The fresh air in NZ will definitely revive your lungs!
Thanks.
Dr. Paga for the safety of your house while you and your family were on vacation, i think its better not to post online where and when you are leaving. Cheers!
Haha, thanks. I don’t usually say exactly when i am going. My house is in gated and guarded area. Relatively safe
Doc, I am in my mid seventies and I have always believed in evidence based medicine (Western medicine).
And at my age, I am healthy!
All I take daily is a 50mg of Atenolol for my high blood pressure – that’s all!
And I can tell you that I have been horrified by seeing some much younger patients collecting five or more medicines at the dispensary of a clinic or hospital, not to even mention the costs!
I also noticed that more and more of the younger generation are dappling in the use of alternative medicine (herbal medicine).
They have the idea that since they are herbals, they are harmless.
But they can be proven to be deadly wrong,
But by then, it will be too late.
They will just not accept any advice about the dangers of such herbal medicines.
It is indeed very hard to make the stupid, smart.
magic drugs being promoted at roadsides, which can cure your Gout, Body aches and Joint painsor whatever illness , sounds familiar . Haha
Anyway , Dr paga , for the anti vaccination movement , do you think policies should be made to punish those people if some mishappens happens?
Eg: those who refused to vaccinate their children will have to pay the full cost even at government hospital if any associated complications or problems arise and they will be sued by the government for child abuse .
Yes, the government should. Australia and US has started something like that.
The best patients has always been those who had been deprived. They will be the most grateful ones. This was the case in the early days of Malaysia, when we were still under-developed.
Education and affluence, contrary to popular believe, does not make patients “better”. The simple patient just trust the doctors. The “well informed” patients on the other hand, have lots of information, but do not know how to understand them, and often come to the wrong conclusions. And it leads to “patient directed” treatments. How many times you have been asked by patients to have “laser” treatment for everything, from gallstones to kidney stones to stomach cancer?
Alternative healthcare has always existed. In fact, in the old days, they are the ONLY healthcare available. We think we are mainstream. But to a lot of people, WE are the alternatives, they would rather seek help from the Chinese sinseh, ayuverdic practitioner, or bomoh first. And these alternatives (to us) has been very clever to be on line to expand their reach. And have purposely tell lies about scientific medicine. Go read any of the healthfood websites and you will see how often they tell mistruths.
Dr. Pagalavan, happy holidays in NZ!
Back to the issues stated.. It could be that the traditional healers or sellers speak a common language with the patients. The products may be a total scam but it’s the way these healers relate to the patient that the patient can trust them entirely. And give them hope of healing. Do we actually lack that opportunity to generate mutual trust due to the large patient crowd & patients having to see different Dr’s at every visit compared to say, private hosp & GPs where you choose your doctor? Its that one-to-one interaction that I believe, may be able to increase compliance & implicit trust in patients. & that is what patients also want.
Sometimes it’s hard to empathize when patients seek healers outside instead of us to their own detriment, but the crux of the matter is that we must make ourselves more appealing to win over their trust.
IN actual fact, no matter how much time you spend with the patient, they would still not trust you. I use to think the same way when I was in government sector but after being in private sector for 5 years, I don’t see any difference. Patients prefer traditional healers just because they feel these guys are giving natural treatment and promises a cure. We practise evidence based medicine with chemicals!
It is a shame that in spite of more education, many people remains grossly ignorant. You would think having learnt Chemistry, they will understand. Our human body is actually nothing but a tub of chemical reactions. For any treatment to work, it needs to invoke a change in the chemical equation somewhere. All so called “natural” cures, if they actually work, will need to invoke chemistry too. Active chemicals abound in all “natural” substances. Both the good and the bad.
Dr. Paga, happy holidays down under..
Back to the issues mentioned, perhaps it is the way traditional healers or sellers relate to the patient in a common language and testimonials that is able to make the patient totally trust them & feel there is a hope or cure for their disease.
Are we lacking in that one-to-one interaction until patients feel they cannot trust us? Do we give patients hope despite the disease being chronic and incurable? I believe this is what patients are seeking. Its a battle of hearts and minds when we want compliance & implicit trust. Its hard to empathise when patients seek alternatives to their own detriment but we as healthcare professionals have to make ourselves more appealing than whatever there is out there.
i think the whole complementary medicines have become the mainstream in msia. In the western world, complementary medicine will not and can not be mainstream, simply because the people are more educated and they are sceptical of everything even western medicine. BUT THE POINT IS WESTERN MEDICINE TRIUMPH ABOVE ALL BECAUSE THE EDUCATED READ FOR THEMSELVES in Mr google and they VERIFY THAT WITH DOCTORS. DOCTORS are highly regarded in the west and their opinions are powerful. i think the problem in malaysia boil down to 2 factor, both problem within patients and doctors. Firstly asians they don’t listen and think they are always the best and their arrogance lead to western medicine comes with CT/MRI in just few hundred years but chineses accupuncture still can’t prove the its validity after thousands of years, their/asian attitude is abhorrent. Secondly it is the doctors fault, we are ” too nice” and you can imagine doctors who can survive in medical field are generally nice and will not attack herbs or others as toxic lead or steroid openly, but only questioned its validity, unlike those Asian Ah Pek go around with lound speaker claiming their efficacy and success and condemned even panadol that can cause renal failure. Because of their ignorant and eager to triump attitute and not willing to read more research and lack of education/English proficiency , they will only focus on 1 or 2 success as miracle ignoring thousands of others that failed terribly, afterall they are making so much money by giving panadol / steroid powder mixed in herbs that claim to cure arthritis, with no ethical sense at all just to claim more money . It is also failure of Malaysia doctor not to speak up rather than just vague statement like “not enough data to support….” Medical Council in NZ is very strict on guideline , if you don’t have studies to back you up, don’t expect any funding and those prac will slowly demise, even accupuncture funding with thousands of years of history will only be limited to back pain and muscular skeletal sprain, where else any fracture will be treated with cast and bigger funding of about nz 200 dollar a cast with proper orthopedic follow up rather than chinese manipulation of fracture bone (wonder why people still want to endure so much pain where we got all the plexus block to help you) !!! So complementary medicine in NZ will never flourish due to money and strong regulatory body. Even back pain and sprain need permission from doctor to get an ACC form (ACC is a strong regulatory body for accident funding) in order to get free acupuncture treatment !! So doctors are highly valued here, which make sense because any red flag syndrome will be referred straight to orthopedic for operation immediately like caudal equinal and etc where else those with sciatica can still wait for MRI, do you think any of those acupuncturists know about these triage priority? THEY WILL NOT KNOW. So we are the gate keeper rather than those self proclaimed herbalis that can treat women cancer and boast as professor that can cure all illness and specializing in all!! Msia is very sad because those chinese medicine, acupuncturists colleges are mushrooming like medical school. Unless doctors speak up and regulatory body start to put their feet together, western medicine will not be the mainstream and that will be the doom day for malaysia. You will then continue to see people with hba1c of more than 100 and relying on herbs and eventually needing amputation and dialysis which is going to cost more. The foolishness of regulatory body and greed of certain herbalis will end up sucking up more funding and collapse of the whole system, no matter how much hospital you built, there will only serve pt for amputations and dialysis! !
I am used to be a medical doctor but now I am doing a Phd in Statistics and Mathematics. I enjoy my newly found interest immensely and I think there are many things things that I learnt from Mathematics and Statistics that can be applied to medicine. I know most doctors feel a bit daunted and fearful of linear algebra, calculus (integration and differentiation alike), number theory, numerical analyses, trigonometric, Fourier series, Laplace transformation, but don’t worry with persistent effort and unwavering enthusiasm, Math and Stats are not something that we should really be afraid of.
So there are still many things beyond medicine that we can learn from. I never regret even for one second in my life leaving medicine since working with numbers makes my life more fulfilling than working with my superiors who only knew how to “bastardize” the IQs of intelligent and aspiring young doctors. Hard to accept but that is what really happened in our clinical practice nowadays; it seems the only way to teach is by humiliation.
Many thanks and best of luck to all of you (young and senior doctors alike). May the force be with you and let my stethoscope remain in the garbage bin forever. Sayonara adios amigos.
PhD in Maths?what field was your masters?
Msc in Medical Statistics and Epidemiology… Now in training to become a full-fledged medical statistician and a chartered statistician (Cstat, Royal Statistical Society).
Wow..thats nice..good for you..congrats
Good Luck!
Thanks bro for that… Hopefully can finish my training in three years… By the way life is good after leaving medicine…(albeit temporarily since i intend to go back into medical research once my training finishes)
I have heard that even Singapore is not taking in foreign soon to be HO’s who study overseas anymore, saying that there is a good supply of local grads and singaporean overseas grads
Singapore will continue to take in foreign graduates as long as they need them….
They need them at the moment because Singapore does not train enough doctors for their own needs. Even when the new NTU-Imperial med school starts graduating, it will still not be enough.
Many Singaporeans therefore seek medical education overseas, and Singapore does recognise quite a few foreign medical schools, albeit not as many as Malaysia. However, they are mostly in the developed countries, and like Malaysians, many Singaporeans also choose to stay back after graduating. Therefore the numbers returning varies significantly.
When the time comes where Singapore can produce enough doctors amongst their own citizens, they will stop taking foreigners.
At least 2 Malaysians and one HK studying in the UK have been rejected. That was what the interviewers told them. Extrapolate from that what you will. I also don’t think you know what you’re talking about. Have you heard of the successful PEG programme for Singaporean medics?
No country guarantee all applicants a job. It depends on vacancy and your interview performance.
What did I say that was wrong? I am well aware of the Sporean gov’s incentives to attract their citizens back to work. However, like I said, many do not find that attractive enough, and stayed back when they graduated.
In one particular Australian uni, half of Singaporean decided to stay on to work. The numbers returning to Singapore vary from year to year, hence the vacancies available for foreigners will also vary year to year.
So they were called for an interview in the first place.
The number of doctors that they need will surely reduce over time as they produce more. However, they still do take foreigners to fill up their vacancy. I also know of UM/UKM graduates who went there for housemanship finding it difficult to get into their residency program.
Dr P, what is your general opinion on the residency program in Singapore? Assuming one gets in, and goes through all the necessaries, one becomes a specialist consultant much faster than the “traditional” GMC-styled route. Is this necessarily better? Does it in reality mean that these consultants are ONLY familiar with their specialty? From the perspective of a patient, i can only imagine being sent from one clinic to another, if diagnosis is yet to be conclusive. Please correct me if I’m thinking this wrong. Thank you.
Singapore is trying to merge both system. I understand that they still need to do housemanship as before and then apply for residency program. Not everyone will be accepted. There are still doctors doing UK exams and it is still accepted as part of training. However, residency system is the way they can become a specialist.
as a mbbs student, i feel challenged with homeopathy medicine . as we know they have their own degree such as bachelor of homeopathy medicine and surgery BHMS, and they were plead their syllabus is same like mbbs except allopathy pharmacology. can you explain this issues Dr.Paga? is they legal to practice like modern medicine? why some of them is given ‘DR’ tittle?
Yes, they have been using doctor title for a long time. They are not bound by any laws unlike modern doctors. Yes, they can practise what they want. You can complain to KKM if they are doing anything which is the same as medical doctors like doing surgeries etc. Even then they can still get away with it as there is no law to prevent them from doing so. They are even running hospitals.
http://www.harakahdaily.net/index.php/headline/38684-pas-cadang-skim-gaji-doktor-bermula-ud48
To all MBBS/MD grads, the world is wide open for you to explore beyond clinical medicine. Do not despair if you find out after years of gruelling medical training, your true calling is not by being a doctor. I am not in medical profession but many of my family members were trained in medicine and 3 out of 5 do not practice as medical doctors. My cousin graduated with MBBS but instead of applying as a HO in Malaysia, he continues with second degree in Computer Science. He is currently in his final year of study and already working in health informatics in Australia. I survive with meagre salary as an engineer here in Malaysia, while he enjoys $70,000/year working 16H/week there.
Exactly but what if they had spent RM 500K or in debt? That is where problem arises. If you are from a rich family or under scholarship, then you have nothing to worry about after 5 years. However, if your average parents had spent RM 500K by taking loans etc, then wasting 5 years in medical school in not the answer. That’s why I keep saying that you should know what you are getting yourself into.
It is not great when they said Malaysia is the 5th most expensive country to do a degree program. Any idea which country is cheaper?
Each country have their own policy. Some western and european countries, education is government sponsored and free!
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