In October 2015, I wrote regarding the crisis that was blooming in UK healthcare system. While negotiation was going on between BMA and the government of UK, it seem to have headed no-where. In January 2016, the junior doctors had their first strike since 1975 to go against the proposed change in contract and definition of working hours. On 15th January, the Health Secretary released statistics on the number of deaths during weekends to justify the change in the contract. Remember, this is exactly what I said the politicians will do in my October 2015 article. Once they prove to the public the statistics, they will get public support. Unfortunately, despite the strike, the government stuck to their plan. Another strike took place early this month. It looks like the government of England will go ahead with their plan soon. So, graduates who think grass is greener on the other side should always think carefully. Being a doctor is always stressful no matter where you are. The only difference is the healthcare structure, facilities and training.
There is also another issue that is being discussed aggressively in the UK. It is the change of migration policy. The UK Migrations Advisory Committee had suggested that UK trained international doctors, of which there are around 500 each year, could be subject to the Resident Labour Market Test (RLMT) when moving from the second year of foundation training to specialty training. Previously doctors were exempted from RLMT. You can view the document here: bmj.i1008.full.
I received an interesting email from a Malaysian doctor in UK who is intending to come back home. He had given permission to publish part of his email below.
“I am not sure if you are aware but staying in the UK post-FY2 (i.e. housemanship) will not be as easy. Being subjected to the Resident Labour Market means that:
As I had always said, doing medicine with the intention to migrate is the worst thing to do. However, even my suggestion to do medicine in the country you intend to migrate is also falling apart. Meanwhile, in the US, by 2023, the rules for ECFMG certification will also change. This change was already suggested in 2010. At the moment, as long as your medical school is listed in World Directory of Medical Schools (WDOMS), you are eligible to sit for USMLE and receive ECFMG certificate for your Step 3 and residency application. However, WDOMS only list the medical schools which has been approved by the authority in a respective country to conduct a medical program. It does not give any form of recognition, accreditation or assessment regarding the medical schools listed. Basically, it only states that such a university is offering a medical program in such a country. The programs do not even need to be accredited by the respective country’s medical council.
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In favour of them closing down soon than having “half baked”graduates loose on the streets!
We need Malaysia’s medical education to be consolidated. We need to shrink down the number of medical programmes to less than 20. We need to close the door to overseas programmes which purely cathers to “foreign students”. i.e. those Russian/Ukraine/Indonesian/Indian/Chinese medical programmes recognised MUST be the same as those being run for their own students, using the same syllabus, lecturers and language as the local programme.
The smaller and struggling upstarts must either close, or merge with established medical schools. Since the IPTS med schools are incapable of ensuring appropriately eligible students be selected, the selection process and minimum qualification guidelines needs to be tighten. Imagine, it is much harder to enter teacher training than med school! A common entrance exam is one possibility (albeit a politically unacceptable one). A common exit exam is perhaps an appropriate compromise, although that can mean 5-6 years of wasted time and money for those too weak to ever pass.
IPTAs need to move away from NEP dogma into merit based selection, to ensure the best available are accepted.
What did I say? In my dreams?
Yes, dreams. There is no political will to do any of these.
We need people to have realistic expectations about what being a doc is about. If so they won’t be too surprised when they struggle for jobs throughout their career. Gone are the days when there is only a handful of doctors, therefore a good income and stable job and loads of respect. Like any other profession, survival of the fittest is the key in the medical field
Doctor Pagalavan, any chance your book to be sold online or at Popular book shop?
I may sell it myself online. Will take time to get it into bookshop.
to be frank, i am really satisfy with being a doctor, i really don’t think situation is really that bad globally, at least here in NZ, an old GP offers NZ 400,000 per year and vacancy still not filled!!mind you aussie is offering more than this!! yes people feel miserable because he can’t be a glamorous cardiothoracic surgeon but being a specialist GP or A&E specialist is also good enough so what if you can’t be a neurosurgeon!! I still think people should migrate and come and grab all these opportunities!! http://m.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=11593835
The question is why people do not want to work in these rural places? The same reason why people don’t want to work in rural Malaysia like Sabah and Sarawak . It is not just about money but life as well. Frankly, most are only interested working in urban or semiurban areas . You never hear anyone wanting to go to African countries to work do you? At the end of the day, it is about life and money.
you are right dr p, but in urban area like auckland, gps are still earning NZ250,000/yr for 38 hours of work per week and still heaps of vacancies (about 14k after tax permonth ). we still got Paparich and life is ok too although not as entertaining as in KL. that is just me, at least i think grass is really greener in nz provided you are not aiming for popular hot job like neurosurgeon/plastic ! come to aussie or nz !! it is really quite good here and i wish to share it with all msian mates! !but the only downfall is a 4/5 bedroom house in auck/mel will easily cost NZ1.2 million compared to only 500 to 600k 6 years ago. Expect to pay more if you are in a good school zoned. the point i am making is grass is really greener outside if you can suffer some isolation in rural you will earn 400k and go ski field on weekends(and you don’t need to work on weekends!!may be just fly to gold coast for NZ100/one way with airasia), if not 250k in urban is just fined. But if u work in rural sabah/sarawak you will have neither the money and life. You choose !!
Yes, but it does not come easy. The country you are in is very strict in their quality control unlike our bolehland. UNless you graduate from there, the chances of getting an internship after passing their entrance exams is getting very slim. However, if you are young, you can always try. Family is another issue. As long as you are single and got no dependents, you can do all you want. Once you have a family, life gets tougher to migrate if you are doing medicine.
The wast majority of students and doctors do want to migrate if they can. In education forums, students and parents also always ask if they study in Msian medical schools, can they go work “overseas”. Yes, Australia and NZ are top choices, but Singapore is the favourite, being near, and familiar. However, for the vast majority as well, they CANNOT. Their qualifications are not registrable, the hoops they need to jump are too difficult. Not everybody can cope with migration and a new way of life, isolated from your confort zones.
The majority of students cannot afford to study in these “lifestyle” countries. The majority of those who can affort cannot qualify to enter. Many attempted in private colleges in these countries, but to fail to secure an direct offer and return to study in local med schools. IMU-PMS is a favourite as a easy backdoor entry into these countries.
Finally, those who CAN migrate, once they are in the system, they too want to stay in urban centres rather than rural areas. Beyond lifestyle issues, the other big reason is children’s education. I should know. My brother was a GP in rural North Island for 20 years, but eventually had to move when the children’s education needs caught up.
Yup, exactly.
I am one of those who chose life instead of money and lucky enough to migrate from Canada to Australia with the luxury of city life and good earning. I left rural Canada despite having the chance to earn up to CAD$700k to $800k per annum. So i agree with Dr Paga on this as well!
im interested..please tell us more the pathway to work in newzealand?
go to their medical council website. its nz rex and AMC for aussie exam. both recognize one another. good luck !!
It is interesting that after all that is written in this blog, you are still asking this question. Please go and check the NZ medical council website which is available online.
i agree majority want to migrate, but it will be a steep obstacle. guys, the reason i am telling you all these is medicine is not tht bad globally , at least in nz and aussie;) i want to encourage you guys to take the registration exams and many colleagues of mine from russia, india, and etc did just fine!! i come with good faith and hope you guys can make it!! but whether you are up to the challenge is another story, but once you get through it you will be secure!! and your retirement is all secure with all the welfare benefit here!!but up to you, you either rot in msia looking at the current political situation or try your luck abroad and come back if fail. either way you hv nothing to lose!!
Another issues is , all these sitting for entrance exams, travelling etc cost a lot of money. After spending huge amount of money, there is no guarantee that you will get a post or even the location you want(hoping you are single). But i know many from other fields who had easily obtained PR even before migrating! A friend of mine who is a physician with MRCP just got a PR in Australia for his WIFE via the skilled workers nomination pathway. She is just an English Teacher. Where as my friend(husband) who is a physician of 15 years can’t as his degree is not recognised in Australia.So, you see what I mean? Why go through all these medical licensing hassle to migrate when you could have done it much easier with other fields? Another friend of mine who is just a remisier easily migrated to Melbourne with the whole family after getting PR. This is what I am trying to say. There are more non-medical profesionals who had easily migrated to OZ/NZ than medicine.
i see all your concern. the truth is i hv many colleagues who are from russia, india, sri langka, yogoslavia , Bangladesh , china etc who are much poorer but they make it and they learn English from the scratch. some are neurologist or obstetricians back home. guys, i am a diplomatic person, i am just throwing in all the options and you will make it if you work hard and humble enough. some of my trainee can be my father’s age but does it really matter. anyway i am just sharing my experience and depend on how you look at the half filled bottle !your choice 🙂
Yes, anyone who work hard can find a way. However, who would want to do that at that age? Many do it for the sake of their family and children. If not, most would like to retire at that age rather than going back and working as a registra/MO. That is what I am saying. You are right when you said, people should plan to migrate when they are young. Unfortunately, when you are young, you do not have the financial capability to spend huge amount of money to sit for various exams and to migrate.
jonathanwly, i don’t know which part of aus or nz you’re living in, i am currently in the training program in aus and it is darn difficult to get in. A minority will pass AMC and even if they do, it is rare that they will be in the training program as the locals will be prioritized first, not to mention, they will have to start from scratch and have to work their way into a training program and have to be known… ?secured jobs, definitely not in victoria, it’s a yearly contract… Then again, i’m talking about victoria, not sure about the other states
With the changes coming up in the UK and the expected resignation of quite a number of doctors looking at greener pastures elsewhere, it is also an opportune time for many who are looking to climb into higher positions as a result of the vacancies made available. In any transitional period, there are always gainers and losers. For a start, junior doctors in Wales and Scotland will not be affected. Another referendum in Scotland in the near future may even made it to be another independent nation.
EU citizens will fill up the vacancies
Dr Pagavalan,
I intend to do medicine in Scotland. May I know if areas outside of England( wales, scotland, and northern ireland) are subjected to the Labour Market Test as well? Would appreciate to hear from you.
Thank you.m
I think yes as it is going to be UK migration policy.
One aspect i find appealing working abroad is the absence of over reverance to senior colleagues. Mutual respect is the key and people who speak their minds are appreciated.
Pitfalls are homesickness, having to start at a lower rung of ladder and settling for less popular jobs. Generalist like gp s and general physicians are more likely to get jobs. However if looking for popular subspecialties like interventional cardiology may face stiff competition from locals. Md/ phd s are almost a requirement.
So if moving abroad is important and willing to settle for less popular specialties then defo can consider. Get in the system and work thy way up.
I completely agree.
Dont forget, the local intake is usually within the 99th percentile, so you’re up against some seriously bright individuals. All the A’s / GPA scores mean nothing when you are competing against the real cream of a non-biased education system.
For people who are thinking of migrating for a better life, just a word of caution. If you are currently working here and think that you deserve to earn more, think twice!!. Generally, if you cannot make yourself successful here, the chances of making a success there is an illusion. If you are qualified and cant achieve something worthwhile in our country which is somewhat less competitive, what makes you think you will be better in a more developed and competitive country.
I think there are many reasons why someone wants to migrate. It is not necessarily to earn better money. Most migrate for a better life and for children’s future. And also for a better environment, to run away from all these racial and religious fanatism that is creeping this country.
That is not true. These societies do things differently from Malaysia. One is, everybody earns pretty the same amount of money, as a salaried worker. In basic terms, a teacher, nurse, junior doctor, accountant, engineer, etc all are paid very similar salaries, for the same hours worked. In fact, having a skill earns you even more than professionals, eg plumbers, electricians, locksmiths etc. My plumber charges AUD$90/hr, when I locked myself out, the locksmith charged 250 for 1 hr’s work, and my daughter working as a junior doctor earns less than 50 an hr.
Secondly, the society is fair, and rewards hard work. So anyone who works hard, are diligent and honest, will make a decent living. You don’t to be “successful”. Egalite is the principle.
The problem is, in Malaysia “making it” is different from the Western world. It means become very rich, and usually means ability to adjust your circumstances to your advantage, whether it be through connections, political patronage or plain corruption. We tend to think that’s the same way we will “make it” in these places too. It’s not.
Agreed with you on “making it”. If one is in the top 10% of the EPF bracket, life would be fairly comfortable here. Its still one of the easier places to earn a living. I dont really bother about the daily nonsense being spew out as it does not affect me. Comparatively, its just impossible for most Malaysians to carry out a successful business venture in China as they are too shrewd and cunning for us.
The daily nonsense will affect you eventually !
I also used to think the “daily nonsense” will not affect me. It hit me last year with the 6% GST, money which I have no control over how it’s spent. It hit me again recently when I went to Europe and changed my MYR to Euros. It will hit me again when the IRB widen their witchhunt to take more money from taxpayers by moving the goal post mid game.
Don’t fool yourself to think it will not affect you.
Thanks Dr Pagal. Ever since i found your blog years back you have been nothing but providing kind analysis of our healthcare scenario. Indeed they are sharply deduced.
Great job Dr Paga
Malaysian likes to complain a lot, in general