It looks like we are making headlines again. Few days ago, the Chief Secretary of the Government publicly announced that housemen are the highest number of civil servants being terminated. As for me, it did not come as a surprise. This is something that is well-known to the medical profession. Many housemen just go missing without any notice. I had said this before that it is better for them to give a resignation letter than just go missing in action. The government’s procedure is as such that it will take almost a year to terminate someone from civil service. During this time, no one else can occupy your post. This is one of the reason I support giving housemanship under contract. It will be much easier to terminate someone who goes missing. It will also keep everyone on their toes.
Today, NST published several reports on these issues as below. I had said it many times since I started this blog that you should know what you are getting yourself into when you decide to do medicine. That is the reason why I started this blog in 2010. Unfortunately, many still refuse to believe what is written and in denial. Parents on the other hand do not even bother to ask their child what they want to do in their life. They pressurize their child in doing medicine by promising a good life and money.
Medicine is a stressful job. It is not about sitting in an office and having a chat with a patient and pocketing RM 50-70. IT is much more than that. The time taken to be competent and the amount of responsibility taken is huge. With increasing literacy rate and demand of patients, it further adds to the stress level. Some times I get amused when the person who makes the most fuss in a clinic or a hospital actually sends his own child to be a doctor! I know another parent who do not believe in western medicine and takes only complementary medicine but sent his son to do medicine overseas! Is this called hypocrisy or they simply believe that medicine brings easy money for their children?
As a response to the issue, our Health Minister says that all future housemen would be given counselling! Sometimes I simply don’t understand the logic behind some of the answers coming out of our politician’s mouth! Why do counselling after they graduate? Why don’t we start counselling before they even enter a medical school? Or even conduct some form of standardised entrance exam and interview? Tell them and their parents the reality out there. Unfortunately this will not happen as it will affect the enrolment into our 35 medical schools. Then the medical schools will start making noise as they will be loosing money! The very moment our policy makers decided to commercialised medical education and put quantity ahead of quality, we know where we are heading!
For those who intend to do medicine, please read this blog or buy my books! I had many comments which said that I am discouraging many budding doctors by being very negative. I had explained many times that what I write over here are the REALITY out there which you should know before putting your foot into medicine. If you only going to realise it after you graduate, then it is simply too late…… Trust me : Life in Medicine never gets easier…….
My Books are still available and can be purchased directly from me by following the instructions over HERE. Each and every budding medical students should read this book before deciding to do medicine. Softcopy is available at Google Play Store.
Doctor dilemma: Why are Malaysia’s housemen buckling under pressure?
BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:03
MANY housemen find it difficult to cope with the pressure when they cannot adapt to the rigorous training regimen in hospitals. Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said this had led to many housemen not completing their training, especially those who studied abroad, as the systems were different. “In some countries, interns are not even allowed to touch patients, and they do not even know how to get a patient’s history. “There is also the language barrier. If they studied in Indonesia, the common language is Bahasa Indonesia, but in Malaysia, we use English,” he said, adding that this had increased the pressure on housemen. Dr Hilmi said there were about 10,000 housemen from various backgrounds in Malaysia, including graduates from local, overseas and unrecognised universities. He said of the number, at least 20 per cent had difficulties with training and were asked to extend their internships up to six to eight months. “Last year, 1.2 per cent of housemen were either terminated or had quit because they could not take the heat. “Many went to other countries to complete their internship, while those who did not show up for many months were sacked.” On why it took so long to identify absent housemen, Dr Hilmi said there were so many housemen that sometimes their superiors did not notice that they had gone missing. “That is why some have gone missing for up to 400 days,” he said after launching World Leprosy Day at the Gombak Orang Asli Hospital in Selangor yesterday. He was responding to Chief Secretary to the Government Tan Sri Dr Ali Hamsa, who had said trainee doctors made up the highest number of civil servants who were given termination notices. Health Minister Datuk Seri Dr S. Subramaniam said about 20 to 30 per cent of about 5,000 housemen who joined the service every year opted to extend their housemanship. He said there were cases of housemen leaving the profession or were removed after they disappeared after finding out that they could not meet the expected requirements of working as a doctor. “I’ve seen some who resigned within 24 hours. “Many don’t resign, but they are not in the system because they don’t go to work. “Later, when we identify them, but can’t trace them, we have to take disciplinary action,” said Dr Subramaniam at a seminar on workplace health here yesterday. He said stress was the main reason housemen dropped out, were absent or extended their housemanship. “People who take up medicine and don’t know what it is all about (often find that) they can’t fit in the system.” However, he said, the number of such incident s had dropped as the ministry had taken steps to intervene by counselling the housemen. He said the respective sections had been instructed to counsel and train housemen before they began their programme and to offer them transfers to other facilities to help them adjust. Dr Subramaniam said universities should consider using an aptitude test. He said to address the problem, the ministry’s main job was to ensure that working conditions were conducive. He said universities might need to regulate interviews to ensure the screening system was compatible with the ministry’s requirements. He said imposing such requirements on private institutions was a tall order as a strict vetting process would reduce the number of students who passed,thus leading them to collect less fees. He said housemen who dropped out and wanted to rejoin the service would not be given a second chance. “Once they drop out, it is the end of their medical career. “The Malaysian Medical Council will not recognise them as practising doctors. “The ones with major disciplinary issues will not have a certification of good standard and they will find it difficult to find jobs in other countries.” Ali Hamsa had said some housemen were laid off because they went missing for up to 400 days. He said some of them had studied abroad on government scholarships. It was reported that sponsoring a medical student overseas could cost as much as RM1 million or more, while the cost in local universities was far lower, but still hefty. Ali Hamsa attributed the policy of permitting hospital interns to follow their spouses overseas for study purposes as another possible reason many went missing from work, and called for a policy review.
Planning to become a doctor? Get set for burnouts, depression
BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:00 PM
While many consider being a doctor a dream profession, a growing number of those working in the field find it miserable. Numerous reports can be found on how a growing number of physicians and trainees are going through dark periods of turmoil due to stress. Dr Elaine Cox, in an article on health.usnews.com, said statistics on the number of doctors-in-training and those practising medicine who faced stress was alarming, with about one-third of physicians reporting experiencing burnout at any given point. “As a matter of fact, doctors are 15 times more likely to burn out than professionals in any other line of work, and 45 per cent of primary care physicians report that they would quit if they could afford to do so. “Physicians have a 10 to 20 per cent higher divorce rate than the general population and, sadly, there are 300 to 400 physician suicide deaths each year.” She said the lack of control over schedules and time could contribute to high-stress situations for physicians. “This can result in poor sleep patterns, interference with family activities and events, and poor self-care. “Because there is a patient in need at the end of every phone call and every office or hospital interaction, setting limits is beyond difficult. “The result can be physical and emotional exhaustion, leading to cynicism and burnout. Add to that the increasingly litigious society in which we live, and there is a recipe for quite a few failures.” Dr Cox said in a study published recently, medical students reported a rate of depression that was 15 to 30 per cent higher than the general population. “This can lead to poorer performance, such as 6.2 times more medication errors, exactly the opposite of what we are striving for through the education process.” She said many physicians did not recognise and seek help when they experienced early signs of burnout, primarily because of fear. “Frequently, privileges and licences could be denied if physicians are under treatment for substance abuse or depression. Without those certifications, the source of livelihood, not to mention identity and many years spent in training, is lost.” She said many feared that the struggles they faced would be noticed by the doctor they were getting the treatment from, and, as a result, many self-medicate, which was not a good strategy. Alexandra Sifferlin, writing for Time.com, said research showed that almost 40 per cent of doctors in the United States experienced emotional, physical and psychological burnout from their jobs. “The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the healthcare system, leading to less motivation to improve conditions, both for themselves and for patients,” she said. 2106 reads NST Infographic
Read More : http://www.nst.com.my/news/2017/02/212607/planning-become-doctor-get-set-burnouts-depression?d=1
Pagalavan's Avatar 
I have heard stories about private medical schools not getting adequate or full access to the public healthcare facilities for their students’ training purposes. Full of red tapes and little napolean rules. And then later, when the graduates cannot perform that well during HO time, the senior docs bash them. The common statements made are “private med schools should have built their own hospitals if they want to train the students, otherwise licence should not be given”. They cited the reason like UM or UKM have their own full scale hospitals hence they don’t rely on other hospitals for training. Now my question to them will be, “How come many private hospitals also not having enough specialists, eg no neurosurgeon, no psychiatrist, but yet allowed to function?” Their licence should also be revoked, unless they can be well equipped like HKL (using HKL as the benchmark). I think it’s unfair to compare UM and UKM as those are public funded institution, together with their hospitals. For private med schools, I think the public hospitals SHOULD cooperate with them, to provide the best teaching environment so that the students benefit, and these are the people who will soon be our future doctors. For private medical schools to build hospitals, it is costly, and to survive, they applaud the govt’s 1Care (or whatever health insurance scheme) so that the govt can “buy” their services for sustainability – but then again, the same docs who opposed to private med schools shouted TAK NAK 1Care. To me, that’s unfair and counterproductive in producing quality doctors for our country. Having said that I agree with the contract system to weed out those incompetent ones, and agree to have a unified exam system before the entrance into med schools, whether public or private.
Private medical schools are build with the sole purpose to make monetary profit. If they can provide the whole package of medical education and unable to afford a training medical hospital, they should not even start the medical school on the first place.
I am quite amazed by the way you claimed that “Private medical schools are build with the sole purpose to make monetary profit”, instead of thinking in the positive direction of how we get quality doctors to serve the nation. But then when the public perceived GPs are out there solely to make money, all you guys get jumpy! What a hypocrite! 😀
Whatever said and done, private colleges are profit driven. The problem is, proper monitoring and standard setting by authorities concerned. Minimum standard vs expected standard! We follow minimum standard.
@Paga: Private hospitals and GP clinics are also profit driven. And many private hospitals and GP practices are dodgy and unprofessional. Minimum standard vs expected standard! We follow minimum standard too for these practice. So theoretically it is OK for the enforcement officer to raid the clinics, or put heavy penalty on the doctors found guilty. But then when 7 docs got handcuffed in Penang, all the docs became jumpy!! That’s hypocrisy to the max.
Yes, enforcement must be made. And I agree with you that these doctors should not be jumping unnecessarily without knowing the facts. Sometimes truth hurts!
I do not think private med schools have any right to complain. They are a very much the reason why we are all in this mess. The private schools have made enabled anyone who can pay to do medicine.
You sure it is the private med schools which have caused this mess? Show me some statistics. Don’t make generalised statements if you don’t have some facts to back you up! Be more professional and constructive in the discussion please. This is a public domain where anyone (even non-med people) can read.
yes, it happened but since the introduction of the minimum entry requirement in 2011, they could not take any tom, dick and harry into their program. That’s the reason why many medical schools could not meet their student’s quota. However, the situation is not the same for those who go overseas.
The minimum entry requirements is just too low of 5Bs in SPM for those doing matriculation, foundation in science and pre-medical and a CGPA of 3. I am sure if we increase to 5 As, a lot of undesirable students will be weeded out. A painful consolidation of medical colleges will happen.
Yup but MOE refuse to do it despite recommended by MMC
As I replied to you before, I wrote about these little napoleons in MMA magazine almost 10 years ago. Unfortunately, nothing has changed. The problem is more of attitude as well as “you are private and I am government mentality”. At the same time, these government hospitals are not built for teaching and thus there are many limitations in teaching. Students attitude is another. Most students nowadays do not even bother to go to wards except during bed side teaching by the “time-tabled” lecturer. The students refuse to even follow the ward consultant’s rounds. And then we have atleast 2 medical schools using one hospital, not to forget the student nurses wondering around in the wards. Personally, the issue is more complex than what everyone thinks.
Well, for me, I think if a hospital is given to 2 schools, then the MOH must work with the GH to sort this thing up. Not penalise the innocent private med school!
And I agree with you taht “Personally, the issue is more complex than what everyone thinks.” – as many who comment here or in some FB sites are not in the knowing (exactly) of the deal between private med schools and MOH, and the probelms they are facing day to day – with those malignant HODs whom I think should be terminated.
Actually it is the private medical schools who insist on using those hospitals despite knowing another medical school already using it. It is not MOH who allocates the hospital. It is done on request and application done by the medical college.
Well,well.It seems you are the hypocrite here mr John Doe! Not all private medical schools are so innocent as you would like to believe. A private medical school insisting on using hospitals despite knowing another medical school is already using it? Terrible.
Come on bro. We have too many medical graduates for our own good. And the number of private medical schools churning them out are not helping! And another thing, its enough of a headache dealing with the large number of incompetent housemen nowadays who graduated from certain schools (local IPTA graduates usually are very competent), you want expect us to have time to entertain these students? when it was never our responsibility nor is it included in our contracts
Then stop sending MARA and JPA to do Irish Leaving Cert and subsequently all the way to med schools back in those days! Hypocrite! Local private med college is supposed to cut cost, and produce local grad for local needs. Cut off those overseas MARA and JPA scholars first, and encourage local colleges enrolment. Having said that, like i said earlier, I agree with contract to weed our incompetent ones, or unified exam to select the best. But is that done yet before we keep on pointing fingers at the local private colleges?
Wow..you sure are quick to call me names. Shame on you. I did not send JPA/MARA students overseas and would support termination of programmes to send students overseas to study medicine simply beacuse there are too many medical graduates. Shame on you!
@Fridaus Z: I am sorry if you think I called you hypocrite! I did not. I should have made it clearer that I was calling on the current govt and the authority who are in the position to approve scholarships and the med school programs. So please don’t say “shame on you” on my face! Peace bro.
GPs resorting to crime? – http://www.nst.com.my/news/2017/02/212505/fake-mcs-real-doctors-macc-bust-secretive-penang-based-operation
It will only get worst…….
I didn’t know that pimping is a life skill beneficial to a future doctor… 😀
http://www.freemalaysiatoday.com/category/bahasa/2017/03/08/berdepan-54-tuduhan-lacur-wanita-2-pemuda-nangis-di-mahkamah/
@John Doe, private/public hospitals are not obliged to help out with training of medical students from private medical colleges! The private medical colleges have to negotiate a deal/contract with which ever hospitals they want for their medical students to be exposed to clinical settings.
In a lot of countries, these medical students will have to pay a clinical fee to the hospitals that they are being attached to for their clinical training.
Thanks for saying this for me! I like the way even you (whom I presume not dealing with such deals btw private med schools and MOH) thinks that “…have to negotiate a deal/contract with which ever hospitals they want for their medical students to be exposed to clinical settings” – which in fact most med schools did so with black and white MOH dicuments to say that particular hospital is for training purpose. But the local little napolean taking this into their own hands, and bent the rules – sanctioning med students from exposure to certain areas of the training centres, or some even more daring in asking for “donation” or “rental” which is not supposed to be made known to central MOH HQ. Otherwise they will start to ask the med school to “leave” the premise, which is against the MOU signed. Not sure if you know that?
Actually, there is an MOU signed between the medical college and MOH and for every student, RM 500 need to be paid per-year to MOH (the last I know). On top of that, every HOD must be paid a facilitation fee. Every consultant who takes students even for their routine rounds/clinics must be paid a hourly fee.
RM475 to be exact. Then please tell me how to deal with those “asking for “donation” or “rental” which is not supposed to be made known to central MOH HQ. Otherwise they will start to ask the med school to “leave” the premise”?
@John Doe,
Could it be that these private medical colleges did not pay the necessary fees??? As Dr Pagalavan said, besides the fees to MOH, there is also fees to every HOD, and Consultants, etc.etc.
@Peter C: You would be surprised that the payment has been made. But it’s the little napoleans in the local health facility sites which continuously play dirty tricks!
.”…a strict vetting process would reduce the number of students who passed,thus leading them to collect less fees.”
At least the above is spot-on.
On why it took so long to identify absent housemen, Dr Hilmi said there were so many housemen that sometimes their superiors did not notice that they had gone missing.
Great read, but i could use some advice.
Could i get an idea of how difficult is it to procure a training post for part 3 MRCS in Ortho in Singapore? If possible to get in, do you think it is advantageous?
If any, which pathway do you propose for as an aspiring orthopod?
Is your basic degree recognised in Singapore? From what I gather, even those Malaysians working there finding it very difficult to enter the program.
Can you guide how can international medical graduate work in Malaysia.
Malaysia do not provide jobs to foreigners.
Dear Dr Pagalavan,
I’m a medical officer in KKM right now. I’ve been reading your blog since I started housemanship. I am thankful for your blog as it provides an inside view of our world. Whatever you have written 7 years ago is starting to show now. If I knew medicine would be like this I would have not chosen it.
However since its too late for me I would to advice anyone who wishes to do medicine (or parents who want their kids to do medicine) to please consider this field very closely. Medicine in Malaysia has deteriorated to ‘Bolehland Attitude”.
There is no common medical licensing exam all graduates have to sit for before being certified safe to be a house officer here. The ever growing debate of which university is better be it public or private medical schools has become irrelevant as of late. For what happens if there is a Malaysian medical licensing exam and a JPA student or MARA student does not pass it? Will there be transparency in it? Who will mark the papers? MOE or MOH? A lot of clouding factors there by itself.
As the pool of house officers from dubious medical school increases, the quality has indeed gone down. Even the good ones would start thinking why should I work hard if my colleague who is not even doing much gets the same pay as me and they will lose their drive eventually.
Poor house officers if they work hard enough can become good. However it takes strength of character to improve oneself i.e. studying after a hard day’s work or on call or coming extra early to learn about the cases in the ward. Unfortunately, although I do know of a few who do that but most do not.
These large group of poorly trained house officers will become medical officers. Since it is difficult enough to monitor over 100 plus house officers in a department, the specialists or consultants would let them continue their training as the paperwork to terminate their service would take over a year. (a side note, you need to be especially talented to be fired from civil service).
Now these medical officers are underexposed and inexperienced, they will get sent out to district hospitals, polyclinics and the lucky few get a post in specialty departments i.e. general surgical, internal medicine etc.
Again, a poor medical officer can become a good medical officer if they have the right attitude and continue on with their continuous medical education with the intention to better themselves for the benefit of the patient. However, this number of medical officers are small.
Eventually they would want to specialise, remain medical officers or go to private as a general practitioner or resident medical officers.
Those who want to specialise would sit for their respective masters or parallel pathway. To sit for the masters you’d need good SKT marks and be able to pass their entrance exam and interview. The selection into masters programme is at best vague and cloudy. It eventually comes down to either who you know and what race you are born into. Bear in mind you will not get overseas exposure and you’re masters degree is not recognised anywhere except for Malaysia. On top of that you would have to fund your own travelling expenses for courses as well as to pay for the course you are going to. Trust me they are not cheap. Finally once you graduated in 4-7 years you will be bonded to the KKM for a further 5-7 years depending if you choose the in campus or out campus programme.
By the time you come out you’d between the ages 35 – 40 years old. Out of this batch some would opt to subspecialise which is another 3-4 years of your life, some would be content to be a general specialist in KKM and the rest would be interested in going to private. Now the issue is, KKM has trouble keeping experienced specialists in service. To look at the human issue, if they have children, they would want to earn more money to send their children to have the best education (meaning not Malaysia). That would need money that their KKM salary cannot meet. Before you can say KKM pays at a grade scale i.e. according to your years of service, the price of things has gone up as well and our currency is not doing well internationally. To put in perspective a jawatan utama sektor awam or JUSA spot is limited. So most specialists would remain UD54 for years before one opens up (now with this new UD56 I’m not sure what it entails honestly). A medical officer who is senior enough can be a UD54 minus their specialist allowance which is RM2000 (correct me if I’m wrong).
With the quality of medical graduates now (in terms of both professional and personal qualities) they will eventually enter the specialist training programme. Most of them would pass to become specialists. Would you want yourself, or your loved ones to be treated by doctors of this quality?
Well said. Something that I have been talking and writing about since the last 10 years. But who cared! At the end of the day, it was your choice.
hi dr paga, i really need your advice sir. Im a HO in my second posting. I realised that i cant handle this pressure anymore. Its mentally and physically exhausting and top of that RACISM is very bad. Its very depressing. I attempted try to attempt for suicide but got scared. I was about to jump from 3rd floor. Went for psy couselling for 2 months. they gave me bunch of medicine for sleeping, it helped me a little. Till today im depressed to go to work. I dunno whether i can still do it anymore (another 19 months to go). lets say if i were to resign, what other career option i have in malaysia. Pls suggest me medical and non medical career. Thank you a lot sir.
Sympathies for your predicament. Hope you find your way soon.
Can you elaborate on “RACISM is very bad”? Thanks.
Looks like medicine is NOT for you. If you can’t take it, might as well look for other options.
You can try pharmaceutical industry, insurance or do some Master’s in hospital management etc as part time
Hi Dr Paga, I’m a uk graduate and and am thinking of transferring my career back here after what’s equivalent to a 2 years of housemanship and another 2 of MO-ship in the uk. I’m planning on finishing MRCP before returning.What are the chances of me being absorbed into the system as an MO on returning? Or will it be a better idea to complete CCT training before coming back?
Appreciate your advise.
I would suggest to complete CCT first.
Hi Dr.Paga, my ambition is to become a doctor. My SPM results were all average, but i’m from science stream. I’ve been resiting for SPM examination for the past two years and this year my results turn up to C(but the minimum requirement for medicine is 5B’s but i endup in 5C’s). There was one college which suggest me to do my foundation in science there and they told me if i study abroad for example in russia or indonesia there woudn’t be any problem with my results and i can continue my MBBS.The thing is i’m worried if i’ll be in trouble once i graduate and return to Malaysia to seek for a job in gov hospitals. will they accept me or they’ll start questioning about my SPM results saying i dont have the minimum requiremnets?? pls reply as soon as possible doctor … 😦
Definitely!! If you don’t fulfill your minimum entry requirements, you will NOT get a job once you return. This has already been informed by the health minister last year.
thanks for your reply Dr, but i was told by the person incharge in that particular college that graduates who didn’t fulfill the minimum requirements in SPM are getting job here..but what do i do now Dr? do i need to resit for SPM again this year ? this is really bothering me..but i really have the interest to pursue my career as a DR..pls suggest me a way DR..
Previously yes but not any more as post are limited. Only A level, STPM, IB etc can supercede SPM.So if you think you are good enough, why don’t you try sitting for these exams than wasting your time resitting SPM?
good morning Dr, as you have mentioned above can i do A-levels and continue my degree(MBBS) ? but i’m worried i’ll have to show up my SPM results …will there be any problem to continue my degree ?
You must fullfil the minimum requirements for A level. A level supersedes SPM results, so no problem in doing MBBS.
Alright Dr..thank you very much
Hi Dr! Im a college student who is about to start my MBBS programme in UM. But after what you have written in your blog ( literally every passage I read ) about the truth of being a doctor. Eventhough I have passion to help people who are in need, and serve humanity, but how am I suppose to help when even to become a doctor is a struggle in Malaysia? And also like you said, whatever passion may be, in 10 years time, money DO MATTER FOR LIVING. So, should I remain in this course? OR Im planning to switch lanes to dentistry or actuarial science?
Need your ADVICE, DR! Thanks in advance. Hope it helps.
https://polldaddy.com/js/rating/rating.js
have replied your email
Hi, you have gotten offer letter from UM for MBBS program? I thought UPU results will only be out in August.
https://polldaddy.com/js/rating/rating.js
Yeah, thats true. But did you went for the interview?
https://polldaddy.com/js/rating/rating.js
Even if you went for the interview, the results will only be out in August right? Just curious if you have gotten the offer letter since it is only June now.
Haha… No worries.. I haven’t got it yet! 😁