Sometimes I really feel sorry for some students or graduates who expect everything to come to them on a silver plate. Life is never easy. It only gets tougher day by day. You have to live with what you have and try to be better in every sense in order to be a successful person in the future. Unfortunately, the current generation of graduates grew up in a comfortable environment with everything being provided by their parents. Their parents on the other hand do not want their precious child to get his/her hand dirty! They want their child to be in a chamber, work from 9-5 and come back home and live a comfortable life and earn a lot of money! In reality, that will never happen!
Over the last 1 week, there were many interesting letters to the Star. The chain reaction was started by THIS letter, supposedly written by a graduate who is yet to even start his housemanship. How ironic! The issue brought forward was about “tagging”. I must say that I don’t totally disagree with the author but he must understand that, it is the reality and part & parcel of life. For years people are talking about it but why are there no changes to the environment? I agree that our working environment is pathetic. Most of the older hospitals do not even have proper room for doctors(HO/MO) to rest or sleep. Housemen need to use whatever room available to rest/sleep during their calls. However, some of the newer hospitals do have proper call rooms but the numbers are generally not adequate. When I was in SCHOMOS/MMA Johor, I had to put multiple request to change all the “worn-out” air-conds in all the so-called “call” rooms in the hospital. It took me almost 1 year to get it done. Thank fully I had a wonderful hospital and state pengarah who supported my request. In the 2000s, we only had 1-2 HOs in each ward and thus we did not require that many rooms to even start with. Only 2 MOs and 3 HOs were “on-call” every night. Unfortunately, we have tons of HOs in a hospital nowadays.
Coming to the issue of tagging, I feel someone will never complain if his/her intention to do medicine is to learn and help people. After all, tagging is just 2 weeks in the first posting and usually will become 1 week in subsequent postings. I don’t see a big fuss about that. The tagging period is to enable you to learn how the system works and at the same time to build up your physical and mental strength of being a doctor. Medical graduates feel that they are the only one working “so” hard compared to other graduates. I beg to differ. Almost all graduates in any other critical field do the same during their early career stages. The only difference is, you are dealing with life and death matter and your job is in the hospital. You can’t bring your work back home like engineers, lawyers etc. Till today, I am still working 24hrs a day 7 days a week!
Medicine is a life long learning. Till today I am still learning and discovering new things which I had never seen before. The most crucial part of medicine is the early years of housemanship and MOship. During this time, you are always guided by someone senior who is much more experienced than you. Your responsibility is actually the lowest as you don’t have to make life and death decision. Medicine cannot be learned from books. Medicine is on the job learning. The more patients you see and the more time you spend in the ward, the more you learn. If you want to be a good doctor, then stop whining and spend your time learning the most during the early years.
The next day, another letter supposedly written by a parent was published in the Star. Again, I don’t totally disagree with the letter especially about the working environment but the “parent” must realise that being a doctor is not an “office” hour job! You have to make sure your job is done before going home as you are dealing with lives. I don’t understand why is he complaining about 12 hours shift? I presume he wants a “start at 8am and go back at 5pm ” kind of job! Than I am sorry, he is in a wrong profession. These issue arises because parents and even students do medicine thinking that it is a cosy job, sitting in an air-cond room and earning quick bugs! The reality is totally the opposite. That’s why I keep saying that EVERYONE who intend to do medicine MUST read my books! Know the reality before putting your foot into anything. I have also said this many times, never get married during housemanship (in reference to the letter which talks about parenting!). And please stop comparing with other countries. Each country have their own problems as the healthcare structure and system are different. In Australia, you do not have hospitals without specialist. Here, you are thrown to a district hospital after housemanship where you will be the one who will be making decisions! You will be doing vacuum/forcep delivery, inserting chest tubes, doing minor surgeries etc. The competency level needed is totally different!
These letters were discussed extensively in social media and some senior doctors did write to the Star. “Doctors NO Different from Soldiers” in The Star and “An appropriate baseline in quality and quantity of training” in Malay Mail are worth reading. You will only know how important housemanship is when you are posted to a district hospital or alone in a hospital without anyone to consult! Till today, I still remember what I learned from my seniors during housemanship. I still remember who thought me to do a CVP line at 4am in the morning and he is a succesful cardiologist now. Looking back, I enjoyed my housemanship as all of us back then, helped each other very well, without being calculative. Unfortunately, we have too many housemen nowadays who are calculative and do not help each other. Trust me, housemanship will be a wonderful experience if your colleagues help each other.
And for those housemen/parents who are whining , there is an important message from our Deputy DG:
MESSAGE FROM THE DEPUTY DIRECTOR GENERAL OF HEALTH THIS MORNING 22nd March 2017
There appears to be some confusion on what is being said on HOs and the contract system.
The current modified flexi system was formulated by a group lead by myself where a HO will work between 68-74 hours per week with HO : patient of 1:4 ( in most other countries 81 hrs and HO patient ration 1: 8-10)
So for starters they are working less hours and with less patients to look after.
But the system is designed to ensure ownership and accountability of patients to each HO. So much so only HO training in Malaysia is accepted by the GMC uk as equal to their training for those who have degrees registrable with the GMC .
In order to ensure adequate clinical exposure and competence each posting has 16 mandatory topics which they need to know before they can exit a posting , it is very transparent and questions asked are within these topics and answers given are documented for reference in disputes on unfairness and I was asked a postgraduate question !
Also they are given protected time to ensure they attend 75% of the CMEs.
So if a HO working under these conditions can’t complete his/ her work within the shift period I have no comments , would you find them safe to run your clinic ?
They are given 16 weeks to complete each posting and allowed 2 extensions of 8 weeks i.e. another 16 weeks if still not competent a final 24 weeks at another hospital to given them a fair chance ,then terminated . So they are given more than enough opportunities to remedy their short comings .
With this in place and only 5000 places for each year , when HOs get extended or disappear and as they are permanent civil servants , it takes more than a year to terminate them !
So I have on an average 6-700 who are non performing each year added to those who don’t want to take up their post HO , MO posting by refusing to move they by depriving others getting into the system !
So with the contract system you disappear for 7 days out you go and in comes the next person in the queue , if you finish you HO training and don’t want to go to your new MO posting when your 24 mths is up so too is your salary , so they will not be able to work till they accept their new posting and once there is a lapse in pay it will take about 3 mths to get the system back Bec MOH has almost 40k Drs !
Next those who don’t complete due to not being competent and are terminated that is the end of the road .
Those who have disappearance and return they have a 6 mth cooling off period before JPA allows them to reapply so in reality it will be about 9 mths before they get a job.
When numbers are high , we have no option but to be fair to those who have not been given a job , we hope those given a chance will value the job given .
Work is very different from being a student and the reality is many students don ‘t spend long hours in the wards so working in the ward for ” long” works is alien to them!
This is compounded by the fact that all private medical colleges don’t have their own teaching hospital which to me makes a big difference , how many lectures and professors of private medical schools actually work in the wards ? So this to me is another reason for the standards and attitudes of the newer medical students .
With the contract system compulsory service is still there 2yrs as a HO and 2 more as an MO , once you have completed the 4 yrs then we cross the bridge , the MOH as it stands with it’s future needs can only take in about 2-2500 max per year so about 50% will not be given a job in MOH .
Who will be taken ? , those pursuing a postgraduate program either the Masters or the parallel pathway of the Royal college exams Bec for every masters slot now there 5-7 applicants ! So to give an opportunity to the others we are developing the parallel pathway including Primary care .
So I have put a lot of thought and effort into planning for the future of healthcare delivery in Malaysia to ensure we have a truly great system with competent and safe doctors delivering quality health care .
I am open to comments if you can suggest ways to make it better Bec this is a dynamic process that may need to be adjusted from time to time .
I am now working on the rationalisation of MO post to ensure workload levelling , it took my team 9 mths to ensure equitable HO distribution , so in the next 3 mths the MOs issue will be resolved and finally the Specialist will be next Bec not all of them are working just as hard !
Once that is done my work is done and I can leave my job , I have delivered on what I was tasked to do as DDG in MOH , other task of mine are also in various stages of completion.
🙏 DATUK JEYAINDRAN TAN SRI DATUK DR C SINNADURAI
So, just to summarise:
- those who go missing for 7 days: out you go!
- those who return, have 6 month’s cooling off period for even JPA to re-consider
- those who don’t complete HO in 3 years, out you go!
- those who refuse to transfer out to wherever you are posted, salary will stop within 24 hrs
- only 50% of HOs completing will be given Moship post in MOH
- the rest have to “cari makan” on your own
- preference for MO permanent post will be given to those who have postgraduate interest
Did anyone say that doctors will never be jobless? Well, the reality is here. When we have more bodies than post, the employer aka MOH have the right to pick and choose. Dr M once said, he want to flood the market with doctors! His ambition has come true……
SPM results were just out 2 weeks ago. For those who intend to do medicine, please buy and read my books! You can visit my blog post HERE on instructions on how to buy the books.