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.
Pagalavan's Avatar 
You are still working so hard 24/7? No wonder rumours have been rife that you are migrating to down under! 😉
Nope, I am NOT migrating downunder!
But your wife intended to right? LOL! 😀
My wife, not me! Lol
Doctor was a noble profession until it is feel up with arrogant people. Nowdays doctors are just too arrogant. Just because they are treating people illness they think they are God. The fish market run by the uneducated one have a better working environment. Only in hospital, so called the professional one don’t even know to resepect their colleague, their Junior doctor and nowdays even the patient. Seriously years in medical school doctors don’t even learn this. That day I saw a senior doctor shouting at Junior doctor in front of my mother in hospital. My mother was frightened and loss trust in both of the doctor. Is that what they call professional. Just sick men. Just hope doctor can find a away to improve their working environment. Try to become human first before becoming doctor. Try to treat junior doctor in proper way. I’m sure there a better way to teach them. Don’t take me wrong but the article is obviously so biased and does not reflect a mature way of responding to the problem. There is no need to compare what happened during the training period 30 years back with current one. Time have change, im sure there are better way to teach and learn now. Admit it, if we were stuck in the same era probably you won’t get the opportunity to make profit out of this. Anyway that’s not my problem. I’m just trying to say that the Junior doctor are facing problem in their training and it’s the senior doctors responsibility to address the problem, find the root and try to solve it in proper way. I’m sure the only reason the issue come out in newspaper is because no one listening at their workplace. BTW as far I know no human can work 24hrs a day 7 days a week. Just one example of how biars and arrogant the author is.
I am very happy that you wrote this piece. It simply shows how ignorant our society is! No human works 24hrs a day and 7 days a week? You seriously need to grow up. Just simply walk into any private hospital and ask each and every consultant who works there. They all work 24hrs a day, 7 days a week. They can never shut down their phone and should be available within 30 min of being called. Any of your patient can walk into the hospital at any time and you will be called. Any of your patient in the ward can develop something at any time, and you will be called. There is no such thing as junior doctor taking care of your patient in a private hospital. AND, this is ontop of the clinic the doctor is running from 8am till 6pm everyday(except sunday).
Coming to shouting. Yes, I never agreed to shouting to a junior doctor infront of a patient. I had mentioned that many times before, if you care to read my blog since 2010. I never did that in my entire 21 years of being a doctor. However, rather than just talking about shouting, what was the matter that made the senior doctor to shout at the junior? Have you found out about that? Let me give you a scenario. Assuming your mother has kidney impairment with creatinine reading of 200 (you can google it if you don’t know). A junior doctor has given her Voltaren or Arcoxia (painkillers) as your mother complained of knee pain. 3 days later, her creatinine reading jumped to 500 and no urine output. She has to be started on urgent dialysis.
NOW, would you shout at the doctor and sue his/her pants down? It is learned from medical school itself that painkillers should not be given to a patient with kidney impairment as it can worsen kidney function and lead to permanent damage. Now, this doctor has made your mother to go into permanent dialysis with just a twist of his/her pen. I am sure you won’t be kind enough to say, “it’s OK, he made a mistake, he can learn along the way etc etc”. BTW, your mother’s life expectancy has just been reduced to 5 years.
You see how ignorant you are? When something like this happens, the senior doctors loose their temper as most of them are much more busier than the junior doctors. You are only seeing the tip of the iceberg! The above example is not a made up story! It is still happening , infact in increasing numbers. Junior doctors in district hospitals (who had finished their housemanship) still do not know what can kill a patient. I can give you tons of example. Would you allow such a doctor to treat your relatives, ever in your life?
Okay, now I understand the necessity of a senior doctor to be strict. I apologise for accusing you in the earlier comment. Maybe I was bias with the incident that happened with my mother in hospital earlier. But such incident make the doctor look unprofessional and as patient we lose trust on them. If that is the case I wonder how come Junior doctor nowdays that incompetent to work? They should pass their medical school first right.
Thank you for admitting. As for your last question, I think you should read my blog since 2010. Why are they incompetent?
1) commercialisation of medical education: quality takes a back seat
2) have you ever come across students who failed medical school in Malaysia?especially private colleges? Unless they drop out themselves?
3) we have the highest number of medical schools percapita population in the world and done in the shortest time in history!
4) once students graduate, it is not the university’s problem anymore
5) It’s a money making business
6) passing medical school does not make you a doctor but you suppose to know the basics to not to cause harm!
7) all these issues has been written in my books
Well said Dr, I totally agreed with you.
* hint hint.. Private hospital doctor with extremely small team and hence one own’s choice to work 24 hours a day and 7 days a week. This would an irrelevant statement in a public hospital setting as different consultants/specialists would be oncall on different days and you would be shot if you call the consultant who is not oncall.
I suppose this does not apply to extremely small hospitals but this is where more doctors would be useful in these places.
Yes you are right but most student’s aspiration is to work in private to make money!
If the main intention of a person to be a doctor to make money, I have no sympathy for these people then.
I do agree with Anonymous in terms of senior doctors screaming at junior doctors in front of patients. It doesn’t not improve the outcome in these situations and in fact, worsens an already bad situation. Lack of patients’ trust will no doubtedly lead to dissatisfaction of all cares from any doctor. No doubt there are really bad apples. Having worked in Malaysia, seeing mediocre senior doctors treating junior doctors poorly really saddens me. These senior doctors often do lack evidence-based medicine practises (relying on habitual management and prescribing) and until I left to train overseas, I could see the vast differences as I have worked in 2 other health systems. I feel that there are always room for improvement in any health system and not just saying “this is what it’s been done in Malaysia and hence it’s the right way.
Yup, agreed. Unfortunately the problem in our system is that the deadwoods cannot be removed. The good ones get frustrated and leave. Thus, mediocre fellows run the system.
U r the one get scolded by senior doc.. oh man what u did wrong?
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Not sure what u meant by that n how u came up with such conclusion. It seems I m the one likely being referred to. Inefficiency is so rife n I couldn’t wait to train. Time, race n connections r important factors to train in msia. If you must know, I got into training after 2 years of graduating. Will be a consultant (in a subspecialty) hopefully by age 33 years old. I do empathise those working in Msia really. My working hours are 8-4pm weekdays n Oncall once a week with maximum hours of 15 hours :). Double d basic pay. Will I trade that for anything else? No thanks.
So it would appear that 50% of doctors will not be able to get a job with the MOH in the very near future once the contract period is over. But what about those incompetent or deadwood doctors who are already in the MOH service? Are there any mechanisms to remove them from the system Dr ?
Unfortunately, it is very difficult to remove such people once they are full time civil servants.
Dear Sir,
I’ve heard that Singapore offers housemanship to bright students and I have actually heard from some seniors of mine that their friends from other schools apart from UM and UKM received housemanship offers from Singapore. Do you think it’s true?
I’m currently a medical student at NUMed and I am planning to pursue the Master of Research programme that is offered by the school for intercalation after my fourth year. I will also be taking the USLME. I’ve always been at the top 10% of my cohort for the past 3 years.
I’m hoping it’s true because working in Singapore would be a dream come true. If it isn’t true, are there any other countries that offers housemanship to Malaysian graduates?
Not that I know of. Please check with Singapore medical council. However, if you are a Singaporean, you can sit for their entrance exam. If you are not then your university must be listed as recognised university in their list
Heard from my UM graduate HO friend that they have only taken in a total of 11 Malaysian grads (UM, UKM) into Singapore in 2016. Very tough for you, I’m afraid. Especially since LKC med school will start producing graduates from 2018. I’d advise you to take the MRCP which is recognised by Singapore as a registrable postgraduate qualification irrespective of initial medical degree. Do note that that has to include the whole MRCP including paces.
Also I wanted to ask whether you are familiar with the clinician scientist pathway instead of the normal clinical practice in Malaysia, Singapore or any country that accepts Malaysia graduates? Because I’m more interested in research.
This would be the Academic FYP in the UK. You can check eligibility.
As long as you don’t touch patients, you don’t need to be registered with a medical council, which means recognition is not important.
Doctor, is there an age limit for doctors to be employed as medical officers under the MOH? I heard that for civil service, it is 35 and wonder whether it applies to doctors. In future, there will be more who will take the graduate entry route especially those studying in Australia
Generally, civil service works the same way, no matter which field you are in. However, looking at the scenario, I don’t think any preference will be given to graduate entry students. Furthermore, personally I feel doing housemanship at the age of 35 and progressing after that is not worth it, unless you got no family etc.
I agree. I have been told “first come, first serve” basis.. Even for training and pay rise.
I would think it would be better to come back as a specialist/consultant (especially by the age of 35, coming back from overseas) as this would be a better contribution to the country (of course, one could argue what about the other countries that have paid to trained you to be a consultant, leaving in the end).
Hello Dr Pagalavan.
I was wondering if you have any thoughts regarding the comment of this MP:
http://www.freemalaysiatoday.com/category/nation/2017/04/18/dap-psc-incompetence-delaying-medical-grads-becoming-housemen/
I was quite excited when I thought I would know my SPA results on the 17th. But it was postponed indefinitely. It is very frustrating.
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I don’t think it is incompetence. The issue is post! How can they give a job when there is NO post.
Hello Dr Paga,
I’m a Malaysian medical student in the U.S. I would like to know if it’s advisable to come home and serve the country, considering the factors you mentioned in your previous posts.
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If you are not a sponsored student, stay there.