It has been a while since I updated my blog. Too many events and personal issues to settle along the way. However, the medical field in Malaysia is undergoing some new changes since early this year. It started with the contract HO post and multiple complaints in the news regarding the delay in housemanship posting etc. In May 2017, MOH announced that ozone therapy is banned from July 2017! Beauty centres are also being monitored for providing unlicensed beauty treatments. Sadly, there are many doctors who are providing such services to beauty centres. Since beauticians can’t inject any substance into a person, they need doctors. Doctors/Paramedics are the only one licensed to inject substance into a person. Drugs under poison act can only be administered by a doctor. As I had always said, in the end it is all about money and survival. There are many GPs who are struggling to cope with rising cost of running a medical business and turn to aesthetic medicine. While there are guidelines issued by KKM in practising aesthetic medicine, the enforcement is rather weak. BUT always remember that whenever you go to a beauty centre to do a procedure, it is ILLEGAL if the centre is NOT registered under your APC as a place of practise. Furthermore, any centre that are using medical equipments and drugs MUST be registered under Private Healthcare Facilities and Services Act 1998. If not, you will end up like this doctor in court!
As of July 2017, as I had mentioned in one of my earlier post, MMC will be corporatised. The Medical Act(Amendment 2012) will come into force after almost 5 years being passed by Parliament. I have been waiting for this amendment to take place as it will put certain rules and regulations in place. The regulation can be read over HERE.
The 2 most important new rules that will affect everyone will be the specialist registration and APC renewal. Firstly, APC renewal from 2020 will be limited to those who have at least 20 CPD points/year and an indemnity insurance. Indemnity insurance will become mandatory for APC renewal. I was informed that the CPD collection will start officially from July 2018 till June 2019, most likely under MMA and Academy of Medicine. MMA is working hard to standardised everything with a phone app being developed. Once you have the points, you can apply for APC 2020 after June 2019. For those budding doctors who do not know what APC is, it is your ANNUAL PRACTISING CERTIFICATE. Without APC, you can’t practise clinical medicine. I know many GPs who do not have indemnity insurance. With this new rule, every doctor must have an indemnity insurance in order to practise medicine. Please visit MMA website for further information regarding indemnity insurance.
Secondly, the specialist register had been made mandatory under the law. The National Specialist Register (NSR) was first introduced in 2006 by the Academy of Medicine. This was in anticipation of the amendment to medical act 1971 which suppose to be tabled in Parliament in 2008. Unfortunately, with election along the way, it was delayed till 2012. Thus, it was optional and voluntary till 1/07/2017. From 1st July 2017, all specialist must be registered with NSR which will be handled by MMC, from now onwards. If your name do not appear in NSR, you CAN’T call yourself a specialist. If you continue to call yourself as a specialist, disciplinary action will be taken against you by MMC which includes suspension and fine. For those who have not registered, please do so by end of this year. From 1/01/2018, your name must appear in NSR in order to call yourself a specialist. NSR must be renewed every 5 years with a minimal CPD point of 100 in total. This applies for government specialist as well.
Another issue that is of concern are the fees that need to be paid. Since MMC will be corporatised, they have to generate their own revenue on top of MOH grant. Thus, as expected, fees will be increased. The APC renewal fee will be increased to RM 100/year from RM 50. This is not really a big increase as the RM 50 has been around since 197os. However, civil servants who were previously exempted from paying this fee will now need to pay themselves. The DG had issued a circular to all hospitals that all civil servants must pay the APC fee from 2018 onwards. This was followed by circulars by hospitals that all APC fee must be paid by the respective doctors directly to MMC and cannot be claimed(tidak boleh dituntut):
This also includes the Specialist registration fee of RM 1500 every 5 years. Please be informed that all specialist in MOH must also register with NSR by end of this year. If not, legally you can’t call yourself a specialist! Another issue you must understand is that gazettement by MOH is not the same as NSR registration. NSR has it’s on guideline on registration of specialist. For example, you can only get NSR registration after 1 year of post qualification working experience for internal medicine related field and 2 years for surgical related field:
“Effective January 2017, applicants must have at least ONE (1) year post qualification working experience for medical related specialties/fields of practice and at least TWO (2) years for surgical related specialties/fields of practice.”
This basically means, for those who finish Master’s, you are NOT a specialist after 6 months of gazettement as far as NSR is concerned! I hope KKM and MMC can streamline these requirements so that no confusion arises. Another interesting figure in the new fee structure is the Certificate of Good Standing(CGS) and translated documents fee! It use to be FREE but it will cost you RM 500 for CGS and RM 200 for translated documents! As far as I know, each CGS is only valid for 3 months! You will need this if you intend to do training overseas or migrating!
There is another interesting development in terms of compulsory service.Till 2008, we had 4 years compulsory service, which included 1 year housemanship. In 2008 when housemanship was made into 2 years, the compulsory service was reduced from 3 years to 2 years post housemanship. The total was still 4 years. We all know that what I had predicted many years ago had come true. Job is no more guaranteed in civil service. Housemanship is given under contract for a maximum of 3 years after which you will be given contract just to finish your compulsory service. Only about 50% of those who are completing housemanship will be given permanent post. How this selection will be done is being ironed out. So, what happens to those who are returning from overseas after completing their housemanship overseas? Firstly, your housemanship must be recognised by MMC. NOT all housemanship outside Malaysia is recognised by MMC. Secondly, you may need to do certain postings which you did not do overseas before being given full MMC registration. The question now is , would you be able to get a job in MOH ?
To “overcome” this issue, DG has issued a new circular dated 6/07/2017 which is rather interesting. If you are a self sponsored student from overseas and have done at least 2 years of clinical practise post housemanship in a recognised country, you can be exempted from the 2 years compulsory service. If you are returning from overseas and are eligible for full registration from MMC without any need for additional training AND unable to get a job in MOH within 6 months, you are EXEMPTED from compulsory service! This is going to open another can of worms! This basically means you will be able to open a GP clinic immediately, under trained and flooding the market with GPs. This also means that if you do not get a job in MOH, you have practically no chance of specialising in any field except the Family medicine program under AFPM. So, if you are returning from overseas assuming to continue your post-graduate training in Malaysia, you may be in for a surprise! It is another way of saying, sayonara! We will be having almost 5-6000 graduates by next year waiting for housemanship alone! Imagine how many will be waiting for MOship locally alone!
Compulsory Service Exemption Request Form
(source: Deputy DG presentation at MMI conference)
For those who do not have minimum entry requirement, please be aware that you may not be considered for housemanship at all! It is in the pipeline. Well, if only they had listened to all those who voiced out their concerns almost 10 years ago, we will not be in this situation! We are very well-known for creating a problem and then trying to solve it, by creating more problems! No one plans for long-term. Everyone thinks with a knee jerk reaction!
Happy 60th Merdeka Day……..
Pagalavan's Avatar 
http://www.freemalaysiatoday.com/category/nation/2017/08/15/hard-to-stop-fake-doctors-in-big-hospitals/
what do u think Dr P, isn’t this stupid and crazy? would u let a thief enter ur coffer with gems and more over this is ur love one’ s life? ? how hard is it to have a swipe card only accessible to doc or nurses? how expensive is it? it is stated this bogus doc is making his own rounds in the ward for a year ( not just public area)!! what if he put a bomb in the hospital?? i am not being negative but we must be prepared! !wait untill the next disaster untill we start looking into it?
hahahaha, you are talking about Malaysia. Our hospitals are open system. Anyone can go in and out, especially visiting hours.
http://www.freemalaysiatoday.com/category/nation/2017/08/14/ministry-to-review-security-measures-after-man-plays-doctor-for-a-year/
he made his own rounds! !
Good evening Dr Paga,
From what I know some medical schools offer degrees with honours and some do not offer degrees with honours, just either pass or fail for their medical degrees. Does graduating with a medical degree with honours influence the future outlook of doctors such as applying for post-grad studies? Would graduates with honours prioritised over those without?
Thank you for your time.
Nope. No difference
In the UK, it can influence. Honours are awarded to students in the first decile, i.e. the top 10%.
Technically, it makes no difference, whether you hold an honours or not. In the application for FY, you will be given points, and the top centile will get the full 44 points irrespective of whether you get the honours or not. The SJT results may be more important, contributing up to 50 points.
Beyond the FY, your original undergraduate qualification becomes irrelevant, and your progress depends on your work performances and references.
Good evening Dr Paga,
From what I know some medical schools offer degrees with honours and some do not offer degrees with honours, just either pass or fail for their medical degrees. Does graduating with a medical degree with honours influence the future outlook of doctors such as applying for post-grad studies, the waiting time for housemanship placements etc? Would graduates with honours prioritised over those without?
Thank you for your time.
Good Evening Dr. I have a question regarding recognition. I wonder if a UKM graduate is able to work in Australia? I know Singapore recognises UKM M.D. but does Australia? I check here http://www.amc.org.au/assessment/list-of-medical-schools and it seems that they do, I’m not sure if I’m checking with the right source.
I have already answered this question. The list shows the universities whose graduates are allowed to sit for AMC exams. It means you can sit for AMC exam in order to be registered with AMC.
Is that’s a typical UKM graduate (?), who can’t understand simple statement which stated clearly, “eligible for an AMC assessment”. Hmmm.
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The current minimum entry requirement still need to be reviewed. Getting 5B’s in SPM not a big issue nowdays. Standardized the examination for everyone regardless of race or religion, planning to study oversea or locally. STPM or A-Level would be the best entry point for medical degree.
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yes of course but education is a money making business
The MMC minimum qualification guidelines is indeed very lax, but even so, many med schools both local and overseas, still fail to comply.
It’s a money making venture for most private med schools, and they want to fill ALL available places, and they do NOT want the floor to be lifted. As it is now, they are having difficulty in recruiting enough eligible students to fill their allowed quota.
There is no shortage of qualified and interested students. There is however a shortage of qualified and interested students who can AFFORD the fees. And there is a significant group of unqualified but interested students WITH the money. That money is difficult to say no to.
Good day Dr. Paga,
I am an A level graduate and now still making my mind to step into medical fields. My first choice was to study medicine in public uni either UM or UKM as I intended to work in SIngapore but I didn’t make it. Therefore I choose to go for private uni and got my offer from Newcastle Medicine University. But I am confuse recently due to news from relatives and friends that many of the med school graduates jobless due to overflow of houseman. I read through many of your blog post too and this make me think twice about the future of being doctor.
The main reason that I choose to study medicine is my interest towards human body and I love to deal with people and take care of them plus I love learning new knowledge and deal with something that is challenging. My concern is the long working hours and stressful life of a doctor. I am worried that I will have lesser time to accompany my parents and to travel (my hobby is to travel around
Recently I got another offer for electronic engineering from USM and I am now struggling to make my decision. Hope to get advice and opinion from Dr.
Thank you.
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I feel you are doing medicine for wrong reasons! Please buy my books and read, to understand what medicine is all about.
You will never have time to travel with your family! That is for sure.
Choosing medicine is very tough especially at the early stages. I personally had to sacrifice a lot of precious time and energy for work. I had to wake very early in the morning and only get back home at night time – every single day! It gets even worse if you are on-call. Plus, you have to do the professional exams on top of a busy working schedule which adds even more stress (unless you want to be a chronic MO or self-proclaimed specialist after doing a bogus course).
You are still young. Think carefully about your future. Explore other options like economics, finance, research or even take a gap year and travel!
Malaysia needs about 3000 good well trained, committed doctors each year, so I still see lots of scope. Even though we have 5-6K graduating each year over the next few years, eventually natural selection will sieve out the good ones. Going forward, I see the enrolment dropping, as the glamour and money starts to fade in the eyes of many.
But yes, do it with eyes wide open, about the life and commitments you must make.Travels you can still make, you will still have you annual leaves. Work hard, and play hard, nothing inconsistent with that.
Please allow me to ask a few more questions to clear my doubt.
1. I am thinking of another options to study pharmacy as i think it is somehow related to my interest and will not be as stressful as medicine relatively. How is the future of pharmacist in Malaysia?
2. What is the job options if I study Master of Pharmacy after my MBBS? Do I still need to complete my housemanship to study the master program?Does it make any difference with studying degree for pharmacy and MBBS?
3. How long and how much effort does it takes to become a lecturer for MBBS?
Thank you so much for the comments. I will certainly value your opinion and reconsider again 🙂
1) compared to medicine, pharmacist are still very much needed in Malaysia. However, the civil service is still struggling to cope with the number of graduates. We will need a lot more pharmacist if and when the government decides to separate dispensing rights.
2) If you want to do pharmacy, why waste time doing medicine?
3) to become a lecturer for MBBS, you must be a specialist!
Daphne. Do not do medicine. You seem ill informed about what a doctor is. I suggest you talk to someone who is in the field of medicine. A house officer or medical officer and ask them how life is like.
Good day Dr Paga,
I have a question regarding the SPA interviews for dental graduates. Sorry if the question is unrelated to medicine but I’d thought they might be correlated.
Heard from a friend of mine that SPA have ‘stopped’ (for the time being) all further interviews to be held this year for dental graduates ‘until further notice’. I believe this is worrying because it creates uncertainty and anxiety in many of the affected graduates as they would not be able to at least gauge the time for the next possible interview. Any advice on this?
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I am not sure but SPA can’t offer a job if there is no post.
Dear Doctor Pagavalan,
I am a junior medical officer in ministry of health and looking into aviation medicine. What is the best way to pursuit in aviation medicine which is recognised in Malaysia?
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Dear Doctor Pagalavan,
I am a junior medical officer in ministry of health and looking into aviation medicine. What is the best way to pursuit in aviation medicine which is recognised in Malaysia?
Hello. With regards to your post. I am a medical officer who quit KKM before my compulsory service was over, two years ago. I had only finished a year of compulsory service but I went to singapore for work, to get experience.
I have tried applying for the exemption of compulsory service but was told that I was not eligible to apply.
However with this new circular, does it mean that I can work in Mapaysia one day if i decide to return and dont get a post under MOH within 6 months?
I feel that my experience overseas coupled with my local stint as a HO and a year of MO ship should be an advantage if I was an applicant for a post in some other sectors such as management of a company etc.
However in medicine we have all this red tapes preventing people who are qualified to practise in a country with top tier healthcare but cannot practise back home. It is an irony.
PS:On a side note, I remember seeing your signature (something like Paga was here) in one of the cupboards of Banting medical student hostel.
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Welcome to the field of medicine! It’s just not in Malaysia, the red tapes are everywhere. Foe example, with years of experience i still can’t be registered in Australia etc. That’s why I use to say, if you intend to migrate, never do medicine! BTW, if you are in Singapore, why do you intend to come back? Might as well try to do your postgrad over there if possible.
As for the new circular, it should be applicable to you as well.
Hmmm, I was in Banting hostel but frankly, I don’t remember whether I wrote anything in a cupboard! it’s almost 24 years ago!
Dear Dr Paga
May I know if it is possible to do masters in MOHE after ive quit kkm and gone abroad to work? Or even KPJ masters
Thank you.
Chances are minimal but there are quotas for private full paying candidates.
So when im doing private full paying masters,
Can i get a contract post with say UMmc or ukmmc?
I asked the institutions but the clerks did not give a convincing answer.. I would rather hear from someone who has seen it been done/knows someone who has gone through it.
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It depends on the university. They may or may not.
[…] for renewal of APC and NSR as well as compulsory indemnity insurance. I had written about this over HERE. The APC fee increased to RM 100/year and there is also a RM 1500 specialist registration fee every […]
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Hello Dr Pagalavan
I hope to get some clarification regarding compulsary service .in mmc website stated 3 yrs of compulsary service,does it include ho ship or 3 yrs post full mmc?
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Compulsory service is 4 years which includes 2 years housemanship
dear Dr Pagalavan,
oh dear, i wish i ran into your post earlier before deciding to go home. Currently about to finish my housemanship in the UK with plan to go home as I’m not too sure what specialty I’m into. I forego taking core medical training (internal medicine), to be honest due to the severe shortage and I guess I’m not willing to be training doctor in that situation. Being on my own in UK, I’m not to keen to do locums there until I have better look into my interest so I thought might as well go home as I can at least be closer to family.
i don’t mind needing to do some more rotations in malaysia as I was not assigned to much variety in rotations of my housemanship here in UK anyway, but sounds like it’s going to be a difficult for overseas graduate to transition…
or am I worrying too much?
anyway, I really enjoy all your posts
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The problem in Malaysia now is availability of post! The chances of getting a job. Waiting list is getting longer and all are given under contracts.
Hi Farhana, I am currently im similar situation as you. How did it go for you in Malaysia if you don’t sharing your experience? Did you manage to get the full registration and a job as MO?
Regards,
Unless one is “un-appointable”, there should be jobs for IMT. How do docs continue training in Malaysia, after having completed foundation training F1 and F2 in the UK?
you will be given an MO post anywhere in Malaysia if at all you get a job. Training is a different ballgame all together.
So it makes sense to finish one’s specialty training abroad before thinking of coming back.
Yes and that has always been my advise
Doc, among medical specialties, how do you see the prospect for rheumatology in Malaysia, in 10 years time?
We still need a lot of Rheumatologist, especially outside Klang Valley
Thank you, Doc.
Hello Dr. Paga..
whats your take on doing Biomedical Science instead of medicine? I am considering this option for me daughter
It is a very broad field with many options.
Thanks Dr.
I do see many area of specialisation. Any specific area that you foresee as good take going forward.
Regards
I think it all depends on where your interest is. People will become successful if they do a field that they have real interest in. Unfortunately, our education system do not prepare students to learn skills that they are interested in
Medical degrees of AIMST U, MAHSA, IMU and Newmed are now recognised by MCIndia that Indian nationals are allowed to do Housemanship at Meenakshi Mission Hospital and Research Centre, Madurai, Tamilnadu, India. I think that’s a positive trend for the Malaysian medical education.
It is not directly recognised. It is recognised for the purpose of sitting for a screening test aka entrance exam. These universities are not listed in their 2nd Schedule. It is listed here https://www.mciindia.org/CMS/information-desk/for-students-to-study-in-abroad with a caution of not to be fooled by agents.
Malaysia in gloaming days, feel energised after reading your * open heart * articles. When the politicians can be open mind to consider people not only themselves?. May not every doctor without sufficient personal life. Here can see specialists are travelling seasonal.
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Dear Dr Pagalavan,
I am a Malaysian UK medical graduate and I will be doing my foundation year programme (UK’s housemanship) in the UK starting August 2018. For your information, my rotations are as follow.
FY1
– Pediatric (4 months)
– Internal Medicine (4 months)
– Trauma & Orthopedics (4 months)
FY2
– A&E (4 months)
– General Surgery (4 months)
– General Practice (4 months)
My current plan is to work in the UK for a year whilst waiting to get a HO post in Malaysia.
With that being said, may I find out whether will I be exempted from the rotations that I have went through?
Also, do you have any advice for me?
Yes, you will be exemptEd from the rotation that you have done. But why bother coming back if you get a job there? It is better to complete FY2 or specialist training before coming back
[…] from overseas? Obviously you will be at the bottom of their list and not their main problem. The MMC circular 2 years ago had already given a guideline for those who are returning from overseas. I had posted it in my blog […]
May I know why there is penalty charges when applying for APC? Isn’t it we need to pay RM 100 for APC application, and at the same time why need penalty charges for? As from my understanding yeah, agreed that my Full MMC date was Nov 2019, but was still doing my last posting housemanship. At the same time even I applied for Full MMC ealier before entering my final posting housemanship but officially I only get my Full MMC this year April. It really doesn’t make sense why I was imposed Penalty charges in addition with application charges.
Penalty occurs if you don’t apply for your APC before the 1st of December the year before.