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Archive for June, 2021

For Future Doctors: Finally, the Hurricane is leading to a Hartal………

Posted in Education on June 29, 2021| 147 Comments »

Frankly , you don’t need to be a rocket scientist to predict what I had predicted since 2006. It’s just simple mathematics and statistics. When I first started writing about the future of doctors in Malaysia in the MMA Magazine, I was brushed aside by MMA itself. No one took it seriously. In July and November 2006, just before I left the civil service, I wrote my last 2 articles about the civil service doctor’s future. I started my blog in 2010 where I spent the most amount of time writing about the mushrooming of medical schools, quality of medical schools and the very likely scenario of future doctors: unemployment! I was again called by all kind of names by parents and students themselves. Well, all those are history now. My blog posts since 2010 are still available in this blog. I had never removed any of it and even the books I published in 2016 are still available.

Let’s come to the topic. There are various social media and news agencies highlighting the upcoming “Hartal” by contract doctors which is being scheduled on 26th July 2021. Meanwhile SCHOMOS is starting the “Code Black” campaign from 1st-12th July 2021 which will end on 12th July 2021 with Black Monday event. Many have asked for my comment. In August 2020, I had a discussion about contract doctors in DOBBS which was posted in this blog. On 17th April 2021, I gave a talk via Zoom to a group of medical students in UKM for the Career Progression workshop where I spoke about the current situation, how we reached this stage and what are the options for graduates, concentrating on foreign countries’ opportunities. It was an interesting discussion. Some of the slides I will reproduce below.

We must face the fact that we are producing just too many doctors. Poor planning and knee jerk reaction is the reason for this. You can read all these information from my blog post dating back to 2010. We have one of the highest number of medical schools per capita population in the world. Have a look at the slides below ……..

With our typical Malaysia Boleh style, we lead the world, on how to start a medical school in the shortest time possible. Quality? Who cares, we just need the numbers! It is just too fast too soon. Our government is always obsessed with numbers. Let’s look at the doctor’s figures below……

These figures are from our government’s statistics (MMC and MOH). As of 2019, we had achieved the ratio that the government always wanted (1: 400). Almost 50% of the 31 medical schools started to produce their graduates between 2011 and 2018. Fifty percent of that 50% only started to produce their graduates between 2014 and 2018. Basically, we have not even reached the peak yet! This is what I call planning human resource with your butt! We are producing close to 5000 graduates annually since the past 3 years and these figures will continue to increase till about 2023 before it stabilises. But look at the number of new health facilities built since 2010? On paper, we have enough doctors, the issue is maldistribution ( I have written about this many times before) and the healthcare system.

Now, did the government ever promised you a job? The answer is NO. No government in the world promises you a job. These goes to all other profession as well. Do the government stop producing engineers just because engineers are jobless? Obviously NO. However, Malaysia is a unique country. Instead of investing in public universities , we started private universities since 1996. Once education is made into a business, 3 scenarios will happen: mushrooming of poor quality education centres, low quality graduates and mass production. These universities do not give a damn whether there are job markets for their graduates. They are just degree mills and profit driven. The government can only control the public universities intake(which is hardly done) but private universities are driven by market force. Few years ago, MOE did reduce the intake of medical students into public universities which I feel is the dumbest thing to do. It should be the opposite but hey, who do you think are the board of directors of these private universities?

Almost in all developed countries, doctors work on contract basis. Malaysians are just not used to it. The main problem is the fact that we are still stuck in a civil service system which was left behind by the British. Most countries have already restructured their civil service into a contract based system, including Britain. The old permanent civil service system and pension system is not sustainable. It is a huge burden to the financial coffers of a country. Remember, for every permanent post created, the burden is not just the salary you are guaranteed of receiving till the age of 60 (aka 35 years with increment and promotion) but also the life long pension that you will get after that, which your spouse will continue to receive after your passing. If you have a 2nd wife , she will also continue to receive 70% of your pension till she gets remarried or dies! Imagine if your wife or second wife is 20 years younger than you! Thus, it is a huge financial burden to the country which may even bankrupt a nation, similar to what happened to Greece few years ago.

Basically, what I am saying is that the government will never be able to create 5000 post annually. It is simply not possible. Based on what the Minister had said, out of about 23 000 contract doctors since December 2016(when it was first introduced) only 789 received permanent post after completing their 1st 3 year contract. Even if against all odds, the government agrees to create 22000 post to absorb all these contract doctors into permanent position, it will be, as usual a knee jerk reaction to satisfy the masses due to COVID. The next question will be on where these posts will be located and whether these doctors will be willing to go there.

Unfortunately, medicine is once again a unique profession. Our training and education does not stop after graduation. It goes on and on with various laws and regulation governing us. I am very sure not all of those 23 000 contract doctors planned to stay in civil service after completing their compulsory service. I have already heard many who had resigned after the 3 year contract and MMC even allowed them to be released before they completed their 4 years compulsory service (less than 1 year short).Some did not even take up the extended 2 years contract. Some left to overseas whenever possible (not to say it is greener out there). The problem with our healthcare system is the fact that specialisation can only be done in KKM hospitals and the local Master’s program. Parallel pathways are available but the training can only be done in KKM hospitals till you are gazetted as a specialist. Private hospitals are simply not suitable for this except for some big tertiary private hospitals but, would the patients allow trainees to treat them?This training process will easily take about 5-10 years depending on whether you want to pursue the subspeciality program. As for our local Master’s program, at the moment, this is only open for KKM staffs who are holding a permanent post (as HLP is only for permanent staffs). Of course you can still enroll as a private candidate and pay the full fee which may be in the range of RM50K/year. While the number of slots for private candidates may be small currently, if the contract system continues, it will likely increase.

I believe the contract system is here to stay. We just have to get used to it. At least you are given the opportunity to complete your housemanship, receive your full registration and complete your compulsory service. You would still have a job for at least the first 5 years. I understand that the 1st batch of contract doctors who started in December 2016 and did not receive permanent post, who are scheduled to complete their extended contract in December 2021 are being promised that their contract will be extended another year. The real problem is for those who want to continue to specialise. Other options are university hospitals and military hospitals.

The entire healthcare system has to be revamped. We have to move on to a more sustainable system. Like many other countries, I believe eventually all doctors will be hired on contract basis. This means that the government employs based on need except for the guaranteed first 3 year contract. Nothing is permanent. You need to reapply for a new contract whenever the previous contract comes to an end (this is how it is done in other countries). However, the way a person is recruited and trained to become a specialist has to change. Both Master’s system and the parallel pathway have to be merged into a single training system under a single body (academic colleges?). Those who wants to do any basic specialist training have to apply directly to this body before their 1st 3 year contract ends. If you are accepted into the training program then your chances of extending the contract till you graduate is almost certain. However, you need to pay whatever training and exam fees needed, by yourself.

What is the purpose for this Hartal? If it is to ask the government to absorb everyone into permanent post, than I feel it is NOT going to happen. It is not the long term solution. If it is to threaten the government, then it is also not going to work as the government never promised you a job anyway. If you think the public is going to support you, rest assured it will not happen (except your family members)! The public will only consider you as a selfish group of people. There are many people out there who have lost their jobs during this pandemic (commiting suicide) and here we have a group of doctors who are earning monthly salary and demanding to be absorbed into permanent jobs and endangering public’s life, if it is really going to be a proper strike. The public will never treat you as someone special. Trust me!

My opinion is to have a complete restructuring of the healthcare system to enable doctors who are interested in specialisation to remain on contract till they complete their training and gazetted as a specialist and continue till they decide to leave. I believe the way forward is to abolish permanent system and only go by contract system with full transparency in selection. Individual hospitals should be given full right to recruit the contract doctors and also determine their workforce numbers. Unfortunately, the word “transparency” do not exist in our government dictionary as you would have noticed from our controversial Minister’s reply letter. As I have said many times before since 2010, the days of guaranteed job for medical graduates is all OVER. Doctors, like any other profession have to find their own way. In Australia, there are consultants who do not have a full time job and ALL medical jobs are given on contract basis, between 3-5 years duration. No one complains as they are simply, used to it!

Stay Safe…………………..

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Post Wawasan 2020: Where to, Malaysia? Part 4

Posted in Politics, Uncategorized on June 23, 2021| 40 Comments »

Continued………..

In 1989, I sat for my SPM examination. As I mentioned earlier, there were 3 science stream classes in my school, out of which there was only 1 Malay student. The rest have all disappeared to MARA colleges, Boarding schools, military college, agama schools etc. I took the maximum of 9 subjects and received 7A1,1A2 and 1C3(in BM). I applied for JPA scholarship but decided not to attend the interview as I was told beforehand that medicine is only for Bumiputera. Some of my friends who attended the interview were told point blank that medicine is only for Bumiputera but they can request for other fields. For those who are from the 21st century, scoring 8As in those days were less than 10 students per state, unlike now where we have 10K students scoring straight As in the country!

Thus, I had to bite the bullet and go on to do STPM which is a 2-year program run by national schools (not all but selected national schools). It is considered as the toughest pre university exam in the world. Two years of knowledge tested by 1 exam at the end of the 2 years. We are allowed to choose 5 subjects. It was the only way for us to attempt to enter the public universities. There were only 3 universities offering medical program. Matriculation/Asasi science were reserved for Bumiputeras till 2003 when 10% of seats, in some programs were given to non-Bumiputeras.  Most Asasi programs in major universities are still reserved for Bumiputeras, till today. By God’s grace, I scored 5As in my STPM science examination, the only Indian student to do so in Malaysia. There were 72 students who scored 5As in the country, in 1991 STPM.

As I had mentioned in my earlier articles, our universities work on a quota system. While the Bumiputeras enter via an exclusive matriculation pathway, all non-Bumiputeras must use the STPM pathway. Two different system with 2 different standards. Further to this, we had the quota system. There were hardly any private colleges except for some which were running twinning law programs. Otherwise, you need to go overseas under your own parent’s sponsorship. As far as the medical faculty is concerned, 60% is given to the Bumiputeras, 30% to the Chinese and 10% to the Indians. The total intake for the 1992 UM medical faculty was 180 students. The ratio is the same for all other faculties. It supposed to follow the population ratio of the country. The number of intakes were fewer in UKM (150) and USM (110). Chinese students will need at least 5As or 4As in their STPM while the Indians can get away with 3As, to enter the medical faculty. Well, we had to accept the fact that we are treated differently. It became part and parcel of our life. It made us a better person and a fighter as we need to fight for entry into local public universities for 40% of the seats that are allocated to the non-Bumiputeras. BUT we were all Malaysians and I only had Malaysia as my country.

It was in the university that we yet again see all the 3 major races coming together. It is also here that I realised what “educational segregation” at primary and secondary school levels has done to our social integration. Many of the Malays were totally isolated for at least 7 years before they start to see non-Malays again. Many of them were from boarding schools, MARA colleges and agama schools, before entering matriculation. All these schools were reserved for the Malays. For some, even their primary schools were predominantly Malays as they were from rural schools where there were hardly any non-Malays. Some did do up to SPM in a national schools before entering matriculation/Asasi. As a non-Malay, I could clearly see the difference among these people. The ones that mingle around without any issues are those who were in the national schools up to SPM or from a major city where they are used to non-Malays. Many seem to have a culture shock looking at the non-Malays, not to mention the inferiority complex, being brought up in a non-competitive environment. They don’t mix around much and tend to keep to themselves. They did improve along the way especially when we started our clinical years. But I must say that there were some excellent Malay students as well, who had now achieved successful career in their respective field. It is sad that the society may still look down upon them just because of the different entry pathway and the quota system. Society’s perception cannot be changed unless everyone is at a level playing field.

Similar issue could also be said about some of the Chinese students. Many were from Chinese vernacular schools up to Form 5 or even STPM. I could clearly see how they prefer to be among themselves and speak their own dialect even when they are among the non-Chinese, because they are so used to do so. They don’t realise how rude it is, to the others. While the national school educated Chinese were able to mingle around more freely and more proficient in English, the vernacular school educated prefer to stick to themselves. As they enter the clinical years, some of them do improve and mingle around more with the other races.

As for the Indians, all of us are from national schools. If I can remember, there was only 1 among us who was from a Tamil primary school. As there are no secondary Tamil language vernacular school, even if they do go to Tamil primary schools, they will end up in a secondary national school. We were among the students who can get along with anyone in the university. Almost always we speak in English as even many among us are not Tamilians. We were a rojak group.

Did religion affect us in any way? Yes, it did. When I was in the 1st year, the Malays will form their own study group and the Chinese will form the own study group. The Indians usually play around. We don’t form any study group. We only play football together. So does the national school educated Chinese. We are happy go lucky kind of people. There were also some Malay boys who are in the same category. In my batch there were 2 Indian Muslims who entered the medical school under the Indian quota, via STPM. They used to mingle around more with the Indian students at first. Both were approached by the so called “dakwah people” who are usually students from the religious faculties. They were told openly that they should not be with the non-Muslims. They should only help the Muslims. They were told that they should avoid being close friends with the non-Muslims but spend more time with the Muslim students. One of these Indian Muslim student heeded their advice and moved away from the other Indian students. He eventually came closer to us when we started our clinical years. The other student remained close to the Indian students and became one of my best friends. We were roommates from Year 2 to Year 4. He now heads one of the top cardiothoracic unit in KKM.

Every residential college in UM use to organise respective religious festival celebrations. We had Malam Raya, Chinese New Year celebration, Deepavali Night and even Chrismast night. Everyone in the college will participate as it is considered as a cultural event. I was the Director of Deepavali night in 1996 for my 6th residential college. I even worn the best director award for the college. Deepavali night is considered the biggest event of the college every year. Unfortunately, I was informed that 2 years after I graduated, UM banned any other religious celebration in individual residential college. I am not sure what is the current status.

It is also in the university days I realise that many of these Malay students do not know what is happening out there. The more you talk to them, the more you understand that they are totally unaware of the racial policies in education and scholarships. While they understand that the Malays are given privileges in boarding schools, MARA colleges and Matriculation, they felt that the “others” are also given equal opportunities. They felt that the special opportunities given to them were because they are from rural /poor areas. Some are not even aware of the quota system and lack of scholarship for poor non-Bumiputeras. Many do empathise with us as they learn about the situation.

Five years of my medical school came to an end in May 1997. What appeared to be a long journey at the beginning, appeared rather short when I completed the course. It was a fun filled journey. I made new friends and learned a lot. Our lecturers were excellent. It was the days when Professors teach undergraduate students. I could still remember those great names like the late Prof John Bosco, Prof CT Chua, Prof Siva, Prof Raman, Prof Deva, Prof Fatimah, Prof Annuar Zaini, Prof Alan Teh and many more great teachers who thought us at the time. Many of them had retired but many did resign when I was about to graduate. As the private hospitals began to mushroom from late 1990s, many of our great lecturers left for greener pastures. It was a great loss to the faculty.

It was when I was about to start my Final year that I met my wife, who apparently is in the same batch! Since we had 180 students, sometimes we only knew those who are in our group or partner group. It was very difficult to get to know everyone in our batch by name. Sometimes we can recognise that they are part of our batch but do not know the name. How ironic! My wife was in my partner group starting Year 4. We first got to know that we exist somewhere towards the end of Year 4 and became friends when we started Year 5. By the time we sat for our final exams, we had confessions to be made! The rest is history…..

To Be Continued …………

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