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…………………..
Pagalavan's Avatar 
It looks like China will have many job opportunities for medical doctors. However, China uses Chinese medical terms. Even Chinese Malaysians also have difficulties understanding the medical terms. LOL.
It should be noted that even specialists are never promised a job by government. Better and actually safer to remember that. Otherwise, we Malaysians will be simple-minded to think specialists are guaranteed a job.
Well done, Dr Paga. You are more qualified to be MOH director general. Let the MOH people read this comment.
Hear, hear, Dr Paga. Please publish the contents of this article in the DOBBS Telegram group. In the hope that some will see the truth for what it is!
well, you can forward it. Hahaha
well said, Dr Paga. Youve been harping on this for ages, hopefully people see the truth.
Good morning Dr Pagavalan Im not agreeing with Dr when want to compare Malaysia with Europe country such as British or Uk or Us…….because Malaysia are just not the same status of living as those country…..In Malaysia we are developing country and economy is just pretty much moderate while if you compare to British they are rich and developed and the cost of living in British is quite low and so their salary and type of contract maybe relevant to them…..Please respect Malaysia……We have our own Minister and Ketua Pengarah which is more authorize to said in relate to it…..you have your free will said anything as Malaysian has fredoom if speech……whether valid or not it is not depend on you……For me I can say it is 100 percent invalid……
FYI, even developing countries have moved on to contract type system. We can’t be waiting to become a developed country before taking action. Action starts while you are heading towards a developed country. Did I ever say that my opinion is relevant? This is my opinion and suggestion. The government need not listen to me. The very fact you are in this situation is because the government DID NOT listen! So, you can go and ask your own Minister and Ketua Pengarah.
Oh my english!
Is there a Zoom recording of the discussion you had with the UKM students? I am keen to know the options discussed
Sorry, I don’t have the recording. I was an invited speaker.
Hello, I did not know how I ended up here but I really appreciate your blatant honesty. We need more of these discussions . I’m a secondary school student about to sit for SPM and believe me when I say, even if we don’t look like it, the younger generation are extremely worried about the future of our country. I really wanted to go into medicine purely because it has been a passion and dream of mine to help other people but after researching and reading a lot about the future of medicine in our country, I have been extremely anxious. Will pursuing this career work me to my bones ? Will our country not be there and support me and other people in this field and continue to treat it like any other business ? Should I be looking to pursue other fields that are more financially stable ? But I know that I am not the type of person to chase money. I’m sorry if this seems too much or irrelevant to what you are talking about. Thank you again for using your voice and speaking out about this . Stay safe and take care. (Sorry if there are any mistakes ehehe)
I suggest you read all my articles under my ” For Future Doctors ” page. Passion is one thing but living a life is another!
Don’t talk about passion when there is no money
What is passion when you yourself don’t even have a job security ?
Passion can feed your mouth ?
Think twice before step inside this hole
dont. pursue another field. u might think oh wow i have good results in spm or whatever exam. but when u see the reality behind it, and the batches the government used to sponsor for mbbs/md, alot of underqualified. Trust me, dont fall into the same trap. go for something else. Fly high!
The number of public doctors indicated in the table is 52129 in the year 2019 which is a tremendous job from 22429 in the year 2010. I have to assume it is partly due to contract doctors.
I wonder what is ratio of permanent to contract doctors in this year 2021.
The number of contract doctors from the media is now about 23,000. Like you said it is impossible to create permanent posts on this large scale.
nope, it is actually due to massive production which was absorbed into available permanent posts till 2016. Contract started after that as there were no more permanent post. The available permanent housemen posts were then converted into MO post, which was also taken up by those who completed housemanship in 2016.
despite the contract system has implemented for almost 5 years , the pathway of the specialist training is still yet to be formulated. There is no solution provided as the regulation of the specialist training is totally contradicting with the duration of service. I:e: you will be kicked out from the specialist training way before you completed it, due to the contract duration , and master program is not opened for contract officers.
over 5 years , there is no solution provided , because it was proposed that all HO with credit factors and never extended , will receive permanent post eventually.
However , in reality , many HO/MO with part 1 examination papers/ publications , still stuck with contract post.
During PN era , only vague statement is provided , hence it’s known that he has no intention to solve the long term problem.
this leads to a new long term problem, lack of specialist trainee , if not addressed .
transparency issue is chronic, and easily manipulatable due to political wills.
By the way , Dr Paga , do you think this problem will be solved (partially) , if the pension system is abolished completely ?
KKM never promised that all in contract will be absorbed into permanent post. The 1st contract issued in Dec 2016 clearly says that it depends on availability of post. I had posted this in 2017. Then they came up with the statement that those who have passed Part 1 etc will be given priority, not guaranteed for permanent post as the 1st and foremost criteria is “availability of post”. The only way forward is to convert everything into contract post and slowly abolish the permanent post as doctors retire or resign.
Found this interesting on FB.
Sir, i wished I’ve read your blog even before entering medical school. I only knew it existed when I was in 4th year of studying. I’ve just finished and waiting for my placement.
Hi Dr Pag, will you advice medical students to go for overseas(UK/US) immediately after our graduation? If yes, will we face difficulties in registering with MMC and practice in Malaysia after completing our specialisation ( programmes recognised by NSR) in overseas? Since we will not be completing HO in Malaysia. Thank you.
Of course you can do whatever options that you have but everything needs money(sitting for entrance exams etc) and also not guaranteed. As long as the post graduate is recognised by NSR, you can be registered in Malaysia.
I’m currently working in the UK. Yes, medical graduates can try to migrate to the UK/US to get specialty training. But as Dr Paga said, it is not easy and costs lots of money. A lot of commitment and sacrifice are needed as well. I still remember many of my friends in my year wished to migrate but only a handful actually ever attempted to do it. If u have the money and resource to do it, by all means have a go at it. Plus, once u get here, u still have to do lots of stuff before getting a shot in a specialty training post (publication, presentations, postgrad exams, etc.). One thing for sure is that over here, everything is based on merit and achievements. UK is more transparent in choosing someone for a specialty training. No ‘cable’ like in malaysia. All the best if u want to try this pathway!
Jimba Jimba, your suggestion is interesting. May I ask whether your friends who did make the decision, are Malaysian University graduates (not UK offshore campus). Did they sit for the entrance exam to qualify for medical practice or PG exam.
Jiimba Jimba, your suggestion is interesting. May I ask whether your friends who did make the decision are Malaysian University graduates (not UK offshore campus). Did they sit for the qualifying exam for medical practice or PG exams?
Jimba Jimba, will 2 years (fy1 fy2) enough to complete the publications, presentation to stand a chance to get a speciality post?
Besides that, may I know what is the average number of years of specialisation in medicine ( from foundation to fellowship)? Thanks 🙂
Hi all
I am a msian doc from nz, all your answers could be found by googling FRNZCGP/FRACGP/FRACP/FRCS websites. Post graduate training ( means min 2 yrs after graduation) could take from 3 yrs to 7 yrs ,depend on fellowship you are taking/or more yrs if you fail. After 2x failure, the colleges committee will decide to let you continue or not or withdraw of the program. The time above is only if you pass your exams at first go. First you have to get a job as a contractor/permanent employee/ and stay in that specialty to show your enthusiasm and get references, then apply for interviews. The specialist colleges will pay for your training. Highly competitive specialty/plastic/surgical field will have applicants who are doing Phd research prior to selection interview and etc.
After all, other things to consider are financial/isolation from family
/mental wellbeing issues. An average house price in Auckland is already >nz 1 million.
All in all, there is no right or wrong. If you think you are prepared to take the challenges above/and go to rural areas, then by all means go ahead.
@Mash, that’s the equivalent of
@Mash, FY1 & 2 is equivalent to housemanship in Malaysia. You then apply for jobs for 3 years of “Internal Medical Training” (if doing medicine, not surgery). Towards the end of IMT, you apply again for “specialty training jobs”, which is actual specialty training of 3-4 years. When you pass the exams, you get a CCT, and then you become a consultant, ie a specialist. That’s my understanding. Please do correct @Jimba Jimba, if I understood wrongly.
I am a University of Malaya graduate, working as a Consultant in London.
May I add to Jimba Jimba’s piece, that it is not just the paper qualification, audits, research or publications that matter. It is also one own’s attitude in working professionally and also in life. Opinions on how suitable a doctor to progress in his/her career are usually sought from patients, colleague, other consultants, nurses/midwifes, clerks medical secretaries and even hospital cleaner. This is to avoid another Dr Shipman’s disaster.
Obviously, we can only terminate one’s career pathway after exhausting all remedial venues….and mind you, we as consultants know if these remedies are successful or not
If it is on contract basis then recruitment and renewal of contract has to be on a meritocracy basis. That will inspire people to perform. But I do not think Msia’s public sector recruitment has ever been done one a meritocracy basis.
Also regarding most Australian specialist not having full time jobs.. most people don’t mind and prefer it because the work life balance is most important… and no full time in public usually means plenty of time in a largely Medicare/ private health fund supported private sector
Yes, transparency is never on our government’s dictionary. In Australia, you can earn much more in public than private unless you are a procedural based specialist. However, the cost of living in Australia is way lower than in Malaysia for the income you earn. Since healthcare and education are well taken care by the government, you really don’t need to earn very high.
Do you believe there will be a shortage of specialists in the future under this system? Or will that be a glut too?
There should be no reduction in postgraduate output, as there are still plenty of permanent job people waiting to get into training, some already into their 5th, 6th, 7th years.
If the powers liberalise postgraduate training like they did undergraduate, there will be a glut.
Malaysia still faces shortage of specialist. That is a fact. The problem is also distribution as most specialist are in private sector in major cities.
My empathy to medical students, parents and doctors who are facing the issues of unfair or unfavourable employment terms in KKM. I have no interest on this matter but wish to share my thought.
1.MMC is entrusted with the responsibility to regulate the medical profession, as such it has a big say in ensuring the optimal quantities and qualities of doctors to meet the needs of the country. Have MMC, MoHE, KKM (SPA) and MMA done enough? If not, are they not responsible for the current mess the doctors are in? I can see here, doctors are the victims of circumstances.
2.Were the students and parents fully aware of the employment prospects in medicine? Simply pointing to the fact that someone has written something years ago about the imminent storm facing medical graduates is not an excuse to absolve the authorities of their responsibilities and duty of care, nor should that be exploited to blame the students and parents for being ignorant.
3. I agree that the govt need not promise jobs for doctors, glut or not, the same yardstick should be applied to profit-making (if not profiteering) medical schools. But medical schools seemingly have a field day in enrolling students, giving the false impression that everything in the profession is alright and cared for(Kao-Tim). Such schools should, when necessary, subjected to appropriate quotas and limits in intakes of locals but fully open to foreign students.
Unfortunately it does not work that way. MMC has no jurisdiction on approving or accrediting any of the medical schools. It comes under MOE and MQA. It also has no role in ensuring the quality of the medical education except to determine the lecturer: student ratio and bed: student ratio. MMC also has no legal role on the hospitals that are being used by medical schools as it is an agreement between KKM and the medical college. It is a very complex phenomenon and I can even write a book on it. MMC has no statutory role in doing anything except regulating doctors. MMA is just an association that can voice out the issues. Way back in 2006, when I was in the MMA committee, we had a meeting with MOH and clearly informed them that we are approving too many medical schools. MOH just passed the buck to MOE despite knowing that based on their own projection, there will be more body than post by 2012 (please read my MMA article written in 2006). They knew it is coming but as usual, their answer would be, government service is a privilege and not mandatory for government to provide.
Yes, many parents and students are aware. The word has been going around since 2012 but NO ONE that I knew personally even believed in it! They only threw accusations that we are trying to take care of our rice bowl! Unfortunately our government do not have any long term plan. In 2015, the then health minister clearly said, let the market force decide. So, they are aware but did they even promise everyone a job in the first place?
These medical schools are private and profit driven. That’s why education should never be commercialised. Every country that has commercialised education landed with the same problem. As long as there are demands, they will continue to do so. They can say whatever they want but it is up to the public to do their own research. Ignorance is not a bliss!
There is another angle to the story. The Malaysian Medical Council (MMC) recognises >250 medical schools around the world. Just look at the 2nd schedule of the Medical Act. Sadly these countries (to quote a few like Russia, India, Indonesia, Iraq etc) do not recognise our Malaysian medical school even the likes of UM, UKM or USM. At this point of time, when we have so many local medical schools, why is this practice continued. Worst, about 6 years ago the MMC went on to recognise 3 medical schools in China where the medium of instruction is in Mandarin! There were attempts to derecognise the foreign medical schools but it seems the MMC did not go for the idea. There was an attempt to to set a national exams for all foreign graduates like that practice in India, Sri Lanka, Australia etc but the MMC did not go for this initiative too. As such, there are medical school that were recognised like 40 years ago continue to be recognised to this date. I wonder whether they still exist or not. On the establishment of private medical schools in Malaysia, this is really an issue of greed. It is a money making program. The most profitable academic program is the medical undergraduate program and this is the ONLY reason why every university wants to set one. Let me repeat, there is no other motive to set a private medical school except for making money. To maximise profit, the local private medical school usually cuts corners in the quality of students (to get the numbers) and the quality of lecturers (mainly foreign lecturers). Even though these foreign lecturers cannot be registered as Specialist in Malaysia, the MMC allowed them to teach in the private medical school. A few private medical schools like Manipal in Melaka and IMU in Seremban are given atrocious quota intake of 400 per year! Just imagine, 2 local private medical school is generating 800 graduates per year! Unbelievable! Even as we are discussing and the moratorium is on, another medical is approved by the MMC. The current predicament of our doctors is of our own making. Of course, the MMC being the guardian also fail in its duty.
Yes, this is an issue and it has nothing to do with MMC. You must understand that MMC is NOT an independent body as far as Malaysia is concerned. It comes under MOH and the Chairman is the DG (despite the amended Medical Act 2017). The reason why it was not removed is simply because JPA and MARA and many other sponsoring organisation still send students to these universities. In 2012, MMC did recommend a common entry exam for all those who graduate overseas and suppose to be included in the amended Medical Act. However, this was shot down by the cabinet (I have written. about this many years ago). The chinese medical school approval was again, purely political (MCA and SARAWAK)
The teaching certificate is issued by MOE. Only if they do bedside teaching, they need MMC registration. As for IMU, MMMC etc, these quota was given when they first started in late 1990s. At that time, these schools were the first private medical schools and they had many hospitals as their teaching hospitals. The problem is, once you had approved the number of students that you can take, you can’t retract back years later unless the university can’t provide the same ratio of student: lecturer and student: bed. If they do, MMC can be sued as they had already been sued by one of the medical school in 2016 for suggesting cancelling a medical program after approving it!
MMC is not the guardian of medical education. It comes under MOE and MQA. It is very complex.
By the way Aliff, British is not a country so you shouldn’t write ‘British or UK’. I hope if Dr Paga were to become your so-called minister/ketua one day he shall make his statement 100% valid, in your face.
Jiimba Jimba, your suggestion is interesting. May I ask whether your friends who did make the decision are Malaysian University graduates (not UK offshore campus). Did they sit for the qualifying exam for medical practice or PG exams?
Hi S. Not many malaysian uni grad. I met one from UM and one from UKM. The rest were mainly from NUMED/IMU. Even then, we are talking about small numbers here. My point is if condition in malaysia is very dire and bleak for newly grads to gain specialty training after housemanship, u have to try other countries such as US/UK. I met loads of medical grads from Nepal, India, Bangladesh, Myanmar, Pakistan etc who did their PLAB and then gain experience here for 1-2 years (as a trust grade doctor) and following that enter specialty training. I know getting here is the hardest bit but once u are here, everything is fair game and is based on merit.
I believe the IMU grads are probably those who did the twinning program. As for the countries you mentioned, they have huge population and the numbers you see in UK are just a small fraction of those who actually applied.
Thank you
Jimba Jimba, will 2 years (fy1 fy2) enough to complete the publications, presentation to stand a chance to get a speciality post?
Besides that, may I know what is the average number of years of specialisation in medicine ( from foundation to fellowship)? Thanks 🙂
The govt. can amicably solve the predicament by retrospectively reverting the compulsory retirement age of medical personals to 55 and optional retirement age to 50.This move will to a large extent solve the problem.Your reasoning does not take into consideration of the disparity and the psychological factors involved and which factors are extremely relevant and imperative in this area.
Let me very frank. It will NOT happen! The sole purpose of our government service is to satisfy certain group of people or shall I say race. Whatever changes that they have made to the system will never be retracted. Optional retirement can still be done as before, 45 for female and 50 for male. My argument is the fact that contract system is the way to go but the benefits and salary must be the same as for the permanent post.
Agreed.At least the government must make an immediate announcement that both categories will be at par in all respects hereinafter.
Tq Dr Paga.. Easy to digest the main issue.. I think the medicine graduate should know better. No one in the world, government will guarantee a job for everyone after you graduate from university. Nice to read and think wisely.
When will the announcement be due? Next Cabinet meeting scheduled this week?
I believe cabinet meetings are on every wednesday.
Any initial report from govt? The newspaper and social media keep publishing article after article on a daily basis.
newspaper will always do that for a while then everything will quiet down. FYI, those who are going to finish the contract in December 2016 (1st Cohort) just today, received their extension for another year which is conditional. It was clearly stated that it is a one-off extension and the doctor must go where the letter has instructed him/her to go. Some were instructed to report to vaccination centre! Not negotiable! I don’t think I can attach it here , in comment section
There is another dimension to the issue of permanent post.Usually there is a mandatory interview process before being accepted into govt service.If I am not mistaken only the first few cohorts had an interview before their contract started.
Usually who are on the panel? SPA, JPA and MMC?
Interviews are done by SPA.
I’ve known about your writings for a decade. Nobody listened to you. Now the young doctors want to “strike”. One of their argument is unless the government solves this problem, the will be “brain drain”. I don’t know why they think the government cares about brain drain when it never cared about the brains, ever. It only cared about the skin. So these doctors are focused on the wrong organ. Also, with brian drain there will be large money remittances from Malaysian emigrant workers. That’s good for the current account balance so again the government wins. So as Dr Pag has said. The government will not change the process. They won’t and they can’t. Those whose dream was to be doctors will have to emigrate.
Yup, Gov does not care where you’re working, but is very concerning about your oversea CPF savings. Decade old story, he still does not forget.
“According to the Mahathir, another issue that was discussed was on the Singapore’s Central Provident Fund but did not not elaborate further.
It is believed that the CPF issue is related to the difficulties faced by many Malaysians who have left the republic for more than a decade after working there but are unable to withdraw their (CPF) savings.”
http://www.dailyexpress.com.my/news.cfm?NewsID=128658
Sorry to tell you the truth. Little brain drain if any. As Dr Paga has said many times, medicine does not help your immigration. You have to consider whether your medical schools are recognized by foreign countries. You may need to take some qualifying exams. Possibly only those graduates from UK, US medical schools may have some advantage.
Our government never bothered about brain drain. Furthermore, the government very well knows that most doctors can’t go anywhere!
Hi Dr Paga,
This article is a distilled version of the medical field in Malaysia in the past 15 years. I agree that we have to move on from a permanent post system and into a contract system. Having a job for life in the government may have worked during the baby boomer and generation x era, but for us millennials it is just not sustainable. For this to work, a few more changes needs to be made.
1. Change every permanent post to contract basis
everyone needs to be on contract basis be it the consultants to the junior house officer, nurses, PPKs, medical assistants etc.
I have been working in Australia for a few years now as a doctor and my colleagues were shocked when I told them doctors in KKM have jobs for life.
To be fair, who would not want that degree of security with the option of EPF or lifelong pension.
But being in a system where you are given contracts from 1-3 years does give me a different perspective on life. Going for job interviews is a good learning process on how to promote yourself to your employers. It allows me to reflect on my CV and decide what areas should I invest my time and money in to improve my knowledge and skills i.e. doing a course in dermatology for example which I am currently doing. Visiting these prospective work places and seeing how things are run is an experience by itself. It keeps me on my toes and I am grateful for all these experiences as it helps me grow as a person.
Conversely, should a person feel they have outgrown a work place (or in my case found my previous workplace not complementing my professional growth), one can leave and find hospital/clinic to work in.
2. Establish a post-graduate system that is transparent and self funded
the post graduate system in Malaysia is haphazard. take surgery training for example. There is USM, UKM, UM and if I remember correctly a couple more. Each of them would produce their own surgeons. To be accepted into their programme, you would need to have permanent posts because it would entitle you to “Hadiah Latihan Perseketuan” or HLP. Basically a scholarship that binds you to KKM for another 8 years.
This is not sustainable. It takes hundreds of thousands of ringgit to train a specialist via the masters system. And some do continue on to serve their 8 years and longer, some choose to leave and go to private which is entirely up to them.
In Australia, the colleges decide the training. The candidates enroll to these colleges and pay the fees, courses and exams which are mostly self funded. They find their workplace of choice that is approved by the colleges and train there. After passing their exams they are free to practice independently as a specialist. The RACGP training is flexible and understands that life can throw curveballs in your way. They allow the candidate to progress at their own pace.
3. Phasing the universal health care system we have to a mixed model
Our health care system is crumbling, corrupt politicians or not, it is not sustainable to keep it running. In a few years we will be bankrupt. It is not a Malaysian problem exclusively. The NHS is facing the same problems too. As our understanding of diseases changes, treatment has changed to allow people to live longer. That is great, yes. But that also means more is needed to maintain that level of care. paying RM 1 to see a KK/ED doctor RM 5 to see a specialist would not cut it. having to pay RM 30 to see a GP is too little. specialists waving consultation fees is not fair to the specialist. For doctor’s to improve their knowledge, they need to go for courses. Good quality courses are not cheap. Speaking from my own experience, I paid AUD 2000 for a skin course. It is dear but I got my moneys worth and can use what I learnt to better help my patients.
Generally speaking there are two assets in life that are important. Time and Money. Time spent studying, researching, practicing medicine. Time that could be spent doing other things like hobbies, time with family etc. That time has to be compensated with money. What we are doing is just burning the candles at both ends.
4. Destigmatizing mental health among health professionals in Malaysia
Anxiety, depression, burn out, substance abuse, self medication. Find any doctor and you’d be sure to get one out the five above. We were told to wear our sufferings as a badge of honor. This has to stop. Doctors are a resilient bunch of people by nature. You have to be if you see suffering day in and out. Now add on your own basic needs not being met (lack of sleep, food, water, toilet breaks), financial issues (contract work, on call claims not getting approved, car/house loan due), family issues (parents, spouse, children), work place bullying, post graduate training/planning. This is a pressure cooker ready to explode. I have known colleagues who turn to the bottle, cigarettes, self medicate with benzodiapines (and this is in Malaysia). The darkest is when one of my colleagues committed suicide and found dead in the river. We need to be kinder to our colleagues and ourselves.
This may sound selfish but it has to be said: We are cogs in the machine that is our health care system. If the cog malfunctions, it is replaced and the machine keeps on chugging. For your family are you replaceable?
Side advice here: Deal with the life and death situation at the work place, hand over to your colleague and switch off. No patient, no boss, no colleague is worth your own or your family’s well being. Do your job properly, do it correctly and safely, if you cannot complete it hand it over to the next doctor on shift. Once it is time to go home, go home. Reach home to your love ones, body AND mind. Your career would last longer.
In conclusion:
Yes, we took an oath written by an ancient Greek doctor 2000 years ago to help people, but 2000 years ago they also believed in the 4 humors that make up the bodies composition. If we don’t adapt to the times we live in, our profession is doomed.
I do hope someone who can make a major change can read this.
Hi there,
I agree with all of your points except point 3. I still think that universal healthcare is doable, the issue is managing it properly as you know in Malaysia, everything is mismanaged and corruption probably adds to the problem too.
I am against raising prices of healthcare to a point where we become like the US, where people could go bankrupt to seek medical care. I believe that healthcare and education should be the responsibility of the government. Everyone wants to make money, doctors included. Opening the floodgates would just result in overcharging and unnecessary procedures being done, which is already the case in private practice in Malaysia.
Increasing the prices in public healthcare to plug the gap could be done, but by what quantum is something that is needed to be researched on. The majority of Malaysians still can’t afford private healthcare.
Come to some Klinik Kesihatan, OPDs and specialist govt clinics. Inspect the pharmacy returned/used medication box and the drains surrounding these places. Better still join a home visit/domiciliary team and inspect the patient’s houses then go to any govt hospital yearly finance dept briefing and see how much losses are made each year. If you think people value the meds they get for free/RM 1/RM 5 you’ll be in for a nasty suprise.
Yup, well known. As Lee Kuan Yew once said, if you give everything free, then why should people work for it?
I strongly disagree with you. Universal health care is not sustainable. Even in developed countries it is not sustainable. Why do you think taxes in Australia is as high as 40%? The money goes into Medicare. Even then, there is a gap fee that the people here have to pay. What Malaysia is doing will destroy our health care system within the next decade. COVID 19 just revealed all the fallacies within our practice.
Health and Education is the government’s responsibility. However, universal healthcare has many definitions. The key issue is, no one should be denied healthcare.
You can’t simply change those who are already in the permanent post to contract system as the government already promised that when they joined. What you can do is to phase out the permanent post gradually as they resign or retire. That’s what Singapore did.
Phasing out the permanent posts is the way to go and I agree with you Dr Paga. I am not sure if the current batch of doctors will see it that way. For our health system to survive, this is a painful but needed step. Post grad training needs to be revamped. There must be away to train specialists without over-relying on the local masters programme. Even if they need to go through the masters programme, there has to be a structure to enable them to work and pay for their post graduate studies at an affordable cost. Most doctors feel that talking about money is beneath them. I strongly disagree on this. Everyone needs to be comfortable talking about money in a healthy way. But I guess there are too many dinosaurs who want to their world to be as it is and never change.
yes, that is what I was saying. There must be a single post graduate training system. Unfortunately, politics is at play here. The universities insist that they should run the Master’s program. it is very complicated and need political will to change it. I don’t see it coming anytime soon even though Prof Adeeba from UM was working on it for the past 5-10 years.
Not offered a permanent post may be a blessing in disguise. That was what happened to me in 1981. I did not get a credit in BM for MCE, only a pass. I accepted the fact that I would not be a surgeon. Without wasting much time, I set up my own GP practice building it up gradually. I was also able to pursue an external LLB(Hon) degree followed by a Masters in Family Med from an Australian University by remote learning. It has been a fulfilling career and retired recently with no regrets.
Having done a bit of locum just prior to complete retirement, I noticed that GP practices, especially those set up in the last few years are not family medicine orientated. They were set up just to cater to managed care organizations, companies and the occasional walk in patients. There are very few cases of long term care of NCDs, pediatric follow ups, minimal minor surgical procedures. Seeing three generations of a family unit in the same consultation room is almost non existent. Opportunities for family counselling are rare.
Looking at the current situation now, many of the contract MOs will eventually become GPs, I would encourage them to start planning to be one as soon as possible. There are many postgraduate courses now being offered such as, Postgrad cert in Family medicine, post grad diploma in primary care dermatology, post grad diploma in pediatrics, post grad diploma in diabetic care, etc. These can be done while still in service. It will make them more marketable in joining established practices or become a better GP running their own practice.
That is what I experienced when I did GP locum before leaving. Most of the GP clinic in Malaysia needs to partner up with a companies just to survive. I made the choice to move in 2018 to Australia. It is a learning experience for me over here. However unfortunately Australia may be heading the way of ‘6-minute consultations’ with their bulk billing system.
I agree with you when it comes to postgraduate learning. Not only would it be aesthetically pleasing on a CV, what you learn can be used to help manage your patient base.
Anyway, enjoy your retirement!
Busy and popular clinics can charge a gap and see less patients and provide better consults. It all about choice of lifestyle.
let’s face it, many do medicine for money, period. That’s why we have instant GP practices which are set up purely for MCO etc. Also the reason why they are willing to take any amount of payment from the MCOs and then complain about it later!
Do academic postgraduate medical degrees have a marketable asset during the search for jobs in a scenario where there is a medical graduates glut. Not many may have access to a professional postgraduate course/exam and may be ineligible for it.
I disagree. All the information can be available online if one is willing to spend time to do their research. Upskilling to provide a service others cannot offer will be the difference of employment or retrenchment. Medicine is no exception.
Yes.Point taken.But what about academic medical postgraduate degrees in this climate of uncertainity?
The problem is, how many can afford to do such courses on their own? Our ringgit is going for a free fall.
J , what do you mean by academic postgraduate? Is it just teaching and non clinical work?
Yes.That is correct but in medical field.For eg M.Sc Oncology, M.Sc Diabetes.
Non Cliniical but attend classes at University
Full time university courses cost money. Issue is what are you going to do after acquiring these degrees?
Understood. tt does cost money.. Does it add to the CV in the search for jobs as a non-practitioner and practitioner after graduating? Non-practitioner jobs may include research and pharmaceutical..
It looks like hell may break soon if the government does not come up with a feasible and sustainable solution. Sustainable solutions may or may not include pensions. Govt employees do generally demand pension as part of the benefits. It has been inculcated a very long time ago and difficult to change.
Simply put the flood gates may be opened soon, releasing hundreds if not thousands of doctors to the private sector. It is going to be very competitive to secure a job, especially in big towns. near your present home. A scenario that was predicted by Dr Pagalavan but not accepted by many in the past..
My own personal check on private hospital websites is that MO’s usually number about 5-7 in a medium-sized private hospital. The rest are specialists. numbering 30-40 or more. with The private hospitals cannot absorb all the MO’s..
I have been following this blog for about 10 years and find lots of useful information here.
Are the courses you suggested available locally? Are they offered by course work or by research? To be recruited as a researcher, I presumed you must be attached to a university. As a Masters graduate, it would be difficult to obtain grants for research, unless you can come up with a promising research proposal, able to convince a head of department or a reputable professor to support you. Bottom line is opportunities post graduation in the field you suggested is uncertain and limited.
Private hospitals are profit driven. Why would they employ MOs and spend more money when the current model is running well?
Thanks for the input, drplhon
With the potential surge of medical graduates, once there are too many medical graduates applying for housemanship, won’t the government raise the SPM requirement for future doctors compared to previous doctors and even other future civil servants in the future?
For example, like getting all future doctors to not only sit for and pass BM with a Credit and pass Sejarah (History) to be employable as housemen in the civil service and by extension, doctors in Malaysia, but also at least a few other subjects (like English, Maths and necessary Science subjects) before being allowed for housemanship using SPM results?
I thought good grades in Maths and relevant Science subjects are required for med school enrollment!!
You only need 5Bs in SPM which include Maths, Biology, Chemistry
SPM is not an entry standard into medicine. The reason why many are harping on this SPM qualification is simply because we have messed up our education system in a way that there are so many pre university courses which are being conducted in Malaysia. Most of it are not standardise and thus the only standardised exam that almost all sit for is SPM!
MMC wanted to raise the requirement in 2015 but was shot down by Ministry of Education. It is all about politics. Furthermore, why are we even using SPM as the yardstick?
Dr, how do you think the cabinet discussion on the issue of contract medical doctors will go?
I got no idea but as the PM said, it involves a huge cost. I would be happy if they at least, agree to extend contract till complete specialisation.
Fair view, dr
True, but what about the Malaysians who took their Maths and Science subjects in IGCSE and university and only sat for (or only passed) BM (with a credit) and Sejarah in their SPM as they prioritised studies for IGCSE instead of SPM?
SPM results should never be used as entrance for med school enrollment. It should be good pre-uni qualificatons such as A levels, STPM, Matriculation, IGCSE. Some good unis have their own Foundation. Credit in SPM is a govt policy thing, not related to medical education.
I checked UM’s entry requirements and its already there and quite high. UM MBBS requires someone to have at least A- in SPM for all Biology, Chemistry, Physics, English, Maths or Add Maths. They require 3As for BIO, Chemistry, Physics or Maths if someone is taking A-levels instead of STPM. Not sure about other universities though. I think this serves as a filter in taking in candidates.
If you got brilliant results for SPM, but fare badly for Pre U exams do you think the Uni will enroll you? That is why reputable Unis give you a conditional offer based on interviews, SPM and trial Pre U exams, condition upon obtaining good grades in the real Pre U exam eg 3As for A Levels or STPM, >95% for Aust Matriculation, Even IMU require min. 3Bs.
Generally the criteria is set by MOE. However, since UM and USM are apex universities, they are given special right to take their own students.
BM and Sejarah is only needed to become a civil servant.
Cuepacs is now asking all contract staff to be absorbed into permanent posts. The demand includes non medical staff from all ministries. It is another point to be taken into account.
Lot of creative thoughts. Good to ponder over it.
No Minister is going to make any permanent decision. Why should they? Buying time to delay the decision is the best option now. So , extend the contract for another year. All happy, at least for the time being, as I , as a Minister also don`t know how long I will sitting on this position.
There are many private medical schools. Correct. All of them are depending on the medical programs to make money.Take IMU. It costs around RM550,000. If twinning, it will cost RM800,000. Find out who are the owners. Once done, you will know no quota can be imposed on the intake. Find out also if medical student fails unless the students drops out himself.
Who wants to listen to you? Tell the parents, doctors have no more jobs, they will fire you. They insist on sending their children to medical school. It is a status symbol.Within the family, there is conflict. My sister`s children can go to medical school, why can`t I send my children? But your children are not good in their studies. It is okay. I will mortgage my property to send them. What to say?
Some contract MOs have received their permanent posting letters last week. All races not confined to Malays only. All sent to Sabah and Sarawak. For those who are not happy, question arises why make noise now when you are now a permanent doctor? Government position means you can be posted anywhere anytime.
Yes, they do this every year based on available post. April last year they gave about 120 post, all in Sarawak. Only about 70 took up the post.
Another example. Perdana University. Runs medical programs. Collaboration with one foreign University. Had some problems relating to payment. Had to change to another foreign University. Fees is RM750,000. Owned by Bursa Listed Turiya Berhad ( Datuk Dr Mohan Swamy) under one of their subsidiaries. But Government sends their government scholars here. Why? Said to be linked to Mahathir. Now Turiya is selling off Perdana University to potential buyers.
Another one is CUMS ( Cyberjaya University of Medical Sciences).Datuk Palaniappan. Said to be a very close friend of our current PM. CUMS took over Masterskill. Changed to Asia Metropolitan University. Previous owner Edmund Santhara, MP. CUMS operates under SMRT, also Bursa Listed.
When the Universities are connected to top people and they are Bursa listed, how to impose quotas?
The talk of jobless doctors in the near future is a worrisome thought. If I am not mistaken, it has never happened in the history of Malaysia.. The authorities have also become complacent partly of this. The growing pool of doctors was to have been absorbed easily by the govt.
What’s is the next step in this muddled state of affairs?
never happened does not mean can’t happen. It has happened in many countries. Why should the government be bothered about doctors quitting civil service when they will have 5000 waiting to get in?
Why should anyone worry about jobless doctors? Too many medical colleges. Too many aspiring students wanting to become doctors. But insufficient places.Taxis are gone. E hailing has come in.Owning cars will be history. Follow German style . All cars are on lease. Every 3 years can change your car. Technology is evolving fast. Now all medical classes are online. Who would have imagined this before? Re-strategise your life and move on.
Title of news article in FMT July 20 2021 3.30 pm. Doctors quitting, giving 24 hours notice, says Hartal Group.
Do you think anyone is bothered? You quit , another 5,000 ready to take your place. Full stop.
If the govt does give a substantial number of permanent positions, what would happen to future batches of fresh medical graduates entering housemanship.This solution can be provided to appease the masses and politicians but does not solve the next intakes. The future intakes may be frustrated and vent their anger in public. Is that a sustainable solution.?
That’s what I wrote above.
Learn to accept everything is possible. Petrol stations will be history once electric cars come into place.Online shopping has now replaced physical stores.Next physical banking is being replaced by online banking. Prepare to accept changes coming in fast. Politicians are only interested about today. They know they will not be around long. So make hay while the sun shines and keep buying time.
There is a recent spate of resignations of junior doctors. What does happen to the compulsory service with the government? Overlooked by the authorities?
Since October 2020, MMC do allow a reduction of compulsory service of about 6 months, meaning you can apply for reduction of compulsory service after 1 and a half years of receiving full registration aka finishing housemanship.
Junior doctors quitting due to work load/work pressure/stress/ sleep disorder and dime a dozen reasons.If they had read all the articles here and elsewhere, they should know a doctor`s life was never meant to be a bed of roses. You quit today and you become an instant hero. Everyone claps except existing doctors. What happens after one week or one month.? The same people who clapped at your resignation will spit at you for giving up the doctor`s job. All heroes die young. This is how society functions.
Dr `s suggestion is to at least extend the contract till specialisation is completed. Question will again arise, how long ? 3 years.? 5 years? 7 years? Not all can pass at one go. Then Government may decide and tell you what area you must specialise if you want to stay longer. That area may not be of your interest. Mind you, 5,000 housemen joining in every year. Previously you had 5 juniors following the senior doctors on rounds. With more housemen, will there be more than 10 or even 15 juniors joining the senior on their rounds.
Tough times for all. In Malaysiakini, some subscribers are suggesting junior doctors to quit and migrate overseas. They are totally unaware of what is the scenario in other countries.You can try but all costs money.Sitting for their exams itself can cost a fortune.
Hi Dr, I saw this in an article by FMT today, it stated that ” Besides this reduction, doctors who finish their internship are allowed to apply for postponement of their compulsory service from the minister for valid reasons while those who do their housemanship in recognised hospitals abroad can request for exemption after returning.
Those who have served abroad with at least 10 years’ clinical experience can also apply for exemption from compulsory service locally upon their return.” I would like to ask is this already in place or it’s what the gov is planning to do? Thx
Source : https://www.freemalaysiatoday.com/category/nation/2021/07/22/docs-can-leave-govt-service-after-18-months-now/
Yes, I gave the details to the reporter to write this article!
These are nothing new. Those who complete internship overseas recognised by MMC can be exempted from compulsory service if they cannot get a job in civil service within 6 months. This circular came out in 2017 and I have written about it. I think you must have atleast 2 years experience.
If medicine isn’t a good sector to work in that what sector is good in Malaysia? Every professional career is oversaturated. Any recommendations as to what the younger generation should look at dr
Firstly, do what you think you will have passion to do for the rest of your life! Never do something for glamour, so called money, guaranteed job etc. Secondly, do whatever course that you think you will be good at. No job is guaranteed. The problem in Malaysia is many teenagers got no clue what is happening in the world out there. They believe that just because they got good grades, they have to do medicine etc and the world have to give a job to them. The reality is not what you think it is. There are many new fields that are appearing like renewable energy, AI, IT software and security etc. Unfortunately, malaysia is far behind when it comes to these type of jobs. Our youngsters also don’t bother to read!
Dr, if you could do it over again would you be a doctor again or what would you do?
No I would not, frankly. I would have rather chosen Accountancy or Engineering. Of course I am talking about early 90s and not now.
What are the implications of the PM’s announcement carried by FMT just now ?
Exactly what I wrote above. Your contract now extended from 3+2 to 4+2. If during the last 2 years contract, you get enrolled into a specialist training program, you can get extended contract for a maximum of 4 years. You are now entitled for local Masters program with HLP but nothing mentioned about bond after HLP masters. Not to mention the q to get into masters. Many may not even get masters within 4 years after housemanship
I dont get this dr. Can you explain this more throughl, dr? Please
Which part you do not understand?
The feedback so far is mixed with some doctors disappointed not getting permanent jobs.
As I have written, you will never get that many permanent post. It is simply impossible.
For Malaysia civil service , a permanent post comes with a pension. It is a heavy burden on the nation. But nobody mentions the pension stuff.
Pension scheme for doctors? All removed some years back if not mistaken. All are now under KWSP scheme.
Nope, permanent doctors still have a pension option.
I stand corrected. Thank you for the clarification. Options given to doctors.
There is talk of amendments to the Medical act. Any idea on the proposals put forth?
I am not really sure what amendment they are talking about. Job has nothing to do with Medical Act, unless they are talking about compulsory service or common licensing exams.
When you are in a critical medical condition or involved in a serious accident or going through labour pains, only a doctor will be able to save your life at that critical moment. Everyone looks at a doctor as God. You will never ever come across any one saying a particular engineer is God or an accountant is God. That is Godliness attribute is only applicable to doctors.
Unfortunately that era is gone. Trust me. Nowadays patients don’t even thank you. On the contrary, litigation is going up by leaps and bounds. So much so, many indemnity companies are reducing their coverage and putting a limit.
A few bad apples giving the medical fraternity a bad image. Sad indeed.
Not really a “few” bad apple!
A good article into the current contract doctors crisis in Malaysia. 1 point I wanted to highlight is that the contract system in developed countries is so very different from what Malaysia is doing.
I worked in Malaysia as an MO for 5 years & then left in 2012 ( family reasons). Restarted my career from scratch in the UK. As a foreign graduate; & I’ve been working here fully as a doctor for 5 years now, ( after maternity leaves etc) I’ve passed my final MRCP exam & accepted into the British training programme for progression into higher speciality & then eventually Consultant’s post. They have various stages to the UK training programme( you might know this), the final stage of ST3- ST7 is a 5 year contract; then you apply for a permanent Hospital Consultants’ post, directly to the hospital you’re interested in. Also… no I don’t pay for my training, the UK government does that .
For a GP here; its a different training pathway & hugely popular. After 3 years of training you apply to a GP practice…if you get a job you can stay there till you’re 67 ( official retirement age).
The point with just saying developed countries have done this contract system for years is an oversimplification…as a contract doctor you dont renew your contract yearly unless directly employed by a goverment hospital. That is through hospital trusts, & its called the non training pathway. If the hospital likes you; they keep renewing your contract yearly but you dont get much perks of a training programme like protected study time while working, or almost 2 weeks of study leave staggered throughout the year for various courses, audits, research & publication.
Now the training programme; if you’re successful & get into- its competetive for higher training into specialities like cardiology & respiratory (some examples), no trainee pays to do these programmes. In fact the UK goverment pays these higher trainees a relatively high salary with perks to reflect the responsibilities that go with the job. And this even if you’re a foreign trained medical graduate like me, providing you can prove you’re equally competent as a local British graduate via various exams & English language test.
If Malaysia wants to follow through with permanent contract positions as you have suggested; then it should study the various ways the developed countries have done it; in such a way it attracts doctors from all over the world. The only requirement is entry by merit; & to prove you’re good enough. The system is transparent; I did not know single soul in the medical field when I came here ; all entry requirements & guidelines are published & easily available to anyone who does research into how to gain employment into the goverment run training programmes. Private hospitals here have a different system altogether; usually doctors established in their careers go into these, similar to Malaysia.
It will be to Malaysia’s credit if they can start such a goverment system for their own citizens. Have contracts; but have them in such a way you don’t deny your own citizens from progressing into the speciality they want to pursue . And no, doctors don’t have to be charged to do higher training; if emulating developed countries then absorb all the good systems they have put in place as well; not just the emphasis on short term contracts. Find out how they make it work; & then do it to adapt to the local system, but fairly.
Excellent clarification from Prema. Thank you. But introducing meritocracy fully will be a problem here as the Government has been assisting Bumiputeras from childhood.It is not possible to impose the same passing mark of 90 per cent for non Malays, for the Bumiputeras who have been used 40 per cent passing mark.They will not stand a chance, very few will make it.
yes, this is exactly what I am saying. The system in developed countries are well done and transparent. Unfortunately, that will not happen in Malaysia. I am well aware of the healthcare system in UK and Australia. What I meant when I said the candidates have to pay their own fee is in regards to the examination fee. Even in MOH Malaysia, if you are in the parallel pathway, you don’t pay anything for the training, including the subspecialist training. What you pay is the exam fees. However, the Master’s program is a totally different system. That’s why I mentioned that we need to have a single post graduate training system and an open transparent system done by a single body. The GP system in UK and Australia is also a totally different system funded by a National Health Financing system. This is again has been a hot topic for the last 25 years! No one wants to change. I have written about this in 2019 when the town hall session was held with Dr Zul where most GPs were against it.
Dear Prema,
May I inquire, whether you started your career in the UK after passing the full MRCP in Malaysia or another entrance exam within the UK? I am assuming you are a non-UK MBBS graduate. Your input would help.
She did say she started from scratch and only passed MRCP recently.
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Dear dr, which field you recommend me to pursue based on current situation in Malaysia? I am thinking of whether actuarial science or biomedical science and others fields as well. Thank you!
Actuarial science is still in demand by many multinational companies.
Dr Pagalavan. May I share this on FB?
No worries