In May 2011, for the first time in history, MMC came up with the minimum criteria and qualifications for entry into a medical programme. I wrote about it over here in June 2011. MMC had no choice but to introduce these criteria as there were just too many dubious foundation courses being conducted by various colleges to attract students. Unfortunately, I still felt that the criteria set was just too low. I am sure everyone knows that the standard of SPM has gone down the drain, compared to 10 years ago. Everyone seems to be scoring 10As etc. I have spoken to many who had A1 in English but could not even talk or write in proper English. Examples are aplenty in this blog comments.

Since then, MMC has amended it several times as you can see over here. One of the major amendments made last year was to allow A-level, STPM and few other well-known Pre-U courses to supersede your SPM results. Prior to that, Pre-U courses should be “in addition” to SPM results. The latest amendment was in July 2013 as seen over here. I don’t really see much changes compared to 2012 but few caught my eyes.

The last sentence in this circular clearly says that if you do not fulfil these criteria, you will NOT be allowed to sit for the MQE exams if you do medicine in an unrecognised university. In one way, this is a good start as I have seen many students with poor results who go on to do medicine in some unrecognised universities and come back to sit for MQE exams. Most of them do not pass the MQE anyway but given this new criteria, they would not even be able to sit for the exam!

Also, please be aware that you need a credit in BM & English to be able to apply for a civil service job. With the upcoming glut , I am sure you will be automatically excluded from civil service if you don’t fulfil this criteria. Previously, you can still get a job on contract basis as there were severe shortage. Once you pass the July BM paper, you can be absorbed into permanent service.

There were also rumours recently that MOH/MMC may introduce an exit exam after housemanship. I have not heard any confirmatory news about this but as far as I am concerned, it is inevitable. Can the government create almost 6000-8000 post yearly ? Obviously not. With the huge debt of the country and worsening economy, I am sure the government would not be able to absorb all these graduates, once the posts are full. I was informed that those who fail the exams will not be given a government job and those who pass borderline will be given job on contract basis. Only those who pass will be given permanent post in the government service. I felt that an entry exam would have been a better option, as suggested by our ex ex DG.

Furthermore, I am sure by then only those who fulfill the minimum criteria above will be even entitled for a government job despite having a recognised degree. The unrecognised degree will not even be sitting for the MQE if they do not fulfil the criteria.

Well, day by day, whatever I have been saying all these years is slowly becoming a reality. Who knows that some day, our smart politicians will ask private hospitals to take housemen with a pathetic salary……………….

Happy Malaysia Day…………….

Read Full Post »

Well, we just received our first of the many presents that we are going to receive for voting the current government. I use to tell people that our debt is just too huge for the government to go on spending money by whatever name they want to call it. Unfortunately, since most of these in formations come from the so-called “opposition” supporters, the hardline pro-BN supporters will always refuse to believe despite showing the facts and figures. Tomorrow, as a Merdeka present , RON95 petrol price will go up by 20cents! With a pathetic public transport system, we’re going to see many more motorbikes on the roads soon! Wait for the budget  and I am sure you’re going to see the GST and 1Care system being mentioned. The government got no choice but to cut their expenses, after spending money like it was their grandfather’s money! Janji dicapatikan and good for those who voted for them all these years. Stop the leakages and you will earn money, as what Selangor and Penang is doing!

Now, coming back to the topic above. I had written about the realities of medicine since I started blogging in 2010. The article below (The Star) was written by a good friend of mine and a fellow UM batch mate from Penang. He is spot on about the status of medical education and practise of medicine in this country. All of it has been mentioned by myself many times before. With the economic situation as mentioned above, will the government be able to absorb ALL the graduates by 2016, amounting to about 6 – 8 000/year? The income of private doctors has been declining over the years. I just heard an O&G consultant who is only earning less than 10K/month after 2 years being in a private practise! Something that we never heard, 5 -10 years ago.

The government just increased the petrol price by 20cents, which is about 10.5%. This increase will eventually increase everything else that involves transportation. So, your cost of living will increase much more than that. Remember the headline when doctors asked for 30% hike of their fees ? Someone wrote a letter to the newspaper that doctors drive expensive cars but plumbers drive old “retired” cars and thus cannot compare apples and oranges? The person who wrote that got no clue about life in medicine. Unfortunately, what she wrote is exactly what the public perceives. They always tend to forget the cost involved in being a doctor and subsequently a specialist(debt ++), the time taken, the multiple exams that they go through, the risk taken, the quality of life that is lost etc etc. Then, when their child had to work beyond 5pm, they will complain to the hospital’s Pengarah! Their so-called “grown-up” graduated child is still an infant, I guess!

BTW, I know a plumber and an electrician who drives a luxury car and only does supervising work! His workers do all the manual work. They drive the “broken” car to work as they dumb all their instruments and tools into the car! Who wants to do that on a BMW or Benz? I know doctors who drive big cars just for glamour but has a huge amount of debt!  So, don’t judge a book by its cover!!…………….

Realities of pursuing medicine

Read Full Post »

Here we go again. On and off, news like this appears in the mainstream newspaper over the last 2 years.  BUT nothing has changed!

Today, The Star produced an article of possible “unemployed doctors” coming, very soon. You can read the article below. Well, I have been talking about this since 2006! When I first wrote an article in MMA magazine in 2006, even the MMA President then said that I am over exaggerating. Now, it has become a reality. Just few days ago, I wrote on Health Facts 2013 which clearly explains what the situation is going to be in the next 2-3 years. How many graduates can the government absorb? I was also recently informed in this blog that a UKM graduate is still waiting for 4 months to be posted ! This is something that I had never heard of. Usually, public university graduates ,where the SPA interview is conducted within the university before the students graduate,  will get their posting letter within 1 month! Does this mean that MOH is running out of post and waiting for those who finish housemanship to become MO first? The MO post is also getting filled up very fast. Don’t forget about the type of training these doctors are receiving and issues concerning limited post-graduate training. I just heard that a “locum” MO gave calamine cream for vaginal discharge!! Looks like a joke? Well, that’s what happening out there! Poorly trained graduates coupled with poor training during housemanship/MO.

The article below also has some factual mistakes. It claims that there are 33 medical colleges in “Full Production” mode which is not right. We only have 20 medical programs in production mode! The remaining 23 is yet to produce any graduates. So, if there are 5000 graduates even by 2014 (as mentioned in the article), what will happen when all 43 medical programs are in “Full Production” mode? You can do your maths!

What happened to the moratorium issued in 2011 ? Only GOD knows. It only remains on paper, I guess.

There was also another interesting article in the same news paper, concerning doctor’s consultation fee. As I have written before, doctor’s charges are regulated by the government under the Private Healthcare Services and Facilities Act 1998 and it has not changed over the last 20 years ! The article has rightfully said that even a plumber, Hairstylist and electrician can charge more than that. An electrician can earn about RM 20-30K a month single-handedly. What about doctors ? Well, I had written enough about declining income and many are being forced to close shop or go into unethical practices as I had written over here. As I had said before, only less than 20% of the hospital’s bill belong to doctors. The rests are hospital’s fee. Unfortunately, these are NOT regulated, as most private hospitals are GLC owned! YOu know what I mean………………

Too many doctors, too little training

BY CHRISTINA CHIN
SGCHRIS@THESTAR.COM.MY

The future remains uncertain for aspiring doctors unless more training hospitals are opened.

COME next year, some 5,000 doctors are expected to be jobless.

This is because there are not enough government hospitals to train the large number of medical graduates being churned out, says Malaysian Medical Association (MMA) president Datuk Dr N.K.S. Tharmaseelan.

“There are just too many doctors and too many medical institutions flooding the market,” he claims, adding that there are now about 40,000 active doctors in the country.

“Some 5,000 doctors are graduating yearly but where are they going to do their housemanship and compulsory training?

“Currently in government hospitals, there are some 60 doctors in one unit so how are they going to learn?” he asks, adding that soon there will not be enough posts for medical officers in government hospitals.

According to the 2011 Health Ministry Annual Report, 21,765 out of 28,309 vacancies for medical officers have been filled, he says.

“This means that by now, the 6,544 available posts would have almost been filled. Where will the fresh graduates go next year?”

Dr Tharmaseelan calls on the government to build more hospitals, increase the number of beds in existing ones and equip the district hospitals with training facilities to accommodate the influx of aspiring doctors.

“There were 130 government hospitals in 2007 and 132 in 2011 – that’s an increase of only two hospitals in four years. It’s definitely insufficient. If this continues, doctors will soon join the flock of some 15,000 unemployed nurses,” he claims.

He adds that although the Health Ministry has assured the association that there are some 1,000 vacancies for doctors this year, the future remains uncertain for aspiring doctors unless more training hospitals are opened.

He believes the problem of unemployed doctors would be worse if the compulsory two-year government service is stopped.

“There is talk that after completing their housemanship, the doctors won’t need to serve at government hospitals anymore. MMA is concerned because this will result in doctors who are not adequately trained,” he says. MMA is urging the Education Ministry to monitor closely the many medical colleges that have sprouted recently, adding that entry requirements are too low for most.

“Students from colleges that are not recognised can sit for an examination to make them eligible to practice locally.

“We have an Air Asia ‘everyone can fly’ syndrome – it seems that everyone can become a doctor. Adopting Henry Ford’s industrialisation of car production to training doctors will result in poor quality medical practitioners,” he adds.

He attributes the glut to a lack of co-ordination between Education Ministry and Health Ministry, with the former bent on allowing medical colleges to mushroom without considering the Health Ministry’s needs.

He adds that medical colleges should have their own hospitals instead of sending their graduates to train in government hospitals.

“Another way to prevent unemployment from setting in is for doctors to become specialists and ‘super specialists’ in niche areas of medicine,” he says.

MMC member and senior medical practitioner Dr Milton Lum points out that there are currently almost 9,000 housemen nationwide.

“How many of them can the government hospitals absorb? Unemployment is not a possibility – it’s a probability.

“In one to two years’ time, government hospitals won’t be able to take in housemen anymore so medical graduates will have to leave the country to find work because they can’t get registered here,” he says, adding that less than 50 hospitals in the country are equipped with the necessary training facilities.

Quoting a Health Ministry study done last year, he says housemen now see less than three new patients daily.

“When I was doing my housemanship 40 years ago, I was seeing between 15 and 25 patients daily.

“Medical graduates today are not getting enough exposure and experience which will definitely result in a drop in quality for doctors,” he cautions, adding that in recent years, the MMC had received more than 100 complaints concerning doctors yearly. Before 2005, the council only received about two or three complaints.

Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) president Dr Steven Chow says there are more than 33 local medical schools in “full production” excluding overseas institutions.

“The total number of posts for doctors available in the Health Ministry, universities and other public institutions is about 25,000.

“We are already seeing difficulties in getting enough training posts for housemen and medical officers.

“This will worsen with influx from neighbouring countries in due course,” he adds.

Comenting on the “glut of doctors”, Health director-general Datuk Dr Noor Hisham Abdullah says the phrase is “very relative”.

The Health Ministry, he says, is working closely with the Malaysian Medical Council (MMC) and the Education Ministry in managing the supply of doctors for the country.

The country has been producing more doctors yearly with almost 85% of the ministry’s vacancies for doctors already filled, he adds.

“However, the posts available do not commensurate with the needs of the country.

“Malaysia will definitely need more doctors when we reach the status of a high income country.

“By 2020, the population is expected to reach 34 million so Malaysia will need a total of 85,000 doctors to attain the ratio of 1:400,” he says, adding that the ministry will apply to Public Service Department (JPA) for additional posts for doctors.

More doctors are needed to accommodate the fast expanding private healthcare services, health tourism, new health facilities, higher level of care by the Health Ministry, rise in specialisation and sub-specialisation of medical practice, expansion of more complex speciality services like cardiothoracic and hepatobiliary surgeries, and the emergence of new infectious diseases, lifestyle-associated diseases and chronic disease patients.

“More are joining the post graduate and sub-speciality programmes and coupled with the brain drain of medical practitioners, we need doctors.”

Doctors call for 30% hike

BY CHRISTINA CHIN
SGCHRIS@THESTAR.COM.MY

A doctor checking a young boy as his mother looks on. -filepic

PETALING JAYA: Doctors in private clinics and hospitals are asking for a 30% increase in consultation fees, saying it is impossible for them to survive with rising operating costs.

Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan said the proposed hike was more than a decade overdue.

He claimed that doctors were now paid less than plumbers, electricians, hairstylists and food outlet operators.

General practitioners get between RM30 and RM50 per consultation while specialists charge between RM50 and RM80.

Dr Tharmaseelan said: “It is a misconception that doctors are rich and greedy. Many doctors are scraping the barrel with rising utility, rent and salary costs, and quite a few have even quit practice as it’s just too expensive to maintain a clinic.

“On average, the operating cost for a general practitioner to run a clinic in Kuala Lumpur is about RM20,000 per month.”

There are over 7,600 private clinics and hospitals nationwide. The association represents over 3,000 members.

Dr Tharmaseelan added that a general practitioner charged cough and cold patients between RM45 and RM50, including medication.

“It does not make sense that people are paying more for a haircut or a meal than for treatment,” he said.

He said that a rise was necessary for doctors to cover their “basic costs” in light of mandatory rulings like paying minimum wage.

“We are also required by law to have medical indemnity insurance, hire radiographers and engage waste disposal contractors at our clinics.

“It’s been three decades and our fees have remained unchanged,” he said.

He said the MMA submitted the new fee schedule to the Health Ministry two years ago but the proposal was rejected because the Government felt it was steep.

He said the MMA could not agree to the Government’s 14% fee increase proposal made last year as it would result in a bleak future for its members.

Malaysian Medical Council member and senior medical practitioner Dr Milton Lum said: “A plumber charges between RM50 and RM100 just to check my pipes – that’s way more than what a general practitioner charges (for a consultation).

“These days, RM100,000 medical bills are not uncommon but doctors only receive a fraction.

“Between 75% and 85% of the bill goes to the hospital and managed care organisations,” he said.

Federation of Private Medical Practitioners Associations Malaysia president Dr Steven Chow said the existing schedule amounted to only 2.3% per year since 2000.

“Bearing in mind the inflation rate, the 30% hike is a fair request,” he said.

Read Full Post »

In September 2012, I wrote about Health Facts 2012. The data was till 31/12/2011 which shows that the doctor: population ratio has already reached 1: 791. This figure included all the housemen with the total number of doctors standing at 36 607. The data for 2012 was just released by MOH. The ratio has come down to 1: 758 with the total number of doctors standing at 38 718. However, I feel that the data may not have captured all the housemen who joined the civil service towards the end of the year 2012 (the major bulk).  This is because the rise in the number of doctors seem to be smaller than the year before which is obviously not right (3 626 in 2011 vs 2 111 in 2012) when the number of graduates/medical schools has actually increased! Something is not right about this statistics unless there are about 2000 doctors who either left the country or resigned from being a doctor! . From my MMC sources, I was informed that the number of new doctors reported last year was about 4000, which will make the ratio very much less.

Below, I list the 34 functioning medical schools in Malaysia at the time of writing:

1)    University Malaya (UM)

2)    UNiversiti Kebangsaa n Malaysia (UKM)

3)    Universiti Sains Malaysia (USM) : 2 programmes

4)    Universiti Putra Malaysia (UPM)

5)    UiTM

6)    University Sains Islam Malaysia (USIM)

7)    Universiti Darul Iman

8)    Universiti Sarawak Malaysia (UNIMAS)

9)    Universiti Sabah

10) Universiti Malaysia Kelantan

11) Melaka-Manipal Medical College

12) Monash University Malaysia

13) International Medical University (IMU):  2 batches + twinning program)

14) SEGI University College

15) Allianze College of Medical Sciences (ACMS): 5 programmes

16) Penang Medical College (PMC)

17) Mahsa University College

18) Masterskills University College of Health Sciences (Asian Metropolitan University)

19) Royal College of Medicine Perak (UNIKL) : 2 programmes

20) Universiti Islam Antarabangsa (UIA)

21) Newcastle University Malaysia

22) Perdana University : Graduate Medical School

23) Perdana University : RCSI

24) Inssaniah University College

25) Quest International University Perak

26) Cyberjaya School of Medical Sciences

27) AIMST

28) Taylor’s University College

29) Management and Science University (MSU) : 2 programs

30) University Tunku Abdul Rahman (UTAR)

31) University College Sedaya International (UCSI)

32) University Pertahanan Nasional Malaysia (UPNM)

33) Lincoln University College 

34) University College Shahputra

We have atleast another 2 on the cards : Xiamen University, China (Medicine, Salak Tinggi, 2015) and Shanghai Jiao Tong University, China (Kuching, 2014/2015). Even though the number of medical schools is 34, we have close to 43 medical programs as some of the medical schools conduct more than 1 program/batches.

MMC had only accredited 20 medical programs as of June 2013 as listed over here. This means that only 20 medical programs have produced graduates (not in maximum capacity yet) and the remaining 20 ( about 50%) have yet to produce any graduates. So, everyone who can count will know the situation in near future. If each produces 100 students (most medical schools will need atleast 150 students to make profit), we will have 4000 graduates locally by 2016. Another 1000-2000 will come from overseas, making a total of atleast 6000 graduates annually !! I presume it will hit 8 000 by 2018!

In March 2013, I wrote and published a circular from MOH that almost 95% of the post for MOs has been filled in most states. Today, I received an info via Facebook that almost 80-85% of the post for doctors in Malaysia has been filled ( see below). The shortage now is in Sabah and Sarawak.

As for 1 June 2013

Total Dr Post in KKM/PPUKM/HUKM/HUSM (Uni only have HO):  27573

Filled: 22374 (81%)

Vacant: 5199

Vacancy in Sabah/Sarawak : ~1500

Total HO post: 10387 (about 5 000/each year)

Vacancy: 1707 (16%)

Vacancy in Sabah/Sarawak : ~500

Total MO post: 17186

MO vacancy: 3487 (20%)

Vacancy in Sabah/Sarawak: ~1000

Post filled at present: 80%-84%

Eventhough, new hospitals and posts will be created by the government, the number of new post will not be sufficient to absorb all these graduates. This will likely happen by 2017/2018 when most of the 40 medical programs would have started to produce graduates. Likely, the government may still give Housemanship post on contract basis after which, there will be no guarantee that you will get an MO post. Likely, the compulsory service will be scrapped. How the selection is done remained to be seen. Obviously, government sponsored and public university graduates will be given priority. The rest may need to sit for some sort of exams or evaluation after housemanship.

It is really going to get very messy by then. I just hope our current Health Minister will make some serious attempt to stabilise the situation by closing down some of these sub-par medical schools. Anything related to healthcare sector use to have guaranteed job just a few years ago. Unfortunately, our great Human resource planning has screwed up most of it. We have jobless nurses, radiographers, physiotherapist and recently even teachers! Welcome to the education hub of this region!

Enough said, I hope people will make wise decisions for their future. Never do medicine for wrong reasons…………..

Read Full Post »

I read 2 interesting articles over the last 2 days. The first was in Malay mail which basically tells the truth of what is happening out there (see below). Many students nowadays do not know what they are getting into. Just because they score a good result in their exams, they feel that they are destined to do courses like medicine, dentistry, engineer, lawyer etc etc. Over the last few weeks I received many queries about which university to choose, which course to choose etc etc. Who am I to tell you which course you should do? It is entirely up to you to find a course that you feel you will have the passion to work for the rest of your life. Talk to people and friends who are working and get a feel of what the job is all about. In this blog I had written what medicine is all about and what kind of life a doctor undergoes. Similarly, you should find out what the other professions do. Unfortunately, many of the students are only interested on whether they will get a job, what is the income going to be and whether they can get a job overseas. Nothing is guaranteed in the future. Job opportunities changes over time. Who would have thought that doctors would become jobless ? But it is happening in many countries including developed countries.

The other article that I found interesting was ” 10 things to give up to become a doctor” which was written over here (see below). All those points had already been mentioned in this blog over the last 3 years. Nothing has changed no matter where you practise. One thing I always tell people is that, you will never become rich with a salaried job. Do you see any millionaires who are not businessman or politicians ? Even doctors are not going to earn a lot of money unless they start their medical business. The difference is, you would have spent tonnes of money studying and years of training even before considering opening a medical business. Furthermore, medical business is a 1 man show unlike other businesses where you can become a boss by the age of 35/40 and the business will run by itself. In medicine, that’s when you even think of starting your business. The era of opening medical business after 4 years of service is coming to an end due to stiff competition. Many GPs are now selling their clinic to companies that are running franchise clinics. That will be the future. You will not be able to run an individual clinic all by yourself. Without panels you will not survive. I just got to know that 1 more clinic just closed down near my place.

The articles below are worth reading…………………….

Tired of doctor, lawyer, engineer and accountant wannabes… — Cass Shan

JULY 26, 2013

JULY 26 — The truth is, most students don’t know much about the world after secondary education. They simply assume that the best career options are to be either a doctor, lawyer, engineer or accountant. And if they are good academically, they automatically get pigeonholed into these career paths.

While these professions are noble and worth aspiring to, too many students simply fail to grasp what it means to have a career and fall for the assumed social status and prestige associated with these careers.

And sure, some can argue that vying for social status and prestige isn’t all that bad, but surely there’s more to a career than that?

The recent spate of students complaining about not being offered courses of their choice is nothing new in Malaysia. Institutionalised racism aside, students should already know that if everyone got the course of their choice, there would be an over supply of doctors, lawyers, engineers and accountants — thereby driving down the market rate and value of these occupations. Thus, demand must exceed supply to ensure the value of these professions.

For those who fail to get a course of their choice; they can appeal or look elsewhere — either going abroad or seeking scholarships (which if they are worthy, they are more likely than not to get). For others who don’t have that option, it may not be such a bad thing to look at other career options.

For one, I sincerely question how many of these applicants are genuinely passionate about these courses they are applying for. True passion is when you are willing to do something for nothing, because just doing it gives you a sense of achievement or satisfaction. I am willing to bet that if the medical profession didn’t pay as much as it does in comparison to other professions, there would be a lot less takers despite it being a noble profession.

For instance, how many people actually grow up saying “My dream is to spend my working hours looking into people’s mouths and attacking cavities?” And yet, dentistry is a competitive course. I’m not saying that dentistry is not something to aspire to but essentially, a lot of students are taken in by the “halo” effect that the medicine line has.

I know a classmate in school who studied nursing because she truly cared for the sick. When offered a chance to pursue her career as a doctor with her already sound knowledge of healthcare, she turned it down as she saw how little doctors interacted with patients compared to nurses and stuck to being a nurse for the pure joy of caring for the sick. Now, Pamela Patricia Perera can truly hold her head high as someone who is truly passionate about helping the sick. How many of our doctor wannabes, if denied the option of studying medicine, would opt for nursing and still get to care for patients? And how many would take the longer path towards being a doctor by becoming a nurse first in their so-called ambition to be a doctor?

I know a girl who loved airplanes since she was young, collecting model airplanes and watching “Airwolf” with anticipation in the ‘80s. This is someone who cuts out articles on aircraft engineering when she was in school despite not being requested to by the school syllabus. Not surprisingly, Ruth Anandaraj went on to study aircraft engineering and is now working for Airbus in the UK and will soon be working for Boeing in the US. This is what true passion is about — reading up information about your career choice with hunger in between studying for school exams.

On the other hand, I know a Mara scholarship recipient who studied engineering in the UK (and yes, he was academically bright with straight As) and came back to Malaysia only to ditch a career in engineering. It turned out a career as a sales manager was more rewarding to him and possibly the best turn of events that could have happened where he achieved money, respect and a fancy job title as a sales director at the age of 33 to boot.

Now, how many students say their dream is to be a salesperson? Not many I’m sure. In fact, among the so-called respected community of academic high achievers, a salesperson is akin to being a pariah in society.

I know of an accounting graduate who studied accounting on scholarship (yes, she was sent abroad to the UK) who called a floor of salespersons a “sweatshop” and equated salespeople to being “con artists”. She would never lower herself to that job title, yet she was happy to stay in her prestigious, high-paying, but unfulfilling job.

The point is, there is more to a career than academic results, money and presumed prestige.

A career isn’t necessarily about how good your exams results are. I’m sorry to break the news to you but scoring straight As in our education system only mean you’re good at memorising, it doesn’t guarantee that you are a critical thinker. A career is about whether your personality is the right fit for the job requirement. Many professions in Asia tend to require long hours and — before you make it — most graduates have to climb their way up the salary scale. So you better enjoy your work if you are going to be spending a lot of time in it.

The crucial test — would you do it if you weren’t paid for it — comes to mind.

In the instance of not getting a course you want, the world suddenly opens up with new possibilities. You may find out that nursing helps you care for the sick more than doctors do. Or that you really love doing PR because you love interacting with people more than you do staying in the office. You may find out that a career as a teacher is more rewarding than a fat paycheque when you see the improvements in your students. Or maybe, that “pariah” job as a salesperson is more fulfilling to your go-getter type of personality.

We face many setbacks in life and often, when a door closes, another opens.

Students shouldn’t be preoccupied with prestigious jobs and ask themselves hard questions of what personality type they have. They should ask themselves what they would still do even if there was no money on the table, and that they’d do it because it gives them fulfilment.

Too many students have a myopic view of life after secondary education and think that a prestigious job is the only way up. It may be a way up — but does it truly satisfy you or are you just looking for the next family reunion where you get to proudly mention your job title?

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malay Mail Online. 

– See more at: http://www.themalaymailonline.com/what-you-think/article/tired-of-doctor-lawyer-engineer-and-accountant-wannabes-cass-shan#sthash.KiOb9gVJ.dpuf

 10 things to give up to be a doctor 

Following a recent article elsewhere which generated an interesting discussion, I started thinking about the things one must give up on the road to becoming a doctor. It’s a long road, beginning with an initial decision, some early voluntary experiences, an application to university and some hard work trying to achieve the barely possible at GCSE and AS / A2.

But it doesn’t even end there. The hard work really only begins at medical school where long hours and repeated exams are considered normal and where you need your patients more than they need you.
There are plenty of things you have to give up along the way, here are my top 10:

1. Your desire to be wealthy
Very few people in medicine ever become hugely wealthy, at least not in Europe. If riches are what you desire there are many many easier ways of getting that involve alot less heartache, money and stress. If you want to be a millionnaire before you’re 30, my advice would be to avoid university altogether. Most doctors are in the profession for genuinely altruistic reasons as well as the satisfaction that comes from knowing that you have the skills and knowledge to save lives and apply these every single day as a routine part of your work.

2. Your desire to change the world
Equally you must, eventually, give up on the idea of becoming some sort of medical superhero who can solve the worlds medical problems one by one. Yes doctors can do some impressive things when applying their skills to the right situation. But remember that however good your intentions, you will not be able to overcome the problems caused by poverty, war, government neglect or abuse, or coorporate profiteering at the expense of the sick. That doesn’t mean you can’t try to help people afflicted by any of these, you’ll just find that you are usually too small to make any real systemic difference.

3. Your free weekends
It starts at medical school when the work starts to pile up, and weekends are sacrificed to meet deadlines and for exam revision. Once you start working as a junior doctor, you’ll find yourself scanning each new doctors rota to work out where your on-call weekends have landed and who can swop with you so that you can still go on that holiday or get married or whatever. There will be sunny weekends when your non-medic friends will be having a barbecue whilst you sweat it out on a ward seeing yet another gastrointestinal bleed wondering why you chose this path.

4. A good nights sleep
Gone are the days where doctors would be on call for 48 or 72 hours and then do a clinic for the boss before retiring to bed. However, modern working arrangements have brought into existence the ‘week of nights’ where you work 4 or 5 and sometimes 7 night shifts in a row.

As someone who has done these I can confirm that doing nights is pretty inhumane. The talk amongst doctors doing nights together often centres around changing specialty or leaving the profession. Don’t worry, it all gets forgotten once normal daytime duties are restored.

5. Your desire to avoid feeling like a fool
You will make mistakes from time to time in this job and your mistakes will all be potentially serious ones, simply because everything you do affects your patients’ lives directly.
Furthermore, there will be times when you have to withstand an onslaught from senior doctors who feel that teaching by humiliation is the only way forward. You will feel like an idiot at times and if the thought of that frightens you you should promptly pick a different profession.

6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him.

Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.

7. Your desire to please everyone.
Whether it’s your friends or family, as above, or your future patients you’d better get used to upsetting people from time to time. Telling your wife you need to postpone an evening engagement because you are still operating on a difficult case, or telling a patient you won’t be operating on them as they only have three months to live, are both likely to be met with upset. Each situation has it’s unique challenges and needs some communication skills, but the bottom line is that you will have times when you will have to make someone want to either hit you or cry in despair.

8. Your creativity
Not many people admit this but medicine takes people who are often very creative and turns them into workaholic, automatons who have little room left in their lives for creativity. If you want evidence for this, go to any dinner party that includes more than one doctor. Chief discussion topic will be work and medicine.That’s partly because anecdotes from doctoring are entertaining, but also because if the medics stray from this conversation topic, they will rapidly expose their banality and limited insights in other areas particularly all things creative.

Much of medicine does not allow much creativity in it’s day to day practice and the intensity of the work beats any desire for creative thinking right out of you before you even realise it’s happening.* Of course whilst accepting this fact you must fight this tendency and attempt to keep up your other interests, otherwise, I can guarantee medicine will invade everything you do.

*There are a few notable exceptions to this!

9. Your desire to stay in one place / live close to friends and family.
Want to do something competitive, like medicine? You have to realise that choosing your location is a luxury and you may have to follow your dream in a less than ideal location. Even after you graduate, having your heart set on one speciality is a sure way to geographical instability. Some people don’t mind this, but some with strong family ties or a mortgage, the need to move frequently is a pain.
I began to come to terms with this when I found that even the most obscure places have hospitals. Working in these places you’re just as likely to meet doctors who have also had to move from here from the other side of the country. It’s a great way to meet people but easy to lose touch once you move on.

10. Good health
You may not know it, but you’re joining a profession that has high rates of physical and mental illness as well as drug and alcohol misuse. Doctors are also less likely to seek help than other professions which all adds to a rather worrying picture.
Although ill health isn’t guaranteed in a medical profession you should realise the future risk now and take steps to formulate good lifestyle habits to minimise your risk factors. A good network of non-medical friends should also protect you from neglecting your own needs while you’re treating your patients.

That’s plenty to sacrifice just for a job isn’t it? However, I guess the reason you’re in medicine (or trying to get in) is that you’ve realised that medicine is not just a job, it’s a whole way of life, that’s difficult to let go of once you’ve decided to enter it, and these sacrifices are simply part of the deal.

Well, those are the 10 points I thought were worth including. If you have more I’d love to hear about them.

Leo

Read Full Post »

I am sure many of us would have read the article that was published in the Star 2 days ago. You can read it below. This is the first time a title such as that has been published in a main stream newspaper. I had written many times about unethical doctors and how the competitive market is creating more and more of them. It is a known fact, mainly in private sector. Fortunately, the numbers are still small. Unfortunately, the example that this writer pointed out is NOT about unethical practise (at least the first example). The writer obviously do not know how to differentiate between unethical practices and management issues. As for the second case highlighted, it can be. In fact, I had seen many patients who presented with AGE symptoms without any abdominal pain, ending up with an appendicectomy done! However, it is still defendable in the court of law as symptoms can change. MMA has given it’s response over here

Unethical practise is when a doctor does an upper and lower endoscopy in a 16 year old girl presenting with acute gastroenteritis, doing multiple lumpectomy in a 17 year old with lumpy breast, doing upper scope in a patient with neck pain, doing angiogram is a 24 year old with iron deficiency anaemia with no chest pain etc etc! These are the type of unethical practices that we do see, on and off. It is not uncommon as I had written before. Doing further test to rule out any other possibilities/diseases is not unethical. For example, if a middle age heavy smoker comes with chronic cough and left basal pneumonia, you may want to do a CT Thorax to rule out Cancer of the Lung causing proximal obstruction. If not, he may sue you 3 years down the line for missing a cancer. It is a delicate balance between treating a disease and not to miss out something that can be life threatening. The first case is about that, nothing unethical. MMI (Malaysian Medical Indemnity) insurance has just tripled the premium for Obstetrics and Gynaecologist. MMI is a Malaysian based indemnity insurance company unlike MPS (Medical protection Society) which is global society providing indemnity to doctors all over the world, where the rates are much higher. Click on the links to see the rate. This basically shows that the litigation and payout rate in Malaysia is increasing exponentially.  BTW, the doctors consultation and surgical fees are controlled by the government and the rate has not changed since 1998 !

Surprisingly, the same newspaper published another interesting article yesterday. It is about finding reliable doctor !. Well, to be frank, due to some bad apples in the profession, the public are now advised to be more vigilant and find a reliable doctor. The public has the right to choose. BUT how do you choose ? How do you know that the particular doctor is good, reliable and trustworthy ? It is interesting to read Dr Alan Teh’s response over here .The enforcement is weak in Malaysia and the enquiries conducted by MMC is troublesome for the complainant. Thus, not many complains are made. Private hospitals on the other hand rarely takes action against a consultant despite unethical practices as the hospital gets money out of it as well. It is a business entity and profit is what matters.

However, the second article do mention a lot about the reality and future of the medical field. Somehow, I feel that all those that was mentioned came from my blog! It has all been explained in this blog with facts and figures:  oversupply of doctors, competitive private practise, declining income, limited postgraduate opportunities, venturing into aesthetics, beauty therapy, selling supplements etc etc.

MY advise to budding doctors whose sole intention in doing medicine is for money; please don’t do medicine. It is a long way to go and money is what that drives you to do unethical practices. Money that is earned “illegally” will disappear as fast as it comes. I believe that no matter what you do, if you do it sincerely, work hard and be truthful, you can be successful, live a decent and comfortable life.

Beware of unethical doctors

DIFFERENT SPIN BY SHEILA STANLEY

Read Full Post »

Over the last 2 weeks, I have been receiving numerous emails and blog queries about which university he/she should choose to do medicine. It is rather surprising to see that each student seem to be have received at least 3 university/college offers to do medicine ! This is what happens when you have close to 36 medical schools with almost 45 medical programs. It is surely an Air Asia theme like scenario “Now, everyone can become a doctor…….” This does not include those who go to various other countries to do medicine. Shockingly, after writing so much about medicine in this blog, I still get questions that I find rather irritating at times. There are many students out there ( some are already 4th/5th year medical student) who still do not understand about degree recognition issue and post-graduate educations. They still think they can go to another country and easily get a job! They still think that postgraduate education is as simple as reading books and sitting for exams. Gosh, what do our schools teach the current generation of students ! They really fulfil the criteria of “katak bawah tempurung” .

As I have been saying many times over the last 3 years, just imagine the glut of doctors that we are going to face in 3-4 years time. When the market is saturated, the income of all doctors will decline. Even now, I see new clinics being open just few doors away from another clinic. That is how competitive it has become. In fact, I was just informed that some insurance companies have started to reduce their consultation fees for doctors by at least half ! If you don’t agree, they will go to another doctor who will ! The newer GPs will obviously agree, to get some income, rather than nothing. To add salt to the wound, our Health Ministry is planning to open another 40-50 1Malaysia clinics throughout the country as mentioned here and below. The 1Care system is still being kept under the carpet till further announcement.

In January 2012, I wrote an article on how doctors in US are going broke. Well, the situation has not changed much. The latest news from US says that many private practices are being closed/sold due to poor income (insurance companies have started to slash the payment), increasing litigation rate and high maintenance cost. Thus, many of the specialist are running back to hospital based practices with a fixed income. The situation is the same in many other countries as well. Even in Malaysia, some of the private hospitals have started to employ doctors compared to “self-employed version” which use to be the norm for a long time. This clearly shows that we are now at the mercy of the private hospitals and they can now demand what they want. A fixed income means that your income will be generally lower with higher tax, since you can’t play around with your tax. Furthermore, your income will not be much of a difference from what a government consultant earns.

The declining income has increased the amount of unethical practices. Whatever said , a private practice is a business to earn income for a living. Once you are used to a specific amount of income, you will try to achieve it no mater what. Thus, unethical practices will surface. That’s why I alway tell people that,never let money to buy over you. Keep your commitment low and earn a decent living. Medical business is a “one man” show. If anything happens to you, your income is ZERO!

Doctors bail out on their practices

By Parija Kavilanz  @CNNMoney July 16, 2013: 9:18 AM E

Dr. Patrick Cobb sold his private oncology practice in December 2012. “It just wasn’t feasible for us to stay in practice,” he said.

NEW YORK (CNNMoney)

Doctors who own private practices are looking for a way out. Fed up with their rising business expenses and shrinking payouts from insurers, many are selling their practices to hospitals.

It’s happening nationwide and has picked up pace, said Tony Stajduhar, president at Jackson & Coker, a physician recruitment firm.

Experts say the number of physicians unloading their practices to hospitals is up 30% to 40% in the last five years. Doctors who sell typically become employees of the hospital, as do the people who work for them.

The reasons for the trend vary. Doctors are tired of the hassle of filing insurance claims and collecting payments from patients and want to only focus on medicine again, Stajduhar said.

Obamacare has also created more fear of the unknown. Doctors are worried that new regulations will add to their administrative work and require them to pour more money into their businesses, Stajduhar said.

Related Story: One doctor gave up on health care in America

Dr. Patrick Cobb, an oncologist in Montana, sold his 30-year group practice Frontier Cancer Center to a hospital in December. His practice was struggling for years even before health reform passed.

Changes in chemotherapy drug reimbursements badly hurt the business, he said. In cancer treatment, patients don’t buy the drugs themselves. Oncologists buy the drugs and then bill insurers for the cost. Medicare significantly reduced reimbursements in 2003 for chemotherapy drugs.

That was a turning point, said Cobb. “We spent millions on drugs that we bought directly from distributors. When reimbursements fell, our costs went up,” he said. Cobb and four other oncologists at the practice took pay cuts to offset declining revenues, but it wasn’t enough. In 2008, the practice closed one of its four locations.

Cobb and his partners looked for a buyer in 2012 and found one in Billings, Mont.-based St. Vincent Healthcare. The hospital system hired Cobb and the rest of the practice’s staff. “It just wasn’t feasible for us to stay in practice,” said Cobb.

Related Story: Doctors driven to bankruptcy

The cycle of hospitals buying private practices has happened before. In the early 1990s, hospitals went on a buying spree as a way to get access to more patients, said Thomas Anthony, an attorney with Frost Brown Todd in Cincinnati. At the time, it was a sellers’ market and the deals were financially rewarding for doctors.

This time, the market dynamics are different. Doctors are eager to sell and might not be able to make as much as they did in the first wave of acquisitions, said Anthony.

But, for sure, hospitals are buying.

As more of Obamacare is put in place, hospitals are rushing to increase their market share in anticipation of millions more Americans getting access to health care. Buying practices is a quick way to do that, Anthony said. And more private practice doctors want to enjoy steady salaries and hours again as hospital employees.

Dr. Dwayne Smith, a bariatric surgeon, sold his group practice to a hospital two years ago. His practice was profitable but costs were creeping higher in recent years because of shrinking reimbursements.

Related Story: Why doctors can’t stay afloat

One big cost coming down the pike was tied to electronic medical records. Federal law gives physicians until 2015 to implement digital records technology or face a 1% reduction in Medicare payments.

“This would have been a very difficult investment for us,” said Smith.

Smith’s practice approached Cincinnati-based St. Elizabeth Healthcare in 2011 with an offer to sell. The hospital bought the practice and Smith became a hospital employee. He’s happy with the decision even though he has had to adjust to the loss of autonomy.

“My hours are better. I’m not spending hours on administrative work or worrying about my business,” said Smith.

The private practice model is very expensive to operate, said John Dubis, CEO of St. Elizabeth Healthcare. “That’s why it’s diminishing,” he said. Most of the 300 physicians employed by the hospital’s specialty physicians group have come from private practices.

Said Cobb, the oncologist: “We have a joke that there are two kinds of private practices left in America. Those that sold to hospitals and those that are about to be sold.” 

Are you a private practice oncologist struggling to keep the business going? E-mail Parija Kavilanz and you could be featured in an upcoming story for CNNMoney.com.

 

40 To 50 More 1Malaysia Clinics To Be Set Up From Next Year

KUALA LUMPUR, July 18 (Bernama) — Forty to 50 more 1Malaysia clinics (K1M) will be set up nationwide from next year to meet the demand from the public, especially in the rural areas.

Health Minister Datuk Seri Dr S. Subramaniam said the clinics would be concentrated in areas with many residents from the low-income group.

“Despite grumblings from the operators of private clinics when K1M was set up, K1M still receive encouraging response from the people because of the low charge imposed.

“It is a successful 1Malaysia product and can benefit the people by ensuring a good level of healthcare,” he told reporters after attending a gathering, here, Thursday night.

There are now more than 200 K1M nationwide serving about 1.5 million people with the minimum charge of RM1 for citizens and RM15 for non-citizens.

K1M is one of the initiatives under the 1Malaysia concept mooted by Prime Minister Datuk Seri Najib Tun Razak.

— BERNAMA

Read Full Post »

I received the following “prescription” from a friend of mine! It is definitely a prescription from a government hospital as you can clearly see. I can also say that it is likely from a medical department looking at the types of medication being prescribed ! In my last blog post, I was talking about how  some pharmacist are treating patients like doctors and giving dual sulphanlyureas. Unfortunately, the situation among doctors is also getting bad to worst.

For those who do not realise, please look at the last medication that was prescribed:  “GlaxoSmithKline 250mg bd” !! This is NOT a name of a medication. It is the name of a pharmaceutical company aka GSK. I still can’t figure out what it should have been. I hope some of this blog readers can give me an idea or make a guess.

I was informed that in many of the new medical schools locally and overseas, pharmacology is not being thought as it use to be. They expect the student to learn along the way. It could also be due to the fact that a pharmacist always follows and plays an active role in the management of patients in other countries. Unfortunately, we have a long way to go, even though many general hospitals have started to do so.

In this case mentioned, I am sure the pharmacist would have picked up the mistake. As for the doctor, even though it would not have caused any serious problem to the patient (since the drug does not exist), prescription errors does cause serious harm ! Thus, it is important for any doctor to check their prescription properly before giving it to the patient.

Laughter is the BEST medicine………………

Read Full Post »

In March 2012, I wrote an article of the same topic. It was about a referral letter from a pharmacist who was managing the patient’s Diabetes and his diabetic foot. Patient ended up with a BKA. The Ministry always says that despite all the unofficial complains about pharmacist acting like doctors, there are no official complaints. Thus, I decided to send the letter and an official complain to Jabatan Kesihatan Negeri and MOH. Both the UKAPS and Bahagian Penguatkuasaan Pharmacy came to see me and I provided all the info, even the patient’s particulars. Unfortunately, during the interview by the person from Bahagian Pharmacy, I was told that diabetic medications are Class C drugs and thus, can be prescribed by a pharmacist without a prescription ! Of course I know that but should they be managing the patient like a doctor? She claim that they should not and should advise the patient to go and see a doctor. After that, I did not get any feedback from both Jabatan Kesihatan and MOH.

Last week, I received another interesting referral letter, as attached. Surprisingly, it is from the same pharmacist!! It looks like the pharmacy is still alive and kicking and doing the same stuff again. A patient with Diabetic foot was taking multiple types of medications from this pharmacy for the last 1 month (after an initial treatment at another private hospital), including antibiotics! She was given Metformin, Gliclazide MR, Glipizide, Galvus and Unasyn ! I never knew you can give 2 different types of sulphanylurea for the same patient. Worst still, the treating pharmacist do not even know the renal status of this patient!

Another shocking thing about this letter is the instructions given. She is practically ordering the “specialist” on what suppose to be done for this patient. As a Consultant myself, I do not write letters like this, even if I were to refer the patient to a MO in KK etc. However, this “so-called” pharmacologist has written what we should do, like providing X-rays and Scans to look at the extent of infection, to provide surgical intervention  etc. Very interesting and daring indeed. A BKA had to be done for this patient due to late presentation with almost gangrenous Left foot.

Well, in this Bolehland, anyone can do anything. I had again sent this letter to Jabatan Kesihatan and would like to see their response. In fact, I had seen several patient who had visited this pharmacy who claim that there is a doctor in the pharmacy! It looks like they are behaving like a doctor and our ill-informed patients believe that they are doctors. One patient even told me that it is doctors who are running this pharmacy!! WTH!

Read Full Post »

I received an interesting info today from both the FMT News and the Star. In May 2012, I wrote this. When our great, previous Health Minister announced that 16 medical institutions will conduct MQE exams, which include few private medical schools, I did not agree. I felt that a standardised MQE exams conducted by MMC will be a better option, like GMC. Furthermore, allowing private medical schools to conduct this exam is not acceptable, as far as I am concerned, as these are profit orientated organisations and MMC will not be able to monitor the exam standards. As I wrote before, every of this universities have different curriculum and different format of exams. Monash do not even have a final year exam!

Both the article above (attached below) says that MMC has withdrawn MQE exams in private institution. However, nothing is mentioned on MMC’s website. If it is true, I feel that our current DG, Dato Hisham is doing a good job. I just hope he will continue to bring good standards of medical education and practice to this country. I also feel that Dato Subra’s comment is a valid comment as this decision is MMC’s decision and nothing to do with MOH. MMC should be an independent body to monitor the standards of medical graduates. It should never be influenced by politics.

Now, coming to the parents and students who complain about this. Firstly, it is not the MMC’s or MOH’s fault when you do your MBBS in an unrecognised university. The list is available on MMC’s website (last updated 11/06/2013) for everyone to see. If you graduate from an unrecognised university, you must sit and pass the MQE exams. It is the law under Medical Act 1971 (amended 2012). It is the same for any other country. In fact, for some countries, as long as you graduate outside their country, you need to sit for an entrance exam (UK, Australia, US etc). Unfortunately, our society is an ignorant society. I still have queries in this blog asking about recognition of their medical schools when it is easily available on the net. I still have parents and students who feel that no matter where they do medicine, they can work anywhere in this world ! Some get cheated in broad daylight by agents and medical schools when WHO/Avicenna/IMEI listing is used as a form of “international” recognition of the medical school ! I am also amused when they say that their degree is recognised by EU but not Malaysia. I wonder whether they can use their degree to get a job in any of the EU countries including Ireland and UK?

Day by day I am hearing horror stories about our increasing number of new doctors. Some do not even know basic medicine for which you spend 5 years in a medical school. The shift system is only making the situation worst. I just hope our new DG would do something about it. Forget about foreign medical schools, our very own 36 medical schools also need proper accreditation to be done. If they do not comply to MMC’s standard, they should not be recognised. I have written many times in this blog about all the hanky panky things that goes on in some of the medical colleges in this Bolehland.

Finally, we definitely do not want doctors who do this :

Medical grads in limbo, want govt help

– See more at: http://www.freemalaysiatoday.com/category/nation/2013/06/21/medical-grads-in-limbo-want-govt-intervention/#sthash.Om5N7viF.dpuf

Govt should help medical grads in limbo, says Hindraf

Read Full Post »