Archive for the ‘Education’ Category

It has been a while since I updated my blog. Too many events and personal issues to settle along the way. However, the medical field in Malaysia is undergoing some new changes since early this year. It started with the contract HO post and multiple complaints in the news regarding the delay in housemanship posting etc. In May 2017, MOH announced that ozone therapy is banned from July 2017! Beauty centres are also being monitored for providing unlicensed beauty treatments. Sadly, there are many doctors who are providing such services to beauty centres. Since beauticians can’t inject any substance into a person, they need doctors. Doctors/Paramedics are the only one licensed to inject substance into a person. Drugs under poison act can only be administered by a doctor. As I had always said, in the end it is all about money and survival. There are many GPs who are struggling to cope with rising cost of running a medical business and turn to aesthetic medicine. While there are guidelines issued by KKM in practising aesthetic medicine, the enforcement is rather weak. BUT always remember that whenever you go to a beauty centre to do a procedure, it is ILLEGAL if the centre is NOT registered under your APC as a place of practise. Furthermore, any centre that are using medical equipments and drugs MUST be registered under Private Healthcare Facilities and Services Act 1998. If not, you will end up like this doctor in court!

As of July 2017, as I had mentioned in one of my earlier post, MMC will be corporatised. The Medical Act(Amendment 2012) will come into force after almost 5 years being passed by Parliament. I have been waiting for this amendment to take place as it will put certain rules and regulations in place. The regulation can be read over HERE. 

The 2 most important new rules that will affect everyone will be the specialist registration and APC renewal. Firstly, APC renewal from 2020 will be limited to those who have at least 20 CPD points/year and an indemnity insurance. Indemnity insurance will become mandatory for APC renewal. I was informed that the CPD collection will start officially from July 2018 till June 2019, most likely under MMA and Academy of Medicine. MMA is working hard to standardised everything with a phone app being developed. Once you have the points, you can apply for APC 2020 after June 2019. For those budding doctors who do not know what APC is, it is your ANNUAL PRACTISING CERTIFICATE. Without APC, you can’t practise clinical medicine. I know many GPs who do not have indemnity insurance. With this new rule, every doctor must have an indemnity insurance in order to practise medicine. Please visit MMA website for further information regarding indemnity insurance.

Secondly, the specialist register had been made mandatory under the law. The National Specialist Register (NSR) was first introduced in 2006 by the Academy of Medicine. This was in anticipation of the amendment to medical act 1971 which suppose to be tabled in Parliament in 2008. Unfortunately, with election along the way, it was delayed till 2012. Thus, it was optional and voluntary till 1/07/2017. From 1st July 2017, all specialist must be registered with NSR which will be handled by MMC, from now onwards. If your name do not appear in NSR, you CAN’T call yourself a specialist. If you continue to call yourself as a specialist, disciplinary action will be taken against you by MMC which includes suspension and fine.  For those who have not registered, please do so by end of this year. From 1/01/2018, your name must appear in NSR in order to call yourself a specialist. NSR must be renewed every 5 years with a minimal CPD point of 100 in total. This applies for government specialist as well.

Another issue that is of concern are the fees that need to be paid. Since MMC will be corporatised, they have to generate their own revenue on top of MOH grant. Thus, as expected, fees will be increased. The APC renewal fee will be increased to RM 100/year from RM 50. This is not really a big increase as the RM 50 has been around since 197os. However, civil servants who were previously exempted from paying this fee will now need to pay themselves. The DG had issued a circular to all hospitals that all civil servants must pay the APC fee from 2018 onwards. This was followed by circulars by hospitals that all APC fee must be paid by the respective doctors directly to MMC and cannot be claimed(tidak boleh dituntut):






This also includes the Specialist registration fee of RM 1500 every 5 years. Please be informed that all specialist in MOH must also register with NSR by end of this year. If not, legally you can’t call yourself a specialist! Another issue you must understand is that gazettement by MOH is not the same as NSR registration. NSR has it’s on guideline on registration of specialist. For example, you can only get NSR registration after 1 year of post qualification working experience for internal medicine related field and 2 years for surgical related field:

Effective January 2017, applicants must have at least ONE (1) year post qualification working experience for medical related specialties/fields of practice and at least TWO (2) years for surgical related specialties/fields of practice.”

This basically means, for those who finish Master’s, you are NOT a specialist after 6 months of gazettement as far as NSR is concerned! I hope KKM and MMC can streamline these requirements so that no confusion arises. Another interesting figure in the new fee structure is the Certificate of Good Standing(CGS) and translated documents fee! It use to be FREE but it will cost you RM 500 for CGS and RM 200 for translated documents! As far as I know, each CGS is only valid for 3 months! You will need this if you intend to do training overseas or migrating!


There is another interesting development in terms of compulsory service.Till 2008, we had 4 years compulsory service, which included 1 year housemanship. In 2008 when housemanship was made into 2 years, the compulsory service was reduced from 3 years to 2 years post housemanship. The total was still 4 years. We all know that what I had predicted many years ago had come true. Job is no more guaranteed in civil service. Housemanship is given under contract for a maximum of 3 years after which you will be given contract just to finish your compulsory service. Only about 50% of those who are completing housemanship will be given permanent post. How this selection will be done is being ironed out. So, what happens to those who are returning from overseas after completing their housemanship overseas? Firstly, your housemanship must be recognised by MMC. NOT all housemanship outside Malaysia is recognised by MMC. Secondly, you may need to do certain postings which you did not do overseas before being given full MMC registration. The question now is , would you be able to get a job in MOH ?

To “overcome” this issue, DG has issued a new circular dated 6/07/2017 which is rather interesting. If you are a self sponsored student from overseas and have done at least 2 years of clinical practise post housemanship in a recognised country, you can be exempted from the 2 years compulsory service. If you are returning from overseas and are eligible for full registration from MMC without any need for additional training AND unable to get a job in MOH within 6 months, you are EXEMPTED from compulsory service! This is going to open another can of worms! This basically means you will be able to open a GP clinic immediately, under trained and flooding the market with GPs. This also means that if you do not get a job in MOH, you have practically no chance of specialising in any field except the Family medicine program under AFPM. So, if you are returning from overseas assuming to continue your post-graduate training in Malaysia, you may be in for a surprise! It is another way of saying, sayonara! We will be having almost 5-6000 graduates by next year waiting for housemanship alone! Imagine how many will be waiting for MOship locally alone!

Compulsory Service Exemption Request Form




(source: Deputy DG presentation at MMI conference)


For those who do not have minimum entry requirement, please be aware that you may not be considered for housemanship at all! It is in the pipeline. Well, if only they had listened to all those who voiced out their concerns almost 10 years ago, we will not be in this situation! We are very well-known for creating a problem and then trying to solve it, by creating more problems! No one plans for long-term. Everyone thinks with a knee jerk reaction!

Happy 60th Merdeka Day……..





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Just 6 days ago I wrote on the issue of SPM BM in regards to appointment into civil service. Just after the issue was publicised by the newspaper, it became a hot issue of discussion on TV. For at least 2 days following the news report, both RTM and TV3 were having a field day condemning the decision to exempt medical grads from SPM BM requirement. All the political heroes and defenders of the country suddenly appeared from nowhere. Well, election is coming……

In my last article, I wrote clearly the historical events over the last 20 years in regards to the need for SPM BM to join civil service. I also wrote on how the opening of enrolment into international schools had led to another big issue that we are facing now. However, the original intention of the news article reported by TheStar was actually in regards to the need to sit for 6 SPM papers and the inability to sit for a single SPM BM paper. Unfortunately, it was blown out of proportion by various quarters leading to a cabinet discussion of the matter.

Yesterday, the cabinet had decided that SPM BM is now needed even for contract post! This basically means, for those who had graduated but do not have SPM BM, you are now required to sit and pass SPM BM paper before even being eligible to apply for housemanship post. This will only further delay your posting. As it is, graduates are already waiting close to 8-12 months, those affected students would probably have to wait for 2 years now! So, for those who are currently still an undergraduate student, please sit for SPM BM as soon as possible. You just need a pass! The only good news is that you don’t need to sit for 6 papers anymore.

As I had always said, when the number of post becomes limited (admitted by DPM himself), the government can pick and choose. This is just the first step. For those who are doing medicine without the minimum entry requirement or NOC since 2012, please be prepared to be next in line. The government don’t give a damn whether you are a medical grad or not. No special privileges will be given.


Pass SPM Bahasa and be in civil service, medical grads told

PUTRAJAYA: Medical graduates must pass the SPM-level Bahasa Malaysia (BM) paper to be appointed as contract-based doctors in public hospitals.

However, these contract doctors will not be required to take the six core SPM subjects – Bahasa Malaysia, English, History, Mathematics, Science and Moral or Islam Studies – to be in the civil service.

Once they pass the examination, they can serve as housemen in government hospitals.

Contract-based doctors are those undergoing housemanship as well as those on compulsory service.

 Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi said the matter had been clarified by the Education Minister at the weekly Cabinet meeting yesterday.

“The Cabinet was told that the Malaysian Examinations Syndicate allows for professionals to take a single paper. So these graduates can take their Bahasa paper in November and then apply for housemanship,” he said.

Last week, The Star reported that some 300 medical graduates with O-Levels qualifications would be required to take the SPM-level BM to be accepted into housemanship.

Making it clear: Dr Ahmad Zahid explaining the ruling for contract doctors to the media at his office in Putrajaya.

Making it clear: Dr Ahmad Zahid explaining the ruling for contract doctors to the media at his office in Putrajaya.

A medical graduate said that they were given a waiver for SPM BM from 2003 when the country did not have enough doctors but the waiver was suddenly removed this year without adequate notice.

Before the waiver was withdrawn, O-Levels BM or Bahasa Kebangsaan A was accepted.

Following their plight, the ministry asked the Public Service Department (PSD) to waive the SPM-level BM pass requirement for contract staff and in February, the PSD agreed to the request. But they still need the SPM-level BM for permanent posts.

However, some medical graduates in Selangor said they could not register for only the BM subject but had to register for all six core SPM subjects at the state Education Department, while those from some other states were required to take only BM and History.

On Sunday, Health director-general Datuk Dr Noor Hisham Abdullah said on his website that a waiver was given on the SPM-level BM for contract-based doctors (two years of housemanship and two years of compulsory service) but not for permanent posts.

Dr Ahmad Zahid said the Cabinet decided that SPM-level pass for Bahasa Malaysia would remain a requirement for those who wanted to work with the civil service.

“We are committed to uphold what is stated in the Federal Constitution when it comes to the issue of the national language,” he told a press conference.

Dr Ahmad Zahid said that apart from the Health Ministry, no other ministry, department or agency had relaxed the ruling.

But at one point, the Health Ministry needed doctors, so this exemption was made. Now, the Cabinet wants the requirement to be maintained,” he added.

He also pointed out that only 23 medical graduates were given the exemption and not “300 or 3,000 as reported”.

Health Minister Datuk Seri Dr S. Subramaniam said the requirement for contract medical officers, including contract-based doctors, to sit for the SPM-level BM paper was re-introduced last December because of the current flood of medical graduates.

Read more at http://www.thestar.com.my/news/nation/2017/07/06/pass-spm-bahasa-and-be-in-civil-service-medical-grads-told/#sEXLrVQ65GovGxtz.99



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So, finally the issue of BM is out in the open. Today, TheStar published several articles regarding this. Over the years, I have been constantly informing everyone who was intending to do medicine that they need to make sure that they have sat and got at least a credit in SPM BM paper. 30 years ago, this was never an issue because almost all went through the same education system. SPM BM is a mandatory requirement to be appointed into civil service. Housemanship can only be done in civil service.

In the 80s and 90s, even up to early 2000s, other than some who studied in Singapore, almost everyone completed their secondary education till SPM before leaving the country, doing PreU or entering university. Thus, almost everyone had done SPM BM. I know some friends who studied in Singapore and did not have SPM BM but were given contract civil service post. During this contract post, they are required to sit and pass SPM BM paper(usually July paper). Only after passing SPM BM paper, the post is confirmed and converted to permanent post. This new dilemma that we are in currently, started in mid 2000.

Up to 2004, International schools are only limited to foreigners/expats or to families where at least 1 parent is a foreigner. This is the same in almost all countries including Singapore. IN 2004, the then new PM Tun Abdullah Badawi announced 30% quota of international school enrolments to locals. This quota was immediately taken up and the demand increased. Just 2 years later, the government allowed 100% enrollment of international schools to locals. This caused mushrooming of International schools in Malaysia. Rich parents were sending their children to these schools in droves, to the extend some had to enrol at least 3 years earlier for a place to be confirmed. When I came to JB in 1999, there were only 2 international schools catering to Japanese and Korean expats. Now, I lost count of the number of international schools in JB, all in just 10 years!

These international schools have now created a new issue. The students do not sit for SPM or SPM BM paper. These very same students are also rich enough to enrol themselves into private medical schools. SPM BM is not a requirement to enrol into private universities. These naive students or even their parents do not understand how complex the field of medicine is.

IN 2004, our Minister of Health Dato Dr Chua Soi Lek manage to convince the government to exempt medical graduates from SPM BM requirement for permanent civil service post. They were absorbed directly into permanent civil service with a special communication BM paper being conducted by MOH itself. Once they clear this paper, they will be confirmed in service. Unfortunately, the situation has changed. At that time there were abundant number of post which were vacant. The government changed the rule to encourage Malaysian doctors to return home from overseas. However, we now have more bodies than post. Being employed in civil service is a privilege. The government is NOT obliged to provide job to everyone. Thus by end of 2014, SPA reintroduced the need for SPM BM for civil service appointment.

Early this year, I was informed by 2 parent that MOE had introduced yet another new rule. You can’t sit for SPM BM alone but need to sit for the entire SPM papers which include at least 6 subjects. Only then, a certificate will be issued. However, I could not find a circular regarding this issue. I did make some comments regarding this when some students made some queries. But now it is out in the open with the news today.

Since Housemanship is being given under contract from December 2016, technically SPM BM is NOT necessary as mentioned by MOH today. However, be informed that in order for you to be eligible for a permanent post after your contract compulsory service ends, you will need SPM BM!! So whatever it is, SPM BM is still mandatory unless you intend to open a clinic after your 4 years compulsory service. In my last post, I did mention that ONLY 50% of contract officers will be absorbed into permanent post and continued in civil service. So, if you do not have SPM BM, you might as well forget about continuing in government service. Be also informed that specialist training can only be done in government service.

Many people argue about the basis of this requirement. We must understand that we are in Malaysia. Our national language is BM. Thus, to be eligible for civil service, SPM BM is made mandatory. What they need is just a credit or at least a pass. It is the same in any other countries as well. In almost all English-speaking countries, IELTS is mandatory for even registration or work permit application. In Australia, you need a minimum of 7 in all parts of IELTS to be eligible for Medical Board registration. At least in Malaysia, you only need SPM BM for civil service appointment. Imagine if that was the case for even MMC registration!! IN some non-english speaking countries, you also need to sit and pass their national language test to even enroll into their universities.

I know some students from international schools who can’t even speak a sentence in Malay. How are they going to clerk a patient or even understand what the patient is saying? O level BM paper is way inferior to SPM BM, I was told. That’s probably the reason why JPA do not want to recognise it as equivalent anymore. To make everything equal (as what people always want) , only SPM BM is acceptable now.

I feel all this started due to poor planning. Nothing new, as far as our government policies are concerned. The class division of education system, mushrooming of medical schools and lack of post, contributed to all these mess. The mandatory need for SPM BM should have been told to ALL aspiring medical students before they even enter our private medical colleges. NO medical schools will inform you that, as they need students!

As far as I am concerned, you can’t run away from the need for SPM BM to be appointed into civil service. That will not change since they have the liberty to pick and choose now. For those who are from International schools, please sit for the exam while you are in medical school. However, asking the students to sit for minimum 6 subjects is atrocious. They should allow the student to sit for individual papers.

 Medical grads told to sit for six core SPM subjects and pass BM to get cert

PETALING JAYA: Some medical graduates are frustrated that they need to “go back to school” after being told that they must have Sijil Pelajaran Malaysia-level Bahasa Malaysia to be accepted into permanent government posts.

No more exemptions would be given and some graduates said they were told to register for six core SPM subjects in order to get the BM certificate if they want the posts.

A source said about 300 graduates were affected since the change came into effect on Jan 1. They were from private institutions and waiting for housemanship placements.

Previously, O-Level BM or Bahasa Kebangsaan A (BKA) qualifications were accepted for entry into public service but from this year, those with such qualifications were rejected, according to the affected students.

 A graduate, who declined to be named, said he submitted his application for housemanship to the Public Service Commission (PSC) a month after he graduated last August, and after obtaining clearance from the Malaysian Medical Council (MMC), his application was accepted.

But in December, he was told by a PSC officer that he did not pass the screening process to be interviewed for housemanship acceptance because he did not possess “SPM-level Bahasa Melayu or its equivalent” as per the JPA 1/2016 circular.

“The PSC officer told me that the BKA paper I took for my foundation studies was previously accepted as an alternative to SPM BM for public service, but not from January onwards,” he said.

To ease the situation, he said the PSC later relaxed the requirement for medical graduates so that they did not need SPM-level BM for contract jobs – only for permanent posts.

However, when he tried to sign up for the BM examination at the Selangor Education Department, he was told he could not get a certificate for SPM-level BM unless he took six core subjects and passed BM and History.

The other subjects he has to take besides those two are Mathe­matics, English, Science and Moral studies.

The graduates feel it’s like asking them to go back to secondary school.

“This sudden change is very frustrating,” he said, adding that this was in addition to waiting nine long months for housemanship placement since he submitted his application in September.

Another medical graduate who graduated in July last year said MMC and PSC had considered her qualifications complete in August but in December, a friend told her that they would not be able to get an interview with PSC because they did not have SPM BM.

“I called PSC to check and it was true. I asked why they didn’t tell me earlier and they said they did not know things would change,” said the graduate, who declined to be named.

According to an e-mail reply from the Health Ministry, the rule for having SPM BM to enter public service as housemen was relaxed from 2003 and O-Level BM was accepted but the exemption was removed from 2017, she said.

“If there are too many graduates and they want to restrict the numbers, they should plan ahead. We were not given notice,” she added.

A final-year medical student with O-Level BM studying in a private university said that after hearing how some of her seniors could not enter public service without SPM BM or its equivalent, she decided to sit for SPM-level BM.

However, her mother – who went to help her register for the examination – was told by the Selangor Education Department counter staff that her daughter had to sign up for the six core subjects because she had not taken the SPM before.

“I have a lot to learn (as) I am in my final year of medical studies,” she said.

When contacted, the PSC said it was only observing the requirement set by the Public Service Department (PSD) which, in turn, said it was only implementing the decision made by the Health Ministry.

The PSD said in an e-mail reply that from Oct 1 last year, the appointment of UD41-grade housemen had been carried out on a contract basis. This was to enable graduates who meet housemanship requirements, but did not have an SPM-level BM pass, to serve in order to get a full registration certificate as medical officers.

However, SPM BM is required if the candidates want to apply for permanent posts, the PSD said.

Read more at http://www.thestar.com.my/news/nation/2017/07/01/upset-over-back-to-school-policy-medical-grads-told-to-sit-for-six-core-spm-subjects-and-pass-bm-to/#QPVX0U8Y6L3SqF5g.99


Health Ministry confirms it has waived SPM-level BM requirement

PETALING JAYA: The SPM-level Bahasa Malaysia requirement for medical graduates to be appointed for contract-based housemanship as well as compulsory service has been waived, the Health Ministry said.

According to the ministry, the Malaysian Examinations Syndicate also said that the graduates could sit for the SPM BM paper alone through special approval from the director of the syndicate.

This, however, was not what the affected graduates were told when they went to register for the paper, as some were told that they had to sit for six SPM core subjects: BM, History, Science, Maths, English and Moral studies.

The ministry said it had asked the Public Service Department (PSD) to waive the SPM-level BM pass requirement for the contract staff and in February, the PSD had agreed to the request.

 “However, the requirement (for an SPM-level BM certificate) must be fulfilled prior to their permanent appointments in the public service,” it said on the issue of O-Level medical graduates who claimed that they could no longer get permanent public posts with the Malaysian Qualifica­tions Agency’s Bahasa Kebangsaan A qualification.

One of the entry requirements for medical graduates to be appointed to public service is an SPM or equivalent pass in BM. Article 152 of the Federal Constitution and National Language Acts 1963/67 also required that Bahasa Melayu, as the national language, be used for all official purposes, the ministry said.

“Currently, Bahasa Melayu at ‘O’ or ‘A’ level or any other similar examinations are not considered equivalent to SPM by PSD.

“However, due to complaints from medical graduates regarding the changes in government policy (the appointment of new medical officers from a permanent to a contractual basis), discussions were held to resolve this issue,” the ministry said.

Read more at http://www.thestar.com.my/news/nation/2017/07/01/health-ministry-confirms-it-has-waived-spmlevel-bm-requirement/#FSgLGbGXgg1pj8Ch.99

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A year ago, I wrote an article about unscrupulous agents recruiting students to universities in Russia, Indonesia, Egypt etc. It is a guaranteed seat with just 6 month’s foundation program. SPM results DO NOT matter! You can even FAIL SPM but you are guaranteed a seat! I wrote the article after it was widely discussed in The Star. How low has medicine gone! Everyone is trying to make money at society’s obsession and ignorance. Do you think the agents had stopped doing this? The answer is NO. Every now and then I am still hearing unqualified students being recruited by these agents to overseas universities. They even tell these students that as long as you have a recognised degree, your job is guaranteed!

Few weeks ago, I received the following comment in my blog:

Dear Dr, I wanted to ask that my bro has failed his SPM (None of the science subjects got B4) and STPM (Pointer 1.67) but he still wanted to do medicine. He was then met the agency XXXXX and was told by the doctors from that agency that he could do medicine with that result by going through a 4 months foundation programme at XXX college to modify his pre-U result to be eligible for application in Russia medical uni. I read through the minimal requirement at MMC website that the candidates must at least got B4 for Maths, Add Math, Biology, Physics and Chemistry in order to be qualified to study medicine, but the agent convinced my friend that they could help him get his NOC even though he didn’t retake SPM. Is that true? He already studying his 1st year at Russia without any obstacles. He didn’t have B4 for his science subjects and only with that “fake?” pre-U result“.

So, it looks like the agents are still active and actively recruiting students who do not meet the minimum entry requirement. The Minimum entry requirement was introduced in May 2011. Prior to that, as long as you complete a recognised medical degree, MMC is legally bound to give you Provisional Registration and SPA/MOH is bound to provide you with a job. Furthermore, up to about 3-4 years ago, there were enough post for all graduates. Unfortunately, the situation has changed. Everyone should be aware now that the waiting time for housemanship is almost 8 months. Even graduates from June 2016 are yet to receive their appointment letter. Also not to forget that it is on contract basis since October 2016.

Since last year, MMC only provides you with a provisional registration once your job is confirmed. SPM results were also made mandatory when you apply for Provisional Registration and SPA application. The job of filtering the candidates has been given to SPA. Minister of Health did mention last year that those who do medicine without minimum requirement may not be considered for a job. Since the minimum entry requirement was only released in May 2011, we should be seeing unqualified graduates starting from this year onwards. So, SPA has every right not to entertain job application from those who do not qualify to do medicine. When you have more bodies than posts, job becomes a privilege and the government can pick and choose.

Few days ago, I received the following email:

I am xxxx, 27 years old and a 4th year medical student of a medical university in Russia. I’ve been reading through your blog since couple of years, and I love reading all your current update regarding future doctors and what about it..
At the end of my SPM in 2007, I didn’t get good grades. My science subjects were D in biology and physics. I didn’t even get the chance to study in matriculation due to my ridiculous spm results. I did try appeal to the ministry for a seat in matriculation by sending letters for several times and got rejected as well..
and yes, my ambition is to become a doctor. Of course not because of the salary but because I love doing it. It’s always been my passion. I came to a private university to study foundation in science but in the end my results were not good which is 2.7cgpa.. Then i decided to took bachelor of medical science which i was not finish because in 2013 I found an agent which can help to study medicine in Russia (country which i am currently studying at now) with few others student..
Years had passed.. I’ve heard so many updates regarding on the future of medical career.. Some says that you can’t get NOC (a certificate which certify our degree for working place in Malaysia) if you get even C in your SPM.. thus they won’t let you work as a HO.. some waited for years long to get a seat into HO.. However, what I am concern is because of my ridiculous result. I am now hanging on my thoughts, in a very sad way whether or not to stay.. or leave and do other course..? I’ve beginning to felt burden on my back, while broken hearted from inside. This is a very crucial time for me, as time won’t wait for human…”

Again, another unqualified students being duped by unscrupulous agents into medicine. When will this stop? The problem is what the agents are doing is not an offence under any law! They only promise you a seat and never said that it is legal and job is guaranteed! Malaysian law /requirement is not valid outside Malaysia. Once they get you a sit, it is no more their problem. You have to shoulder the burden of whatever comes after. I would rather blame it on the ignorant and uninformed society that we have. The society still believe that by hook or crook, they must make their children a doctor because it is a guaranteed job, good money and good life. NO one talks about what the job is all about! You are dealing with lives! NO matter what people say, to do medicine you need certain level of intelligence and competency. In most developed countries, you need to be the top 2-5 % of students in Pre-university. Remember what I wrote in February 2014? That’s why MOE introduced NOC about 10 years ago when they noticed unqualified students doing medicine overseas. Unfortunately, it is also not legally binding. However, with limited number of post now, NOC will become a requirement in job application. So, for those who are currently doing medicine since 2011 and do not have the minimum entry requirement, please be prepared for the worst. Furthermore, NOC should be applied and received before you start your medical education and NOT after you graduate! At one point there we even reports that agents are faking SPM results to get the NOC! I would suggest to those students who are being recruited by these agents, please report them to MQA/MOE and MMC. You can email the particulars to these agencies.

Well, a lot of sad incidences are happening in this country. Two young chaps being bullied and murdered by youngsters?. The society seems to be going backwards rather than forward. It is becoming a decaying society. We have patients who scream and do not hesitate to hit a health care staff, including doctors/specialist! The number of medico-legal cases are going up by leaps and bounds. Doctors are rapidly loosing all the respect they once had from the society. Just look at the drivers on the road nowadays! Totally disrespectful and “do not care” attitude. Are we really heading to a developed country status or are we going to the dungeons? Frankly, I would blame the education system and the leaders we have. Our education system is creating students who do not know what is happening in this world! They seem to be living in a cave, shielded from what is happening outside. General knowledge is becoming a rarity. Just because they get As in all subjects, they think they know everything. The world is changing rapidly but our students and youngsters are still living in dreamland. Try talking to a SPM leaver or even a graduate and you will know the answer. Only a minority knows what is happening out there.

A messed up education system due to politics. A society which is decaying day by day. A beautiful country destroyed by racial and religious politics. Where are you heading , Malaysia……….?  Probably this comment by Tun Musa Hitam may enlighten the readers……


Selamat Hari Raya to all my Muslim readers and friends…………..have a safe journey

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Due to higher than expected sale of my books during last month’s sale, I will be extending the sale below till end of June 2017 (after raya). Those who are still eager to buy and read these books which has full of information for budding doctors, please get it as soon as possible.

Since September 2016, these books are available at Kinukuniya and selected MPH bookstores. It is also available at MPH Online, Kinokuniya Online and Google Play Store(soft copy)You can also visit http://www.hardtruthsofbeingadoctor.com if you wish to buy using credit card/pay pal. Or for those who have paypal account, you can pay to my paypal account pagal72@gmail.com.

AND, to celebrate my 1st year anniversary of launching my first set of books, for a limited time ONLY, I will be selling the books(a set of both volumes) for RM 85(including courier within Malaysia) till end of May 2017(extended till JUNE 2017). For those who have NOT purchased these books, this is the best time you can buy it cheaper than the bookstores, directly from me. Each Book will be personally signed by me. Please see below on how to purchase the books.

These books are meant for budding doctors, parents, medical students and even junior doctors. Despite all the articles in this blog, I keep being asked the same questions repeatedly. Thus I thought of compiling everything into a book. Unfortunately, due to high volume of the book, it has to be divided into 2 books of about 250 pages each. Foreword is written by A/Prof Wong Yin Onn from Monash Malaysia. Here are the titles:




Please be informed that there are many updated information in these books compared to some of my old articles. Information about income, salary, post-graduate educations etc have been updated. There are 5 chapters in Book 1 and 4 chapters in Book 2 with the following titles:

Book 1:

  1. General Misconception of Being a Doctor
  2. General Information for budding doctors
  3. Malaysian Healthcare system for Dummies
  4. Housemanship, Medical Officer and Post Graduate Education in Malaysia
  5. Employment and Job Opportunities

Book 2:

  1. Housemanship
  2. Post Graduate Training
  3. Income of Doctors
  4. The Doctor’s Dilemma

These books will be sold as a set of 2 books , purchased directly from me.

This is how you can order your copy:

  1. Make a payment of RM 85 (including postage within Malaysia) to CIMB Bank Account No: 8006158099 (Pagalavan Letchumanan)
  2. Send your Bank-In Slip to email hardtruths2016@gmail.com with your name and address/particulars
  3. Give me 1-2 days to courier the books.
  4. Courier tracking number and invoice will be sent to you via email after it has been mailed.
  5. An Invoice will be provided for Tax purposes
  6. For those who are ordering from overseas, please email me first as I need to check on courier charges.

Hope everyone will enjoy reading this, one of its kind book in Malaysia……………

For those SPM leavers, this is the time to grab the books………..

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After my last post on the above topic in January 2017, I had updated several more information along the way. Over the last 2 weeks, I had few comments in this blog about the delay in SPA releasing the names of those who can start their housemanship, despite attending the interview in February 2017. I was told that these graduates have been waiting since last year, almost 6-8 months. Subsequently, even an opposition parliamentarian brought up the issue to the press.

Let me put it this way. No one is obliged to provide you with a job, period! The government is not obliged to provide everyone a job. The fact is, you must thank your lucky stars for being offered a contract housemanship job to at least get the full registration to practise as a doctor. That is the fact! Graduates should stop thinking that the government owe them a job. NO government owes anyone a job. Of course, our government has already messed it up to glory. Don’t expect anything to change. How the government is going to give you a job when they got no money to even create new post?

I noticed that many parents were upset that the interview results were not out, even after 2 months. The problem is not inefficiency of SPA BUT lack of post. Despite housemanship post being given under contract, the government can’t be creating new post as they like. It has its financial implications. Furthermore, how many housemen a hospital can take is limited by the number of beds and number of consultants. This is decided by MMC and MOH. There is NO such thing as unlimited number of HO post in any hospitals. Remember: it is a TRAINING and NOT simply a job.

I was made to understand that there were almost 3000 applicants with only about 1000 post to offer. Finally, the names of graduates who succeeded were announced few days ago. Those who did not get a job this time around were asked to wait till July or August as per email below:


Today, someone wrote this letter (attached below) to the Star. The writer has a point as to the dates of future intakes. At least by knowing when is the next intake, they can plan their lives. However, our government never works that way. A lot of meetings are called on ad-hoc basis. Even up to today, we are called for a meeting with a letter faxed to us 1 day before the meeting!! How are we suppose to close the clinic and come to the meeting ? Most people are sick and tired of telling this to the higher authorities for years. I never saw any changes since I left government service 11 years ago. NOTHING has changed.

So, the students can have high hopes of anything to change. ON the other hand, SPA interviews are not actually testing your medical knowledge. It is more about attitude, your presentations and manner. Remember: it is a job interview! The way you talk and carry yourself is important. IN any job interviews, not everyone will get a job. The same situation applies here. Graduates must not forget that jobs are never guaranteed. As for transparency, that is not something that is in our government system’s dictionary. So, you can forget about knowing why you failed. It is their right to choose who they want. It is a privilege and not a must. This is why I said that letters like this will be flying all over the place in years to come. Wait till those who finish their contract housemanship and apply for permanent post. A lot more letters will be flying.

Whether you like it or not, you just have to wait. The waiting period will only get longer as more and more graduates begin to appear starting from this year. You may even end up waiting for 1-2 years. And for those budding medical students: DO NOT get carried away with some universities claiming that their graduates are getting housemanship earlier than others! Total rubbish. They are just marketing themselves. 5 Years down the line, they will disavow any knowledge of making such statement or they will say, time has changed! Don’t get fooled. There are enough medical schools who are misleading students by claiming internationally recognised degree etc. Do your home work!

The more graduates make such noise against the government, the more likely a common entry exam is coming. Once a common entry exam becomes compulsory, no one can complain when they fail the exams and don’t get a job. Trust me, this is my next prediction. Talks are taking place again despite being shot down by cabinet in 2011.

Well, welcome to Bolehland. No one listens and no one will listen……………….

 Happy Labour day………..

Medical graduates want clarity and certainty

HUNDREDS of medical graduates heaved a sigh of relief when they were called up by the Public Service Commission (PSC) last Friday, but thousands more remain in a limbo over the status of their application. Sadly, those who were not accepted were not given a proper reason, apart from being told they did not ‘rank’ as high as their peers during the interview session.

Desperate medical graduates have taken the initiative to call for updates with regards to the intake for housemanship from the PSC.

Unfortunately, most of our queries were responded to unprofessionally or many of us were told dismissively that the next intake would commence in July or August, provided vacancies are available.

A lack of clarity from the PSC engenders uncertainty among the graduates. The non-availability of the date of the next intake of housemen on the PSC website makes it difficult for graduates to plan for the future. Many who opt to work are unable to sign long-term contracts, fearing they may be called into the service at short notice.

 We miss golden opportunities to hone our skills be it medical or otherwise, due to the lack of a structured plan from PSC. Clarity in knowing the exact dates as early as possible would keep medical graduates motivated, and prepared for the upcoming housemanship as we would be able to plan and confirm our attendance at housemanship courses.

An opaque system with no attempt from the relevant authorities to correct it serves only to heighten confusion and frustration among medical graduates.

While messages through the Whatsapp grapevine have been rife with news from individuals claiming to have information after they called the PSC, no official information has been forthcoming to assuage the anxiety in these graduates.

The interview process is questionable by itself. Questions posed to medical graduates were not standardised, with many interviewees not tested on their medical knowledge.

How can medical graduates be compared and ranked against one another when the barometers used were not uniform across the board?

We look to the PSC as the agency that should be the pinnacle of civil service efficiency and transparency. Instead, what we see is its inefficiency and opacity.


Johor Baru


Read more at http://www.thestar.com.my/opinion/letters/2017/04/29/medical-graduates-want-clarity-and-certainty/#tOfD6vmOAy0h4Xb7.99

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Time flies…… I did not even realise that it has been 1 year since I launched my first set of books. The sale of my books has been quite encouraging without any major promotion. Since September 2016, these books are available at Kinukuniya and selected MPH bookstores. It is also available at MPH Online, Kinokuniya Online and Google Play Store(soft copy)You can also visit http://www.hardtruthsofbeingadoctor.com if you wish to buy using credit card/pay pal.

AND, to celebrate my 1st year anniversary of launching my first set of books, for a limited time ONLY, I will be selling the books(a set of both volumes) for RM 85(including courier within Malaysia) till end of May 2017. For those who have NOT purchased these books, this is the best time you can buy it cheaper than the bookstores, directly from me. Each Book will be personally signed by me. Please see below on how to purchase the books.

These books are meant for budding doctors, parents, medical students and even junior doctors. Despite all the articles in this blog, I keep being asked the same questions repeatedly. Thus I thought of compiling everything into a book. Unfortunately, due to high volume of the book, it has to be divided into 2 books of about 250 pages each. Foreword is written by A/Prof Wong Yin Onn from Monash Malaysia. Here are the titles:




Please be informed that there are many updated information in these books compared to some of my old articles. Information about income, salary, post-graduate educations etc have been updated. There are 5 chapters in Book 1 and 4 chapters in Book 2 with the following titles:

Book 1:

  1. General Misconception of Being a Doctor
  2. General Information for budding doctors
  3. Malaysian Healthcare system for Dummies
  4. Housemanship, Medical Officer and Post Graduate Education in Malaysia
  5. Employment and Job Opportunities

Book 2:

  1. Housemanship
  2. Post Graduate Training
  3. Income of Doctors
  4. The Doctor’s Dilemma

These books will be sold as a set of 2 books , purchased directly from me.

This is how you can order your copy:

  1. Make a payment of RM 85 (including postage within Malaysia) to CIMB Bank Account No: 8006158099 (Pagalavan Letchumanan)
  2. Send your Bank-In Slip to email hardtruths2016@gmail.com with your name and address/particulars
  3. Give me 1-2 days to courier the books.
  4. Courier tracking number and invoice will be sent to you via email after it has been mailed.
  5. An Invoice will be provided for Tax purposes
  6. For those who are ordering from overseas, please email me first as I need to check on courier charges.

Hope everyone will enjoy reading this, one of its kind book in Malaysia……………

For those SPM leavers, this is the time to grab the books………..


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Sometimes I really feel sorry for some students or graduates who expect everything to come to them on a silver plate. Life is never easy. It only gets tougher day by day. You have to live with what you have and try to be better in every sense in order to be a successful person in the future. Unfortunately, the current generation of graduates grew up in a comfortable environment with everything being provided by their parents. Their parents on the other hand do not want their precious child to get his/her hand dirty! They want their child to be in a chamber, work from 9-5 and come back home and live a comfortable life and earn a lot of money! In reality, that will never happen!

Over the last 1 week, there were many interesting letters to the Star. The chain reaction was started by THIS letter, supposedly written by a graduate who is yet to even start his housemanship. How ironic! The issue brought forward was about “tagging”.  I must say that I don’t totally disagree with the author but he must understand that, it is the reality and part & parcel of life. For years people are talking about it but why are there no changes to the environment? I agree that our working environment is pathetic. Most of the older hospitals do not even have proper room for doctors(HO/MO) to rest or sleep. Housemen need to use whatever room available to rest/sleep during their calls. However, some of the newer hospitals do have proper call rooms but the numbers are generally not adequate. When I was in SCHOMOS/MMA Johor, I had to put multiple request to change all the “worn-out” air-conds in all the so-called “call” rooms in the hospital. It took me almost 1 year to get it done. Thank fully I had a wonderful hospital and state pengarah who supported my request. In the 2000s, we only had 1-2 HOs in each ward and thus we did not require that many rooms to even start with. Only 2 MOs and 3 HOs were “on-call” every night. Unfortunately, we have tons of HOs in a hospital nowadays.

Coming to the issue of tagging, I feel someone will never complain if his/her intention to do medicine is to learn and help people. After all, tagging is just 2 weeks in the first posting and usually will become 1 week in subsequent postings. I don’t see a big fuss about that. The tagging period is to enable you to learn how the system works and at the same time to build up your physical and mental strength of being a doctor. Medical graduates feel that they are the only one working “so” hard compared to other graduates. I beg to differ. Almost all graduates in any other critical field do the same during their early career stages. The only difference is, you are dealing with life and death matter and your job is in the hospital. You can’t bring your work back home like engineers, lawyers etc. Till today, I am still working 24hrs a day 7 days a week!

Medicine is a life long learning. Till today I am still learning and discovering new things which I had never seen before. The most crucial part of medicine is the early years of housemanship and MOship. During this time, you are always guided by someone senior who is much more experienced than you. Your responsibility is actually the lowest as you don’t have to make life and death decision. Medicine cannot be learned from books. Medicine is on the job learning. The more patients you see and the more time you spend in the ward, the more you learn. If you want to be a good doctor, then stop whining and spend your time learning the most during the early years.

The next day, another letter supposedly written by a parent was published in the Star. Again, I don’t totally disagree with the letter especially about the working environment but the “parent” must realise that being a doctor is not an “office” hour job! You have to make sure your job is done before going home as you are dealing with lives. I don’t understand why is he complaining about 12 hours shift? I presume he wants a “start at 8am and go back at 5pm ” kind of job! Than I am sorry, he is in a wrong profession. These issue arises because parents and even students do medicine thinking that it is a cosy job, sitting in an air-cond room and earning quick bugs! The reality is totally the opposite. That’s why I keep saying that EVERYONE who intend to do medicine MUST read my books! Know the reality before putting your foot into anything. I have also said this many times, never get married during housemanship (in reference to the letter which talks about parenting!). And please stop comparing with other countries. Each country have their own problems as the healthcare structure and system are different. In Australia, you do not have hospitals without specialist. Here, you are thrown to a district hospital after housemanship where you will be the one who will be making decisions! You will be doing vacuum/forcep delivery, inserting chest tubes, doing minor surgeries etc. The competency level needed is totally different!

These letters were discussed extensively in social media and some senior doctors did write to the Star. “Doctors NO Different from Soldiers” in The Star and “An appropriate baseline in quality and quantity of training” in Malay Mail are worth reading. You will only know how important housemanship is when you are posted to a district hospital or alone in a hospital without anyone to consult! Till today, I still remember what I learned from my seniors during housemanship. I still remember who thought me to do a CVP line at 4am in the morning and he is a succesful cardiologist now. Looking back, I enjoyed my housemanship as all of us back then, helped each other very well, without being calculative. Unfortunately, we have too many housemen nowadays who are calculative and do not help each other. Trust me, housemanship will be a wonderful experience if your colleagues help each other.

And for those housemen/parents who are whining , there is an important message from our Deputy DG:



There appears to be some confusion on what is being said on HOs and the contract system.

The current modified flexi system was formulated by a group lead by myself where a HO will work between 68-74 hours per week with HO : patient of 1:4 ( in most other countries 81 hrs and HO patient ration 1: 8-10)

So for starters they are working less hours and with less patients to look after.

But the system is designed to ensure ownership and accountability of patients to each HO. So much so only HO training in Malaysia is accepted by the GMC uk as equal to their training for those who have degrees registrable with the GMC .

In order to ensure adequate clinical exposure and competence each posting has 16 mandatory topics which they need to know before they can exit a posting , it is very transparent and questions asked are within these topics and answers given are documented for reference in disputes on unfairness and I was asked a postgraduate question !

Also they are given protected time to ensure they attend 75% of the CMEs.

So if a HO working under these conditions can’t complete his/ her work within the shift period I have no comments , would you find them safe to run your clinic ?

They are given 16 weeks to complete each posting and allowed 2 extensions of 8 weeks i.e. another 16 weeks if still not competent a final 24 weeks at another hospital to given them a fair chance ,then terminated . So they are given more than enough opportunities to remedy their short comings .

With this in place and only 5000 places for each year , when HOs get extended or disappear and as they are permanent civil servants , it takes more than a year to terminate them !

So I have on an average 6-700 who are non performing each year added to those who don’t want to take up their post HO , MO posting by refusing to move they by depriving others getting into the system !

So with the contract system you disappear for 7 days out you go and in comes the next person in the queue , if you finish you HO training and don’t want to go to your new MO posting when your 24 mths is up so too is your salary , so they will not be able to work till they accept their new posting and once there is a lapse in pay it will take about 3 mths to get the system back Bec MOH has almost 40k Drs !

Next those who don’t complete due to not being competent and are terminated that is the end of the road .

Those who have disappearance and return they have a 6 mth cooling off period before JPA allows them to reapply so in reality it will be about 9 mths before they get a job.

When numbers are high , we have no option but to be fair to those who have not been given a job , we hope those given a chance will value the job given .

Work is very different from being a student and the reality is many students don ‘t spend long hours in the wards so working in the ward for ” long” works is alien to them!

This is compounded by the fact that all private medical colleges don’t have their own teaching hospital which to me makes a big difference , how many lectures and professors of private medical schools actually work in the wards ? So this to me is another reason for the standards and attitudes of the newer medical students .

With the contract system compulsory service is still there 2yrs as a HO and 2 more as an MO , once you have completed the 4 yrs then we cross the bridge , the MOH as it stands with it’s future needs can only take in about 2-2500 max per year so about 50% will not be given a job in MOH .

Who will be taken ? , those pursuing a postgraduate program either the Masters or the parallel pathway of the Royal college exams Bec for every masters slot now there 5-7 applicants ! So to give an opportunity to the others we are developing the parallel pathway including Primary care .

So I have put a lot of thought and effort into planning for the future of healthcare delivery in Malaysia to ensure we have a truly great system with competent and safe doctors delivering quality health care .

I am open to comments if you can suggest ways to make it better Bec this is a dynamic process that may need to be adjusted from time to time .

I am now working on the rationalisation of MO post to ensure workload levelling , it took my team 9 mths to ensure equitable HO distribution , so in the next 3 mths the MOs issue will be resolved and finally the Specialist will be next Bec not all of them are working just as hard !

Once that is done my work is done and I can leave my job , I have delivered on what I was tasked to do as DDG in MOH , other task of mine are also in various stages of completion.



So, just to summarise:

  1. those who go missing for 7 days: out you go!
  2. those who return, have 6 month’s cooling off period for even JPA to re-consider
  3. those who don’t complete HO in 3 years, out you go!
  4. those who refuse to transfer out to wherever you are posted, salary will stop within 24 hrs
  5. only 50% of HOs completing will be given Moship post in MOH
  6. the rest have to “cari makan” on your own
  7. preference for MO permanent post will be given to those who have postgraduate interest

Did anyone say that doctors will never be jobless? Well, the reality is here. When we have more bodies than post, the employer aka MOH have the right to pick and choose. Dr M once said, he want to flood the market with doctors! His ambition has come true……

SPM results were just out 2 weeks ago. For those who intend to do medicine, please buy and read my books! You can visit my blog post HERE on instructions on how to buy the books.



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Time flies…… I have so much work to do and so little time to handle it. As a doctor, you will never have free time. Just when you thought you would sit down and do something, comes a phone call from the hospital. There goes your time. I always believe that family come first but being a doctor, sacrifices have to be made. If you are not ready for sacrifices, then you need to find some other course.

It is now confirmed that job is not guaranteed for doctors. All housemanship post will be given under contract. A maximum of 3 years is allocated for you to complete your housemanship. After housemanship, you will be renewed to complete your compulsory service (4 years in total including housemanship). You can apply for permanent post based on criteria mentioned in my earlier post. Whether the selection process will be transparent or not, time will tell. The latest Berita MMA had some information regarding these issues and the issues of promotion/sponsorship, after a meeting with MOH, as attached below:


Most of the issues discussed above are self-explanatory. Recently , the deputy minister of health did mention in the parliament that 2 more hospitals will join the list of housemanship training hospitals which include Hospital Shah Alam and Hospital Langkawi. Military hospitals were included this year. Interestingly, he said there are 44 medical programs in this country!! If I am not mistaken, there are close to 35 medical schools in the country but a lot of them have more than 1 intake and some have more than 1 program. So, even if we say that each program produces an average of 100 graduates, we will have close to 5K graduates locally alone, may hit as high as 6k. This coupled with those returning from overseas, the numbers may hit about 7-8K graduates. An excellent Bolehland achievement. Enough said! A recent article by Malaysian Pre-Houseman Joint (MPHJ) which I never knew existed was a good read(see below). He had summarised what I have been saying for almost 10 years.

I heard rumours that MMC will be corporatised in compliance with Amended Medical Act 2012, somewhere in July this year. It is likely that APC fee will increase and NSR registration for specialist will become mandatory(not sure who will pay for civil servants). Minimum CME points requirement will be needed for APC renewal. I heard it will be about 20 points annually. NSR renewal every 5 years will also need minimum CME points of about 100. BUT we still need to wait for the official announcement on these issues as discussion is still ongoing. Please be also informed of NSR new rule effective 2017:

General Requirement On Post Qualification Experience
Effective January 2017, applicants must have at least ONE (1) year post qualification working experience for medical related specialties/fields of practice and at least TWO (2) years for surgical related specialties/fields of practice.

This new NSR rule makes it impossible for anyone to leave to private sector immediately after post-graduate/subspecialist qualifications. Once NSR is made mandatory, only those who are NSR registered are considered a specialist. Frankly, I feel it is a good move as medicine is a life long learning process and having a qualification alone does not make you competent.

Then came several other information regarding U56 promotion and issues in KKM. This message below is nothing new but it is a very important information for doctors in civil service.

UD56 post

1.Only for gazetted NSR Specialist

2.5 years after gazzetemnt & 5 years after being a UD54

3.Will get around RM 2100 more than what is being earned currently by a UD 54 specialist

4. No car or petrol card given to UD56

5. Not everyone will have to go through UD56, some an jump straight to JUSA C

Other matters raised

1. No subspeciality allowance will be given once sub completed

2.Anyone can do locum but need to register/inform Pengarah

3. Doing locum – buy own insurance ( MO doing in private clinic & specialist )

4.No more contract doctors – JPA phasing out . 

5.Senior consultants who retire & reemployed as contract will not be in the same hospital

6.Husband & Wife who are specialist as far as possible will not be placed in same department

7. Optimize the use of resources & consumables 

8.No direct sponsorship by Pharma companies

9. Sponsorship via societies allowed , but has  to be transparent – documented in the minutes of the society meeting

10.Those who want to go for voluntary medical relieve work overseas have to be registered with KKM – special form to be filled up .

11.FPP – not for foreigners

12.Pharma company reps only allowed to see HOD , should not see MOs & specialist

As you can see, life as a doctor is never going to be easy with new rules and regulation being put in place. Sometimes we doctors are to be blamed for all these issues. Greed took over some of the doctors, giving rise to unethical practices to survive. The recent press release by MMC on disciplinary actions against errant doctors is rather shocking but it is just the tip of the iceberg. The recent MACC arrest of doctors for signing heavy vehicle driving license medical certification without examining the patient is rather worrying but not surprising. At the end of the day, it is all about survival…………

Once the election is over, more surprises may be coming for doctors. …………….

Junior doctors trapped in catch-22 predicament

March 10, 2017

Unemployment is high among medical graduates because housemanship training is only provided by accredited government and university hospitals and places are scarce.

By Dr Muhammad Firdaus Syukri B Ahmad Zubaidi

In the past decade or so, the number of university graduates has soared in most professional fields. This, coupled with the current challenging global economic slowdown, has consequently led to higher unemployment among graduates.

Until recently, the medical field has been relatively spared from this crisis. With promises of guaranteed employment, more and more people have ventured into the medical field. However, unemployment has finally caught up. Many spend hundreds of thousands, if not millions, on their medical education, only to graduate and realise that the paradigm has shifted.

The past few years have witnessed an exponential increase in medical graduates produced both locally and abroad. The increment in number would not normally be as big an issue in other fields; however the medical field is unique.

A graduate interested in pursuing a career as a doctor has limited options to continue his or her junior training – in fact, they only have one. In order to be recognised to practise in a country, a graduate must obtain a full medical licence, which they receive upon completion of housemanship training.

Housemanship training is only provided by accredited government and university hospitals, and junior doctors are solely dependent on these limited training posts to continue their careers in medicine. Yet, as the number of graduates has increased in the past five years, the number of training centres and houseman posts has remained relatively static.

Inevitably, this has led to a mismatch between the number of graduates produced and the places for their training. With limited posts available, graduates now have to wait many more months before it is finally their turn to enrol into housemanship.

And as the number of medical graduates increases year by year, so does the waiting period for housemanship. Medical graduates of 2013 waited an average of three months before starting housemanship while graduates of 2016 have yet to be employed after eight months of waiting. The promise of a secure career in medicine is now a thing of the past.

The long waiting period does not come without a cost. As graduates are not able to put their knowledge into practice, their medical knowledge becomes rusty and withers by the day. Not to mention the skills learned in medical school – the art of communicating with patients and carrying out procedures such as drawing blood will surely be lost without constant practice.

Corporations and non-governmental bodies offering pre-housemanship courses have mushroomed of late, but the fees charged are steep and can only be afforded by the more affluent graduates; even then, how much can a two- to three-day crash course substantiate five years of medical school teaching?

This is probably the major cause of the ever growing complaints of poorly performing house officers, and less the “failures” of medical school programmes to nurture the passion to care and heal. House officers are doomed even before they begin work.

And when a house officer performs badly, they are viciously scolded and harassed by their superiors as mistakes in the medical profession could potentially costs lives. Is it any wonder that the rates of depressive illnesses are high among junior doctors in training?

This further leads to poor learning and poorer performances, aggravating an already vicious cycle. Poorly performing house officers have to undergo extended training, taking up posts designated for new house officer intakes and further escalating the problem of limited posts. As house officers are the first line of doctors serving in tertiary government facilities, at the end of the day it is the rakyat who bear the brunt of the housemanship crisis.

You may be wondering what most graduates do while waiting for their housemanship. According to an online survey conducted by the Malaysian Pre-Housemanship Joint, a whopping 80% of graduates remain unemployed during this waiting period.

The remaining 20% are mostly employed in part-time jobs such as tutoring, sales marketing, driving for ride-hailing services or as research assistants. Many complain that it is difficult for them to get jobs because not many companies are keen to employ medical graduates, some even citing “over qualification” as an excuse.

The frustrating and ambiguous housemanship waiting period deters employers from hiring medical graduates as they prefer hiring workers who can commit to the job for a decent period of time.

On the other hand, the uncertainty also makes it cumbersome for graduates to decide whether to take up job offers such as research assistants which require commitment for a stipulated period. These employment obstacles results in most medical graduates being without a job and faced with a looming socio-economic catastrophe.

The landscape of the medical field has changed dramatically. But the rakyat has been virtually oblivious of the severe and dramatic repercussions that have befallen junior doctors entering the work force.

Society needs to revise their perspectives of the medical profession. Those intent on a career in medicine and surgery must be made cognisant of the damning changes currently at play and not be misled by false societal perceptions of this once noble vocation.

It is no longer the safe haven it used to be where graduates were virtually guaranteed a good livelihood post-graduation. The private sector is not willing to employ a doctor without a full medical licence, while other countries have laid out strict entrance and linguistic examinations for foreign doctors.

Thus, neither the private sector nor working abroad are viable options for junior doctors – public service is the only option. We are beholden to the mercy of the Public Services Department (PSD) and the health ministry.

In the final analysis, medical graduates are worst off compared with other graduates. Junior doctors are trapped in a catch-22 predicament not entirely of their making. They bear the brunt of the policies of the PSD and healthcare systems (MOH).

Dr Muhammad Firdaus Syukri B Ahmad Zubaidi is spokesman for Malaysian Pre-Houseman Joint (MPHJ).

With a firm belief in freedom of expression and without prejudice, FMT tries its best to share reliable content from third parties. Such articles are strictly the writer’s (or organisation’s) personal opinion. FMT does not necessarily endorse the views or opinions given by any third party content provider.


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It looks like we are making headlines again. Few days ago, the Chief Secretary of the Government publicly announced that housemen are the highest number of civil servants being terminated. As for me, it did not come as a surprise.  This is something that is well-known to the medical profession. Many housemen just go missing without any notice. I had said this before that it is better for them to give a resignation letter than just go missing in action. The government’s procedure is as such that it will take almost a year to terminate someone from civil service. During this time, no one else can occupy your post. This is one of the reason I support giving housemanship under contract. It will be much easier to terminate someone who goes missing. It will also keep everyone on their toes.

Today, NST published several reports on these issues as below. I had said it many times since I started this blog that you should know what you are getting yourself into when you decide to do medicine. That is the reason why I started this blog in 2010. Unfortunately, many still refuse to believe what is written and in denial. Parents on the other hand do not even bother to ask their child what they want to do in their life. They pressurize their child in doing medicine by promising a good life and money.

Medicine is a stressful job. It is not about sitting in an office and having a chat with a patient and pocketing RM 50-70. IT is much more than that. The time taken to be competent and the amount of responsibility taken is huge. With increasing literacy rate and demand of patients, it further adds to the stress level. Some times I get amused when the person who makes the most fuss in a clinic or a hospital actually sends his own child to be a doctor! I know another parent who do not believe in western medicine and takes only complementary medicine but sent his son to do medicine overseas! Is this called hypocrisy or they simply believe that medicine brings easy money for their children?

As a response to the issue, our Health Minister says that all future housemen would be given counselling! Sometimes I simply don’t understand the logic behind some of the answers coming out of our politician’s mouth! Why do counselling after they graduate? Why don’t we start counselling before they even enter a medical school? Or even conduct some form of standardised entrance exam and interview? Tell them and their parents the reality out there. Unfortunately this will not happen as it will affect the enrolment into our 35 medical schools. Then the medical schools will start making noise as they will be loosing money! The very moment our policy makers decided to commercialised medical education and put quantity ahead of quality, we know where we are heading!

For those who intend to do medicine, please read this blog or buy my books! I had many comments which said that I am discouraging many budding doctors by being very negative. I had explained many times that what I write over here are the REALITY out there which you should know before putting your foot into medicine. If you only going to realise it after you graduate, then it is simply too late…… Trust me : Life in Medicine never gets easier…….

My Books are still available and can be purchased directly from me by following the instructions over HERE. Each and every budding medical students should read this book before deciding to do medicine. Softcopy is available at Google Play Store.





Doctor dilemma: Why are Malaysia’s housemen buckling under pressure?


 MANY housemen find it difficult to cope with the pressure when they cannot adapt to the rigorous training regimen in hospitals. Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said this had led to many housemen not completing their training, especially those who studied abroad, as the systems were different. “In some countries, interns are not even allowed to touch patients, and they do not even know how to get a patient’s history. “There is also the language barrier. If they studied in Indonesia, the common language is Bahasa Indonesia, but in Malaysia, we use English,” he said, adding that this had increased the pressure on housemen. Dr Hilmi said there were about 10,000 housemen from various backgrounds in Malaysia, including graduates from local, overseas and unrecognised universities. He said of the number, at least 20 per cent had difficulties with training and were asked to extend their internships up to six to eight months. “Last year, 1.2 per cent of housemen were either terminated or had quit because they could not take the heat. “Many went to other countries to complete their internship, while those who did not show up for many months were sacked.” On why it took so long to identify absent housemen, Dr Hilmi said there were so many housemen that sometimes their superiors did not notice that they had gone missing. “That is why some have gone missing for up to 400 days,” he said after launching World Leprosy Day at the Gombak Orang Asli Hospital in Selangor yesterday. He was responding to Chief Secretary to the Government Tan Sri Dr Ali Hamsa, who had said trainee doctors made up the highest number of civil servants who were given termination notices. Health Minister Datuk Seri Dr S. Subramaniam said about 20 to 30 per cent of about 5,000 housemen who joined the service every year opted to extend their housemanship. He said there were cases of housemen leaving the profession or were removed after they disappeared after finding out that they could not meet the expected requirements of working as a doctor. “I’ve seen some who resigned within 24 hours. “Many don’t resign, but they are not in the system because they don’t go to work. “Later, when we identify them, but can’t trace them, we have to take disciplinary action,” said Dr Subramaniam at a seminar on workplace health here yesterday. He said stress was the main reason housemen dropped out, were absent or extended their housemanship. “People who take up medicine and don’t know what it is all about (often find that) they can’t fit in the system.” However, he said, the number of such incident s had dropped as the ministry had taken steps to intervene by counselling the housemen. He said the respective sections had been instructed to counsel and train housemen before they began their programme and to offer them transfers to other facilities to help them adjust. Dr Subramaniam said universities should consider using an aptitude test. He said to address the problem, the ministry’s main job was to ensure that working conditions were conducive. He said universities might need to regulate interviews to ensure the screening system was compatible with the ministry’s requirements. He said imposing such requirements on private institutions was a tall order as a strict vetting process would reduce the number of students who passed,thus leading them to collect less fees. He said housemen who dropped out and wanted to rejoin the service would not be given a second chance. “Once they drop out, it is the end of their medical career. “The Malaysian Medical Council will not recognise them as practising doctors. “The ones with major disciplinary issues will not have a certification of good standard and they will find it difficult to find jobs in other countries.” Ali Hamsa had said some housemen were laid off because they went missing for up to 400 days. He said some of them had studied abroad on government scholarships. It was reported that sponsoring a medical student overseas could cost as much as RM1 million or more, while the cost in local universities was far lower, but still hefty. Ali Hamsa attributed the policy of permitting hospital interns to follow their spouses overseas for study purposes as another possible reason many went missing from work, and called for a policy review.

Read More : http://www.nst.com.my/news/2017/02/212611/doctor-dilemma-why-are-malaysias-housemen-buckling-under-pressure?d=1

Planning to become a doctor? Get set for burnouts, depression


While many consider being a doctor a dream profession, a growing number of those working in the field find it miserable. Numerous reports can be found on how a growing number of physicians and trainees are going through dark periods of turmoil due to stress. Dr Elaine Cox, in an article on health.usnews.com, said statistics on the number of doctors-in-training and those practising medicine who faced stress was alarming, with about one-third of physicians reporting experiencing burnout at any given point. “As a matter of fact, doctors are 15 times more likely to burn out than professionals in any other line of work, and 45 per cent of primary care physicians report that they would quit if they could afford to do so. “Physicians have a 10 to 20 per cent higher divorce rate than the general population and, sadly, there are 300 to 400 physician suicide deaths each year.” She said the lack of control over schedules and time could contribute to high-stress situations for physicians. “This can result in poor sleep patterns, interference with family activities and events, and poor self-care. “Because there is a patient in need at the end of every phone call and every office or hospital interaction, setting limits is beyond difficult. “The result can be physical and emotional exhaustion, leading to cynicism and burnout. Add to that the increasingly litigious society in which we live, and there is a recipe for quite a few failures.” Dr Cox said in a study published recently, medical students reported a rate of depression that was 15 to 30 per cent higher than the general population. “This can lead to poorer performance, such as 6.2 times more medication errors, exactly the opposite of what we are striving for through the education process.” She said many physicians did not recognise and seek help when they experienced early signs of burnout, primarily because of fear. “Frequently, privileges and licences could be denied if physicians are under treatment for substance abuse or depression. Without those certifications, the source of livelihood, not to mention identity and many years spent in training, is lost.” She said many feared that the struggles they faced would be noticed by the doctor they were getting the treatment from, and, as a result, many self-medicate, which was not a good strategy. Alexandra Sifferlin, writing for Time.com, said research showed that almost 40 per cent of doctors in the United States experienced emotional, physical and psychological burnout from their jobs. “The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the healthcare system, leading to less motivation to improve conditions, both for themselves and for patients,” she said. 2106 reads NST Infographic

Read More : http://www.nst.com.my/news/2017/02/212607/planning-become-doctor-get-set-burnouts-depression?d=1

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