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 So, here you are! I remember quite some time ago that I did mention about this issue in my blog. I remember saying that what Najib had promised 1 year ago that all top scorers will be given JPA scholarship remain to be seen.  And now he is saying that he never promised that all will get scholarship to do degree courses and overseas courses. Personally I know that it will never happen as there is always a quota system to follow, no matter what 1Malaysia crap that Najib talks about. Of course most of the complains seem to be coming from the non-bumiputeras compared to bumiputeras. This is simply because most of the bumiputeras who do well are in MARA colleges and boarding schools and will almost always receive either JPA or MARA sponsorship. I also feel that JPA and MARA should stop giving scholarship to SPM leavers. Everyone should do STPM, Matriculation or A-Levels before even applying for scholarship. Only after these Pre-U courses, a student should be assessed for scholarship. I had seen many who did well in SPM but flopped in STPM/A Levels. In fact, looking at our standards of SPM exams now, I doubt the quality of the As!

On another note, I still feel that JPA and MARA should stop sending students to overseas. The government seems to be promoting Malaysia as an education hub etc etc and talking about world-class education but at the same time sending all our top students to overseas universities. Does this make any sense? Only in boleh land! Most countries DO NOT send their top students overseas. They keep them in local universities and make their local universities world-class.

PM: Govt did not promise overseas scholarships to all top students

KUALA LUMPUR: While the Government promises scholarships for all top students, not everyone will be sent overseas, said Prime Minister Datuk Seri Najib Tun Razak.He said the Government was committed to giving Public Service Department (PSD) scholarships to SPM students with results of 8A+ and better.“We didn’t promise that everyone will get overseas scholarships. This is what the public did not understand,” he told reporters here yesterday.Najib said students given scholarships for diploma and matriculation courses were still eligible for degree-level scholarships.“We will guarantee to sponsor students with a degree scholarship. Some people misunderstand that the sponsorship will stop at the diploma level and not be extended further,” he said, adding that the scholarship issue had been discussed with various groups, including MCA, MIC and Gerakan.http://c.brightcove.com/services/viewer/federated_f9?isVid=1&isUI=1

In a statement, PSD said students were chosen according to criteria approved by the Cabinet in 2009 and agreed to last year.

It said it had received 16,900 applications this year.

It said due to limited places and competition, candidates unsuccessful for overseas scholarships were offered courses in local varsities.

The department said 58.8% of overseas scholarships were granted to Bumiputra students while the rest were for non-Bumiputras.

Najib also said the Government would study the National Economic Council report on the electricity tariff review.

On reports that the increase had already been decided, he said: “We will see first. I cannot say anything.”

Najib said the subsidy rationalisation study was not about reducing subsidies but about reducing its rate of increase.

“The subsidies are increasing from the current RM12bil to some RM20bil. This means we have to find an estimated RM8bil, which is not a small sum,” he added.

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I really find this report in The Star today (2nd page) as a big joke and our PM does not seem to know what he is talking about !! Come on, ” the university’s opening would send ripples through the region and be a “phenomenal lure”, adding that it would also attract students from as far as the Middle East and the Indian subcontinent. I mean, really , does he know what he is talking about ?

First of all this is NOT John Hopkins University. It is Perdana University and the degree offered is also from Perdana University with a small caption saying ” in collaboration with John Hopkins University”. Thus, it is NOT an internationally recognised degree. So, how in the hell does this university going to send ripples through the region and be a “phenomenal lure”!! I wonder!

Secondly, it has not even been accredited by the Malaysian Medical Council but the government is willing to send students under JPA scholarship !! WTH!! it is like forcing MMC to accreditate the medical school by hook or crook.

Lastly, I thought this university suppose to be a graduate medical school, meaning that you need a basic degree before enrolling into their medical programme. May I ask how SPM leavers going to enter this medical school with JPA scholarship without having a basic degree? Am I in some dreamland ? Unless you are talking about JPA scholars post basic degree, which is rather unlikely.

I seriously think Najib does not know what he is talking about. Medical schools are different. Untill today, Monash Malaysia is not even recognised in Singapore. I can assure you, Perdana University will also be the same. Having a collaboration with John Hopkins does not change anything. In US, everyone need to sit for an entrance exam irrespective where you graduate from.

Just face it, John Hopkins is here to make money and to benefit their research projects by using patients from Malaysia and the region who are still naive about medical research unlike in US. And our local private medical school under the name of Perdana University is also here to make money. Whose money? tax payers money! I can assure you that most of the students will be JPA or MARA sponsored. Building grandiose buildings does not mean anything without good human resource. Where are they planning to get the academics from, other than pinching from the nearby medical schools!

Please read Page 19 of this Berita MMA(Jan 2011) on an interview with CEO of Perdana University http://www.mma.org.my/LinkClick.aspx?fileticket=Ev5%2bl9i9XNM%3d&tabid=70

PSD students among 100 in first intake for Johns Hopkins

WASHINGTON: The first intake at the Malaysian campus of world-famous teaching and research medical institution Johns Hopkins University will be in September with 100 students.

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I was informed today via my blog by a senior houseofficer that shift hours may be introduced for houseofficers as one of the measures to overcome the overcongestion of doctors in wards!! It seems that our new DG has picked certain hospitals to run a pilot project to see whether it will work. The person who gave me this info asked for my comment and thus I thought it is better that I write about it as a fresh blog posting.

Even though I am not totally surprised with this move, there are pros and cons in introducing shift work duties. Whether this system will work, depends on the size of the hospitals and the total number of housemen in each discipline. Usually there will be 3 shifts; am, pm and night shift. In big hospitals such as JB hospital which has 8 medical wards of 30-40 patients each, you will need at least 4 housemen for each am and pm shift followed by 1-2 housemen for night shift. This means a total of 10 housemen/ward with an additional 2-4 housemen to cover for the off day (which is given for the housemen who does 2 continuous night shift). This works out to be 112 housemen per medical department!! Currently, as far as I know, the total number of housemen in JB medical department is about 50. Of course, with the current increasing number of production of doctors, we may reach the magic number of 100 housemen per department within the next few years. For smaller hospitals which has only 2-4 medical wards of about 40 patients each, the number may be adequate to start shift hour work. However, it is not going to be an easy task. We must also understand that not all wards are active and admitting patients all the time. So, it is going to be very difficult to coordinate this shift duties.

Working shift hour means passing over the management of the patient to another housemen every shift. This will definitely cause a lot of problems in the continuity of care of the patient. The responsibility of the housemen will also reduce, making the doctor more complacent. The housemen who is not interested in being a doctor( you are seeing a lot of these nowadays) , may just take his own sweat time to do all his work so that he can pass over the problems to the next housemen who takes over. This will go on and on untill the patient may not get the treatment that he needs. Politics will become the main issue among the housemen. The hard-working ones will continue to suffer and definitely it will be more difficult for the consultants to monitor these housemen as they will keep changing every shift. The medical officers will begin to complain as they will end up doing all the work but they will not be doing shift work. I feel that in order to introduce shift hour duties, the entire team should change, from housemen to medical officer to consultants, like in some countries. Only then a proper shift duties can be introduced without compromising the care of the patient. This is impossible at our hospitals and with our current system. Introducing shift hour work during housemanship will also compromise the training of the housemen. Less working hours with less exposure to emergencies.

Furthermore, working shift hours means you are NOT entitled for “On Call” allowance. Currently, with housemen required to do 10 “on-calls” per month, this adds on another RM 1000-1200 per month to their salary. Indirectly, shift hours means less responsibility, less work and definitely a pay cut. If these system is successfully implemented in all hospitals, which I am sure will happen sooner or later when the glut reaches a umimaginable level, the JPA would not hesitate to stop the “Critical allowance” of RM 750. Another pay cut , a total of RM 2000/month!!

There is also going to be a lot of headache to each department in organising these shift duties, especially those departments which needs housemen in running outpatient clinics. I wish the department heads, best of luck. As usual, the instruction always come from the top without prior consultations with the people on the ground, the typical Malaysian style!!

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 So, here you are! As I have been saying over the last 1 year, with 33 medical schools in the country we will achieve a ratio of 1: 600 by 2016 and 1: 400 by 2020. We should also not forget about the foreign medical graduates from various countries in the world. Of course, those students who are going overseas for medical educations from 2012 onwards (if the amended medical act is tabled in Parliament by this July), will have to sit for an entrance exam upon returning home. This will be used as a filtering mechanism. After achieving the target (too fast, too soon) , what’s next?

So, for those who did not believe what I have been saying about jobless doctors, please pay attention. It will become a reality. The number of graduates will increase exponentially from now onwards. Almost half of these medical schools have not produced their graduates yet. Furthermore, most of these medical colleges have not achieved their maximum capacity. For example, Monash is targeting 150 students intake by 2012 compared to 100 now. Newcastle is targeting 180 students compared to 40 students in their first batch (currently in year 3).  So, the existing medical schools will continue to increase their intake , if not they will not be able to make any profit.

The worst is yet to come when all these doctors are going to curse themselves for being a doctor. The postgraduate market is very much limited and the private sector is becoming very saturated. Most GPs are not doing well either. I was told that the latest survey showed that only about 30% of GPs are making net profit of more than 6K/month! So, if you are in for the money, please forget it and choose something else rather than wasting your hard-earned money in doing medicine. Put the money to good use. You will never get back what you had invested, trust me!

The government will not be able to provide job to all graduates by 2016/2017. They may introduce an exam to filter out some students. Or you will be asked to serve rural areas for years and you will never be able to say NO. Some graduates may end up in pharmaceutical companies or as paramedics like what we have seen in countries like Thailand, Vietnam and India.

This 5 years freeze is not going to make any difference. God Bless…………….

Five-year freeze on new medical courses effective immediately

By ALYCIA LIM

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For Future Doctors: Malaysian Healthcare System for the Dummies Part 2

 Time flies! I didn’t realise that it has been 2 months since I wrote the first part of this topic on 28/02/2011. Well, I think I had given enough info regarding the public primary healthcare system and it is time to know more about the hospital based public health care system.

 I will divide this topic into 2 parts which consist of district and general hospitals.

Public Hospitals

1)      District Hospitals

Almost every district has a government hospital. Each of this hospital is equipped with 2-7 medical officers, some even as low as 2-3 medical officers, especially in rural areas of Sabah and Sarawak. There are 2 types of district hospitals: with and without specialists.

 In some bigger districts like Segamat and Kluang in Johor or Kuala Pilah in Negeri Sembilan, there will be at least 1 specialist in each basic discipline. These hospitals are also equipped with Operating Theatres to perform minor surgeries. There are also some district hospitals which may function as a general hospital such as Muar/Batu Pahat/Seberang Jaya/Teluk Intan et etc.

 However, most of the smaller District Hospitals are manned by Medical Officers, mostly who had just completed their housemanship. Almost all of these hospitals do have basic diagnostic capabilities such as routine blood investigations, basic X-ray imaging except Ultrasound and facilities to do Forcep and Vacuum delivery. As such, it is presumed that any MO who is posted to these district hospitals should have the competency to diagnose and treat common medical conditions. This is where some major issues arise. There are practically no senior doctors to supervise you or to teach you any procedures, except an MO who is probably at the most 3-4 years senior to you. You may have Visiting Consultants from the nearest general hospital on a monthly basis to run a clinic and to see some non-urgent referrals. Any case that the MO feels cannot be managed in these hospitals, need to be transferred/referred to the nearest general hospital. However, you need to realise that whatever necessary procedures or treatment that need to be done has to be done immediately before transferring the patient as the journey may easily take 1-2 hours in an ambulance!

 There are also certain limitations for doctors who are working in a non-specialist based district hospitals. This is mainly concerning the drugs that a MO can prescribe as I had mentioned in my Part 1 of this topic. Only drugs that are listed as List B and C can be prescribed by an MO. No list A drugs can be prescribed which includes many antibiotics and antihypertensive drugs.

 In smaller district hospitals, only 1 MO is “on-call” each day and during this “call” you need to cover the whole hospital, including the emergency department, wards and labour room. Usually, the medical assistants and nurses will do most of the necessary early management before calling you. In a busy district hospital, it can really be very stressful. Imagine, while you are attending a case in emergency department, the labour room calls you to do a vacuum/forcep delivery? It is basically a one man show during the night and you need to put whatever you had learned as a HO to good use. This is the reason why housemanship is such an important posting in Malaysia as immediately after that you can be thrown to a district hospital to run the show. Remember, you are dealing with lives and can’t afford to make mistakes!

 Some district hospital, especially those in Sabah and Sarawak are situated quite deep into the interior that you need to do certain surgeries including Caesarean sections, acute abdomen surgeries etc. Usually the anaesthesia is given by Medical Assistants’ trained in giving anaesthesia. Thus, it is important for doctors who are going to be posted here to know how to do certain surgeries.

2)      General Hospitals

 Every state has a general hospital. It used to be known as Hospital Besar but over the last 10-15 years, the names were gradually changed reflecting the state’s monarch. Each of this hospital is usually well equipped with all basic specialities. Some of the hospitals also have subspecialties including cardiology, neurosurgery, gastroenterology etc. They are also well equipped with diagnostic laboratories and imaging such as CT scan and even MRI.

 Most of this hospital are overcrowded and congested with patients. Each ward can have between 40-60 patients at any one time. These are also the hospitals that are used to train housemen and postgraduate students. The workload is extremely high and stressfull due to patient load and lack of specialists. The standard of care is definitely not up to any international standards but can’t blame the doctors. Imagine receiving 30-50 new admissions in just 8 hours when you had not even finished the day’s ward round. Of course, this is in reference to general medical wards but the situation may be better in smaller disciplines. The clinics in these hospitals are also another “mad house” or shall I say “fish market”.

 You may find some General hospitals being more relaxing than the other. This depends on the state and the number of big hospitals that are available. For example, in Perak, you have 3 big hospitals with specialist service namely Taiping, Ipoh and Teluk Intan which dilutes the number of patients.  However, when I say more relaxing, don’t assume that you can shake legs and relax! Most of the time, the patient load is almost the same in most general hospitals but the doctor load varies. Some popular hospital may have better number of doctors compared to others. For example, most hospitals in Klang Valley have adequate number of doctors but same can’t be said about Johor Bahru or Sabah. The maldistribution of doctors is a major problem in Ministry of Health where cables and strings are used by certain people to prevent themselves from being transferred out. Thus, you will find many hospitals in Klang Valley being well equipped with doctors so much so, some of them can even go missing in the afternoons. I will discuss more about this in my last part.

 Next………………….. Private health care system

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I received a few jokes in my email recently as well as in my blog comments, regarding the quality of our current doctors. I was told that these were real incidents that happened to some of the doctors in Malaysia and if it is true, I am really speechless!! It may give us a good laugh but at times you probably have to cry thinking that these are the people who are going to treat us sooner or later. The last one for sure is a true incident in a local private university!

Incident 1:

HO#1: The bloodbank did not have any blood to send up for this patient.
MO: How can that be? No blood at all?
HO#1: No, they said completely zero. They even confirmed it with a +.
MO looks at the chart to verify. Written on the chart was O+.

Incident 2:

MO: Patient is low on Vit B12. Please order this for the patient.
The next day:
HO#2: The pharmacy did not have any Vit B12. But I took care of the problem. I gave the patient 2 doses of Vit B6.

Incident 3:

 A patient with severe pleural effusion was admitted with respiratory distress. A medical officer asked a houseman whether he know how to perform a (pleural) tapping or not? Unsurprisingly, the houseman answered yes confidently. The MO then went to attend other cases.

Half an hour later, he came back and saw the houseman repeatedly “tapping” the patient’s back with his hand!

Incident 4:

A local private university was conducting their Formative OSCE examination for Year 4 students(this is a true story!!). The student suppose to interview a simulated patient(SP) for minor depression:

Med Student: Do you have any suicidal intention?

SP : No

Med Student: Why Not?

SP: @#%$^

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Hafiz Yatim
Apr 19, 11
4:39pm

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I wrote about this college way back in January and I thought they would have found a solution , BUT looking at today’s Page 2 of Star, it has not been solved yet!! As I have mentioned before, MMC had derecognised Cyberjaya Medical College as off Dec 2010 (http://mmc.gov.my/v1/docs/Jadual%20Kedua%2011-02-07_Website.pdf). If the status does not change by September, their graduates for this year will have to sit for the MQE exams. I was informed that the final year students has been told about this possibility.

However, I am sure within the next few days, our great politicians will be jumping into the fray to defend their citizens, since it has appeared on the 2nd page of Star and MARA/JPA scholars are affected. They seem to be busy with sex videos and “erections” this year. MMC will probably keep quiet and recognise the college again by September. I hope I am wrong and I hope the MMC will keep their standards and audit many more of the medical schools in the country. If anyone really look into some of  these medical schools in this country, you will be shocked on how they cheat the people with all their part-time lecturers. The number of full timers will be pathetic! Some college just throws the students to the attached hospital and hope the hospital’s consultants will teach them in the wards. Unfortunately, that does not happen as they are too busy!

Students still in limbo as medical college seeks to rectify quota error

By RICHARD LIM
educate@thestar.com.my

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 This is an another article that appeared here http://goodtimes.my/index.php/Education/shortage-of-trainers-of-doctors.html. There are people who still don’t believe that we are going for a glut soon. Well, it is all up to them. I still get a lot of quarries from budding doctors after the recent SPM results. What I can see is that, many of them had already decided to do foundation studies with guaranteed seat for medicine. What they don’t understand is the fact that all these are a money-making business. I pity for these students who are being cheated into doing medicine by an easier route without strict quality control. They don’t seem to know what lies ahead of them.

Shortage of trainers of doctors

There is a scarcity of medical officers to train the glut of house officers (housemen) in local hospitals. The ideal ratio of trainers to housemen is 1:4 but in some cases the ratio is more, thus affecting the quality of training specialists.

Commenting on the issue, the Malaysian Medical Association (MMA) agrees there is a shortage of trainers to housemen.

“The MMA maintains that we do not have sufficient trainers and supervisors and quality teachers and professors or specialists to help train this big number of medical graduates,” MMA president, Dr David Quek, says.

The former Director-General of the Ministry of Health (MOH) Tan Sri Dr Mohamed Ismail Merican also says that while the ideal ratio of specialist to housemen was 1:4, “if all specialists in MOH double up as trainers and are willing to teach avidly, we should be ok. We are allowing 1:7 or 1:8 for clinical teaching.”

Quek feels that many medical schools simply side-step the criteria by employing junior and temporary staff to fill the required quota. 

“The Malaysian Medical Council (MMC) and the Malaysian Qualifications Agency (MQA) make periodic visits and review these schools, but we are increasingly concerned as to the quality of the graduates due to the barest minimum quality of the teachers,” Quek says.

The glut of housemen is largely due to the fact that the Government has increased the number of accredited medical schools, both locally and overseas in its efforts to reach developed nation status.

The Deputy Health Minister Datuk Rosnah Abdul Rachid Shirlin had announced last year that Malaysia had not met the minimum doctor-population ratio of 1:600 set by the World Health Organization (WHO).

The MOH had also declared that under the 11th Malaysia Plan, the ministry will move towards achieving a doctor to population ratio of 1:400, on par with most developed nations, by the year 2020.

Quek thinks that the government’s efforts to achieve a doctor-population ratio of 1:400 is happening “too quickly, too soon”.

“We feel the MOH is too focused on an unrealistic bureaucratic target and Key Performance Indicator (KPI) which is not keeping with the best universally accepted standards.

Houseman at work … there are over 3,000 housemen overpopulating 41 training hospitals in the country. (Picture courtesy of Loo Kar Yee)

“This sort of 1:400 ratio is only achieved over decades in most advanced countries in the world and never rushed as if these were factory produced merchandise to cater to suddenly thought up demand!” Quek says.

Merican, through an email interview, described some of the steps the MOH had taken to solve the problem of the shortage of trainers in the country.

He said the MOH had brought in 468 foreign doctors and specialists from various countries, appointed on a contractual basis, to serve as trainers as well as to fill in vacancies in several smaller district hospitals.

The number of slots available for the local Master’s programme was also increased to produce more specialists. MOH has also accredited another five hospitals for housemen training in addition to the 41 training hospitals available in the country.

It has also increased the mandatory posting for house-officer training from three disciplines to six in 2008. The six disciplines are Internal Medicine, Pediatric, Surgery, Orthopedic, Obstetrics and Gynaecology and Emergency Medicine

Last year, Anesthesiology was introduced as an alternative posting to Emergency Medicine to ensure a more comprehensive exposure for housemen.

MOH also introduced the “Mentoring Junior Doctors” course which aims at “strengthening the capabilities of housemen trainers”.

However, not all trainers agree that the steps taken by the government has produced the desired results.

A medical officer pursuing his specialist degree in a public hospital, feels that hiring foreign doctors will pose more problems in the long run as it will take away job opportunities for local doctors.

“It is very wrong, to bring in foreigners and forget our own people,” he says. 

According to him, the low salary doctors in the public service earn, compared to those in the private sector is also another factor that is driving specialists away from training hospitals.

He added that for every extra shift he does, he gets an extra RM150 and if he has to work on a weekend or a public holiday, he gets an additional RM20.

“That’s about RM6 per hour. One of the reasons why there are so few specialist trainers is because they have either ‘jumped’ to private hospitals or gone overseas where the pay is better. 

“My father served the government as an agricultural engineer, but he had to ‘jump’ (move to a private company) to pay for my education.” He says he will do the same should the need arise in his family.

Another consultant in the field of pediatrics from a local hospital believes it is the state of under-equipped medical schools which is a more serious problem than the lack of an adequate number of trainers.

A specialist trainer, herself, she related an incident where a house-officer recommended a patient “traditional treatment”, instead of modern medicine to cure his illness.

She had also encountered many other under-qualified, ill-equipped housemen who “could not even answer the most basic questions about medicine”.

Frustrated with the lack of quality, especially among graduates from newer and smaller medical schools, she feels that the right step is to deregister some of these schools and de-list some of the foreign medical schools that have been producing “half-baked housemen”.

Quek feels the low quality of housemen is due to the fact that medical schools can be set up upon meeting only the minimum of standards.

“Many of the officials argue that the quality of medical schools in this country is inadequate, because all the medical schools so far meet the minimum standards or criteria set out by the MQA,” he explains.

He feels it would be better to cut down on the number of medical schools to ensure producing better quality housemen.

“Australia and the United Kingdom had produced too many doctors in the past decades and has since scaled back by amalgamating or closing down medical schools,” he says.

Perhaps the government should take a note from these “already developed nations” and see that quantity does not ensure quality.

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I saw a sudden surge in the number of people visiting my blog lately and I realised that SPM results were just released on 23/03/2011. On 26th March, I had the highest number of people visiting my blog in a day for this year, a total of 1300 people. Since the 2010 SPM result is the best  in 5 years( it seem to be getting better every year!!), I am sure almost all the top scorers wants to become a doctor, without realising what is in store for them. Probably in another 10 years, we will have the smartest students in the world with everyone scoring 10As!! What a joke! It use to be only 2-10 students scoring 8/9As in each state those days . Either our students are getting smarter day by day or our standards are dropping drastically? I think it is the latter.

In order to make it easier for the students to read my articles on “For Future Doctors” , I have copied all the links below. Please also read all the comments in each of the postings. You can also read all my articles under my education page.

https://pagalavan.com/2010/09/07/for-future-doctors-general-misconception-of-being-a-doctor-part-1/

https://pagalavan.com/2010/09/08/for-future-doctors-general-misconception-of-being-a-doctor-part-2/

https://pagalavan.com/2010/09/21/for-future-doctors-housemanship-medical-officer-and-postgraduate-training-part-1/

https://pagalavan.com/2010/10/10/for-future-doctors-housemanship-medical-officer-and-postgraduate-training-part-2/

https://pagalavan.com/2010/11/11/for-future-doctors-housemanship-medical-officer-and-postgraduate-training-part-3/

https://pagalavan.com/2010/12/12/for-future-doctors-housemanship-glut/

https://pagalavan.com/2011/01/02/for-future-doctors-what-if/

https://pagalavan.com/2011/01/09/for-future-doctors-quality-first-not-quantity/

https://pagalavan.com/2011/01/10/for-future-doctors-medical-licensing-exam/

https://pagalavan.com/2011/02/28/for-future-doctors-malaysian-healthcare-system-for-the-dummies-part-1/

https://pagalavan.com/2011/03/19/for-future-doctors-step-by-step-approach-to-subspeciality-in-medicine/

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