As the reality finally comes out of the closet, there has been several new updates on the “jobless” scenario of medical and dental graduates. It is also made known that pharmacist graduates are also waiting in the “Q” for their internship in civil service. In the typical Malaysia Boleh style, our government has once again proven how screwed up our human resource planning is. Knee jerk reactions to everything! We will not be in this mess if a proper human resource planning has been done and each ministry communicated with each other. Unfortunately, we were only interested in numbers and ratios. Nasi sudah menjadi bubur!
3 days ago, after some news reports, our DG issued a press statement on the situation of dental graduates. In June 2015, I did write about the situation of dental graduates when the government decided to reduce the compulsory service to 1 year. This year, the situation has become worst as more and more dental graduates begin to graduate, similar to our medical graduates. Most dental schools which started about 5 years ago, begin to produce graduates from last year. Our DG has admitted that we are in a dire situation. Almost 99% of the post has been filled and 980 new dental graduates registered last year. Out of this only 504 graduates has been given placement. The rest is still waiting for almost 6-8 months. Another 1000 graduates will join the rank this year! While I agree that we still need more dentist in this country, poor planning has yet again messed up the situation. While the DG has said that 391 new post will be created this year, would that be enough to absorb everyone? Interestingly, they are also creating 300 contract post. Does this mean that some will be given dental internship on contract and then need to reapply for civil service? Since the compulsory service is only 1 year, the government is not obliged to provide you with a job. How the selection of permanent and contract will be made? It looks like MOH has to become the dumping ground for all the “grandiose” plans of our education ministry in the name of education hub!
ON another news, our Deputy Health Minister has said that they are discussing with JPA to create more MO post to achieve the magic doctor: population ratio of 1: 400. I simply don’t understand the obsession with numbers by our government. How many post can the government create in a year? WE are graduating close to 4000-6000 students every year from now onwards. Would the government be able to create 4000 post every year? From the statement by the deputy minister, it is clear that we are running short of MO post. I heard him talking in the news and he clearly said that it is new MO post that will be created but the news portal reported as housemanship. Housemanship is a rolling post and the number of post in each hospital depends on the number of consultants and number of beds. You can’t simply create HO post as you like. So, what happens after you achieve the ratio? I expect this to happen by 2018 and not 2020 as projected. I just hope that MMC would not succumb to pressure of reducing the compulsory service, as for dentist and pharmacist!
Today our DG made another press statement regarding the housemanship situation. While most of what he said is nothing new except for approving military hospitals as training hospitals from 2017, the last paragraph interested me. It looks like MOH is mooting an idea where the excellent HOs will be given a choice to choose their field of interest as a MO. From what I understand from the statement, this will prevent them from going to district or rural posting and remain in the hospital for their further training. This in turn will shorten their postgraduate training. While we have to wait for proper circular on this, I don’t feel comfortable with the idea. Does this mean, the ones that go to rural and district postings are second class doctors? I had always felt that doing district and rural postings is a good experience. It teaches you a lot in terms of surviving with minimal resources, taking responsibility and learning the socioeconomic situation of people. How the assessment and selection will be done? Will we be creating more apple polishers? Will there be an exit exam? I heard rumours that those who passed MRCP, MRCS Part 1 etc will be given preference. Would there even be a guaranteed job after housemanship in near future when the ratio has been achieved?
Well, we just have to wait and see. Our DG is also working hard to create alternative pathway for specialisation by working with Royal Colleges in UK and Ireland to accreditate training centres in Malaysia. Hopefully it will create more pathways in doing postgraduate training.
Kenyataan Akhbar KPK 6 Mac 2016: Isu Nasib Graduan Bidang Pergigian yang Terpaksa Menunggu Hampir Setahun untuk Penempatan Khidmat Wajib di Hospital Kerajaan
Pada 4 dan 5 Mac 2016, Buletin Utama TV3 telah melaporkan mengenai nasib graduan bidang pergigian yang terpaksa menunggu hampir setahun untuk penempatan khidmat wajib di hospital kerajaan.
Kementerian Kesihatan Malaysia (KKM) sedia maklum dan sangat prihatin di atas isu penempatan graduan pergigian baru. Pada ketika ini, terdapat kekangan perjawatan kosong bagi Pegawai Pergigian di KKM kerana jawatan yang sedia ada hampir keseluruhannya (99%) telah diisi. Seramai 980 graduan telah mendaftar dengan Majlis Pergigian Malaysia pada tahun 2015 dan jumlah ini menunjukkan peningkatan yang amat ketara berbanding dengan tahun-tahun sebelumnya. Daripada jumlah ini, seramai 504 graduan telah mendapat penempatan di KKM. Baki sebanyak 476 telah menunggu selama 6 – 9 bulan dan masih belum mendapat penempatan memandangkan hanya 87 perjawatan kosong untuk diisi. Tambahan pula, kadar atrisi (attrition rate) Pegawai Pergigian pada 2015 adalah hanya lapan peratus (8%).
Peningkatan jumlah graduan ini sebahagian besarnya disumbangkan oleh jumlah graduan luar negara yang telah menunjukkan peningkatan hampir dua kali ganda sejak tahun 2014 (2013: 245 orang; 2014: 447 orang; 2015: 482 orang). Namun, peningkatan ini bukanlah bermakna terdapat lambakan graduan pergigian. Berdasarkan unjuran keperluan Pegawai Pergigian oleh KKM, negara masih memerlukan Pegawai Pergigian. Dengan mengambil kira pertambahan penduduk, jangkaan bilangan graduan dan bilangan atrisi, nisbah Pengamal Pergigian kepada penduduk semasa iaitu 1: 3,000 hanya akan tercapai pada tahun 2018. Selaras dengan itu, pembangunan dan perkembangan fasiliti di KKM juga akan dikaji semula supaya tidak menjejaskan perancangan penempatan graduan pergigian untuk khidmat wajib.
Keperluan khidmat wajib di sektor awam bagi graduan pergigian adalah seperti yang terkandung di dalam Akta Pergigian 1971. Perkhidmatan awam ini merangkumi Kementerian Kesihatan Malaysia, Kementerian Pengajian Tinggi dan Kementerian Pertahanan. Pada masa ini, majoriti (95%) menjalani khidmat wajib di KKM. Khidmat wajib pada dasarnya dilaksanakan supaya bilangan Pegawai Pergigian di perkhidmatan awam mencukupi bagi meningkatkan aksesibiliti perkhidmatan pergigian kepada Rakyat. Selaras dengan perkembangan semasa dan setelah mengambil kira pengeluaran graduan pergigian dari pelbagai universiti dalam dan luar negara, khidmat wajib ini juga dapat memastikan graduan dapat menyesuaikan diri dengan sistem kesihatan negara.
Beberapa pendekatan telah diambil bagi menangani masalah penempatan ini:
- Pengurangan tempoh khidmat wajib
Khidmat wajib telah bemula pada tahun 2001. Pada masa itu tempoh khidmat wajib adalah selama tiga tahun. Dengan peningkatan bilangan Pegawai Pergigian, tempoh khidmat wajib telah dikurangkan ke dua tahun pada 5hb April 2012 dan seterusnya kepada satu tahun pada 1 Julai 2015. Pengurangan tempoh khidmat wajib akan memberi peluang kepada Pegawai Pergigian untuk berkhidmat di sektor swasta dalam tempoh yang lebih singkat.
- Penamatan Pegawai Pergigian kontrak bukan warganegara dan pesara
Sejak tahun 2012, panduan lantikan pegawai kontrak di KKM telah dikaji semula di mana KKM telah menamatkan lantikan Pegawai Pergigian kontrak bukan warganegara dan pesara. Langkah ini memberi laluan pekerjaan kepada graduan baru.
- Moratorium Program Pergigian
Mulai 1 Mac 2013, Moratorium Program Pergigian telah dikuatkuasa selama tempoh 5 tahun sehingga 2018. Salah satu syarat yang terkandung dalam moratorium adalah menghadkan jumlah pengambilan pelajar tempatan kepada 800 setahun.
- Pewujudan jawatan baharu bagi Pegawai Pergigian
Mengambilkira keperluan dan ekspektasi rakyat terhadap perkhidmatan kesihatan pergigian yang semakin meningkat serta pembangunan fasiliti kesihatan yang dinamik, jawatan Pegawai Pergigian baru diwujudkan secara berfasa. Pada tahun ini, sebanyak 391 jawatan pada gred U41 baru dan 300 jawatan kontrak bagi warganegara telah diwujudkan bagi menempatkan baki graduan pergigian tahun 2015 yang belum dilantik. Permohonan jawatan tambahan Pegawai Pergigian akan dibuat secara berperingkat untuk graduan 2016 dan berikutnya.
- Memperhalusi kaedah-kaedah lain
Beberapa perbincangan telah dan akan diadakan dengan pelbagai pihak berkepentingan (stakeholders) termasuk pihak swasta bagi mengkaji kaedah-kaedah lain bagi mengatasi isu penempatan Pegawai Pergigian. Kaedah-kaedah penempatan graduan pergigian akan diperhalusi dengan lebih terperinci sebelum sebarang keputusan muktamad dicapai.
Sekian, terima kasih
DATUK DR. NOOR HISHAM ABDULLAH
KETUA PENGARAH KESIHATAN MALAYSIA
6 MAC 2016
Press Statement DG of Health 9 March 2016: Strengthening The Housemanship Training Programme
The Ministry of Health (MOH) takes note of the concern of various parties involved on the issues and challenges related to the Housemanship Training Programme. Hence, MOH wishes to reassure the public and the healthcare professionals alike that there have been continuous efforts to transform and further enhance the training programme.
Numerous discussions and engagements have been made with various stakeholders from the Housemanship Training Hospitals, top MOH management, and relevant specialists; including engagements with the Ministry’s Clinical Specialists during the Specialists’ Conferences in Malacca (2013) and Port Dickson (2015). Various inputs were also sought from the Malaysian Medical Council (MMC) and Malaysian Medical Association (MMA).
To ensure adequate clinical exposure and good quality of training, the number of public hospitals that offer housemanship training have also been increased from 38 hospitals in 2009 to 44 hospitals in 2015. Several other hospitals will be accredited as Housemanship Training Hospitals in the near future, including Shah Alam Hospital and Langkawi Hospital. Likewise, Royal Military Hospitals were approved for accreditation and will begin accepting House Officers (HOs) from the year 2017.
To enhance their clinical skills, from 2008 the period of the housemanship training has been extended from one year to two years. Prior to 2008, HOs had to only undergo three major disciplines postings but this was improvised to encompass six major disciplines namely Internal Medicine, Paediatrics, Surgery, Obstetrics and Gynaecology, Orthopaedics and Emergency Medicine. To further increase the training opportunities without compromising the quality of training, three alternative postings were also introduced i.e. Anaesthesiology (2010), Primary Care (2013) and Psychiatry posting (2013); thus increasing the number of disciplines from six to nine postings while maintaining the two-year duration of training.
To further strengthen clinical supervision and assessment of HOs, Housemanship Training Committees were established at the hospital level in the relevant clinical departments, and at the State Health Department level. Efforts were also made to improvise the log book to record HO’s clinical encounters and experiences throughout their training in each discipline.
To ensure HOs receive adequate exposure in these postings while improving the working hours’ system for HO, the Flexi Working System was introduced in 2011. The training programme was reviewed further to ensure the HOs will have greater accountability and ownership of their patients. This was done through the introduction of the Modified Flexi System in 2013 where thereon HOs are expected to work 65-75 hours per week and will have adequate training exposure including in Wards, Clinics and Operation Theatres. This system will be continuously monitored and efforts will be made to improve it further from time to time.
To further improve the efficiency of HOs intake into the Housemanship Training Programme, the Public Service Commission have organised the appointment into public service to be done every two months, depending on the vacancy of posts. Since March 2015, MOH has introduced the ‘e-Houseman’ system by which the medical graduates themselves can choose via an online portal, the hospital where they wish to be posted for their housemanship training, subject to vacancy of posts. There will be a shorter waiting period for those who choose to undergo their housemanship training outside of Klang Valley, especially in the more remote hospitals that often have more vacancies. In contrast, medical graduates wishing to be placed in hospitals in bigger cities, with less post vacancies, will most likely have to wait longer.
To assist the HOs in understanding their work better, since 1stSeptember 2014, the HO induction course has been extended from a one-week programme to two weeks. The first week of the induction programme introduces HOs to the expectations of civil servants, integrity, ethics and Medical Acts and various others service issues. The second week involves clinical orientation conducted at each respective Housemanship Training Hospitals.
Moving forwards, the MOH is mooting a fast-track system to shorten the duration of training for HOs who excel in their training, whereby these brilliant HOs will have the possibility of a speedier promotion to become Medical Officers in their chosen field, and subsequently be able to pursue their postgraduate training to become specialists in a shorter duration.
DATUK DR. NOOR HISHAM ABDULLAH
DIRECTOR-GENERAL OF HEALTH MALAYSIA
9 MARCH 2016