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6 months ago I wrote my first part. 2 months before that, I wrote an article titled ” Passion vs Debt” when some students gave some nasty comments in my blog after the AUCMS loan fiasco issue that I brought up. I had always said that no matter what passion you have, in the end, medicine is just another job to earn a living. No one is going to come to your assistance when you got no money. Just because you help safe some lives does not mean people will come to your help when you are left with nothing. It is a capitalist world.

It is also naive to think that doctors are job guaranteed. I had explained enough in this blog. Frankly, there are close to 50K doctors in this country. How many do you see driving big cars and staying in big houses? Probably less than 10%. Isn’t that the same figure for any other profession? Furthermore, most of these doctors are still working 24 hours a day, 7 days a week. The public perception is usually biased towards what they see you having externally. They never see or want to see what happens behind the stage. That’s why many quit medicine after graduating. Never do medicine for wrong reasons!

Few days ago, a philanthropist made an announcement that he is willing to give free additional scholarship to those students whose parents are earning below Rm 4K/month.  Not even 3 days later, he was shocked and amazed to receive close to 50 applications, almost all wants to do medicine (see below)! Thus, today, he wrote an interesting article asking these students and parents to wake up to reality. He had decided not to give scholarship to those who apply for medicine. Well, this is the very reason why I started this blog almost 6 years ago but yet again, no one listens. Every now and then, I too receive phone calls from students and even parents asking for financial assistance. Almost always the students will be doing medicine and already registered for 1st year. However, she/he is unable to pay the tuition fee for the 2nd year. When I ask them what happens for third year if you can somehow manage to get your fee for 2nd year, they almost always can’t answer. I find it ridiculous at times.

No matter how cruel and harsh it may sound, we are living in a capitalist world. Money talks. If you can’t afford to get scholarship, please do not do something that will lead you to huge debts. Never forget the house loan, married life and car loan that will come along the way. We just have to accept the reality and pursue what is affordable. Success in life comes in many ways. The philanthropist above is an engineer who built 2 conglomerate. How many doctors do you see becoming a philanthropist? How many doctors do you see retiring early at age of 40-50 and going for holidays around the world and being financially independent?

Our students lack in financial literacy. They are too dependent on family to the extent that they don’t understand what life is all about. Passion is one thing but living a life is another. At the end of the day it is all about money and living a life. Even in UK, doctors are going for  a strike to challenge the government in reducing their income as mentioned in this blog before. I had warned many times that we are producing future generations with huge debts. Again this was brought up by another newsportal today.

Happy New Year 2016 to everyone. Sure we have a tough year ahead……….. while I publish my first book……….

Be realistic in your pursuit of a medical degree

January 10, 2016

Students should consider other courses such as accountancy, finance, engineering, marketing etc.

By Koon Yew Yin

Since the publication of my scholarship offer to help students whose parents are earning less than RM4,000 per month a few days ago, my wife has received more than 50 applications for financial help and most of the applicants want to pursue a medical degree which costs the most.

The sole purpose of writing this article is to help inform students who wish to study medicine not to apply for my financial assistance.

There are 40 Medical Colleges and about 500 Universities and Colleges in Malaysia. All of them are lowering their entry requirements to compete for more students.

Tuition Fee for a Medical Degree in Malaysia is between RM250,000 to RM1 million:

Among the cheapest are:

• University Tunku Abdul Rahman (UTAR): RM255,000

• AIMST University: RM250,000.

Among the mid range are:

• Asia Metropolitan University (AMU): RM300,000

• MAHSA University College: RM300,000

• Malacca Manipal Medical College (MMMC): RM348,000, Monash University Sunway: RM455,000

• Newcastle University Medicine Malaysia (NuMED): RM450,000

Among the more expensive are:

• Penang Medical College: RM650,000

• Perdana University offers the following: Royal College of Surgeons Ireland: RM800,000, John Hopkins University School of Medicine: RM1,000,000

All the above mentioned fees exclude accommodation, books, traveling costs, food and other expenses which could easily add another RM100,000 to the total cost of studying medicine.

A student will require at least RM350,000 to complete a medical degree. Assuming he can get a RM150,000 PTPTN loan, he will still require RM250,000.

Is it really worth pursuing a medical degree in Malaysia with such high fees?

It is compulsory for all medical graduates to practice in a government hospital for five years to complete their housemanship.

During this period their salary ranges between RM2,600 to RM4,000. As housemen they work for a minimum of 12 to 15 hours a day. After two years, their salary increases gradually to RM4,000 per month.

When they are promoted as medical officers their salaries range between RM4,500 to RM5,000. After the final year they have an option to continue their career in the government service or private concerns.

However, after 12 years and spending a minimum of RM350,000, is it worth it just to earn RM5,000 to RM6,000 per month as a doctor?

They must remember that they have to pay back the RM150,000 PTPTN loan at RM2,000 per month for about 20 years.

An alternative proposal:

I like to suggest to these students to consider other courses such as accountancy, finance, engineering, marketing, etc. The tuition fee for a one year foundation course is RM8,500 and for a 3 years degree course is about RM38,000 in UTAR. The fees for all government universities are less than RM20,000 for a degree course.

All students whose parents are earning less than RM4,000 per month can apply for my scholarships worth RM15,500 to cover the one year foundation course fee and the cost of living. After the completion of the foundation course, all students are entitled to receive PTPTN Government loans to complete their degree courses.

Since I made the offer to consider helping students who find the PTPTN not sufficient, my wife has received more than 50 applications in 2 days and most of the applicants want to study medicine. We found that most of the applicants are not realistic. They are poor and with poor results they want to study medicine.

With the PTPTN loan, the parents need to subsidize a small amount to complete their degree courses with the exception of a medical degree. If the parents are really poor, I am willing to consider helping them. My offer to help students doing degree courses has opened the door for all students in the country. But the students must be realistic. In any case, we reserve the right to reject any application for financial help.

Note: All scholarship recipients do not need to work for me or pay back the money I spent on them. But they must promise me that they will remember I helped them when they were poor and when they are financially solvent they must help other poor students. I believe many graduates will continue to help poor students when I die. Since I started offering scholarships about 10 years ago, I have given out about 300 scholarships and a large number of the recipients have graduated.

Koon Yew Yin is a retired civil engineer and one of the founders of IJM Corp Bhd & Gamuda Bhd.

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 personal opinion. FMT does not necessarily endorse the views or opinions given by any third party content provider.

READ MORE: Philanthropist Koon offers scholarships to needy

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Day by day, the waiting game seem to be getting more interesting. Right from the beginning of this year, we knew that fresh graduates are waiting for a period of 4-6 months to get a Housemanship post. We also know that MOH has stopped any foreigners, even if you are married to a Malaysian from getting a Housemanship post. I know a person who spend time and money sitting for MQE last year only to be told to take SPM BM paper in order to get a job. She went on to do her SPM BM paper and passed ( she is an Indonesian). Unfortunately, after going through all these hurdles, she was yet again told that jobs will not be given as they do not have enough post, even for Malaysians.

Today, our DG aka Chairman of MMC has issued a press statement. The statement says that due to long waiting time to start Housemanship, provisional MMC registration will ONLY be given once your job and posting is confirmed. Till then only a letter stating that you are eligible for provisional registration will be given for submission to SPA/MOH.

This basically proofs once again that more and more housemen are being retained for poor performance and competency which is making the waiting period even longer day by day. By 2016, all medical schools in Malaysia will be producing graduates. This will further increase the numbers which will create a bottle neck into housemanship. As I predicted almost 5 -7 years ago, the year 2016/17 will be the year when this will happen. We will be flooded by medical graduates!

The Star went a step further by saying that all medical graduates will be screened before being offered a job. I feel they interpreted it wrongly. All graduates have to undergo SPA/PSC interviews before being employed into civil service. It is a standard procedure. It is nothing new but the The Star make it look like it is never done before.

The statement by DG is quite clear that Provisional Registration will only be given once your job and posting is confirmed. The only hidden message I can sense is that ” job may not be guaranteed” soon!

Now, didn’t I say so!

 

Kenyataan Akhbar KPK/YDP MPM 29 Dis 2015: Penyelarasan Pengeluaran Sijil Pendaftaran Sementara bagi Graduan Perubatan

Posted on December 29, 2015 by DG of Health

KENYATAAN AKHBAR

 

KETUA PENGARAH KESIHATAN MALAYSIA

 

PENYELARASAN PENGELUARAN SIJIL PENDAFTARAN SEMENTARA BAGI GRADUAN PERUBATAN

Majlis Perubatan Malaysia (MPM) dalam mesyuaratnya yang ke-347 pada 15 Disember 2015 telah membincangkan dan mengambil maklum bahawa semua graduan perubatan perlu menjalani temuduga yang dijalankan oleh pihak berkuasa Suruhanjaya Perkhidmatan Awam bagi tujuan mendapatkan pekerjaan sebagai Pegawai Perubatan Siswazah (Gred UD 41).

Mesyuarat juga mengambil maklum bahawa pada masa kini terdapat sejumlah Pegawai Perubatan Siswazah yang sedang menjalani latihan siswazah di hospital-hospital Kementerian Kesihatan Malaysia, gagal menyempurnakan latihan siswazah dalam tempoh yang ditetapkan dan terpaksa melalui pemanjangan tempoh latihan oleh kerana pelbagai sebab; antaranya adalah masalah kompetensi dan juga masalah kesihatan.

Pemanjangan tempoh latihan siswazah telah menyebabkan ‘backlog’ Pegawai Perubatan Siswazah yang sedang menjalani latihan di hospital dan telah menyebabkan kemampuan untuk mengisi kekosongan jawatan gred UD 41 bagi tujuan latihan menjadi amat terhad.

Keadaan ini menyebabkan graduan perubatan terpaksa menunggu bagi tempoh yang lebih lama bagi mendapat peluang untuk dilantik menjalani latihan siswazah.

Dengan mengambil kira faktor yang tersebut di atas dan selaras dengan peruntukan Seksyen 12(1)(b) Akta Perubatan 1971, MPM telah menetapkan bahawa:

  • Proses pengeluaran Sijil Pendaftaran Sementara kepada graduan perubatan diselaras dengan keperluan Seksyen 12(1)(b) Akta Perubatan 1971, iaitu Sijil Pendaftaran Sementara (Provisional Registration) bagi tujuan menjalani latihan bagi memenuhi keperluan di bawah Seksyen 13 Akta Perubatan 1971 hanya akan dikeluarkan kepada mereka yang dapat menunjukkan bukti bahawa mereka telah dipilih dan ditawarkan untuk bekerja sebagai Pegawai Perubatan Siswazah (Gred UD 41) bagi memenuhi sebagaimana peruntukan Seksyen 13(2).
  • Sehubungan dengan itu, tatacara pengurusan permohonan Sijil Pendaftaran Sementara bagi memenuhi keperluan peruntukan Seksyen 13 telah dikaji semula, di mana semua permohonan yang layak akan diberikan satu surat memaklumkan bahawa mereka layak dipertimbangkan untuk Pendaftaran Sementara dan tertakluk kepada mereka dipilih dan ditawarkan jawatan Pegawai Perubatan Siswazah sebagaimana yang diperlukan di bawah Seksyen 12(1)(b) Akta Perubatan 1971.
  • Sijil Pendaftaran Sementara bagi membolehkan mereka menjalani latihan sebagai Pegawai Perubatan Siswazah di hospital KKM hanya akan dikeluarkan setelah graduan berkenaan mengemukakan surat tawaran bahawa mereka telah ditawarkan jawatan Pegawai Perubatan Siswazah.

Penyelarasan proses pengeluaran Sijil Pendaftaran Sementara kepada graduan perubatan dilakukan bagi tujuan mengemaskini proses dan juga bagi memastikan pematuhan kepada Akta Perubatan 1971.

 

DATUK DR. NOOR HISHAM BIN ABDULLAH

KETUA PENGARAH KESIHATAN MALAYSIA

Merangkap YANG DI PERTUA MAJLIS PERUBATAN MALAYSIA.

 29 Disember 2015

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Year-end is always a busy time for me. Accounts to settle, children’s exams, meetings and holidays. Over the last few months, I have been writing about debts, UK crisis and job opportunities. Interestingly, there have been reports in news portals regarding debts that Malaysian students are collecting. In my last article, I attached a report stating that Malaysia’s Gen Y are living on the edge due to debts. Subsequently, few more reports emerged over the past few weeks.

Malaysian Insider quoted report from Asia One that Malaysia is the 5th most expensive country to do a degree program, in relation to household income. This is not surprising at all. That’s what happens when you commercialised education. It seems Malaysian parents spend 55% of their pay in allowing their child to finish university. The average tuition fee quoted was RM 77K. This is way below any medical course tuition fee, which can reach close to a minimum of 300K. Imagine the amount of debt if you do not get any scholarship. As one of my colleague said, medicine is only for the rich and for those who receive scholarship. Taking huge loans to do medicine is not worth it! Just few days ago there were some interesting advertisement about loan for wedding (nothing new actually)! We are really creating generation in debt! From study loans to car loan to wedding loan and house loan! Do we have anything left to feed ourselves!

It is also interesting to know that unemployment is higher among the highly educated people in Malaysia. This is also nothing unexpected. The higher you are educated, the choosier you become. Imagine, once jobless scenario hits the medical field, how many of these graduates will be willing to work in another field? Everyone will be blaming the government and colleges. There was an interesting write-up in Medical Journal of Australia (MJA) (see below) regarding job opportunities for doctors who can’t get a job or training post. This was a follow-up article to this article (see below) which confirms that Australia is facing the same crisis as any other country. Doctors are finding it difficult to get a permanent job and training post. He has given some suggestions, which I don’t think many would be interested (see the comments as well). At the same time, he also feels that the situation may get better later, when people stop doing medicine. The cycle repeats itself but it definitely does not console those who are already in the situation now. Trust me, there is NO job security anymore for doctors. Parents and students should remove that from their perception and just consider medicine as another job where nothing is guaranteed. The only setback in medicine is the fact that you would have spent huge amount of money (if not sponsored) and would never be able to practise as a doctor without completing housemanship. No training post means, no hope for further advancement.

IN the UK, as I had written on 2/10/2015, doctors took to the streets to protest against the change of working hours and income. Another protest was conducted on 18/10/2015. The UK crisis once again proved to us that at the end of the day, what matters is your income and how you are going to live a life. No matter how much passion you have, living a life is another story all together. Most of the cries of UK doctors were based on their income and survival. How they are going to feed their children, how they are going to lose their family time and how are they going to settle their debts etc? As I had always said, in the end, it is just another job to earn a living. Whatever passion you presumed you had will be thrown out of the window. Only real passion can pull you through. The Health secretary of UK has finally took back some of the statements he made regarding working hours. However, change is definitely coming to NHS. You can read the other articles in The Guardian news.

The world of medicine is not the same anymore. Patient’s demands are high, huge debts to become a doctor, increasing litigations and increasing risk of being unemployed. Not enough with these issues, we now have to compete with traditional healers, anti vaccine movements, home births, religious and non-religious supplements etc. Patients rather trust these guys than us, who had spent years studying evidence based medicine. Below I attach a Facebook post of a “crying” doctor:

IMG_20151101_220959

It is the same thoughts that run through my mind. Over the last 20 years since I started my medical career, I am seeing increasing number of patients who trust all these “non-western and natural ” based treatment. No matter what you tell a patient, he will always consider you as a person who is making money by selling drugs/chemicals for profit-making pharmaceutical companies. Patients rather spend thousands of ringgit buying a product that supposedly can cure Diabetes and Hypertension. But, do they sue the seller if it does not work? The answer is NO, because you bought the product voluntarily and there is no written agreement between you and the seller on what he had promised. We have various magic drugs being promoted in Internet and even at roadsides, which can cure your Gout, Body aches and Joint pains. Almost all of these pills contain high dose steroids. Instant cure and pain relief is definite. Who are you to say it does not work? Most patients get a shock when I asked them how long have they been taking traditional medicines whenever they walk into my room. The first question they ask “ How do you know?” The answer is right on their face: “Cushingoid” facies!

15-20 years ago, I hardly hear anyone rejecting vaccination. Only a small group of people belonging to a certain religious sect refuses vaccination. Now, we have groups of people who openly rejecting vaccination claiming it is a Jewish plot, causes brain damage etc. We even hear stories that it is a Jewish and Christian plot to poison the Muslim community! Sometimes I do not know whether to laugh or cry but what shocks me further is the fact that there are people who actually believe all these nonsense, even the educated ones. Now, we are beginning to hear cases of Diphteria, Measles and Pertusis increasing day by day. TB will be the next epidemic. Parents are putting their child in danger. Should we create a law to punish these parents? While it is their right to take whatever treatment offered, spreading infectious disease can also be considered as a crime! Some countries have started to remove certain benefits from unvaccinated parents such as reducing tax relief, isolating them in schools etc. Proponents of home birth are another group that is increasing day by day. I had talked about it before.

Frankly, day-by-day I am losing interest in treating patients. The art of medicine is dying. Almost 5 out of 10 patients do not take your advice nor compliant to your medications. We are seeing younger and younger Diabetics and Hypertensives but do they care? WE will be seeing more and more complications from these diseases in years to come. We hoped that as the population gets more educated, we should be seeing fewer complications of chronic diseases but it’s the opposite that we are seeing. Patient feel that it is their right to do what they want as it is their life and body. Who are you to tell them to take medicine? Gone are the days when the community regarded doctors’ advise as golden! This write up from a Malaysian doctor in US is worth reading. That’s exactly what is happening over here as well.

Patients demand that investigations must be done to prove their diagnosis. Do we have test to prove everything in medicine? That’s where clinical skills come into the picture. A good clinician can diagnose a condition from history and examination alone. But patient will never trust you as long as you can’t provide a proof of your diagnosis. Tell them it’s Viral fever and they would want you to show the proof of the type of virus that infected them! These are the type of patients you are seeing nowadays. Tell them the liver derangement is caused by Dengue Fever and they will demand an answer why the liver enzymes are going up despite taking treatment from you! For those who think can do wonders by being a doctor, please understand that doctors don’t cure anything. We are just supporting the body to heal itself. Most of the time we are just buying time. The body will decide which way it’s going to go: recover or succumb! No surgeries are without complications but most patients nowadays do not except that fact either!

The comment below which appeared in my blog few days ago is worth reading:

“Interesting read Dr Paga.
I am amazed by your patience in answering questions here. I think you must be a good and patient doctor!

Anyway, when I was in medical school many years ago, I was already worried about job security and it was not like we have over 30 medical schools in Malaysia back then as it is now.

I think young people will need to look at themselves honestly and not just jump on the bandwagon and try to do medicine just because everybody think it is the right think to do and it is best way to earn money.

If you do something passionately, very likely you will succeed no matter what profession. Need not be medicine.

I used to be a top student in my school and naturally I studied medicine (because I thought that was the best thing to do!). My brother never understood science and he did law. My sister was an average student and did finance. Both of them are far more successful financially than me. Fortunately I have no aspirations to be a very rich man but I do enjoy what I do.

If you want to be rich and successful, you may be disappointed if you think medicine is the answer. Malaysia has very little control system and they allow all sorts of medical schools to sprout out.

UK has twice the number of people as Malaysia and is a far richer country and yet we have more medical schools than them. Something is not quite right.

So my advice is, if your real passion is to be a doctor, to be sensitive and compassionate with people, please go ahead and try your best if you have the means. Going to a good and well-recognized medical school is important. After leaving medical school for over 15 years now, I can still remember the basic medical science taught well to me but many housemen, fresh out of uni, can’t remember a thing!

If you need your dad to sell the house and car for you to realize this dream, you may need to think twice, because you will not necessary return a multi-millionaire to repay him.

If you want to become a doctor because other people tell you it is good, you also need to think twice. Life of a doctor is not for everyone and not everyone will be successful. You may see some successful ones but many are struggling too.

I always like to bring my brother as an example. He is hopeless in studies but can talk and argue really well. Today he is a very successful lawyer, earns easily 5 times more than me !!”

Well, it is time for me to take another break to release my stress. This would be the only article I will likely write for this month. I will be away next week with my parents for Deepavali. A week after that I will be exploring Middle Earth for 2 weeks. Hopefully, when I return early December, my mind will be fresh to start the cycle all over again!

Happy Deepavali to everyone………………..

Simon Hendel: Job opportunities

Simon Hendel

Monday, 2 November, 2015

MORALE is low and burnout across medical specialties is high. In part, this is fuelled by the constant worry about job security for junior doctors. 

 Some doctors who complete their training struggle to find regular work in the public sector for reasons too complex to detail in this short article. As discussed in MJA InSight last week, many junior doctors might not be able to even get a training place.

 However, the lack of job security for junior doctors is likely to be part of normal cyclical workforce patterns, which indicates we shouldn’t be too worried. However, that offers little consolation to new practitioners who can’t find work now.

 Doctors looking for work and those feeling uncertain about their job security often fear that if they deviate from the “normal” training conveyer belt they will be further disadvantaged and passed over in the competitive workplace. 

 I would like to challenge that notion. 

 Medicine as a profession is always changing. New evidence is regularly discovered that informs and changes the way we all practice. These changes are vigorously and appropriately debated. 

 There is no reason to think that significant changes in our workforce should be met with any less critical debate. In that debate, one thing that all practising doctors can be sure of is that workforce changes, like changes in practice, are inevitable. 

 And that change is hard. 

 No other professional graduates have job certainty and few other professions ever have the job security that we have enjoyed. Yet medicine also requires a level of personal sacrifice that is quite different to most other professions. So it’s understandable that this change to a less certain job future is a bitter pill for us to collectively swallow. 

 But it doesn’t have to be.

 Amid change there is opportunity. Junior doctors now have more opportunities than their predecessors to shape the way they balance their life with work. And this is the real elephant in the room. 

 There is more to life than medicine. 

 Having just spent the better part of 15 years learning how not to have a life, but at least being assured of employment, that can be hard to remember and even harder to believe. Studying and specialising in medicine teaches us to sacrifice other parts of our life rather than nurture them. 

 So when we reach the end of the study and training road to find our future job prospects are not as certain as we expected, it can be very daunting. But this is where the opportunity lies.

 For doctors still in training there is opportunity to gain experiences out of the ordinary through locum work, travel or volunteering abroad, or practise in an entirely new setting like the military, or accept an overseas fellowship, or even work as a doctor in Antarctica

 I’m willing to bet that doctors with this broader experience will be more marketable in a competitive job market than those with a generic ticket who are the same as the next applicant.

 And for those of us recently qualified? This is our opportunity too. 

 This might be our only chance to really think about how we want to work — or perhaps how we don’t want to work. Is it time to do part-time clinical work so we can learn other skills we always wanted but never thought there would be time to achieve? Or time to be home for dinner and our children’s bath time? Or time to build a successful private practice? 

 Whatever we choose to do with our time, we have a choice to use it as an opportunity or waste it wishing things were how they used to be. 

 Before we know it there might be too many jobs again and we’ll wish we’d taken the chance when we had it.

 Dr Simon Hendel is a Melbourne based anaesthetist.

 

Tim Lindsay & Harris Eyre: Career crisis

Monday, 26 October, 2015
LAST week the ominous situation facing medical graduates in South Australia was exposed with an estimated 22 domestic graduates projected to miss out on internships in 2017, and up to 39 to miss out in 2018.
Unfortunately, this training gap only represents the tip of the iceberg, with a national workforce report predicting that more than 1000 junior doctors will miss out on an advanced training place by 2030.
The recent approval of a new medical school in Western Australia shows that the tsunami of medical graduates is unlikely to abate, so is it time to rethink medical education?
This year, an estimated 3736 Australian medical students are expected to graduate, an increase of almost 280% from the 1347 who graduated in 2001. Despite this massive increase in graduates, there has been a comparatively small increase in the number of training places available to junior doctors. This leaves many graduates facing a grim training outlook.
The latest Royal Australasian College of Surgeons Activities Report indicates that in 2014 more than 800 applicants to surgical education and training (SET) were unsuccessful. There are reports of similar results for training places in other specialities, including general practice.
Few, if any, training programs across the medical landscape have been under subscribed, with the net result being an unprecedented training backlog with little relief in sight.
When this mass of prevocational junior doctors is added to the still growing tidal wave of graduates year on year, the stark reality is self-evident — not all of us can be clinicians.
Unfortunately, there is no easy solution.
Junior doctors could move offshore, but increasing regulatory barriers mean that the days when young doctors could simply move to the UK or the US and expect to work are gone, let alone come home and have qualifications recognised.
Medical training in Australia could be completely overhauled to more closely resemble US-style training. This would mean service registrar positions, the utility of which has long been questioned, would be abolished and training streamlined.
However, reform would take years and would likely face tenacious opposition.
Another option is to reduce student numbers, but for various reasons this has proven untenable. One reason may be the high cost of establishing and managing medical schools, so reducing numbers is unlikely and potentially short-sighted.
Nonetheless, with an oversaturated market, should these new schools have a moral imperative to ensure that their graduates are employable?
Australian medical education is, by tradition, clinically focused. Variation from this invariably includes teaching, research and, more recently, public health.
The shortening of contemporary medical courses as postgraduate degrees has resulted in an even greater prioritisation of clinical skills, possibly to the detriment of skill diversity. Graduate medics may benefit from exposure to varied subject matter in their undergraduate degrees, but these too are becoming increasingly prescribed and narrow in focus.
The result? Junior doctors often graduate with few transferable skills, making the ramifications on their career prospects even more dire.
The trend towards focused clinical education in Australia actually goes against what is happening in other countries, particularly in the US and UK. In those countries, programs combining degrees such as a Master of Business Administration, Master of Public Health, Juris Doctor or Doctor of Philosophy degree with medicine are booming in popularity and some Australian institutions have been quick to follow this trend.
However, for debt-laden graduates, further studies cannot be the sole answer. Industry placements, non-clinical electives, innovation training and mentorship and coaching programs should all be considered as ways to better equip medical students for modern career challenges.
Producing competent clinicians should always be the main priority of any medical school, but the time has come to ensure that medical schools also prepare graduates for careers outside of practice.
After all, for those trapped in the midst of the graduate tsunami, one thing is crystal clear — we cannot all be clinicians.
Dr Tim Lindsay is an Australian junior doctor and PhD student in the department of surgery, University of Cambridge, UK, supported by the Cambridge Commonwealth Trust. Dr Harris Eyre a psychiatry registrar and is undertaking a PhD through the University of Adelaide.

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It is now beyond any reasonable doubt that we are heading towards oversupply of doctors within the next few years. Almost 10 years ago I predicted it will happen in 2016. The waiting period for housemanship posting stands at about 4-6 months now, some extending to about 8 months in popular spots. With ALL medical schools producing graduates from 2016, we may hit 1-year waiting period by 2017. While the government is obliged to provide housemanship as it is part of compulsory training, it is not obliged to provide a job to everyone after that. Health Facts 2015 KKM_HEALTH_FACTS_2015which was just released last month shows that we had achieved a doctor: population ratio of 1: 661 as of December 2014. This was initially targeted only in 2016! A total mess by our government! Doctors may soon join the 200K unemployed graduates.

2 years ago, I did mention that there might come a time where the government may consider using private hospitals for housemanship training. I also mentioned why it should never be implemented. Interestingly, behind closed doors, this issue was discussed by MOH with the Association of Private Hospitals (APHM) 2 months ago. While our DG did not deny that such an issue was discussed, APHM came out to say that it is not the best option (see below). They have also rightfully pointed out that we should address the root of the problem first!

Private hospitals are profit driven. It is consultant-based service but consultants are NOT employed by the hospital. Each consultant is just renting a room in the hospital and providing service for the hospital. That’s the reason we are not exempted from GST as we are not employees but contracted service provider. Since it is a one-man show, how much time would a consultant have to teach or guide the housemen. Secondly, private patients come to private hospitals for privacy and better service. They definitely do not want any “trainee” doctors to be seeing and managing them. The hospitals definitely do not want to be answering complains which is already piling up in all hospitals as patients are becoming more demanding. As what Dr Jacob mentioned in the article attached, who will indemnify these housemen and who will pay their salary? Why would a private hospital pay a houseman who is not going to bring them any return/profit! Oh, please don’t bring “social responsibility” crap into the picture. We are living in a capitalist world where what matters is profit and return of investment. Most hospitals are trying to cut their expenses to increase their profit, not the other way round. Same goes to medical schools. The government do not subsidise patients in private hospitals.

While private hospitals may have all the specialties needed for housemanship training, do they have a good case-mix to train doctors to be competent? Other than some big private hospitals (> 200 beds), most private hospitals are rather small-sized (less than 120 beds) and do not manage complicated cases. Frankly, the type of cases that I see in my hospital is totally irrelevant to training of housemen. Most of my cases in the wards are Dengue, AGE, Pneumonias, Bronchitis and some uncontrolled Diabetes and Hypertension. IN actual fact, most of these cases do not really need any admission. Admissions are needed, as they would not be able to use their medical card if they do not get admitted. If we really follow a tight protocol/criteria on admission (as in GH), most private hospitals will be half empty.

With increasing private healthcare cost (also due to GST), most cash paying patients are finding it difficult to seek or continue treatment at private hospitals. In fact close to 90% of patients that I see in my clinic/ward are paid by insurance or employers. This takes me to a recent article in Malaysian Digest. However, I find the statement on the number of doctors in private and government is rather inaccurate in this article. The more accurate numbers can be seen in Health facts 2015 attached above (Government 33K, Private 13K). The article has rightfully claimed that more and more patients are heading to government clinics for treatment. Due to increasing litigation rate in the field of O&G, the Ministry of Health had recently, in a letter dated 10/09/2015 increased the fee for O&G procedures and also added some new fees. This will increase the total cost for normal delivery and caesarean section by 100%. How many would be able to afford the increase? Most obstetrics cases are cash paying as insurance do not cover maternity cases. Of course, it will be the doctor’s choice to give any discounts.

On the other hand, our current generation Y seem to be collecting more and more debts. I had always said that taking huge loans to do medicine do not make any economic sense. A recent survey showed that close to 75% of Gen Y between the age of 20 and 33 have at least 1 long-term debt with 37% having more than one. It was an interesting survey (see below) which concluded that Malaysia’s Gen Y are living on the edge with huge debt!

I feel it is time for some medical schools to close shop or merge to reduce the numbers. A common entry examination or a more stringent entry criteria should be introduced. Till then, the madness will continue………

 

Many reasons private hospitals cannot train housemen, says industry group

BY JENNIFER GOMEZ

Published: 19 August 2015 9:00 AM

Private hospitals cannot be the solution for medical graduates who have no placements for housemen training due to a string of issues, the Association of Private Hospitals Malaysia (APHM) told The Malaysian Insider.

Speaking on the supply of newly-graduated doctors exceeding the placements available for housemen in government hospitals, APHM president Datuk Dr Jacob Thomas said the association has had talks with the Ministry of Health (MOH) and the Malaysian Medical Council on the matter of housemen in private hospitals but there is an impasse on a number of issues.

These include the question of who would indemnify trainee doctors against medico-legal issues and concerns whether there would be adequate supervision of housemen in private hospitals.

“Who will indemnify these trainee doctors against any mishaps or medico legal issues?

“Private hospitals might also want to interview and select the housemen they want to allow to be trained,” he said.

Dr Thomas added there were also issues over payment, such as who would remunerate the specialists who had to teach and take these housemen on ward rounds.

“Will these specialist be paid?

“Private hospitals manage with just sufficient staff, so additional medical officers and housemen on the payroll will incur higher expenses and result in increased private healthcare costs and higher patient charges,” he added.

Deal with root cause

The Malaysian Insider had reported on the rising number of medical graduates waiting three to six months for their housemen placements, a situation caused by the high number of medical graduates.

According to Ministry of Health records, there were 3,564 medical graduates reporting for duty as housemen in 2011, 3,743 in 2012, 4,991 in 2013, and another 3,860 last year.

Many graduates held qualifications from recognised medical colleges overseas and their number has increased from 877 in 2008 to 1,600 in 2011.

In 2012, there were 1,563 graduates from foreign medical colleges and this grew to 2,403 in 2013.

To Dr Thomas, one of the root causes of the problem of insufficient housemen placements was the high number of medical graduates each year.

This led to the issue of quality control, with the capabilities of graduates requiring further scrutiny, he added, because medical schools have mushroomed.

“Maybe some colleges should merge. We had a shortage of doctors in the past and had targets to meet.

“So, many medical schools mushroomed, but now it has to be re-looked once more. This problem will never be resolved otherwise,” he said.

Criteria for housemen training centres

The Health Ministry is open to having private hospitals provide housemen training to graduates, as long as they fulfilled certain criteria, the ministry’s director-general Datuk Dr Noor Hisham Abdullah said.

He said the ministry had already raised the possibility of implementing housemen training in private hospitals but said it needed to be explored further.

“This  needs  further  study  in  terms  of  acceptance  by  patients  and  its  long-term  viability,” he told The Malaysian Insider in an email reply.

The criteria to be a houseman training centre includes the hospital having at least six basic specialist services, including internal medicine, paediatrics, general surgery and orthopaedic.

It must also have an adequate clinical workload and mix of cases in order to provide substantial exposure of different medical scenarios to housemen.

The hospital is also required to pay the salary of house officers as well as bear medical indemnity insurance to cover any medico-legal issues.

“There is also the acceptance of private patients to be examined by house officers, as  they (patients) are usually those who prefer privacy and pay higher fees to be seen and treated by specialists,” Noor Hisham said.

The Malaysian Insider had earlier reported the DG as saying that training spots were tight because 30% of housemen do not finish their training in the stipulated period of two years.

Noor Hisham had explained that some of these house officers did not complete their training in the required time frame for various reasons, such as being on leave, their inability to complete their logbook, as well as absenteeism from work without approved  leave and incompetency.

“Currently, the percentage of housemen who do not complete their housemanship training  within the stipulated period is quite acceptable as it is not merely due to competency  issues. 

“However, MOH is working on various mechanisms to reduce this percentage,” he said. – August 18, 2015.

– See more at: http://www.themalaysianinsider.com/malaysia/article/many-reasons-private-hospitals-cannot-train-housemen-says-industry-group#sthash.RO97ePaw.dpuf

Malaysia’s Gen Y in debt, living on the edge, survey reveals

Published: 15 October 2015 11:08 AM

Malaysian young adults are accruing debt at an early age, a survey by the Asian Institute of Finance (AIF)  has revealed, while some 40% are spending more than they can afford.

The survey among Malaysian “Gen Y” respondents between the age of 20 and 33 were living on the “financial edge” and were facing money stress, with the majority living on high cost borrowing of loans and credit cards.

“Our study reveals that 75% of Gen Ys have at least one source of long-term debt and 37% have more than one long-term debt obligation. Long-term debt obligations include car loans, education loans or mortgages,” AIF said in its report “Understanding Gen Y – Bridging the Knowledge Gap of Malaysia’s Millennials”, released today.

“To offset this debt, they are relying on high cost borrowing methods – 38% of Gen Ys reported to taking personal loans, while 47% are engaged in expensive credit card borrowing.”

Their debt woes, AIF said, were the result of “impulse-buying” behaviour, besides easy access to personal loans and credit card financing.

“The impulse buying behaviour of this young consumer is tied to the basic want for instant gratification, which is exacerbated by easy access to the world of online shopping. As a tech-savvy generation, these young adults draw on technology for everyday tasks.

“This includes seamless online purchasing, which encourages the ‘buy-now-pay-later’ behaviour amongst this generation of consumers. Reliance on credit cards for online purchasing has further encouraged this behavioural trait,” the report, targeted at banking, financial and learning institutions, said.

The report said around 16-17% was spent on maintaining lifestyles, 24% on loan repayments and 30% to 31% on living expenses, with little difference between male and female respondents.

There were also indications that there is a steady rise in loan repayment levels as Gen Ys go up the income bracket.

Of the 1,011 young professionals interviewed, 60% were single while the majority (43%) earned between RM1,500 and RM3,000. Some 32% earned between RM3,100 and RM4,500, and 8% earned below RM1,500.

The survey also showed that 40% of respondents were spending more than what they could afford, while only 30% said they were living comfortably within their current income.

“This approach therefore feeds on their impulse-buying behaviour. As a result, many of them stay in debt using credit card lending much longer than they ever intended.”

“Only 30% of Gen Ys surveyed said they live comfortably within their current income, suggesting a generation that is experiencing financial stress. It suggests that they have little knowledge about how to make wise purchasing decisions,” the report said.

Despite this, AIF said Gen Ys were much better at saving then it was believed, as 64% said they saved a portion of their income every month, with the majority keeping aside at least 20% of what they earned.

“The survey findings also reveal that Gen Ys’ appetite for savings grows with age. The highest proportion of savers was the 27 to 33 years age bracket (57%). Studies on Gen Y savings habits also show that, although they do develop good saving habits, these savings tend to be focused on short-terms goals.”

However, AIF expressed worry that youths seemed to be skeptical of professional advice by financial advisors and planners, with only 37% seeking consulting such services on money matters.

Instead, more youths (51%) tended to discuss these things with family and friends.

“This lack of engagement with financial advisors probably stems from their skeptical view of the value of financial advice itself as many of them believe they can find this information more easily by themselves. Again, this is a reflection of the DIY world they grew up with.

“The majority (63%) of Gen Ys who did not opt to seek advice from financial advisors or planners cited ‘prefer to do it on my own’, ‘not interested’ and ‘too expensive’ as the top 3 reasons for not using the latter’s services,” the report said.

Those that do seek advice from experts ask about savings and investments (56%), advice on mortgages or loans (41%) and retirement planning (32%).

As a recommendation, AIF said Gen Ys should look into consulting qualified financial advisors to get the information and confidence they need to make educated investment decisions.

“Grab opportunities to gain financial management knowledge from mainstream channels such as from higher learning institutions,” it said. – October 15, 2015.

– See more at: http://www.themalaysianinsider.com/malaysia/article/malaysias-gen-y-in-debt-living-on-the-edge-survey-reveals#sthash.fN5iYH70.dpuf

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Over the past few months, there has been interesting developments and debates going on in UK, especially in England. Back in March 2015, newly re-elected UK Prime Minister David Cameroon announced that he will introduce a “truly 7 days a week” NHS system by 2020. This resulted in huge outcry by the medical community in UK, resulting in Facebook post etc. In July , we saw this interesting Facebook post by Dr Janis Burns who challenged the government to proof that the mortality was higher in the weekends and also to proof that NHS service is not running over the weekends. She also mentioned about her life story!

Politicians are politicians wherever they are. Their interest is only to get public support to win elections. However, we can’t say that whatever he said are all lies. Every system has it’s flaws similar to Malaysian healthcare system. I can’t say much about the UK system as I am not working there at the moment but I can say that the situation in Malaysia is almost the same. IN Malaysia, during weekends, only the on-call doctors work, including MOs and Consultants. Usually, only 1 Consultant is “on-call” over weekend (each for Saturday & Sunday) with 1 or 2 MOs. This is definitely not the same as the working days where everyone is around. Obviously, the standard of care will not be similar.  Of course, priority is given to emergency cases over the weekend. I presume the situation is the same in UK based on the Facebook post by Dr Janis. The Health Secretary has clearly told BMA to get “real”!

The issue in UK has become more intense over the last 2 months. In August The Guardian reported that thousands of UK doctors have applied for ” Certificate of Good standing” from GMC which basically means they are applying to work overseas. The numbers applying increased tremendously after the new contract announcement. The new contract which is being planned to be implemented in England (Scotland and Wales has not agreed to it yet) has redefined working hours which included Saturdays, removed overtime allowances between 7-10pm but increased hourly allowance for newly defined “overtime” and increased their basic pay. However, the doctors in UK claim (see below) it will result close to 30-40% pay cut as they will earn less on overtime allowances. The GP trainees are also affected as their pay supplements will be terminated.

It is very interesting to note that eventually it boiled down to money and survival. Remember, what I said few months ago in my post ” Passion vs Debt” and  “Passion vs Debt vs Reality” , passion is one thing but living a life is another! That’s exactly what this doctors in UK are feeling. While they have the passion to serve, living a life with debts to pay and can’t even afford to buy a property in London and major towns brings them to reality of survival. I keep saying this to youngsters who do not know the reality of life before venturing into any course. At the end, it is just a profession to earn a living. Bankruptcy rates among Malaysians are at a worrying trend due to huge debts!

On 28th September 2015, doctors marched to Downing street in protest of the new contract. Whether this will change anything remained to be seen as the government is planning to implement the new changes as soon as possible, latest by April 2017 if I am not mistaken.Whatever said, you chose the profession and you need to live with what is given. If the politicians can prove that the weekend standard of care is lower than weekdays, then doctors will not be able to defend themselves. This is why I keep telling the junior doctors, you chose this profession willingly, thus do not complain about long working hours etc. It is the same elsewhere. I had said enough before. Our government can also ask doctors to take a pay cut once they have enough doctors as getting  a job will become a privilege. You go where the vacancy is and can’t demand anything. Worst still, our degrees are mostly not recognised elsewhere! You can’t run anywhere!

Where do you think these UK doctors will go? Most will land up in Australia or New Zealand as their training in UK is recognised in these countries. This in turn will reduce the number of available post for others. Malaysians whose intention is to migrate to Australia will need to think about the effect of this UK policy on us. Those who are planning to move to Australia by sitting for AMC exams will be worst affected. As I had always said, never do medicine if your intention is to migrate. It is the most difficult profession to migrate.

Please read all the links given.

 

‘I can’t sacrifice my family for the NHS’: the junior doctors forced out of jobs they love
Young doctors are seething with anger over new contracts threatening lower pay, longer hours and increased stress. But do they really have it that bad? Here junior medics on the verge of quitting describe salaries that barely cover the bills – and a workload that means they could end up earning as little as £10 an hour
Junior doctor David Watkin: ‘We feel very under-appreciated by the government and the Department of Health.’

Amelia Gentleman
@ameliagentleman
Monday 28 September 2015 17.12 BST Last modified on Tuesday 29 September 2015 09.06 BST
At what point does a dedicated doctor, with a lifelong commitment to the NHS, decide it is time to quit? For Dr Singh, 34, a junior doctor in general medicine, the moment will come when he is no longer able to pay his mortgage and childcare bills, a situation he expects to find himself facing sometime next year.

Dr Singh has worked in hospitals, with regular A&E shifts, for 10 years since qualifying, loves his job and describes himself as “the kind of doctor you’d want to see to your gran”. But, having done an online calculation assessing how the Department of Health’s new junior doctor contract will affect his household income, he believes he and his paediatrician wife face a 25% cut to their joint take-home pay, making life in London unaffordable. He plans to move into the pharmaceutical industry.
New junior doctors’ contract changes everything I signed up for

Several of Dr Singh’s friends have already left the medical profession to work as bankers and consultants in the City; others are considering emigrating to work as doctors in Australia or New Zealand. Most of them are dispirited by the proposed contract, but are more fed up with the daily stress of their work, annoyed that the long hours and considerable financial and personal sacrifices they make during their training are not appreciated, and they worry about the impact that dwindling morale could have on the NHS and its patients.

“I am not looking for parity of pay with my friends in the City. But if you can’t afford to pay your mortgage or your child’s nursery bills and you can’t look after your child yourself in the evening or [at] the weekend because the government is proposing you should work those hours on a normal basis, you can’t continue with that kind of life,” he says, asking for his full name not to be published to avoid annoying his employers. “I am a very valuable resource to the NHS. I do work incredibly hard, I really enjoy looking after my patients and I get immense satisfaction from it. I have an absolute commitment to the NHS but I can’t sacrifice my entire family for that. I have to put a roof over my son’s head.”

Junior doctors will be balloted to decide whether to strike over a radical new contract imposed on them by the Department of Health, which redefines their normal working week to include Saturday and removes overtime rates for work between 7pm and 10pm every day except Sunday. The government says the changes will come with a rise in basic salary, higher hourly rates for antisocial hours and will be “cost neutral” – but doctors believe this change could reduce salaries in some areas of medicine by up to 30%. The British Medical Association (BMA) argues that it is “unacceptable that working 9pm on a Saturday is viewed the same as working 9am on a Tuesday”.

It is unusual to hear doctors getting angry and this swell of rage is disconcerting. A social media campaign means their voices have begun to be widely heard over the past week. If the effects of the government’s austerity drive on care workers, for example, have gone largely unnoticed, the seething protest from this powerful group looks set to be harder to ignore.

Most junior doctors are smart enough to know that they will have to work hard to persuade the public that they are a genuinely needy section of society. A perception of doctors as well-paid professionals has stuck and even a semi-attentive observer knows that the harsh 100-hour-week working pattern that used to characterise medical training has been abolished.

What most people outside the medical profession are probably unaware of is that you aren’t just a junior doctor for a fleeting period after qualifying; this makes up a substantial chunk of your career – sometimes a decade, and often stretching late into your 30s. Basic salaries start at around £23,000 and are enhanced by various complicated supplements, including the antisocial hours pay that is set to be cut. Because medical training takes longer than other degrees, most junior doctors have large amounts of student debt and are expected to continue paying for the exams as part of their ongoing training, in addition to putting in large amounts of unpaid study time and paying out monthly professional payments to the General Medical Council (GMC) and the BMA.

Few people chose to go into medicine for the money, but this contract has triggered a surge of resentment about how much harder doctors work for less money than their equally ambitious and well-educated peers in other fields.
Radiologist Anushka Patchava says she will have to quit the profession if the proposals are implemented.
Anushka Patchava, 29, a radiologist who qualified in 2011 and has at least two more years as a junior doctor before she graduates to being a consultant, plans to switch careers and is midway through a rigorous interviewing process with two management consultancy firms. She is fed up with the hours and the current pay and is despondent at the prospect of getting a substantial cut to her salary. She earns £31,000, which includes a 40% supplement to her basic salary, to compensate for the antisocial hours she works. Once the new contract is imposed, she thinks she will see this reduced to £27,000 or £28,000 and she expects the hours she works will become even more antisocial. She campaigned for David Cameron in May’s general election, but has subsequently rescinded her membership of the Conservative party in protest at the contract.

If she gets the management consultancy job, Patchava will quadruple her salary on day one. “It’s horrific, isn’t it?” she says. She doesn’t consider herself to be materialistic and, in normal circumstances, would not want to leave a job she loves, but the level of needless daily stress has become wearisome and she is constantly aware of lack of morale among her colleagues.

“Going into work is a struggle – you have to psych yourself up. You’re so short staffed that you can’t offer patients everything you want to offer them. There aren’t enough doctors to fill the posts that there are available now, even before the contract is brought in,” she says. “We are not supported and morale is low. You work really long hours, taking decisions that impact on people’s lives and, at the same time, you’re worrying whether your pay check is going to be enough to cover your bills.”

The daughter of two NHS surgeons, Patchava has an deep-rooted sense of loyalty to the NHS, but her parents understand the pressure she is under and why she wants to leave. There are no perks; she has to buy expensive food and coffee from the hospital cafe and pays £12 every night shift to park in the hospital car park. She calculates that, once the long hours are factored in, she earns about £10 an hour, so these costs are not negligible. As junior doctors, her parents used to get free food and free accommodation. Four of her closest friends from Cambridge, where she studied medicine, have already left to work in the City. “One of them got a gold medal in medicine, for being top of the year, but they dropped out for exactly these reasons.”

These are not alarmist stories being spread by campaigners. Even the Conservative MP and doctor Sarah Wollaston, who chairs the Health Select Committee, knows about the brain drain – her daughter has left the NHS for Australia. Now she, her husband and eight of their friends work in a hospital where they have yet to meet an Australian junior doctor in the casualty department. “It is staffed almost entirely by British-trained junior doctors,” Wollaston wrote this week.

Patchava worries about what will happen when she wants to have children and has to organise childcare for the irregular hours. Another aspect of the new contract is that parents who take time off to look after their children will no longer see their pay rise automatically while they are on leave. People who take time out of the medical training system to do research will be similarly penalised. Other changes include the removal of a supplement paid to those going into general practice, to match those working in hospitals, which doctors believe could see trainee GPs losing a third of their pay.

“I don’t have a luxury lifestyle, but I don’t think I could support children with that money and those hours,” Patchava says. “The NHS runs on the philosophy of altruism. Everyone comes in an hour early and stays late to make sure the work is done. We love the NHS, but this has been such a kick in the teeth. I’ll have no hesitation about taking a job elsewhere.”

This sense of mismatch between the commitment put in and reward taken out is widespread. “I’m 30 years old, live in a friend’s flat with three other people, don’t own a car and have still got thousands of pounds of debt,” writes one junior doctor in an angry email. “My friends outside of medicine have bought houses, have children and the majority have their weekends and evenings for themselves. On top of my ‘48 hours a week’, I teach and lecture in my free time, attend courses (which we have to fund), study and do everything I can to be a better doctor. I love my job – I couldn’t imagine living with myself if I left. However, the prevalence of locums and holes in the rota, overstretched stressed GPs and A&E staff make the atmosphere toxic. We miss weddings, funerals, birthdays. Relationships are lost, friends estranged, all because we love our job.”

Foiz Ahmed, a junior doctor in emergency plastic surgery (who is grappling with £30,000 debt) argues that the new contracts will strike a pernicious blow to the NHS and patient safety. “This isn’t just about salaries, although of course a 10-30% pay cut is unmanageable for most of us. Let’s ignore the fact that I used to earn more an hour while working for a mobile-phone company as a student … With the continued denigration of public perception of doctors, there is a sustained attempt to make the NHS fail. A demoralised workforce performs less efficiently, and a less-efficient system can be broken up and sold to private firms.”

The Department of Heath insists these fears are misplaced. “We are not cutting the pay bill for junior doctors and want to see their basic pay go up just as average earnings are maintained. We really value the work and commitment of junior doctors, but their current contract is outdated and unfair.”

Junior doctors are not convinced. The GMC had 3,468 requests for a certificate of current professional status, the paperwork needed to register to work as a doctor outside the UK, in the 10 days since the new contract was announced; usually it processes 20 to 25 requests a day. Partly this was the result of a concerted online campaign to get junior doctors to apply as a way of showing their anger. But some doctors, such as David Watkin, 30, a paediatrician based in Birmingham, truly intend to leave if the contract is imposed. Watkin recently returned from a year working in New Zealand, has stayed in touch with his employers out there and is confident that there will be a job for him.

The day-to-day stress Watkin experiences in Birmingham, which is mainly the result of standing in for unfilled doctors’ shifts, was absent in New Zealand. “But stress is not really the issue,” he says. In New Zealand, he says he felt more looked after, with meals paid for and professional fees covered by the hospital.
Would I be a fool to return to the NHS on the new junior doctor contract?
“Here we feel very under-appreciated by the government and the Department of Health. We have sacrificed a lot – years of training and extra hours studying outside of our work. We have moved around the country every six months to go where our training jobs send us, with no say in where we go, so it’s difficult to settle anywhere and hard to buy a house. We, as a body, are feeling under attack; it feels like any concerns we raise are being misrepresented with hospitals portraying us as just wanting more money.”

At 30, he still has about £9,000 in debt (down from about £30,000). He has done seven years as a junior doctor already and has another four to go before he becomes a consultant. “I worry that this is going to lead to an exodus of doctors, and I worry about the pressure that this will put on those who stay – and on patients. I had a work-experience student with me this week; it feels harder to come out with a positive line about why they should do it.”
Holly Ni Raghallaigh: ‘I worked very hard and put myself in a lot of debt to get here.’ Photograph: Teri Pengilley for the Guardian
Holly Ni Raghallaigh, 29, a trainee urologist, is planning to go to Scotland (which, like Wales, will not impose the new contract). She has been pushed to the brink of bankruptcy by the cost of her training, and doesn’t feel able to take a pay cut. With five more years as a junior doctor, she doesn’t think she could afford to continue if her pay is reduced.

 

“I worked very hard and put myself in a lot of debt to get here,” she says. At one point she had to pay for a urology course ahead of an exam and was so overdrawn that she missed two consecutive monthly payments to the GMC, was temporarily removed from the medical register and subjected to a large fine. She estimates she has spent £5,000 on mandatory surgery courses and exams during surgical training; she is paying back her remaining £10,000 of student loan at a rate of £450 a month. Once her rent in London and her monthly subscriptions to the Royal College of Surgeons (£50), GMC (£40) and BMA (£18) are paid, she has nothing left. It isn’t possible to save towards a deposit on a flat.

“Every single time I found myself in my overdraft or having to borrow petrol money or forego a flight home to Ireland to book a course, or every weekend I spent working as a locum to fund my education – I would do it all over again,” she says. “I adore my job and, honestly, working in the NHS is all I have ever wanted to do. And, for the record, I am grateful to the taxpayer who has put me here.” She says she hopes the tales of difficulties she found “embarrassing and demoralising” make people understand the financial pressures junior doctors face. “I don’t want it to sound like a sob story. I could have managed my finances better, but I had no money.”

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It’s been 2 weeks since I updated my blog, the last being a day before Merdeka day. I was not only busy but also came down with Chicken Pox. For the first time in 5 years of being in private sector, I had to take MC for a week. Sitting at home alone is rather boring and annoying. I wanted to write about issues concerning GMC over the last few weeks but never had the time.

Over the last 15 years or so, IMU has been running twinning program with UK universities. The students will complete their clinical years in UK. Most of them will do their Foundation Year (Internship) in UK to be eligible for full GMC registration. Most of the self sponsored students do not come back home. Sponsored students especially JPA sponsored, will usually come back home to do their housemanship. However, it means they will not be eligible for GMC full registration. When UK started to have problems with Foundation Year 1 allocation in 2012 as I had written HERE, GMC started to look at the feasibility of allowing foreign students to do foundation year in a foreign country. Basically, GMC took the responsibility to make sure those who graduated from UK universities are eligible for GMC registration since UK may not be able to provide an employment for these students. In UK, Foundation year is still considered as part of the undergraduate medical education where the universities are still actively involved in providing the Certificate of Experience. That’s the reason you can do your Foundation year under student visa and do not need a work permit.

IN October 2013, GMC issued an approval for such arrangement with effective from August 2014. However, certain criteria and regulations were set to allow this to happen. The universities were given the role to facilitate the foundation program training overseas and GMC must be informed prospectively. While I am not sure of IMU twinning program in making use of this approval, Newcastle University Malaysia has adopted the program. In June 2015, NuMed had officially made the announcement that 5 hospitals in Malaysia , namely Hospital Sultanah Aminah, Hospital Sultan Ismail, Hospital Kluang, Hospital Kuching and Hospital Queen Elizabeth will be GMC accredited Foundation year training centres. What does this mean?

Since NuMed degree is recognised by GMC, you can be provisionally registered till you complete your Foundation year. Previously, only foundation program in UK is recognised for full registration. However, since the prevailing immigration law in UK will unlikely provide any work permit for foreigners (Non-EU) to get employment, GMC has now allowed NuMed graduates to complete the foundation program in these 5 hospitals and apply for full GMC registration. Please remember that from April 2015, GMC has limited the length of time a doctor can hold a provisional registration to a maximum of 3 years and 30 days.

Does GMC full registration bring any benefit? This is the question that I am trying to find an answer over the last few weeks. As far as I know, each country have their own accreditation process or a common entry exam (e.g. USMLE in US, Canada etc). For sure, it does not make any difference when it comes to Singapore Medical Council (SMC). Their website clearly says that only degrees listed on their second schedule are recognised and branch campuses are not considered (No 3) :

Only the campus that was in existence at the time of addition to the Schedule will be recognised. Any new campus that is off-site from the recognised main campus, whether in the same country or a different country and whether the same degree is granted or not, will not be recognised by the SMC.

The only main advantage of having a GMC full registration is to work in UK, Ireland or EU countries. As mentioned before, getting a job in UK is almost impossible due to their current immigration laws. Ireland has already recognised housemanship training in Malaysia where you are eligible to apply for a post in Ireland without the need to sit for PRES examinations. I had written about the problems that Ireland is facing over HERE. Obviously, not many Malaysian will be interested to work in non-English speaking EU countries. Furthermore, the same immigration laws may apply for foreigners.

What about Australia/New Zealand? This a bit tricky to say the least. Australian Medical Board, under “Competent Authority Pathway” says:

Graduate of a medical course conducted by a medical school in the United Kingdom accredited by the General Medical Council, AND:

1) successful completion of the Foundation Year 1, or

2) 12 months supervised training (internship equivalent) in the United Kingdom, or

3)  if the 12 months supervised training (internship equivalent) is completed in another Board approved competent authority country, approved by that competent authority.”

Unfortunately, Malaysia is not a “Board approved competent authority country“. Thus, it is very unlikely that Australia will recognise GMC registration where the training is done outside UK.

Document: Medical-Board—Criteria—Requirements-for-eligibility-for-the-Competent-Authority-Pathway-2

Please also remember that there is a fee that need to be paid for GMC full registration as well as to maintain the registration every year (annual retention fee). The fees can be seen HERE. Currently 1 pound is about RM 6.80!.

So, I welcome any suggestion or informations from anyone who may know more about GMC registration. GMC registration use to be well recognised in commonwealth countries about 30 years ago. But, the situation has changed over the years. Nowadays, each country have their own way of recognising a medical degree obtained outside their country. GMC registration may not mean much anymore in terms of employment but it may still give you some sort of quality assurance, I hope.

 

 

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IN 2012, the medical fraternity was shocked when our previous health minister announced that private institutions will be included as institutions conducting MQE examination. It use to be only UM, UKM and USM. With the announcement, some of the established private universities were selected to conduct the MQE examinations which is basically their own final year examination. The other shocking statement from our minister was that, unlimited number of sitting will be allowed  and the student can choose where they want to sit for the exams. I wrote about it over HERE. Personally, I feel that any professional exam should have a limit. Even nursing board examinations has a limit. Even final year medical school examinations and post-graduate examinations have a limit on the maximum number of sittings. Subsequently , MMC released the amended regulations for MQE and the list of institutions. Section 4(3) of the regulations says that the candidate will be posted to the institution of their choice. Section 5 says that , the candidates have to follow the rules of the institution in resitting of the examinations and imposition of any fee.

Early this year, while I was talking to someone in MMC, I was told that they are going to change the rules again. The new 2015 regulations for MQE has been released and gazetted on 25/03/2015. The new rule says that once MMC finds you eligible to sit for the MQE examination ( if you fulfil the minimum entry requirement), MMC will decide on the institution where you will be sitting the examination (Section 4(3) ). The fee has also been increased to Rm 1 000 for application process (from the previous RM 200). It also says that you can only resit for a maximum of 3 times ! This basically means that if you fail the MQE for 4 consecutive times ( 1 + resit 3 times), you will never be able to practise as a doctor.

Frankly, I feel it is not worth going to an unrecognised university. With the current glut, the situation will only get worst.

Happy Merdeka Day 2015

Peraturan Ujian Kelayakan Perubatan 2015_25032015

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