Archive for the ‘Education’ Category

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

Posted on March 6, 2016 by DG of Health

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



6 MAC 2016

Press Statement DG of Health 9 March 2016: Strengthening The Housemanship Training Programme

Posted on March 9, 2016 by DG of Health

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.

Thank you



9 MARCH 2016

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In October 2015, I wrote regarding the crisis that was blooming in UK healthcare system. While negotiation was going on between BMA and the government of UK, it seem to have headed no-where. In January 2016, the junior doctors had their first strike since 1975 to go against the proposed change in contract and definition of working hours. On 15th January, the Health Secretary released statistics on the number of deaths during weekends to justify the change in the contract. Remember, this is exactly what I said the politicians will do in my October 2015 article. Once they prove to the public the statistics, they will get public support. Unfortunately, despite the strike, the government stuck to their plan. Another strike took place early this month. It looks like the government of England will go ahead with their plan soon. So, graduates who think grass is greener on the other side should always think carefully. Being a doctor is always stressful no matter where you are. The only difference is the healthcare structure, facilities and training.

There is also another issue that is being discussed aggressively in the UK. It is the change of migration policy. The UK Migrations Advisory Committee had suggested that UK trained international doctors, of which there are around 500 each year, could be subject to the Resident Labour Market Test (RLMT) when moving from the second year of foundation training to specialty training. Previously doctors were exempted from RLMT. You can view the document here: bmj.i1008.full.

I received an interesting email from a Malaysian doctor in UK who is intending to come back home. He had given permission to publish part of his email below.

I am not sure if you are aware but staying in the UK post-FY2 (i.e. housemanship) will not be as easy. Being subjected to the Resident Labour Market means that:

1. International med students graduating from the UK are only allowed to apply for Round 2 of specialty application
2. This means being left with jobs that NO one wants. Popular research spots like London, Oxford and Bristol would be out of the picture.
3. Popular specialties like neurosurgery, cardiothorasics, anaesthesia and paediatrics will not be accessible, based on last years outcome (as there were no round 2 interviews for them).
4. This becomes worst when applying for advanced specialty training (ST3 onwards)… core Medical trainees will be left with geriatrics or acute medicine, and not be given the opportunity to try research heavy specialties like rheum or cardiology.
Just thought I’d illustrate the current climate with the forced implementation of junior doctor contracts – International Doctors are not only forced to obey the contract but all other new laws implemented, including the above.
There really is no more space for doctors in this world. sad times.”

As I had always said, doing medicine with the intention to migrate is the worst thing to do. However, even my suggestion to do medicine in the country you intend to migrate is also falling apart. Meanwhile, in the US, by 2023, the rules for ECFMG certification will also change. This change was already suggested in 2010. At the moment, as long as your medical school is listed in World Directory of Medical Schools (WDOMS), you are eligible to sit for USMLE and receive ECFMG certificate for your Step 3 and residency application. However, WDOMS only list the medical schools which has been approved by the authority in a respective country to conduct a medical program. It does not give any form of recognition, accreditation or assessment regarding the medical schools listed. Basically, it only states that such a university is offering a medical program in such a country. The programs do not even need to be accredited by the respective country’s medical council.

With the new change, by 2023, the respective country’s medical council should apply to ECFMG to be accredited as a accreditation body. This basically means, Malaysian Medical Council must first apply to ECFMG to be recognised as a accreditating medical authority. Only then, medical schools accredited by MMC will be allowed to apply for ECFMG certificate. So, if MMC do not do this, no one who graduates from Malaysian medical school will be able to apply for a residency job in the US. Of course, this boils down to each country’s medical council’s ego. Why should MMC do this if it is going to worsen brain drain? I mean, would you do something to send your workforce out of this country? So, those who are entering medical school now with the intention to go to US, please beware that this may affect you as you will be graduating somewhere after 2021.
So, I had spoken about Australia, UK and now US. The saying that ” doctors will never be unemployed“, ” doctors are needed everywhere” or “doctors never get retrenched” is becoming a fallacy.  Unfortunately, there are still a lot of ignorant parents out there………. However, I am hearing some news that the enrollment into medical schools is dropping in Malaysia and some of the smaller medical schools may need to close shop eventually.
Hopefully, my book that may be launched next month/April will be read by all parents and future budding doctors. Keep a watch as the details are revealed soon………..

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It’s been 10 years since I first wrote in MMA magazine that surplus of doctors is inevitable if the government continue to approve too many medical schools (here and here). No one listened, including MMA president himself. In 2010, our great minister who is currently the transport minister announced that “there will not be surplus of doctors by 2015“. Just a year later, in May 2011, the cabinet issued a 5 year moratorium. Unfortunately, it is simply too late. By then , as I wrote in MMA Magazine in April 2012 (written in September 2011), there were already 36 approved medical schools conducting close to 45 medical programs. Since I started blogging in 2010, I had also written many times about these issues. I predicted that “jobless” scenario will happen by 2015/2016. A blessing in disguise, is the closure of AUCMS (5 programs) and few more twinning programs by certain universities.

Today, TheMalaysianInsider published a report on the “jobless” scenario of medical graduates. It looks like not only the waiting period for posting is about 6-8 months, the waiting period for SPA interviews is also taking 3-4 months. This will create a waiting period of close to a year. Some graduates wanted the SPA interview to be done sooner, probably within a month. I feel many do not understand how civil service works. The appointment to civil service is done by SPA. However, SPA can only offer you a job based on vacancy. So, how would SPA conduct an interview if they do not have any post/vacancy to offer? Thus, SPA can only conduct interviews once they have a considerable amount of post available. Even then, they will call for interview based on first come first serve. With more than 5000 graduates entering the market from this year onwards (4740 new registration in 2014), how many can they call for an interview at any one time? As of this year, all medical schools in Malaysia will be producing graduates!

Once SPA offers you a post in civil service, only then you can apply to MOH for a posting. This is now done via the “ehousemen” portal. Since 2015, you are given the liberty to choose where you want to do your housemanship. However, you decide your own fate on the waiting period. The more popular the hospital, the longer the waiting period. Based on the press statement by DG in December 2015, only once your appointment is confirmed, provisional registration will be issued by MMC. Please be informed that those who went to do medicine after the Minimum Entry Requirement was announced in May 2011 need to fulfill this requirement to be able to get a job. Your SPM results must also be submitted for provisional registration. SPA may reject those who did not fulfil the requirement. SPM BM requirement has also been made compulsory since last year. It has always been a requirement to join civil service but the rule was relaxed in 2006 for doctors.

While no one listened to all that a right thinking medical personal had warned, it is the graduates who eventually ended up in this mess. Poor human resource management and in the name of education hub, our quantity government has done it again. From nurses, teachers, pharmacist and now doctors are all in “jobless” scenario. While housemanship is a rolling post , most will still get a post eventually, probably after 1-2 years. BUT what happens after that? I understand that MO post are also full. Since new posts has been frozen since April 2014, how would the government be able to absorb all post-housemen doctors? I would predict that eventually, housemen post will be given on contract basis and new application has to be made for MOship. Either that or we need an entry/exit exam. The best solution will still be reducing the number of students entering the medical field by strengthening the entry requirement or having a common qualification exam. No one can prevent anyone from doing medicine in this capitalist world but having a stringent criteria will deter many from doing it without proper qualifications.

Medicine has become just like any other job. No job is guaranteed. Never do medicine for wrong reasons!


Grad doctors wait in vain for houseman posting


Published: 15 February 2016 9:00 AM

There are not enough housemanship posts in public hospitals following a government freeze. – The Malaysian Insider file pic, February 15, 2016.

Despite graduating with a medical degree in October last year, Muhammad Faiz Hassan, 29, is working odd jobs, repairing cars and dabbling in wedding photography to support himself.

He is among hundreds of future doctors who are forced to earn a living in fields unrelated to their medical studies because of a two-year backlog of housemanship placements in public hospitals.

“I’ve heard that we may be expected to wait from six months up to a year for a placeent.

“This is an incredibly long time, which not only affects my financial situation, but also worries me, that I might get rusty with my medical knowledge.

“I am now applying for an assistant teaching position at a medical school in Cyberjaya. This way, I hope to stay in touch with my field and be prepared once I finally get called to work,” said Faiz, from Batu Pahat, Johor.

Faiz, a National Higher Education Fund Corporation (PTPTN) recipient, said he felt pressured to find employment fast after receiving an email informing that he was required to start repaying the loan, six months from the notice date. 

“My course was RM300,000 in total and I took the maximum loan of RM150,000 under PTPTN.

“In addition to the interest expected to be incurred, I am daunted by the large debt I am starting out with immediately after graduating.

“My parents are pensioners and I do not want to burden them, which is why I am hoping the government will be able to sort out my housemanship as soon as possible.”

He said most of his seniors have to wait long despite having gone for the Public Services Commission (PSC) interview, after which they were given an online ID to track their housemanship application.

“Through the e-housemen system, we can know when the next intakes for housemanship will be open.

“But I am still waiting to go for my PSC interview. If this can be sped up, it would be helpful.”

Mastura Mukhtar, 24, from Alor Star, Kedah, said many of her seniors have to wait two to three months after their PSC interview before getting a placement.

“At least, if we are called for the PSC interview faster, we will not have to wait so long.

“I’m rather lucky to have doctors as parents and can shadow them at work, but not many of my batch mates are in a similar position.

“I, too, plan to take up part-time teaching to earn some pocket money and kill time,” she said.

According to Malaysian Medical Association president Dr Ashok Philips, the current backlog was because of a shortage following a government freeze on posts.

“There are only 5,000 housemanship posts each year in the 43 public hospitals nationwide.

“There are about the same number of medical graduates a year… some 20% of housemen take more than two years (the stipulated period) to finish, which creates a backlog in the number of available posts,” he said. – February 15, 2016.

– See more at: http://www.themalaysianinsider.com/malaysia/article/grad-doctors-wait-in-vain-for-houseman-posting1#sthash.93YCDAB2.dpuf



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Just a week ago, I wrote on the same topic quoting an article written by a philanthropist, Mr Koon on why he refuse to provide scholarship to those who wants to do medicine. Unfortunately, similar to what I had experienced before, multiple nasty comments were made against him in various blogs and newsportal where his article was posted. Readers can check for themselves. People still do not understand what we are trying to say. It is not about passion we are talking about but the economics. If you are doing medicine purely for economic reasons, than medicine is not the field you should choose at the moment, worst still by taking huge loans. I saw comments like ” there are no such thing as jobless doctors“, ” doctors never get retrenched” , ” doctors will always earn money no matter what the economic situation is ” etc

Today, there were 2 articles that caught my attention. The first was a letter in The Star written by a GP (see below). I have been talking about how opening a GP clinic is not as easy as it used to be. I know quite a number who had closed shop and gone back to work as employee of franchise clinics. Most GPs survive on panels. The letter today clearly illustrates how companies and panels demand what they want from the doctors. Either you take it or leave it. If you don’t want to take, someone else will! That is their motto and since many doctors are also struggling in their business, they do not mind taking the offer. It is interesting that the institution had requested the doctors to pay a fee for the contract renewal and further limit the consultation fee. I know some insurance companies which even controls what medicines that can be given etc. I had written about these issues before. The letter again tells people the actual income of GPs nowadays and not to assume that all GPs are rich with big cars! He quoted 1-2% of GPs of being succesfull which is lower than 10% of doctors that I quoted in my last article.

Another interesting article was published in Malaysian Insider on the issue of patient load in private clinics and hospitals. As I had written before, private healthcare is almost 70-80% supported by insurance and corporate panels. Thus, it is not right for anyone to say that doctors will earn no matter what’s the economic situation is. No doubt you may be able to earn to survive but to say that you will still earn handsomely is not right. The general public still do not understand the economics. The private healthcare cost is simply too high for any middle-income group. Once economic slow down occurs, people will tighten their pockets which in turn reduces the visits to private healthcare. Some will treat themselves with medications bought from pharmacy or cheap medication sold by traditional healers which suppose to cure everything under the sun. Some will default their insurance payment which makes their medical card invalid. Majority will turn to public hospitals and clinics. That is the reality. Income of many doctors especially GPs will decline considerably. Even hospitals can close shop due to high overhead maintenance cost. Insurance companies have already started to control what we do and what we are not supposed to do. They simply refuse to pay if they don’t agree what you had done. And the patient will also not pay! BTW, please read the comments in Malaysian Insider. Just see how many give sarcastic remarks about private doctors!

A GP friend of mine had refuse to sign with most panels due to their unfavourable contracts. He only has one insurance panel. He got this to say “I’m lucky that people around here earns S$… Otherwise I’d be full time Uber driver.. …. ”

So, please listen to Mr Koon! He is a businessman and he knows what he is talking about. 

To make matters worst, it is reported that the government has SUSPENDED JPA and MOE bursary scholarship with immediate effect ( see below)!! 


Panel doctors feeling the squeeze
I AM writing to highlight the underhand methods which some corporations are using to squeeze doctors and general practitioners (GPs) in this country.

Recently, an established and well-known institution of higher learning sent an official communication to all of its existing panel GP clinics, informing them that they were being offered an extension of their panel status with the said institution.

After decades of providing quality primary healthcare services to the institution, these GPs now have to renew their commitments. This is a common exercise, as times are changing and the terms of the contract will need to be reviewed from time to time.

However, what is shocking is the manner it is being done and a new condition which has been introduced. This institution has now decreed that, in order to continue providing services to the institution, the GP clinics would need to pay a processing fee of RM2,500 for the two-year contract period. This means each GP clinic has to pay RM2,500 in order to be eligible to provide services to their employees.

To us, in the medical profession, we feel this is an attack on the integrity of doctors. Through the Hippocratic Oath, we are bound to provide our services to any and all, regardless of race or religion.

Now we have an institution of higher learning, which incidentally also has a medical faculty, that has single-handedly turned this most noble of oaths completely on its head. They are sending a message to the world that doctors now have to pay before they can render medical help to mankind!

They will argue that there is a cost to manage and process the clinics and doctors who provide this care to their employees. They will say that the costs to manage and administer this is rising due to many factors.

But yet, they have the gall to fix consultation rates at RM15 per visit, as opposed to the prescribed rates of between RM35 and RM50 by the Malaysian Medical Association (MMA) through the Fee Schedule.

They have also the nerve to fix medications at unfair rates. For example, upper respiratory tract infection has been fixed at RM21. One pays more for a cup of coffee at certain places these days!

Does this institution, which is also a breeding ground for new doctors, realise that the healthcare industry has also not been spared the increasing costs of doing business?

GPs are subject to increasing costs through higher rentals, utility charges, consumable and disposable charges, equipment costs, etc. This is mainly due to the introduction of the GST, which healthcare has been exempt and therefore cannot transfer the costs to patients. To these people I ask: Who is looking at the welfare of doctors?

The public may have the perception that doctors are wealthy and live the high life. I implore those who have this perception to stand outside any GP clinic and observe what car these GPs drive.

I agree that just like any profession, there would be the top 1% to 2% who have made it. But just because there are high-flying GPs who jet-set across the world, it doesn’t mean all GPs have the same life.

The average income of GPs these days is between RM7,000 and RM10,000 per month, and this is after 15 years of working. Most other professions provide better and greater opportunities to earn much more than that.

In the end, it is the poor GP who suffers. More and more organisations are taking advantage of the market forces to push doctors into a small, pitiful corner.

Additionally, I would like to highlight one important fact. This institution has now also introduced a kickback system into the market. Pay them in order to be allowed to eke some living out of their employees. Pay them before being eligible to provide services and send bills to them. Doctors now need to pay before being allowed to have patients.

What message are they sending to the medical students in their own faculty. This is against the Private Healthcare and Services Act 1998, which outlaws such practices of kickbacks.

Doctors have stood by and just allowed this entire thing to get to this stage. But as a member of this profession, I cannot just stand by and watch anymore.

I am imploring, even begging, for the Health Ministry and the Government to tackle this issue with utmost urgency and importance. Please, help the GPs.


Kuala Lumpur


Private healthcare patients feel pain of weak ringgit, higher cost of living

Published: 20 January 2016 7:00 AM
Private healthcare, the preferred option for those who can afford it, is reportedly seeing a drop in patients with practitioners attributing the trend to the effects of increased cost of living and the ringgit’s depreciation against the US dollar which has made certain treatments more expensive.

Tan Sri Dr Ridzwan Bakar, consultant cardiologist at a private hospital in Kuala Lumpur, said some of his patients have transferred to public hospitals.

He noticed a 10% drop in number of admissions to private hospitals since April last year, when the goods and services tax (GST) was first implemented.
“I think this is the general finding of almost all doctors working at private hospitals in the Klang Valley,” the cardiologist with more than 30 years of experience in private healthcare told The Malaysian Insider.
“The drop has remained persistent towards the end of last year,” added the former president of Association of Private Hospitals.

“People have less disposable income,” said another industry professional, Malaysian Medical Association (MMA) president Dr Ashok Philip.

“We have GST, the economy is not so buoyant, the ringgit has depreciated, and times are uncertain.”

Correspondingly, the number of people seeking treatment at public hospitals appears to have risen. Public healthcare in Malaysia is almost free or certain treatments are heavily subsidised although patients have to endure a longer waiting period for procedures compared with private healthcare.

“My colleagues at public hospitals have noticed a 25% rise in the number of admission in public hospitals, maybe there has been a drifting of patients from the private sector to the public sector,” Dr Ridzwan said.

Dr Ashok concurred.

“Anecdotally, the outpatient load in private clinics and hospitals has declined. This is because the outpatient treatment at government clinics is almost free,” he said.

It’s a sign of the times when even cancer patients are opting to cut back on essential chemotherapy at private facilities in order to trim expenses.

Dr Ridzwan said oncology was a good example of one area in private healthcare affected by the exchange rate because of the nature of the treatment.

“The drugs can easily run into five figures per month and there is no replacement. (Patients) have to be given those drugs.”

Private hospitals which have more patients with insurance might not be as badly affected, but given that about a quarter of patients at most facilities pay out of their own pockets, the impact on the hospitals’ bottom line is of concern.

“Between 30% and 40% of patients at private hospitals are self-funded. We can safely assume that many of them have to tighten their expenses, they have to go to public hospitals,” Dr Ridzwan said.

The weak ringgit has impacted on medical fields requiring expensive chronic therapy, a pharmaceutical industry player said.

“Healthcare involving babies, children and pregnant mothers is less affected,” said the sales representative of a drug firm, who declined to be named.

“The drop in patients also varies greatly between different therapeutic areas.”

Some private clinics are seeing a drop of more than 50% while others seem to have smaller decline of 15% to 20%.

“A large private hospital closed one of its wards due to the lack of patients,” he said, adding that he expected 2016 to be a difficult year for private healthcare, especially those requiring costly and chronic therapies.

“The use of generic medication may increase while health supplements may be affected negatively,” he said.

The Association of Private Hospitals Malaysia did not respond to The Malaysian Insider’s queries on these matters.

Expanding public healthcare

Director-general of the Health Ministry Datuk Dr Noor Hisham Abdullah in a reply to The Malaysian Insider said government facilities have seen a steady increase in demand for services but he did not have data from the private sector to compare with.

“The current economic situation has caused a surge in the demand for our services but with the current strategies we have implemented, we are well prepared to face this surge.”

Figures from the ministry show an increase in total admissions at government hospitals by 13.9%, from 2.16 million patients in 2013 to 2.46 million last year.

The number of hospital outpatients also increased by 2.7 million or 5% from 54.2 million in 2013 to 56.9 million in 2014.

To cope with the numbers, Dr Noor Hisham said the ministry has increased the number of public healthcare facilities, especially Klinik 1Malaysia (K1M), employed more staff by an average of 9% annually and expanded the scope of primary healthcare services.

“For example, in our K1M, from the original treatment of minor ailments, the services have extended to include maternal and child health services, doctor services as well as treatment of chronic diseases.”

Operating hours have also been extended, as well as moves to increase the number of beds throughout the country by building new hospitals, upgrading facilities and using day care services to reduce inpatient demand. – January 20, 2016.

– See more at: http://www.themalaysianinsider.com/malaysia/article/private-healthcare-patients-feel-pain-of-weak-ringgit-higher-cost-of-living#sthash.RqlSI7N3.dpuf


Putrajaya suspends JPA scholarships amid falling revenue

Published Today 9:13 pm     Updated Today 9:25 pm     

Putrajaya has suspended the Public Service Department (JPA) Scholarships for degree courses and the Education Ministry’s bursary for pre-university programmes amid falling national revenue.

According to Sin Chew Daily, this was confirmed by Minister in the Prime Minister’s Department Wee Ka Siong who raised the issue at the cabinet meeting today following several complaints from high-achieving students.

Wee said he had asked the Prime Minister Najib Abdul Razak to rethink and reinstate the scholarship.

“The prime minister understands that the economy is not good at the moment and the people are facing heavy burden so he has instructed the chief secretary to the government and JPA to come up with a new solution.

“I can’t say for certain if there will be a change of decision but we (MCA) have tried our best to appeal the matter because we don’t know how the economic situation will develop,” Wee was quoted as saying by the Chinese language daily.

The suspension applies to both overseas and local scholarships and affects some 700 placements this year.

Urgent resolution

Wee urged for an urgent resolution to the matter as some university commence their intake as early as Feb 1.

He added that Najib had asked the chief secretary and JPA to submit a report to the cabinet next week with their proposal.

The Sin Chew report also pointed out that some students have questioned why the JPA scholarships were suspended, but not Mara scholarships.

However, Wee declined to respond to this claims, citing that he had not heard them personally.

Asked if the suspension of the JPA scholarships was linked to the planned budget revision on Jan 28, Wee said he did not know.

A check with JPA’s website found the “bursary e-filing system” link which is used by students to apply for the scholarships, have also been removed.

Putrajaya is struggling with shrinking revenue as the Brent crude oil price has fallen to a 12-year low, settling at US$27.78 per barrel.

This is in contrast to a high of US$114.81 per barrel in 2014.

Najib has announced that the 2016 budget will be revised to adust for falling revenue and will see government expenditures optimised.

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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






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.





 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:


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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