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

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

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

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

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

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

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

MESSAGE FROM THE DEPUTY DIRECTOR GENERAL OF HEALTH THIS MORNING 22nd March 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

🙏 DATUK JEYAINDRAN TAN SRI DATUK DR C SINNADURAI

So, just to summarise:

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

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

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

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

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

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

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

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

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

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

UD56 post

1.Only for gazetted NSR Specialist

2.5 years after gazzetemnt & 5 years after being a UD54

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

4. No car or petrol card given to UD56

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

Other matters raised

1. No subspeciality allowance will be given once sub completed

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

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

4.No more contract doctors – JPA phasing out . 

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

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

7. Optimize the use of resources & consumables 

8.No direct sponsorship by Pharma companies

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

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

11.FPP – not for foreigners

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

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

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

Junior doctors trapped in catch-22 predicament

March 10, 2017

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

By Dr Muhammad Firdaus Syukri B Ahmad Zubaidi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:03

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

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

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

BY FAREZZA HANUM RASHID AND VEENA BABULAL – 15 FEBRUARY 2017 @ 2:00 PM

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

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

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So, finally the first batch of HOs under contract has been given. I was made to understand that 1300 contract posts were given out after the last SPA interview conducted in October 2016. These were graduates who were waiting since early this year. Interestingly, I was told that none received permanent post. Even JPA scholars were only given contract post and it seems, the agreement that you have with JPA has nothing to do with MOH. There is no guarantee that you will be continued to be employed just because you are a JPA scholar! This comes as a surprise even to me as the scholarship contract specifically says that you will be bonded with the government for 10 years. Only from this year, the scholarship contract was redefined as convertible loan. What happens if the scholar is not able to get a permanent job with the government? Does he need to pay his bond? An interesting question.

The good news is, those who received these contract post were able to get their posting in December 2016(in just 2 months after interview), as long as they are not choosy in picking their hospital on e-housemen portal. But they still waited for close to 7 months to even be called for interview.

There were many questions on the pros and cons of being under contract. Frankly, as long as you are under contract, the salary and leave benefits will be the same. However, you do not get to enjoy other benefits such as house or car loan. Applying for a bank loan may also be difficult as you do not have a permanent job. The government can also terminate you immediately if they find you are incompetent, missing in action or have poor track record. These will definitely keep the HOs on their toes. Below I attach snapshot of some of the “Syarat-syarat pelantikan secara kontrak”

Number 13, 14 and 15 might be on interest for some who intend to pursue post graduate education. Number 13 and 14 clearly says that the government can terminate you anytime by giving a 30 days notice or immediately by giving 1 month salary. Number 15 is another interesting statement about application to be absorbed into permanent post. The first and foremost criteria is “availability of post“! This is were I am worried as the number of permanent post available may not be the same as the number of HO’s graduating. They have also listed the criteria that may be used to decide on who will get the permanent post. Basically, you need to complete your housemanship as per requirement (which means within 3 years), have good track record and gets good recommendation from HOD. …………

Somehow, I feel this will remove all the dead wood graduates from the system. However, I am also worried about lack of transparency in making such selection. Those who are hard working and got no issues in completing housemanship should not have any problems. I feel there should be some sort of committee to make such decisions to be fair. Contract post also means that HOs can stop demanding this and that. The motto will be ” you tak suka, you boleh keluar“, the most favourite statement from our politicians. Your contract can be terminated.

The contract also clearly says that government is not obliged to provide permanent jobs to everyone:

So, what happens to those who do not get permanent post after 4 years contract? Firstly, you need to find a job: either open a clinic, join as emergency department MO in private hospitals or find another non-medically related job. Secondly, all your ambition to become a specialist will have to disappear unless probably FRACGP organised by Academy of Family Physician of Malaysia, join as a private Master’s candidate at local university(you pay full fee and very limited seats) or probably do some non-clinical, part time courses.

Whatever it is, the government will not be able to absorb everyone. They are not obliged to provide every graduate a job. Many may end up with a license to kill…………. Medicolegal cases are going to increase by leaps and bounds………

Finally after settling my tax issues with IRB, I am off again for a long holiday of 3 weeks……… Sayonara to everyone…..

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Just to update for those who wanted to buy my books when it comes to the bookstores, my books are available at the following bookstores for the moment:

1. Kinokuniya (Suria KLCC)
2. MPH (Subang Parade)
3. MPH (Mid Valley)
4. MPH (One Utama Megastore)
5. MPH (NU SENTRAL MALL) (NS)
6. MPH (Vivacity Megamall) – Kuching
7. Smart Book Shop (Kuching)

As informed earlier, my Ebooks are available at Google Play Store and soon Amazon Kindle. For those who don’t wish to buy directly from me as stated HERE, you can also buy it online at Kinokuniya Online and MPH Online.

Thank you for all the support so far and you are welcomed to write reviews at any of their sites.

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I have had many queries regarding e-book version for my books. I am proud to announce that the E-Books are now available at Google Play Store.

Please visit Google Play Store or HERE.

The price is determined by Google and Publisher. I got no control over it. If you want to purchase Hard Cover books, please visit over HERE.

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ON this auspicious 59th Merdeka day celebration, I would like to announce that my books “Hard Truths of Being a Doctor Part 1 & 2″ are both available at Kinokuniya Bookstore in Kuala Lumpur.

If you would like to buy it online from them, please visit the following website .

You can still visit my blog post HERE if you would like to purchase directly from me.

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In my first post with the above topic , I mentioned about the government’s intention to introduce contract HO post. Sometimes I do not know whether to laugh or cry. Few years ago when I predicted that the time will come for graduates to wait in a “Q” and jobs will not be guaranteed for doctors, I was scolded, laughed at, humiliated and given numerous sarcastic remarks. Few years down the line, when what I predicted happened, the situation has changed. Now, these very people claim that I am boasting and self-glorifying. I don’t know what these people really want. When you tell them something , they don’t listen and when it happens, they throw back their tantrum to the very same people who predicted it will happen. What precaution did you take ?

There was a meeting between MOH officials with HODs of a big hospital in Malaysia recently. In this meeting, the current situation of doctor’s post was discussed. Please be informed that MO post is currently 16% oversubscribed! Interestingly, some of the HO post are being converted to MO post to cater for this oversupply. This happens because , all those who are appointed into civil service are on a permanent post currently. Thus, the government is now in the process of trying to get contract HO post to fill up the gap and to shorten the waiting period . However, this new situation will only reduce the waiting period from about 8 months to about 6 months. With the increasing number of graduates from this year onwards (all 32 medical schools will be producing graduates from 2016 with increasing numbers), the waiting time will only shorten for a short period of time before climbing back to about 1 year or even longer.

It is expected that the contract HO post will start from this October if approved by cabinet. The question is “what happens after HO?”. It seems that the government is not obliged to provide jobs to everyone, which is a fact. Thus, if you do not get a permanent post after HOship, your contract may be renewed for another 2 years to complete your compulsory service. After the 4 years compulsory service, you can do what you want! The GP market is going to be severely affected by this as those who can’t get a job in MOH will open their clinics in every corner of the town. The struggling GP market will continue to struggle.

As I said in my previous post, this will affect post-graduate education. At the moment post-graduate education can only be done in public hospitals. I also heard rumours that those with MRCP, MRCS Part 1 etc will have a better chance to get into a permanent post. Another good news is the fact that some of the public universities are building their own teaching hospitals which can probably employ some of these MOs. UPM, UiTM, University Sarawak and Sabah etc are all in the process of building their own teaching hospitals. However, these will take another 3-5 years to materialise.

It is also informed that no more contract extension will be given to those who had retired from civil service. This “post retirement contract” is something which I had always felt is not appropriate. Those who had retired should not be reemployed to the same post under contract unless it is a very much-needed service with no replacement found. In many instances, HODs who had retired continued to become HOD under contract. That is not right as far as I am concerned.

I still get questions from foreigners who are interested to do internship/HO/MO in Malaysia. Let me tell you once and for all, Malaysia DO NOT provide housemanship to foreigners. Foreign Spouses of Malaysians were given internship post till 2014 under contract but stopped since then. In February 2016, MOH came up with the following circular to confirm the fact that foreigners will not be given housemanship post till further notice. It also mentioned on those who has quit housemansip or terminated.

With the introduction of HO contract post, it will become very much easier for MOH to terminate any HOs who go missing or have poor performance.

And for those who think that being a doctor guarantees you a job anywhere in this world, don’t live in a delusional world. Doing medicine for migration is the worst thing to do. It is the most controlled profession in the world and most difficult to migrate. Just recently, there were suggestion that Australia should stop recruiting foreign trained doctors.  Please check how much easier it is for people of other profession to apply for “Skilled Migration” Visa to Australia compared to medicine. With the new PM in UK who supports anti-migration policy, the situation may not be any better. Singapore has also stopped conducting qualification exams for foreigners with unrecognised basic degree. Unless you want to migrate to an African or 3rd world country, doing medicine is the last thing you should do.

The world of medicine is not the same anymore. Majority of those who I talk to are intending to retire early. For those who intend to do medicine, PLEASE read my books. You can buy it online as mentioned HERE. It should be available in Kinokuniya bookstores very soon. Popular will be next………..

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Almost 3-4 years ago I predicted that there will come a time where HO post will be given under contract. In August last year, I again predicted and heard rumours that HO post may be give under contract, after which you need to apply for a permanent MO post. There were even a suggestion than that en exit exam is being considered after housemanship. Well, looks like once again my prediction may become a reality soon.

TheStar reported today that MOH is waiting for green light from the cabinet for creation of temporary HO post. This basically means the HO post will be given under contract. What happens after housemanship? It basically means that you will need to reapply for a permanent post as a MO. There are pros and cons in this system. Firstly, how do SPA or MOH decide on who will receive permanent post and who will receive contract post? I presume JPA scholars/government scholars might be given preference for permanent post as the contract guarantees a bond with the government. Secondly, how do you assess who will get permanent MO post after the contract expires? This is where the said exit exam may come into force. BTW, 300 contract post were created this year for dental graduates as reported by DG and written by me in March 2016.

On the other hand, it will keep all HOs on their toes. If you don’t complete your housemanship in 2 years (usual duration of any contract post), you may not be able to continue the contract. It is also easier to terminate HOs who are missing in action. If you perform badly during housemanship, you are likely to have a lesser chance of getting a permanent MO post. Be also aware that if you do not get a MO post in government, you have almost zero chance of pursuing post-graduate education.

As i had always said, there is no such thing as job security in medicine anymore. It is considered as just like another job but medicine is far more complicated than any other jobs out there. Without housemanship, no full registration. Without full registration, you can’t practise as a doctor etc etc.

What’s next ? A reduction in compulsory service from 4 years to 2 years ? Open clinic after housemanship? Another of my prediction which may come into reality. Then we may have a lot of doctors with apparent ” license to kill”……………

Temporary posts can reduce waiting time for medical grads

KUALA LUMPUR: There is good news for medical students who will be graduating soon as they may not have to wait too long before being offered a job.

The Health Ministry is in the final stages of implementing a plan to introduce temporary posts for medical graduates who face a long wait to do housemanship.

Its deputy director-general (medical) Datuk Dr Jeyaindran Sinnadurai said the rigidity of the current system did not allow the ministry to offer permanent positions to more people as they serve their housemanship.

The plan for temporary posts, he said, needed the Cabinet approval before it could be introduced as “we have to ensure that it is fair to all and no one is marginalised”.

On whether the ministry can justify the number, he said “yes” as it had developed many new services.

“The workload has increased, so we need those numbers to deliver care to the public.

“Presently, we take in about 4,500 house officers annually on permanent posts and upon completing their housemanship, they become permanent medical officers,” he told The Star after chairing a lecture at Hospital Kuala Lumpur on Thursday.

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