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Archive for the ‘Education’ Category

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.

HARD TRUTHS AI BLUE - New Blue

 

HARD TRUTHS AI BK2- New Red

 

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

Part 1

Part 3

 

 

Part 4

 

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:

Part 6

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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I have been very quiet over the last 2 months. I am sure those who are in the private sector(specialist) would know the reason. All of us are undergoing a huge heartache due to a change in the policy of LHDN/IRB to disregard any income declared under our own company (Sdn Bhd). For those who do not know, private specialist are independent contractors in a private hospital. We are not paid a salary by the hospital, thus we are not employed by the hospital. Basically, our income is the fee paid by the patient as what we charge, based on PHFSA act minus 10-15% administrative fee by the hospital. Our fees are limited by the government BUT not the hospital charges. Thus, to manage our tax better, we form our own company where the income is channelled. This practice has been going on for close to 30 years since private hospitals started in this country. Unfortunately, as the government tries to get more income from taxes, the rule has suddenly been changed. Effective mid of this year, a letter from IRB has declared that all income generated by a specialist in a private hospital MUST be subjected under personal income tax! AND it does not end there, we are being asked to redeclare our income tax from 2013 and pay the penalty for the difference not paid! AND we have to do that by 15/12/2016 to receive a reduced penalty rate of 15-20% under the amnesty period introduced by PM from March 2016. Now you know why I was very quiet over the last 2-3 months! The penalty and tax arrears can cost hundreds of thousands of our hard-earned money, working day and night.

Coming to our Budget 2017. In August 2016, I wrote about the soon to be introduced contract HO post to reduce waiting period for housemanship. Well, it has been confirmed in this budget. 2600 contract post will be created by December 2016 to cater for the shortage. He also mentioned that contract post will also be created for dentist and pharmacist but that is nothing new as it has been done. Unfortunately, the budget is silent on what happens to these contract post after they complete housemanship. Will this shorten the waiting period? Personally I don’t think so but it may shorten by 1-2 months for a short period of time. Always remember that starting from this year (2016), ALL medical schools in this country will be producing graduates and those who started to produce graduates about 4 years ago will be producing maximum number of graduates from this year. Another question is how they will select candidates for permanent and contract post? My prediction: probably government sponsored and public university graduates may be given preference and those who do well in the interview might be given priority as well. What happens after you complete housemanship? MO post are also FULL!

Another interesting development is the introduction of a new grade for specialist known as Grade U56. As we all know, since the time based promotion  was introduced in 2010, there is a bottle neck at U54 as all specialist of 9 years of service will be automatically promote to U54. Unfortunately, no JUSA C promotion has been coming since the last 2 years as there are not enough post or money to do that. Thus, the creation of U56 is to relieve the anxiety among all these specialist and to encourage them to stay. I know many U54 and even JUSA C specialist resigning from government sector but with the recent IRB ruling as above, private sector may not be as lucrative as what you expect it to be. You will end up paying 26-28% of your hard-earned money to the government. You will be working 3 months in a year for the government. Now you will know why the mood among all the private specialist is down over the last 2-3 months. For me, the introduction of U56 is just to say that you are not going to get JUSA C anytime soon or even forever!

Budget HO

 

 

The government is also planning to expand their Full Paying Patient scheme to more hospitals as another form of encouragement for specialist to stay in the government sector. I still remember almost 11 years ago, I was one of the SCHOMOS committee member involved in this discussion to introduce FFP.

FPP

 

Interestingly, there is also a suggestion in the budget to build “non-profit charitable” private hospital under government initiative. RM 20 Million loan is nothing as far as building a hospital is concerned.I wonder how long will that last unless the government comes up with a National Health Financing scheme…… How a private hospital is going to survive with government hospital rates? Isn’t that what the government is doing with government hospitals? Sometimes I don’t understand all this populist ideas which most of the time never happens.

Budget 2017 Hospital Non profit

Anyway, government servants will receive RM 500 bonus and no income tax reduction as promised. He did promise few years ago of a gradual personal income tax reduction when GST is in full force. AND what happened to “janji” of reduction in car prices? Janji dicapatikan,  I guess.

Finally, today’s BUDGET speech in Parliament felt like a election public rally! Why do we need all the “public” icons to be made present and introduced? First time in the history of Malaysian Parliment!

I give up some times!

 

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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.

 

whatsapp-image-2016-09-03-at-14-00-11

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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.

Screen Shot 2016-08-21 at 10.54.02 AM

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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