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Continued……….

It’s been 6 months since I last wrote an article in this series. In between, I was interviewed by various organisation in relation to contract doctors etc. This will be my last article in this series. 

Despite all the hardship that I went through since my childhood of being a “non”, one thing that was guaranteed for me was a civil service job! This is simply because, there were only 3 medical schools producing about 450 graduates annually and some returning from overseas. There were plenty of post available for us to fill. Interviews by SPA and MOH were conducted in the universities even before we sat for our final year exams. The moment our results were out, we would receive our appointment letters within 2 weeks! I had written about this many times before and thus will not go into the details. I was asked to report to Hospital Ipoh within 30 days. While the salary was pathetic to say the least, we were grateful that we had a permanent job. Two months before we due to finish our housemanship, we need to apply for district posting and induction course (Kursus Induksi). At that time, district/rural posting after housemanship is mandatory. We must make our 3 choices. I was asked to go to Pontian Hospital in Johor for my district posting.

While there was subtle racism wherever I worked in MOH, it is hardly noticeable. This is simply because the staffs consist of mixed races. There were nurses, MAs (Medical Assistant), attendants from all different races. This reminded me of the time I was in school back in 1980s. While the schools were becoming monoethnic in composition of teachers by late 1990s, hospitals and klinik kesihatans were still consist of multiple races working together. In fact, most of the HODs were non-Malays in JB hospital. Unfortunately, things have changed since then. We hardly see any Chinese or Indian MAs working in MOH nowadays. Nurses are predominantly consisting of a single race and the composition of doctors are also becoming predominantly of a single race. I am not saying that these people are not doing their work or discriminating against non-Malay patients, but it is an unhealthy development in a multiracial and multireligious country. Many of the non-Malay consultants and HODs moved to private sector, mainly due to financial reasons. They have accepted the fact that their children will not receive any privileges in education or scholarship. Thus, they have no choice but to move to private sector to earn better revenue to support their children in the future. Nowadays we even have shariah compliant hospitals, whatever it means. An Ustaz or Imams are allowed officially into a hospital to say prayers, but similar permission are not given to other religious bodies. 

I used to say to my friends that the last government body that use to be multiracial will eventually come to an end, and it happened. Sometimes I should just keep my mouth shut! With the current contract issues and limited permanent position, I doubt the situation will get any better. This coupled with quota system in master’s recruitment and limited post graduate opportunities, will only make the situation worst. What really shocked me the most is when I found out that some of my Malay friends who I worked with as Medical Officers openly expressed their opinion that they would prefer all HODs to be Malays as this is a Malay country! When even highly educated people can think as such, what hope do I have? By mid 2000, I began to realise that this country is heading the wrong direction, the direction of destruction and no return.

The first 10 years of my medical life was a turbulent one. Getting married halfway through my 2^nd year of working life (district posting), passing my Part 1 MRCP on 1^st try and moving to JB Hospital to continue my training was the easy part. With a pathetic salary, busy work life (JB Hospital is one of the busiest hospitals in the country) and studying at the same time really pushes you to the limit. By the time I sat for my Part 2/3 in 2002, I had 2 child and got my 3^rd in 2004. By this time, I was in debt! Looking into the future and where the country was heading, I had to make difficult choices. I quit MOH halfway through my Rheumatology training in Selayang Hospital and joined Monash University in 2006. My wife who sacrificed a lot with me, had to discontinue her Family Medicine Master’s program in 2002, as it was just too difficult for us to manage the whole family with both of us doing postgraduate education at the same time. We lived by ourselves. 

With the help of Professor Khalid Kadir, I was encouraged to complete my Rheumatology training in Singapore while I continue to teach in Monash which was based in Johor Bahru. I am forever grateful to Prof Khalid for this arrangement. This allowed me to complete my Rheumatology training by 2008. Working in Singapore gave me a different perspective of how such a small country could succeed! It is all based on meritocracy and knowledge-based economy. The way they encourage research and development and how they support you to develop new skills and new departments is fascinating. How they attract the best brains from all over the world and keeping their own best brains is something that Malaysia can learn from. Unfortunately, Malaysia is too engrossed with Malay nationalism with race and religion tearing the country apart. The best brains leave to be better received by another country.

Upon returning from Singapore, I encouraged my wife to continue her discontinued post graduate education. She was very eager to complete her post graduate training in Family medicine. She enrolled into the Academy of Family Physicians MAFP/FRACGP program which was a 4-year program. The advantage: you are eligible for FRACGP which is registrable in Australia. As an appreciation of her sacrifice taking care of the family while I was doing my post graduate education, I paid for her course. While Monash gave me a much better salary than MOH, with rising cost of living and higher tax that you must pay in private sector, it was still an uphill task to earn enough for my children’s education, especially tertiary education. As I had mentioned in my past articles, by 2010 I had to remove my children from national schools to private national schools (not international). The racial and religious issues that was happening in the national schools (despite being a missionary school) was not something that I could accept. I do not want my children to grow up with racial and religious dogmatism. It hurts you when your son who is just 10 years old asking you why the Ustaz in his school distributing free food to only Muslim students in the canteen!

Thus, by 2010 with my eldest already 10 years old, I need to save enough money for him to pursue his tertiary education in 7 years’ time. Again, I had to make a difficult decision in my life. While I loved academic life, publishing at least 5 papers in major international journals within 4 years and loved teaching, I had to give up and move to private sector. Columbia Asia Nusajaya invited me to join them as they opened their first hospital in Johor. After much deep thought, I accepted their offer. I was also the Chief of Medical Services for the hospital, for 7 years.

Life working as a consultant in private hospitals in not rosy either. Yes, you may earn much higher than public sector or universities, but it is no work, no money system. The more hours you work, the more money you get. The more patients you see the more money you get. After some time, you will realise that you are earning enough money, but you do not have a life! I have written about this in this blog as well as in my books. There is no work life balance. The unethical practices that happen in private hospitals is something that I could not accept either. In Malaysia, everything seems to be about money. As one of my friends who is a businessman said, Malaysia is the best place to make money! 

By 2015, my wife has cleared her FRACGP. By this time, the country was in turmoil. The 1MDB scandal and billions of dollars being swindled right in front of our eyes was sickening. Politically, the government has lost it’s 2/3 majority since 2008. Racial and religious politics went into overdrive. What more can politicians use other than race and religion, the well-known propaganda known time immemorial. The government started going after the citizens to collect more tax and penalties to patch up the loss. By 2016, the private specialist doctors became a fresh new target. GST was introduced. With just a single letter, LHDN decided that the private specialist can’t form a company and divert their income to the company (something that has been happening since 1980s and considered legal) and have to declare their income as personal income. They backdated these 5 years (2010-2015) with reduced penalty of 15%! After much discussion between MMA and LHDN, it was reduced to 3 years. We had to rush to settle this by end of December 2016 which was the due date for the penalty of 15%. This is when I realised that the government could screw you when they run out of money. LHDN is the most powerful organisation under the Ministry of Finance who can even charge you in court without going through the police/AG. The DG has absolute power to order any audit or change the rule and can deem anything as a form of tax evasion. 

By this time, I had no choice but to decide my next step. While I was doing well in private sector, it was a one man show. My wife was still a civil servant and my children’s education was totally dependent on me. My eldest son was going for SPM in 2017. We decided that it is best to send our children overseas for education. I wanted them to get a degree which would be more widely recognised all over the world. The world in shrinking and we can’t be living in a cocoon. Fortunately, my eldest was not interested in medicine. I let them do what they are interested rather than coercing them to do what the parents wanted them to do. To date, none of my children are interested in medicine. 

After my wife cleared her FRACGP in 2015, we started receiving calls from recruiting agencies in Australia, offering her a GP position. We rejected all the offers. But something happened in 2016. While I was talking to one my friend from KL, he suggested, why don’t you apply for Skilled Migration Visa (using my wife’s FRACGP) which would give you a PR status in Australia? I was baffled. Is there such thing as getting a PR status without even stepping your foot into a country? Surprisingly, there is such thing and he recommended me to have a chat with a migration agency in Subang. We met with the agent, and everything changed! We thought of giving it a try. It involved a lot of work, from getting the medical registration from Australia (including visits to Australia to confirm job contact), numerous amounts of documents, certification of degrees, English test, police clearance etc etc. It took us almost a year to get all these documents sorted, not to mention the money involved. Finally, by March 2017, we submitted.

There were so many things that went through our mind. Are we really going to leave a country where we were born and grew up? Will our children be able to adapt to the new environment? Would we be able to adapt to a new environment and culture? The worst part, what about me? I am not registrable in Australia as I do not have a registrable degree. It is another long process and money to even apply for assessment. While we were considering all these, and my son was going to sit for his SPM (November 2017), we received another shocking news! In June 2017, my wife’s application for Skilled Migration Visa was accepted and we need to do some final document submission such as medical check-up, police report etc within 60 days. We did it in 30 days and submitted all necessary final documents. Woolah, within 3 weeks, our Visa was approved, and we are officially an Australian permanent resident! This visa is for the whole family, not just for my wife! My children will now be able to enrol into Australian university as domestic students with heavily subsidised fee. 

Why am I talking about this? A country which does not even know who we are, gave us permanent residency without even the need for us to step our foot into the country (except I have been to Gold Coast as a tourist). There were NOT a single question of what race or religion we belong to. Those who know me knows that my wife is not an Indian, she is a Malay! What mattered most was your skill and documents! And despite my wife being the main applicant, the entire family received residency status. This is how a country valued your talent and invites you to be part of their country. We are considered equal to their citizens except in voting rights. This is how they attract the best brains. Where are we Malaysia? Race, religion, and nationalism chased away the best brains, only for us to be proud of saying “Malaysian Born so and so……….” Foreign professionals married to Malaysians have to wait close to 10 years to receive their residency status, not to mention the various insults they receive at immigration office. We have a long way to go……

I moved my family to Perth, Australia in December 2017. My wife started working as a GP in January 2018. My eldest son started his university in February 2018 and my other 2 children started their schooling. What happened to me? Well, I had to start my ball rolling. With an unrecognised degree in Australia, I am not registrable in Australia. But as a senior physician I can apply to be recognised (not guaranteed) via the College of Physician. Another long process of degree verification, document collection, English test, interviews etc was conducted by the college (RACP). I submitted my documents in April 2018, called for an interview in Melbourne in May 2018 and finally in July 2018, I received their verdict. I received a “substantially comparable” status which would allow me to work as a consultant with 12 months of peer review before receiving specialist registration. This verdict is only valid for 2 years, which means I must find a job for the 12 months peer review within that timeframe. 

Based on RACP report, there were 145 applications in 2018 from all over the world for specialist assessment. 112 were considered “substantially comparable”, majority of these were from countries where specialist training is recognised by Australia such as UK, Ireland, USA etc. Out of 11 applications from Malaysia, only 4 were deemed substantially comparable and I am one of them. The other 2 options are partially comparable and non-comparable. Partially comparable means you need to do top up training of about 1-2 years as a registrar and may or may not need to sit for Part 2 exams. Non-comparable means, case closed. Once again, as my wife’s visa application, I was extremely lucky to receive the substantially comparable status. This, together with my status as a resident in Australia, I was able to look for a job. This was the next hurdle that I had to endure.

While I was going through all these processes, I was travelling between JB and Perth quite frequently. Then came the 2018 General Election. Everyone was euphoric after the historic result. Many wanted me to stay since a new Malaysia has emerged aka Malaysia Baru. Yet again, based on evidence and sentiments on the ground, I knew this excitement is going to be short lived. I wrote an article in this blog dated 4^th June 2018 with the title “Towards Malaysia Baru? I predicted that if the new government do not perform at a supernatural speed, either the government will fall before the next election or at the next election. My friends laughed at me and said it is unlikely due to overwhelming majority. Nowadays, they asked me to keep my mouth shut as everything that I predicted seem to be happening!

It was only in January 2019 I was invited for a job interview (after trying for 7 months). Again, I was lucky to be given a full-time consultant job in a regional hospital in Western Australia. Hopefully this would be my last leap of faith. I decided to take it and left Malaysia in May 2019. ……. I received my FRACP in 2020. It saddens me to see what is happening to Malaysia since I left. The vision of Wawasan 2020 remains an elusive dream. The country is more divided than the time I grew up in 1980s and 1990s. Racial and religious rhetoric is tearing the country apart. When even a vegetarian food prepared by Gurdwara Sahib can be questioned on halalness and cleaning a temple by Muslims can be haram, where are we heading? 

I can go on writing and ranting but I will stop here. It has been a tough 2 years for most of us. I hope and pray that 2022 will be a better year with disappearance of Covid.

I wish everyone a very Happy New Year 2022………………………

PART 1

PART 2

PART 3

PART 4

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I was invited to give a talk at the UKM Career progression workshop which was held on 17/04/2021. I did mention this in my blog on 29/06/2021 where I showed some of the slides from the talk. Many have emailed me and asked me whether I can upload the talk that I gave. It took some time for me to get the recorded video from the organiser and I also had to do some editing to make it shorter.

So, here is the video of my talk and it is almost an hour long……… Some of the documents might not be clear but those documents are available in my blog.

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It has been 4 weeks since my last post on the Black Monday campaign by SCHOMOS and the hartal that is being organised by a separate group of junior doctors. I had received a lot of feedbacks for my previous post personally and via my blog. In the background, SCHOMOS/MMA has been working with MOH and finally had a direct meeting with PM on 23/07/2021. On the very same day, the PM’s office issued the following circular:

As I mentioned in my previous post, absorbing all graduates into a permanent position is NOT a long term solution. I had explained the reasons for this very clearly. It is almost impossible for the government to do this looking at the number of graduates being produced. My recommendation is for all doctors who are into post graduate training should have their contract renewed till they complete their training and get gazetted. The postgraduate training should be standardised. I also said that the permanent government positions is not sustainable anymore and all positions should be changed to contract from now onwards but they need equal opportunities etc, similar to other developed countries.

The circular above basically agrees to what I have been saying all this while. The government has guaranteed that they will provide a minimum of 6 years contract (4+2), increase from 5 years (3+2) currently. During the last 2 years extension, if you are enrolled into a post graduate training program, the contract will be extended to a maximum of 4 years. I presume this 4 years comes about due to the 4 years Master’s program. Those who are already in parallel pathway, they should be in their specialist training by the time the 6 years is done, especially for MRCP, MRCPCH and MRCOG. This 4 years extension hopefully will support their subspeciality training programme. So, overall, if you are in specialist training program, you will be guaranteed a job and training for at least 10 years. The government has also agreed to provide Cuti Belajar Bergaji Penuh and HLP if you are enrolled into the Master’s program. The only problem I foresee are for those who are dependent on local Master’s program which predominantly will be the surgical fields.

With large number of graduates applying for local Master’s program, the waiting period is going to get longer. I did mention this many years ago. The number of slots for Masters program is only about 1000 per year for all speciality included. My question is whether these doctors would even be able to get into the Master’s program within 4 years after housemanship. If they don’t , would their contract be not extended? What if they do not complete the training within 4 years, like they get extended etc? What if they do complete their training but wants to do subspeciality training? Would the contract be extended further? There are many unanswered questions but at least this circular clarifies some of the urgent matters and hopefully, further improvement could be made in the future.

However I noticed that the letter did mention about amending the Medical Act which I find it puzzling. The medical act has nothing to do with employment EXCEPT in regards to the compulsory service. Are we looking at an official reduction in the compulsory service in the future? Currently MMC (since Oct 2020) do allow junior doctors to leave the service 18 months after completing housemanship, pending Minister’s approval individually. Would this be lowered further, permanently? Or are we looking at a common licensing exam applicable for all graduates? It will be interesting to watch but again, it is all a political ball game!

Unfortunately, the above circular and reassurance did not seem to satisfy the group of doctors who were organising the Hartal. Yesterday, they issued the following circular, insisting that the hartal will go ahead today:

I also understood that many warnings have been issued to the junior doctors by the hospital Pengarahs and DG himself has issued a reminder on his FB post as below:

Interestingly, the DG has said that the Pension Act will be amended. This again goes back to my last post where I said, permanent post with pension is not sustainable anymore and all government positions should be changed to contract basis with continuous extension as long as the post is needed and for post graduate training. The hospital should be given the right to choose their own doctors based on need. I feel this is how this scenario is heading into the future. In fact, if the pension act is going to be amended, it may affect all other civil service jobs as well.

The world is changing. Jobs are changing as well. Unemployment of doctors is also a norm in many countries. Consultant without full time job is also common in developed countries but at least they get to complete their training. We need to change. We can’t keep on harping on the same benefits and perks as the baby boomers generation where the world population was a third of what it is now!

I will stick to what I have said in my previous blog post. The era of guaranteed job and permanent pensionable job in civil service is over. Every job is the same and will be treated as the same based on need. Doctors are not an exemption. Everything should be based on merit. I hope the selection of doctors into postgraduate training will be done on merit and be transparent. I also hope that a single post graduate training system will be implemented rather than 2 separate system. I might be dreaming but it is the only way forward. A total revamp of the healthcare system will be needed. A National Health financing scheme is needed to sustain at least the GP practise. A Restructured healthcare system is needed to move away from tertiary health care to primary based healthcare!

The question is , are the politicians ready to make this unpopular decisions? Looking at the current scenario, I don’t see it coming anytime soon!

At the time of me writing this piece, this is happening :

https://www.facebook.com/watch/live/?v=6447731198586474&ref=watch_permalink

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Five years ago I wrote an article in my blog ” Patient’s Confidentiality and Autonomy” . It was about an article in the Malay Mail discussing on the issue of doctors posting confidential informations of patients being treated in hospital and using it to make remarks against certain group of people on Facebook etc. I wrote in detail my opinions on these matters and did warn the doctors that every patient has the right to choose what they want. Our job is to educate and advise, period. I wrote this same article in my books that was published in June 2016 (Chapter 9, page 185). Along the way I had written numerous articles on issues of doctors and social media. Interestingly, the exact issue that I spoke about in 2015 has taken a centre stage again, over the past 1 week.

We as doctors should learn to control our emotions. The public look at us as a highly educated person and we should not tarnish our names by making mocking or defamatory statement to any particular individuals, especially if we do not know the exact details of a case or never involved in it etc. Making general statements are fine. The issue that has been circulating around over the past 1 week started in early 2018, almost 3 years after i wrote my article. The court has decided that the said doctor has made defamatory statement against an individual and was asked to pay RM 230K in total, as damages and legal cost. I do not want to discuss in detail about this court case unless I have the detail judgement, which may only be released at a much later date.

What I want to talk about are comments made by many medical practitioners claiming that doctors have now lost the ability to advise people on quack practitioners, medical notes are neglected as evidence in courts etc. Some even gone to the extend of saying that doctors should be protected from being sued by member of the public for trying to protect the public from quack practitioners.

Firstly, let me explain that a defamation case is NOT a medico-legal case. In a medico-legal case, your case notes becomes a hardcore evidence against a negligent suit. Medico-legal cases/notes are only applicable from the time the patient seeks your treatment till the time the so-called negligence happens and so forth. The court will take the medical notes as evidence. So, if the patient has lied to you, they cannot turn the case against you as our management plan depends on what patient informs you. The legal test used to determine negligence is way different than a defamatory case.

In a defamation case, you need to proof that the accusation you have levelled against an individual is, on a balance of probabilities, true and proven. The legal test used is totally different than a medico-legal suit. So, when a doctor accuses a member of public of something serious, like causing death of a baby etc, she need to proof this statement in court. Can the medical note be used as an evidence?

My answer is NO, especially if you are not even involved personally in this case. Anything that happened outside a hospital/medical facility is hearsay. That’s the reason when a patient comes to emergency department and says that she/he met with an accident, we say ” Alleged MVA”. This is because we don’t know whether what the patient tells you is the truth and nothing but the truth, as proclaimed in court of law. No such proclamation is made when a patient comes to hospital. That’s also the reason why we always say ” claimed by patient” in our history taking. I hope the medical schools are still teaching this, as I learned it when I was a medical student.

Now, let’s go back to this particular case in general. The case revolves around a doctor who supposedly made remarks on FB against another “complimentary medicine” practitioner, accusing that the said practitioner caused the death of a child. I can vaguely remember the hot issue that was circulating at that time in regards to this case. The doctor made direct accusation and thus, it can definitely be deemed defamatory. No two way about it. If it was a general advisory statement without pointing to any particular person directly or indirectly, then it is not an issue and cannot be deemed defamatory.

Anything that happens outside of an hospital have to be reported to the relevant authorities to investigate. For example, if we suspect child abuse, we need to report to the police and social welfare department. It is up to these departments to take further actions. Just because the child said that she has been abused to you, it does not mean she is telling the truth and we should not depend on that story to throw accusation to anyone. Our job is to report. If we accuse so and so as responsible based on what the child said but subsequent investigations by police showed otherwise, you are liable for defamation and you can never win. Similarly, if any patients makes public accusation against a doctor in social media etc, you have every right to sue them. However, if the patient makes a report to MMC and MMC finds you not guilty, you can’t sue the patient, as she has made the right move. This is similar of us making a police report when we suspect something. The person cannot sue you for making the report.

In this particular case, police reports were made by both MOH and the person being accused of killing the child (directly or indirectly), who is the plaintiff in this case. Unfortunately, police investigations found no evidence that the plaintiff was responsible for the death of the child. This alone is enough to proof that the statement made by the doctor is defamatory. Some said that the mother lied in court and changed her statement, comparing to what was recorded in medical notes. Again, what the mother told the doctor is considered hearsay as it happened outside the hospital. In my 24 years of medical practise, I have seen countless number of patients not telling the truth. Many at times, they make up stories so that you don’t scold them or find them stupid. In the court of law, it is up to the defence lawyers to proof that the person is a liar and to expunge the entire witness statement. Till the judgement details are out, we would not know what happened in the court. I understand the said plaintiff in this case has also won another case in Shah Alam against a doctor as well, who supposedly did not turn up in court to defend himself.

Many young doctors out there do not understand the field of medicine. Defamation and medical negligent cases are 2 different entity. Medical notes evidence is only valid for something that happened within the medical facility, aka from the time the patient come to you. It is only applicable for treatment related issues. Secondly, what patient tells you is confidential and cannot be made public. A doctor who accuses someone publicly of wrongdoing by using this case notes has technically breached patient confidentiality. He or she can be reported to MMC. So, be very careful when you make emotional post on social media on certain issues when it involves specific patient etc. I have written an article on this in 2018.

Some doctors have said that they will stop advising the public against going to traditional practitioners to prevent being sued. Again, many don’t understand the scenario. You can always advise and educate the public in general terms. But what you can’t do is directly accusing someone of doing something. That is defamatory unless you have solid proof. Please do not forget that despite all the advise and education, it is every patient’s right to follow or not to follow. You can’t push your ideas into anyone even if it is based on solid evidence. Always remember your medical ethics: patient’s autonomy. My article in 2015 had explained this in detail.

Our country is in a mess right now and the world is in recession. I know this year’s Deepavali would be uneventful to many. However, I would still like to wish ” Happy Deepavali” for all those who are celebrating at home.

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Recently I took part in one of the discussion in DOBBS forum in regards to contract doctors. I attach the video above for those who are interested to know how the discussion went about.

 

 

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I wrote my last article on 29/10/2019, throwing a question whether our junior doctors are facing a tragedy or a comedy. I modified the sentence, from the highest grossing R-Rated movie of all time, currently playing in cinemas: JOKER. “I use to think that my life was a tragedy, but now I realised it’s a comedy”.  In that article I explained the letter issued by MOH dated 30/09/2019 on the status of floating doctors. I said, those who receive an extension of contract will likely see their final journey in civil service. The end of that contract will be their end of a job in civil service. It looks like my interpretation of the letter was subsequently confirmed by our Health Minister in the Parliament, just 2 days later, on 31/10/2019:

 

 

 

He has also quoted some interesting figures during his answer in Parliament. As of 31/08/2019, we have 15 246 contract officers! In 2019 alone, we have 4 202 new contract officers and 2 515 are waiting to be appointed between November 2019 to February 2020. This figures are nothing unexpected. Since I started this blog, I had warned that this is going to happen. I first raised this issue in 2006 when I wrote an article to MMA Magazine . The mushrooming of medical schools without proper human resource planning will only lead to disaster. I have spoken about this for umpteenth years and thus I would not go into it again. We are producing about 4-5 000 graduates per year (35 medical schools locally and from overseas) when we have already reached a doctor: population ratio of 1:580 last year! The peak has not even arrived! The idea of contract post has a 2 prong strategy. Firstly, you can kick out those who are not performing and another is to allow you to complete your housemanship and compulsory service. This is similar to any developed country, jobs are never guaranteed but they will provide you with an internship post under contract as it is a statutory requirement to be eligible for full registration. However in Bolehland, transparency has never been in their dictionary. Below is a circular that was issued some time ago on how they expect to evaluate those who will receive permanent post and those who will receive a contract extension. REMEMBER, ultimately it also depends on availability of permanent post, as I wrote in 2016.

 

 

 

In June 2019, the first batch of contract housemen (who completed housemanship in December 2018) received their long awaited letter from KKM…….

 

 

While almost 1000 applied, only about 500 received permanent post and about 50 received extension of contract. In September, I heard another 175 received extension of contract. As per the letter above and my previous article, those who received permanent post got transferred “mengikut keperluan”. The worst is yet to come! Two days ago, I received information via this blog that those who got the extension of contract just received their official contract 2 weeks ago. The contract is extended from 5/12/2019(the day the first 3 years contract ends) to 4/12/2021 which is another 2 years. So, the total contract years will be 5 years. The shocking part, which I never expected was the fact that THIS CONTRACT KEEPS THEM AT THE SAME PAY GRADE AS A HOUSEMEN, WHICH IS U41, contrary to my understanding that it should have been U44 !!!

Yes, before the year 2010, most of us will remain in U41 (or U3 as it was known before 2001) for few years after completing housemanship with just annual increment. But in 2010, under the new promotional prospect for doctors in civil service (which I personally wrote during a SCHOMOS forum with KKM in 2006) , all those who complete housemanship will be promoted to U44 from the day of receiving full registration. While those who received permanent post got promoted to U44, those who receive contract extension seem to be “dianak tirikan ” ……………..

 

 

 

I find this totally atrocious! If a person is going to work as a medical officer and doing the same job as another permanent U44 officer, they should receive the same pay! Yes, they should thank their lucky stars that they have a job but we should never discriminate them by paying them lower than the rest. Unless you are transparent enough to say publicly than these guys had such a poor performance that they are not fit to hold a U44 post( that we are just doing a charity work by extending their contract to complete their compulsory service), everyone should be treated the same. Under labour law, can this be considered “forced labour”? BTW, our country’s international standing in labour law is not that great either.

For those who are unaware, SPA/JPA has been requesting to remove compulsory service over the past few years as they know they can’t provide jobs to everyone. However, it will be a disaster to do so, with many having a license to kill, out there. Completing housemanship do not make you competent enough to manage patients without any supervision. MMC has refused to comply to their request as it affects public safety. MMC’s motto is ” safeguarding patients and guiding doctors”. That’s why compulsory service is important, not just to comply with legal requirement but also to make you competent enough to practise on your own.

Whatever said, we should accept the fact that no job is guaranteed. No government guarantees you a job either. People should not assume that just because they are spending RM 500K to make their child a doctor, your investment is going to produce a guaranteed job and tons of money/return. Those eras are gone for good. However, these poor souls became a victim of poor human resource planning (which does not exist in Bolehland dictionary) and a capitalist world where commercialisation of medical education became a money making business!

I was also informed that from now onwards, the number of floating doctors who will receive permanent post will further decline due to availability of post. Remember, 15K is waiting in line! BTW, please be informed that compulsory service is only for 4 years ( 2 years HO and 2 years Mo), so you can leave before you finish your 5 years (after a total of 4 years). The question is : to where? Some can consider university hospitals but they too have their limits. Not to mention that contract officers are not entitled for Master’s program and banks will think twice before giving you a loan.

Basically, those who are being extended under contract will be paid under U41 salary but will end up doing the same job as a U44 MO, with their life in civil service ending in 2 more years. Again……..

IS THIS A TRAGEDY OR A COMEDY……………..

 

 

 

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Since my last article in June 2019, there has been a lot of happenings in our country, as well as in other parts of the world. Is it for better or worst, only time will tell. The tragedy that is affecting our young graduates is something I predicted almost 15 years ago. As usual, our suggestions and warning to MOH was just for filing purposes with no definitive action or plan. It was all about money and how much you can make out of our society’s ignorance and demand. Over the last few months, I have been watching and reading numerous articles in the newspaper in regards to housemanship waiting period and what is happening to those who have completed housemanship and floating around while waiting for MOH/SPA to make a decision whether, you are going to be absorbed permanently into civil service or just an extension of the contract. The frustration among the doctors is palpable but trust me, it will not just end there!

Early this month, there was a circular from MOH:

I find this circular very interesting. As I wrote in my article dated 15/04/2019, the first batch which started their contract housemanship in December 2016, most completed their housemanship end of last year and eligible to apply for a permanent post. Unfortunately, they were waiting for months. While they were waiting, they were kept in the same hospital as a floating medical officer with the same salary as a housemen. As long as the contract is not renewed, they will not receive the U44 promotion. They will remain in U41 as per the earlier contract. The first contract was for 3 years, to cater for any extension of housemanship. That’s the reason the contract has to be renewed after you receive the full registration as only then you can receive a U44 salary. Fortunately, the bright side is the fact that you still have a job till the contract expires.

In June 2019, I was informed that almost 500 of them were absorbed into permanent civil service and only about 50 were given extended contract to complete their compulsory service. Those who were given permanent post were mostly transferred out to where the post is available. A lot of them ended up in Sabah and Sarawak. Either you take it or leave it! There were actually more than 1000 doctors who had applied, following completion of housemanship, end of 2018. What happened to the rest? From my understanding, till September 2019, there were no news about the rest. While waiting, the number of applicants has been increasing as subsequent batches of contract officers began to complete their housemanship. What a mess we are in!

Then, out of no where, the circular above was issued by MOH, dated 30/09/2019. The circular basically says that while waiting for the decision, you can now be transferred to another hospital, klinik kesihatan aka anywhere!. You will not be in the same hospital as a floating officer. It also says that you will be notified of the decision of your application 3 months before your 1st contract ends (which is 3 years from your date of starting housemanship). Basically it just confirms that you will remain a floating medical officer till about 9 months after completing your housemanship (assuming you complete in 2 years on the dot) but in a different location!

The most interesting part of the letter is the fact that, if you manage to secure a permanent post, you will likely be transferred yet again to another location depending on availability of the vacant post that you are being given! Basically means, you will be transferred again within a year to another location! Is this a tragedy or a comedy? The best is yet to come: those who receive extension of contract can remain at the same place where they were transferred as a floating officer! In another word (the way I interpret this), your life in civil service ends there within another year aka completing 4 years of compulsory service. It’s just a diplomatic way of putting it !

All these just points to a simple fact: medicine is not a guaranteed job anymore. The market will be flooded with doctors and no one is going to be bothered whether you have a job or not. How many of them, who did not get a permanent post (can be about 2-3000/year) going to end up opening a clinic? As per my last article in June 2019, the GPs are already struggling to survive!

This is not something that is happening in Malaysia alone. In August 2019, Singapore Medical Council  announced that the number of recognised medical schools will be reduced from 160 to 103, effective January 2020. Many universities in Australia, India, Ireland and Canada were de-recognised. Singapore believes that they are now producing enough graduates of their own to fill the vacancies. Only UM and UKM degrees are recognised in Singapore and I heard that many who applied for a job in Singapore are not receiving favourable response compared to 10 years ago.

Similarly, as I have written in April 2019, Australia is also reducing their dependency on foreign doctors. In April 2019, I wrote that effective March 2019, Australia has introduced a new rule for employers who are recruiting foreign doctors to be a GP in Australia. They must first apply and receive a certification from Rural Work force agency confirming a genuine need to fill the position. In July 2019, Department of Health has reclassified areas which can recruit an International Medical Graduate (IMG). What use to be known as DWS (District of workforce shortage) area is now being replaced by DPA (Distribution Priority Area). These are the areas where an employer can recruit an IMG as you will not be given a medicare provider number(for medicare billing) if you are not working in these areas. Interestingly, many of the areas which use to be DWS areas till June 2019 are now non-DPA areas. DPA now only covers rural and remote areas. For example, in Western Australia, the entire Perth up to Mandurah and even small suburbs like Bunbury and Geraldton are considered non-DPA areas. And you have to work in DPA area for at-least 10 years (the 10 year moratorium) even if you become a PR. The whole idea is to cut down the number of foreign doctors. Furthermore, you can only work in Australia after passing both your AMC Part 1 &2 exams (except Monash Malaysia), where the passing rate is as low as below 20%. As for FRACGP, as mentioned in my April article, those who enter the program in Malaysia from January 2019 will not be receiving FRACGP and will not be able to work in Australia directly. Everyone works under contract in Australia and there are many specialist in Australia who can’t find a full time job. Many work on part-time or sessional basis. There is no such thing as automatic job for a specialist in Australia, upon completing their fellowship. So, don’t assume that doctors are guaranteed a job anywhere in this world!

This interesting letter from a doctor is worth reading, ” Medical Profession is no longer lucrative”.  It is well written, not to mention the increasing litigation and patient demands. Do medicine only if you are determined to overcome all the obstacles. Reading my blog/books will inform you the real life of a doctor and not what the public wants you to believe. It is never as simple and cosy as what the public tells you. Till today, when I look at the comments in social media, the public still believe that doctors can work anywhere in the world. They got NO idea that a doctor cannot work in another country unless his/her degree is recognised in that particular country. They got NO idea that you need to sit and pass an entrance exam which can cost thousands of ringgit without a guarantee of a job! They got NO idea that there are jobless doctors in many countries, Malaysia is on the way to join those countries………

Happy Delayed Deepavali 2019 greetings.

 

IS THIS A TRAGEDY OR A COMEDY…………………..

 

 

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