Finally, the government is putting a stop to any new medical schools for the next 5 years but would this stop the glut? My answer is a big NO.
The current existing schools are just too many and they will keep increasing the number of students to make more money. Thus the number of graduates will continue to rise and whatever I have said in my blog postings will come true. Trust me!
I think it is important, especially for parents that medicine is not a guaranteed life anymore in the next 2-3 years time. I really hope parents and students will stop thinking about glorified life by doing medicine. I thought the figure for new housemen will reach 6000 by 2015 but based on what is written in The Star today, we have already hit 6000 this year! so , will it hit 8000 by 2015? Remember, almost half of the current 32 medical schools in Malaysia have not produced their graduates yet.
Cleaning house
By RICHARD LIM and LOH FOON FONG
educate@thestar.com.my
Concerns persist regarding the quality of medical graduates and the Government is preparing a number of initiatives to finetune the system.
HOW hard is it to tell the difference between a sleeping patient and a cyanosed one who is on course to meet his maker?
Observing the simple rise and fall of one’s chest would be a good start. Checking for a pulse would be another and observing that the patient has turned blue is an absolute must.
However, the obvious did not happen in the case of one Pak Abu, who was deemed to be sleeping by house officers.
Fortunately, an observant doctor on his last rounds came into the picture and Pak Abu was resuscitated.
The three house officers in charge, who graduated from Russian and Ukrainian universities, were reprimanded for negligence, and things went from bad to worse when it was discovered that they did not know the basics of resuscitation or what an oxygen face mask was.
Mohamed Khaled says agents are not appointed or recognised by the ministry.The doctor who blogged about this was among the many who had been highlighting the urgent need to ensure the quality of housemen vis-a-vis their increasing numbers which was highlighted in The Star’s front page report two weeks ago.
The phenomena stemmed from the large number of medical students – at home and abroad – as well as the Health Ministry’s decision to increase the duration of housemanship, from one year to two years.
An overcrowding of housemen has occured at some of the nation’s 39 training hospitals, and senior Hospital Kuala Lumpur (HKL) consultant physician Datuk Dr S. Jeyaindran said that a houseman would normally look after four patients now — down from 10 five years ago.
“The concern is that these interns are seeing fewer patients and hence, have fewer opportunities to carry out adequate procedures.
“In some hospitals, there are more housemen than patients,” said Dr Jeyaindran, who is also the head of medicine at the Health Ministry.
Liow says housemen would be trained at six new hospitals.Different worlds
Following the influx of housemen, senior doctors have sounded the alarm that an over-emphasis on numbers could come at the expense of quality.
They were particularly concerned with medical graduates from Russia, Ukraine, Indonesia and India, whom they said lacked core knowledge and basic expertise in treating patients.
Although all medicals schools should share a universal purpose – saving lives – differences in pedagogy and clinical procedures put some graduates on the back foot when they return to Malaysia.
And this was the case for a Ukrainian university graduate who endured a torrid time in his attachment at a local hospital.
“Many doctors were unhappy that we (housemen from Russia and Ukraine) don’t follow the British system,” he said.
“The terminologies we used were not accepted although they denote the same meaning. This led some to develop the misconception that graduates of Eastern European medical schools lack the necessary knowledge to perform,” he said.
A source said that the emphasis on the study of diseases was also different to a certain extent, as medical schools in a particular country would naturally cater to the common ailments of its citizens.
Dr Quek has blogged about quality concerns at private medical schools in Malaysia.He added that housemen who studied medicine in Eastern Europe lack exposure to tropical diseases and had to brush up on their theoretical and clinical knowledge upon their return.
If there are already so many problems with accredited foreign universities, what should we expect of unaccredited institutions — with poor living conditions, inadequate facilities and lecturers of suspect quality?
And there is the eyebrow raising issue of foreign medical schools accepting students with Arts backgrounds.
The problem is not a new one. In 2005, the Crimea State Medical University was de-listed by the Malaysian Medical Council (MMC) for doing exactly that, among other things.
Giving credit where credit is due, the MMC acted upon complaints by whistle-blowers and the problem was rectified.
Task forces were sent out to check on errant medical schools overseas and warnings were served to foreign medical schools which were found wanting.
Shady dealings
The adage goes, “When the going gets tough, the tough get going.” But who are the tough and where do they go?
A houseman who spoke to The Star on condition of anonymity joked that the tough are those who are hell-bent on receiving an MBBS even though they lack the necessary grades.
Prof Radin Umar says the NOC is only issued to students who will read accredited medical programmes.And in that advent, there would only be one logical place to go to – an unrecognised medical school abroad.
This process normally involves the services of agents who talk parents into parting with hundreds of thousands of ringgit to enrol their child into a shoddy institution – pocketing a fat commission fee in the process.
It must be noted that many parents are often fooled by a ruse, and this was the case for one Ukrainian graduate.
“The agent told me that the university would be recognised ‘soon’, but I’ve graduated and it still hasn’t happened,” he said.
Hitting out at the unscrupulous practice, Higher Education Minister Datuk Seri Mohamed Khaled Nordin urged potential medical students to tread with caution whenever agents come into the picture.
“The ministry does not appoint or recognise agents,” he told The Star. “We have no link with them and we are not responsible for their activities in sending low quality students overseas.
Dr Jeyaindran says in some hospitals, there are more housemen than patients.“Continuous reminders to the public are given through the ministry’s website.”
Back to the shady world of wheeling and dealing, agents are often identified by their insistence that students would not need to obtain a non-objection certificate (NOC) – a certificate issued by the ministry to qualified students – in order to study at various medical schools overseas.
In the past, such advertisements were even seen in papers, and agents made a killing by preying on unsuspecting – and often the uninformed – parents.
Shedding light on the topic, Higher Education director-general Prof Datuk Dr Radin Umar Radin Sohadi said that the NOC, in effect for the past eight years, was a mechanism to prevent parents from getting cheated by agents.
“The NOC is only issued to students who will read accredited medical programmes overseas.
“Additionally, it is a mechansim for sponsors to award scholarships or loans. In most countries, the NOC is also needed for visa renewal,” he said.
Review of criteria
Although greater understanding of the NOC’s significance has helped matters over the years, a recent case involving Mansoura University in Egypt showed that agents are still very much in business.
A taskforce that was sent to the university discovered that a sizeable number of Malaysian students did not possess the NOC.
A houseman would normally look after four patients now, down from 10 five years ago, raising concern that interns have fewer opportunities to carry out adequate procedures.The findings were alarming and the Higher Education Ministry was particularly concerned as Mansoura – fully accredited by the MMC – receives government-sponsored students from the Public Services Department (JPA) and Mara.
It was later disclosed that the students had enrolled with the help of agents, and concerns were raised as agents now had accredited universities in their clientele.
Commenting on the case, a source in the MMC said the agents were pushing their luck by hoping the Government would not reject the graduates as the universities are accredited.
There are currently 926 Malaysian students in Mansoura. The varsity’s homegrown medicine programme has 493 students while the remainder are reading a twinning programme involving the University of Manchester.
Mohamed Khaled said that a joint working group between Malaysia and Egypt had already been set up to discuss and review the criteria of students that would be sent to Egypt for medical programmes in the future.
Under the new ruling, only qualified students – those who possess the minimum academic results and NOCs – will be considered for medical programmes in Egypt.
The ministry’s swift action appears to have effectively countered the movements of agents in Egypt and the establishment of similar committees with other nations might just nip the problem in the bud.
But as they say, change is the only constant and one wonders whether it is a case of check or checkmate for the agents.
The home front
Although foreign universities took most of the brunt, local higher education institutions did not escape unscathed.
A private provider was alleged to have lowered entry requirements in order to fill its initial student intakes, and others were alleged to lack experienced teachers and adequate facilities.
Other concerns include the increasing number of medical programmes offered by private providers, with some offering up to two intakes a year instead of the usual one.
In his blog, Malaysian Medical Association president Dr David Quek said that private providers prioritise public demand over the capacity of delivery in terms of teaching staff and appropriate standards.
Dr Quek said that the increasing number of private institutions had resulted in a shortage of experienced senior clinical staff, and junior specialists who lack experience are hired to teach students.
He added that non-clinical teachers, who cannot be registered as doctors in Malaysia, were imported from neighbouring nations to fill the quota of teaching staff.
As for students, Dr Quek said that many were left on their own to muddle along.
A senior consultant who declined to be named also said that the establishment of private medical schools – at an average rate of one or two a year – over the last decade had lowered the entry requirement of students since these schools required numbers to be profitable.
Others experessed concern that the promotion of Malaysia as a medical hub would add further strain on public hospitals as talent was expected to move to the private sector.
Concerned senior doctors are urging the Government to intervene before it is too late.
Many advocate amending the Medical Act 1971 to make the Medical Qualifying Examination compulsory for all students, as students from recognised schools could also fall short of expected standards.
The removal of the list of recognised basic medical degrees – in the second schedule of the Act – was also proposed.
However, the doctors are divided when it comes to implementation.
Some propose that only graduates from foreign schools should be affected as the entire procedure would be easier to monitor.
However, a consultant said that the standard of final exams in local universities varied widely, and some varsities attempt to pass as many students as possible to look good on paper.
Currently, the exam is only administered to students from unrecognised foreign medical schools.
A senior doctor said the idea of the amendment has been discussed with the Health Ministry, but a solution had not been implemented because local universities wanted to be exempted and prestigious universities in Britain and Australia would likely object as well.
A medical lecturer who declined to be named said that the criteria of the qualifying examination should be made known in advance so that students know what was required of them.
Highlighting the case of a top student from a Ukrainian university who failed the exam, the lecturer said that the different methods of training was an obstacle too big for some.
“No matter how diligent and conscientious students are, the chances of them passing the exam seems next to impossible,” he said.
He said that different examination formats, a student’s unfamiliarity with local practices and the lack of training in medical school were possible causes of their failure.
Concerted efforts
The Government has taken note of the grouses and Mohamed Khaled confirmed that a five-year moratorium on medical programmes in Malaysia was being prepared by the Higher Education and Health Ministries.
“The moratorium is in the final stage of preparation and it will reduce or stop higher education institutions from offering new programmes as the current capacity will be able to meet national targets,” said Mohamed Khaled.
The move is similar to the Higher Education Ministry’s freeze on the number of nursing colleges in the country.
And the moratorium isn’t the only catalyst for change.
The debate on the quality of housemen has made it to the Dewan Rakyat and Health Minister Datuk Seri Liow Tiong Lai said last Monday that six hospitals — in Kuala Krai and Tanah Merah, Kelantan; Segamat, Johor; Lahad Datu, Sabah, Bintulu and Sarikei, Sarawak — would be upgraded to specialist hospitals which train housemen.
With the new avenues, house officers could be deployed in a more efficient manner. Liow said measures had already been taken to ensure quality.
The minister said that the ideal specialist to houseman ratio was 1:5 and each houseman should take care of 14 hospital beds, depending on discipline.
Liow also said that his ministry would be getting 58 contract specialists from Egypt, India and Pakistan next month to supervise housemen.
Liow added that his ministry would look into the possibility of amending the Medical Act 1971 to make the Medical Qualifying Examination compulsory for all medical students.
That said, the relevant ministries have responded with strong statements of intent in the past week and the challenge now is for the Government to strike the right balance.
A balance which ensures that the pursuit of national goals – achieving a doctor to patient ratio of 1:400 by 2020 and the rise of Malaysia as a medical hub – does not compromise the quality of healthcare service in any way.
The road ahead will be tough and if the number of grouses pertaining to the houseman glut are anything to go by, the balancing act will be a fine one indeed.
Pagalavan's Avatar 
Sir,one of my friend mentioned to me that she received NOL (non objection letter)from the government.Is NOL equals to NOC??Looking forward for you reply.:)
should be.
Sir,one of my friend got NOL(NON OBJECTION LETTER) instead of NOC.Is NOC = NOL?She asked her agent abt it,and they told her that the government started giving NOL to the students.She is pursuing dentistry course in indonesia.
Dear Dr, for your comment.http://www.araratadvertiser.com.au/news/national/national/general/anger-as-medical-graduates-miss-out-on-internships/2573501.aspx
Thx for the info. I expected this and have mentioned it before. Same will happen here soon!!
So what happens to Monash Sunway graduates – can they still work in Australia?
depends on availability of post/vacancy
Hello, Dr. Pagalavan. Firstly, I would like to thank you for this blog. It has really opened up my eyes about the health care systems.
I would like to ask what are the prospects for biomedical sciences? I understands from most the blogs I have read that students use it as an entry for medicine degree at graduate level. What kind of jobs would it offers?
I m thinking about doing dentistry at graduate level if there s an oppuntunity and if not I would just go for masters. Is dentistry a saturated field too like medicine? And I also would like to know if its better if I took up the double degree course ( biotech and medical biosciences) than just taking a single degree course for biomedical medicine but I m not sure if the double degree applies for jobs in the health care but more to industrial companies. Would the double degree gives a better job prospects in Malaysia?
Thanks.
Biomedical science is actually a very broad field. There will be many options after that for you to choose. Dentistry at the moment is still OK but the post in government service will be almost full soon as mentioned here https://pagalavan.com/2012/04/05/2011-pharmacist-2012-dentist-20-doctors/.
Double degree is good but try to take a double degree which gives you a Master’s degree like MPharm etc.
I m not sure if the double degree has an honor programme but does matter if I were to continue to master ‘s degree? What I understand about the australian system is that if a student would like to have an honors degree, you ll have to do another year just for that.
The programme is done in Monash(Malaysia campus).
And also doctor which university would be better if I were to do my BSc (Hons) biomedical science at, IMU or nottingham university Malaysia campus? I’m not sure whether IMU is recognised in Singapore because I wish to do my postgrad in singapore(NUS) or doing it at Nottingham (Malaysia campus) would be ok too as it is one if the top universities.
But I m just not sure if IMU is recognised internationally because I came across a blog from a student who was doing pharmacy in IMU. He couldn’t apply for a job in Singapore because IMU wasn’t recognised.
http://davidngkhinboon.blogspot.com/2010/09/slap-on-my-face.html
I think Nottingham will be better. As far as I know, there is no such thing as degree recognition for courses other than medicine. However, having a degree from a well known university do give you a better opportunity in job seeking.
Thank you! It’s really helpful as I’m a future GP as well in Mansoura (via agent), which worried me.
There are so many things I’d like to inquire your knowledge, but let’s start with this.
I heard that you can requested for the government’s scholarship in your first year, assuming that you passed the final exam with flying colours. Such is true?
I heard funny stuff regarding the Twinning Program, that you can continue your study in Manchester University in your fourth year, assuming you get good result consecutively in previous exams, Is that right?
Sorry if this sounds so nonchalant, but it’s really bugging me right now since I’m going to Egypt as well in this September.
Actually, I have another relative who went to study in Mansoura via the same agent and she’s doing fine, though unfortunately the fee is still on her parents since she had to repeat few papers.
i am interested in doing dentistry.how do u think about dentistry?will get saturated as medic and pharmacy in future?which university u recommended to study dentistry?how do u think study dentistry course in indonesia?
It will, probably after medic. At the moment it looks like a better option but the post i gov service is almost full and thus the gov last year reduced the number of years for compulsory service. The only good thing about dentistry is that you can open a clinic much more easier and you don’t depend much on medications. Almost everything that you earn is by using your hands!
Which university you recommended?
IMU or PDC
What jobs that give a guaranteed life 6 years from now-2018?
Nothing is guaranteed in the future. See which field is expanding!
sir, i wanna do medicine. i was offered a place at ums, imu n perdana. im nt sure which to choose. im assuming that the lecturers at imu n perdana will probably be better than ums. bt due to the possible housemanship glut a private uni wud probably nt be a good choice. wat do u suggest?
Are you on government scholarship? IMU has a good reputation among the private medical schools. If you are on government scholarship, there are no doubt you will be employed when you are graduating no matter from private or public uni.
no i’ll b goin with my own cash…..ok thnx
I would not say that Perdana university have better lecturers than UMS or IMU. If you are cash paying, then I rather take UMS. If you JPA sponsored than go for IMU.
ok thnx sir…
Dear sir,
I am planning to study medicine in malaysia but as i am an international student, i was told that i wont be able to do housemanship in malaysia. My home country also does not allow housemanship for those who graduated from a foreign university. Is it possible for me to get a houseman position elsewhere eg. UK or Australia after completing the 5 years here?
Thanks in advance.
None of the medical degree from Malaysia is recognised overseas except Monash Malaysia, which is recognised in Australia/NZ. However, the situation in Australia is such that you will be in the 3rd category to get an internship post. For 2012 graduates of Monash Malaysia, only 7 out of 60 who applied got internship in Australia.
The obvious solution in this case, is to enrol in IMU-PMS programme, and match to UK or Australia. While there is no guarantee that housemanship jobs will still be available by then, but the chances will certainly be higher….
Dr, actually why do you prefer IMU than UMS?
IMU is more established
hi. dr.paga. I am just wondering do medical officer work during the weekends? and do government servants generally e.g professor at public university work during the weekends?
Also; for medical officer, Is there a holiday given during celebrations like CNY, Hari raya & deepavali?
YES for both. Holidays depends on whether there are enough doctors
I heard that there are consultant at government hospital that teaches in public university as professor as well. how is it possible? does it mean when you become a consultant. you hav more flexible time? but he has been teaching for a long time. so in this case, does it mean he received dual salary from the government? cuz working as both consultant & professor at public university.
In Malaysia everything is possible. Usually these consultants are adjunct professors/visiting lecturers. They are not employed by the university but paid a allowance.
Hello dr, Im a medical student and I always follow your blog. I know about the hardships being a houseman and doctor through your blog but I still chose mbbs because I really love this course. Im studying in a gov uni under jpa scholarship. Im still in my pre clinical year and I met prob in my studies. Why I study so hard but my result still so unsatisfying? I feel very difficult to pass the exams. Does studying mbbs need to have a very good memory? I really scare that I cant be a good doctor.
Not memory but analytical skills. I find this lacking among the current generations, likely due to our current education system.
Dear Dr. My daughter had got a medical seat in New castle university Johor. We are singaporeans. And i understand Malaysia doesnt allow housemanship for foreignors. Is there anyway she can do housemanship in any other country. I guess in singapore its not possible as well.
Thanks
NImmi
NO country recognises NuMed degree except GMC in UK. However, unlikely you will get a job in UK due to prevailing immigration law. The only option is to hunt around and sit for each country’s entrance exam, hoping to get a job. The other option is to sit for SMC exam in Singapore to get a job at your home country.
Dr Pagalavan,
Thank you for your blog, its very informative. Looking at the rate with the medical degree graduates and issues on posting them for housemanship, itis definitely an issue in future in Malaysia. My niece currently graduated from MAHSA (first batch of medical student), she was recently posted to do her housemanship in UMMC, Kuala Lumpur. Unfortunately, due to the stress and inability to cope with the high demand in the hospital, she quit her position in UMMC without resigning. She claims that she can still request for another posting for her housemanship through the government since she did not resign. Is that still possible and we are very worried of her future? Please do advise.
Yes, she can appeal to change hospital but with the current glut and waiting period, she will be waiting for few more months! Frankly, workload and stress in university hospitals are so much less than ministry of health hospitals. So if she can’t even cope with UMMC, how is she going to cope in MOH hospitals? Remember, till she transfers, she is still occupying a post and preventing another HO from coming in.
She has quit her post in UMMC , meaning she no longer goes in for her duties and yet the post is kept for her?? . If you don’t come in for work you should be sacked. Try pulling this stunt in the private sector and you will be shown the door in double quick time.
It amazes me as to why people like her are treated with kids glove??
First she does not work thereby wilfully neglecting her duties and secondly another HO is deprived of the post because she does not want to resign.
Maybe, just maybe she is not cut out to Doctor.
That’s government service! It takes months for a person to be sacked!
Hi Dr Pagalavan,
I would like to ask about housemanship training in government hospitals. Is there any priority for medical school graduates to enter government hospitals as houseman? Like IMU students are prioritize while other medical school graduates are not. I heard that MAHSA students are not prioritize due to certificate from MAHSA is not as good as IMU.
Not as far as i know
Dr, from your blog comments, I knew that MBBS course in MAHSA is overall ok, but do the certificate and teaching quality is ok?
Can’t comment as they have produced only 2 batches so far
Thank you for your time Dr 🙂
Hi Dr Pagalavan,
I would like to ask about housemanship training in government hospitals. Is there any priority for medical school graduates to enter government hospitals as houseman? Like IMU students will be prioritize while MAHSA graduates are not. I heard that MAHSA graduates are not prioritize for housemanship as certificate from MAHSA is not as good as IMU.
Hi Doctor! I am Suva. Would you still encourage students to pursue medicine nowing that there are gluts in the future? How is optometry course? Is it good to pursue?
Hope to hear from you Sir.
The glut is already happening, no more ” in the future”.
Optometrist is OK but usually you will work in retail outlets.
Dear Doctor,
I am a semester 1 IMU MBBS student doing local programme. I have been thinking about reasons why the healthcare system is going so hare wire. What if the way to fix this situation is by setting an age requirement for future doctors? For example, a student is only eligible to apply for MBBS if their age is 25 and above. Will this help to produce quality doctors and reduce the chaos? Since only passionate enough people who actually devote their life into medicine will wait no matter how long the process will be. At the same time, I think during the gap of age, he or she might be matured enough or even started their own business before entering medical field. I haven’t considered the marriage factors but I think this might be a really good way to produce less dangerous doctors. What do you think?
https://polldaddy.com/js/rating/rating.js
This is the reason why most developed countries are moving to graduate medical course. You must have a basic degree before going into medicine. So only a matured student enters medicine.
Hi Dr. Pagalavan,
I am in 2nd year of MBBS in MSU. Compared to MAHSA, MSU produced 10 over batches a ready. What is your opinion of MSU?
so far no issues.