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Yesterday (18/03/2012), the Malaysian Medical Association Johor Branch had its AGM for 2012. It was a special occasion as the President of MMA and the SCHOMOS Chairperson were present to have a dialogue session with all the members. It was a fruitful meeting and many issues concerning the medical fraternity were discussed. We also got to know the latest happening that will change the future of medical profession in this country.

1)      Housemanship

The declining standards of medical education and oversupply of doctors were discussed. It is indeed true that the number of housemen is reaching an unimaginable level and MOH is very much aware of this. To cover this up, MOH has come up with the shift duty system and to allocate more district hospitals for training. Most hospital’s housemanship post is fully occupied. The ratio of housemen to specialist supposed to be 5: 1. Unfortunately, the way MOH calculates this figure is rather odd as they include all specialists in the hospital including radiologists, pathologist, ophthalmologist, ENT surgeons etc where housemen are never placed. So, in reality there are not enough trainers for all the housemen who are currently in the system.

The oversupply of doctors is a harsh reality which is going to happen anytime soon. MMA has discussed this issue with MOH but unfortunately MOH puts the blame on MOHE. The moratorium is just eyewash. It is very clear that it is all about money and the only people who can stop this rot will be the general public and not MMA. Whenever MMA brings up this issue to MOH or MOHE, they are accused of being selfish and avoiding competition! Thus, it is very clear that they want to flood the market with doctors and no one is going to guarantee you a job.

The maximum period to complete your housemanship is 3 years. Anyone who does not complete the housemanship in 3 years will be automatically terminated.  Any houseman who is caught doing “locum” will be automatically terminated.

It is indeed true that MMC may soon remove the 4 years compulsory service under pressure. It is no more a rumour as I have mentioned before. It basically means that after 2 years of housemanship which is given on contract basis, there is no guarantee that you will get a job. You will have to apply to get a job in civil service or open a clinic (with license to kill). You can also forget about postgraduate education if you do not get a job in public sector.

2)      Postgraduate education

It is also true that you are only eligible to apply for Master’s programme on 5^th year of service (2+3 years). The number of Master’s post is gradually being increased due to political pressure. It is way too many compared to what the universities can really handle. The quality of Master’s graduates is slowly dropping and many consultants in hospitals have voiced out their concern. We are now seeing Master’s graduates who can’t do simple surgeries. Fresh Master’s graduates are teaching Master’s students in the universities!

Those who quit Master’s programme or who failed 4 times (meaning disqualified) will still need to serve their bond with the government and repay the JPA scholarship.

3)      Insurance companies

One of the GPs brought up the issue about insurance companies cutting the consultation fees and threatening doctors. It seems that many of these insurance companies and MCOs are requesting doctors to reduce their fee if their contract is going to be renewed. If you refuse they will find another GP who is willing. The situation has reached a critical stage to the extent that some newly opened GP clinics are willing to be paid only RM5 per consultation!! How desperate the situation has made of some doctors!

With the removal of compulsory service, many of these unemployed doctors will end up opening a clinic to survive. These doctors would probably even accept RM1 per consultation! Someone in this blog commented about competition some time ago, so here you are………..

It basically means that doctor’s income will gradually reduce and many may just earn enough to survive. It is also unavoidable that the dispensing rights of doctors will eventually be removed.

The 1Care system is still in planning stages and nothing has been finalised. So, we just have to wait and see.

4)      Liberalisation of Health Sector

In Budget 2012, our PM has announced the liberalisation of many subsectors which includes health sector. The MMA has voiced out its concern regarding this matter as proper monitoring mechanism is not in place yet http://www.themalaysianinsider.com/litee/malaysia/article/mma-putrajaya-gambling-with-nations-health-by-liberalising-medical-sector/. Unfortunately, it is unavoidable once again. Since February 2012, the government has allowed private hospital of 100% foreign equity to be set up in Malaysia. They are also allowed to hire foreign consultants as long as their degree is recognised by MMC/NSR. By September 2012, foreign specialist/doctors will be able to set up their clinics in Malaysia!!

Unfortunately, the amended Medical Act 1971 is yet to be tabled in Parliament. Thus, the National Specialist Register (NSR) is not compulsory at this point in time. So, where is the monitoring system to make sure that these “so-called” specialists are indeed what they claim to be? Someone can set up a “proctologist” clinic beside yours and earn a decent living! Even now, there are some private hospitals which are hiring “so-called” specialist “trained” in some other country without NSR registration. Private hospitals are profit driven and what they are interested is only money and not quality. With the poor monitoring system, these doctors can easily get away with whatever they are doing and the rakyat will eventually be the victim.

Over the last 24 months since I started blogging I have been constantly saying that the future is bleak for doctors. Guaranteed job, good money and life are the reasons why many choose medicine. That is the fact! Forget about helping people, curing the sick etc which is actually the minority. Whatever said, at the end of the day, it is a profession to earn a living. Unfortunately, many people believe that just because they spend RM 500 000 to RM 1 million to do medicine, the return of investment is high!! It is a total misconception that the public is totally unaware.  Our society is just obsessed in getting their children to become a doctor for glamour and social status. That must change!

Secondly, doctors are so disunited that the government can just do what they want. The only organisation that we have is MMA but unfortunately how many of you guys who are reading this are even members of MMA? How many of you are even interested to fight for the betterment of future doctors? I have done my part and still contributing to the betterment of doctors in this country. I created this blog to educate the public/future doctors as I realised that many are not aware the mess that they are getting into. MMA received a lot of bad publicity recently but it is still the only organisation to fight for doctors.

The future is indeed bleak……………………….