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 This is an another article that appeared here http://goodtimes.my/index.php/Education/shortage-of-trainers-of-doctors.html. There are people who still don’t believe that we are going for a glut soon. Well, it is all up to them. I still get a lot of quarries from budding doctors after the recent SPM results. What I can see is that, many of them had already decided to do foundation studies with guaranteed seat for medicine. What they don’t understand is the fact that all these are a money-making business. I pity for these students who are being cheated into doing medicine by an easier route without strict quality control. They don’t seem to know what lies ahead of them.

Shortage of trainers of doctors

There is a scarcity of medical officers to train the glut of house officers (housemen) in local hospitals. The ideal ratio of trainers to housemen is 1:4 but in some cases the ratio is more, thus affecting the quality of training specialists.

Commenting on the issue, the Malaysian Medical Association (MMA) agrees there is a shortage of trainers to housemen.

“The MMA maintains that we do not have sufficient trainers and supervisors and quality teachers and professors or specialists to help train this big number of medical graduates,” MMA president, Dr David Quek, says.

The former Director-General of the Ministry of Health (MOH) Tan Sri Dr Mohamed Ismail Merican also says that while the ideal ratio of specialist to housemen was 1:4, “if all specialists in MOH double up as trainers and are willing to teach avidly, we should be ok. We are allowing 1:7 or 1:8 for clinical teaching.”

Quek feels that many medical schools simply side-step the criteria by employing junior and temporary staff to fill the required quota. 

“The Malaysian Medical Council (MMC) and the Malaysian Qualifications Agency (MQA) make periodic visits and review these schools, but we are increasingly concerned as to the quality of the graduates due to the barest minimum quality of the teachers,” Quek says.

The glut of housemen is largely due to the fact that the Government has increased the number of accredited medical schools, both locally and overseas in its efforts to reach developed nation status.

The Deputy Health Minister Datuk Rosnah Abdul Rachid Shirlin had announced last year that Malaysia had not met the minimum doctor-population ratio of 1:600 set by the World Health Organization (WHO).

The MOH had also declared that under the 11th Malaysia Plan, the ministry will move towards achieving a doctor to population ratio of 1:400, on par with most developed nations, by the year 2020.

Quek thinks that the government’s efforts to achieve a doctor-population ratio of 1:400 is happening “too quickly, too soon”.

“We feel the MOH is too focused on an unrealistic bureaucratic target and Key Performance Indicator (KPI) which is not keeping with the best universally accepted standards.

Houseman at work … there are over 3,000 housemen overpopulating 41 training hospitals in the country. (Picture courtesy of Loo Kar Yee)

“This sort of 1:400 ratio is only achieved over decades in most advanced countries in the world and never rushed as if these were factory produced merchandise to cater to suddenly thought up demand!” Quek says.

Merican, through an email interview, described some of the steps the MOH had taken to solve the problem of the shortage of trainers in the country.

He said the MOH had brought in 468 foreign doctors and specialists from various countries, appointed on a contractual basis, to serve as trainers as well as to fill in vacancies in several smaller district hospitals.

The number of slots available for the local Master’s programme was also increased to produce more specialists. MOH has also accredited another five hospitals for housemen training in addition to the 41 training hospitals available in the country.

It has also increased the mandatory posting for house-officer training from three disciplines to six in 2008. The six disciplines are Internal Medicine, Pediatric, Surgery, Orthopedic, Obstetrics and Gynaecology and Emergency Medicine

Last year, Anesthesiology was introduced as an alternative posting to Emergency Medicine to ensure a more comprehensive exposure for housemen.

MOH also introduced the “Mentoring Junior Doctors” course which aims at “strengthening the capabilities of housemen trainers”.

However, not all trainers agree that the steps taken by the government has produced the desired results.

A medical officer pursuing his specialist degree in a public hospital, feels that hiring foreign doctors will pose more problems in the long run as it will take away job opportunities for local doctors.

“It is very wrong, to bring in foreigners and forget our own people,” he says. 

According to him, the low salary doctors in the public service earn, compared to those in the private sector is also another factor that is driving specialists away from training hospitals.

He added that for every extra shift he does, he gets an extra RM150 and if he has to work on a weekend or a public holiday, he gets an additional RM20.

“That’s about RM6 per hour. One of the reasons why there are so few specialist trainers is because they have either ‘jumped’ to private hospitals or gone overseas where the pay is better. 

“My father served the government as an agricultural engineer, but he had to ‘jump’ (move to a private company) to pay for my education.” He says he will do the same should the need arise in his family.

Another consultant in the field of pediatrics from a local hospital believes it is the state of under-equipped medical schools which is a more serious problem than the lack of an adequate number of trainers.

A specialist trainer, herself, she related an incident where a house-officer recommended a patient “traditional treatment”, instead of modern medicine to cure his illness.

She had also encountered many other under-qualified, ill-equipped housemen who “could not even answer the most basic questions about medicine”.

Frustrated with the lack of quality, especially among graduates from newer and smaller medical schools, she feels that the right step is to deregister some of these schools and de-list some of the foreign medical schools that have been producing “half-baked housemen”.

Quek feels the low quality of housemen is due to the fact that medical schools can be set up upon meeting only the minimum of standards.

“Many of the officials argue that the quality of medical schools in this country is inadequate, because all the medical schools so far meet the minimum standards or criteria set out by the MQA,” he explains.

He feels it would be better to cut down on the number of medical schools to ensure producing better quality housemen.

“Australia and the United Kingdom had produced too many doctors in the past decades and has since scaled back by amalgamating or closing down medical schools,” he says.

Perhaps the government should take a note from these “already developed nations” and see that quantity does not ensure quality