April 2012: Madness is like gravity,What you need is just a little push……………..!
Over the last 24 months since I started blogging (http://pagalavan.com), I had written numerous articles about medical education in Malaysia. Unfortunately, our medical education has gone into a vicious cycle of mediocrity with full of entertainments. Our country is not short of any real life entertainment. When I was in Singapore for 18 months in 2007/2008, Malaysia gives them all the entertainment that they need. Their newspapers were full of Malaysian news which is much more entertaining than the happening in their own country.
“Some people just like to see the world burn!”
Over the last 15-20 years, we have had the highest number of NEW medical schools in the world. Anyone can open a medical school in a shop lot as long as they have the right connection. In fact, we have the highest number of medical schools per capita population in the world currently. We should be in the Guinness World Book Records for this achievement! The MOHE had just put their foot into the mouth by approving all these medical schools without looking at the long term consequences, all in the name of education hub. In fact, the medical school can enrol students even before MMC gives its accreditation and many parents are not aware of this. Now, it is just too late and no amount of damage control is going to change the scenario that we are going to get into soon.
Just look at the number of medical schools in this country:
1) University Malaya (UM)
2) UNiversiti Kebangsaa n Malaysia (UKM)
3) Universiti Sains Malaysia (USM) : 2 programmes
4) Universiti Putra Malaysia (UPM)
5) UiTM
6) University Sains Islam Malaysia (USIM)
7) Universiti Darul Iman
8) Universiti Sarawak Malaysia (UNIMAS)
9) Universiti Sabah
10) Universiti Malaysia Kelantan
11) Melaka-Manipal Medical College
12) Monash University Malaysia
13) International Medical University (IMU)
14) SEGI University College
15) Allianze College of Medical Sciences (ACMS): 5 programmes
16) Penang Medical College (PMC)
17) Mahsa University College
18) Masterskills University College of Health Sciences
19) Royal College of Medicine Perak (UNIKL) : 2 programmes
20) Universiti Islam Antarabangsa (UIA)
21) Newcastle University Malaysia
22) Perdana University : Graduate Medical School
23) Perdana University : RCSI
24) Inssaniah University College
25) Quest International University Perak
26) RCSI Trengganu ( starting soon)
27) KPJ University College (starting soon)
28) Cyberjaya School of Medical Sciences
29) AIMST
30) Taylor’s University College
31) Management and Science University (MSU)
32) University Tunku Abdul Rahman (UTAR)
33) University College Sedaya International (UCSI)
34) University Pertahanan Nasional Malaysia (UPNM)
35) Lincoln University College – 2 programmes
36) University College Shahputra (starting soon)
Almost 50% of these medical colleges are yet to produce their graduates. Despite this, we are already seeing almost 5000 new medical graduates entering the market last year with 6000 targeted this year. This is because there are thousands more doing medicine overseas either self-sponsored or government sponsored. Egypt and Russia alone is “training” almost 1000 graduates each, yearly for Malaysia! Based on my calculation, we may be seeing about 8 – 10 000 new medical graduates entering the market by 2016 when most of these medical schools start to produce graduates with their maximum capacity. When even now, we are talking about doctors glut, what more in the next 5 years’ time! Jobless doctors will become a reality! Also, some of these medical colleges above are producing more than 1 batch of doctors as they have twinning programmes running concurrently. If you include all these programmes, we may have up to 50 medical programmes. The recent moratorium is just eyewash. Over the last few months, I saw 2 new medical schools advertising in the papers, namely Lincoln University College and University College Shahputra. So, what moratorium are we talking about? The existing medical schools will continue to enrol more students to make as much money as possible.
Our Society
Our society is obsessed in making their children a doctor by hook or crook. There used to be a saying that “you throw a stone, you will hit a lawyer” but soon the same can be said for doctors. Many still believe that being a doctor guarantees their children’s future but I can prove them wrong. In fact, the comments that I get in my blog further proves that, this is the main reason why many still want to do medicine in addition to glamour. Many of the young students are totally unaware what is in store for them when they decide to do medicine. They still think that their job is guaranteed with good money. They still think they can work anywhere in the world by just having any MBBS degree. They got no clue regarding the fact that in medicine, your degree needs to be recognised by the respective country’s medical council in order for you to be able to work there.
Some still think you can earn RM 6000 starting salary when you join as a housemen! I got no idea where they got the info. I got a parent who was shocked when I told him that a houseman’s salary is about RM4K/per month (much better than during my time!) and it will take almost 10 years to reach a salary of RM 10K, if you are a specialist. Then he asked me back “What is the point of spending RM 300-500K to make them a doctor?” Exactly! I rather invest the same amount of money to start a business venture for my kids. Some even take huge loans (up to RM 150-300K) to make their children a doctor, hoping they can pay back as soon as possible!! Gosh, what an ignorant society that we live in! It will take a life time to settle this loan assuming you got no married life or car/house loan coming along your way! I get numerous enquiries in my blog and emails asking me what to do if they quit medicine and how they regretted in becoming a doctor and how they were misinformed regarding the career pathway.
Milk the cow!
The medical colleges are just using our society’s obsession to make as much money as possible. Let’s face the fact, that’s the reality. Milk the cow before it dies! None of the medical colleges promises you a job after you graduate; this is clearly stated in their brochures. Since almost all our medical colleges are not recognised overseas (except UM/UKM being recognised in Singapore and Monash in N.Zealand/ Australia), if you are jobless in Malaysia, you would not be able to find a job anywhere else unless you sit and pass their respective medical council’s entrance exams. I can assure you that more than half of the medical schools above will not even qualify as a medical school by any international standards. The number of full-time lecturers are pathetic to say the least and mostly dependant on foreign non-clinical lecturers from India, Burma, Sri Lanka etc (no offence intended). That’s the reason almost 100% of the students in our medical schools are Malaysians. What education hub are we talking about? Even the “so-called” John Hopkins degree is not even a John Hopkins degree as mentioned by their CEO! It is just another local Perdana University degree with no international recognition (with a RM 1 million price tag)!
Despite Malaysian Medical Council coming up with “Minimum Criteria & Qualifications for entry into a Medical Programme” guideline in May 2011, these private medical schools are still continuing to take under-qualified students to do medicine due to stiff competition. Many of them have introduced self-assessed foundation courses to attract students. The students were guaranteed a seat even before they start the “so-called” foundation studies. Can MMC even monitor all these medical intakes which run into thousands? And don’t forget the type of students who go to Russia and Egypt where they don’t need any pre-university qualifications. SPM is enough to enter medical schools in Egypt and some 6 month dubious foundation courses is enough to do medicine in Russia!
Jobless Doctors?
Will doctors become jobless in near future? My answer is YES. We can already see how MOH is struggling to place new graduates for housemanship training and they seem to be opening more and more district hospitals for training purposes. What type of training can these district hospitals with no subspecialty units provide? Some hospitals are overcrowded with housemen and they are not learning much. These poorly trained souls are then released into the community, coupled with some poor attitude and snobbishness; they seem to be having a license to kill! God save the country. The good ones get frustrated and leave to private sector, not to say there is a lot of money in private sector as well. The competition is getting so great that the incomes of doctors are gradually dropping year by year. I know of GPs who have closed shop, earning net profit of less than RM10K/month (for working 13 hours a day, 7 days a week) and specialist who only earn less than RM10K/per month!
From September 2011, housemen started doing shift duties. What does this mean? Firstly, it means that we have enough housemen to be able to do shift duties. It may not be the same in all hospitals but most general hospitals seem to be OK. Secondly, “On-Call” allowances are removed since you are working shift duties with limited number of hours/week. Due to the current political climate, a special allowance of RM 600/month was introduced as announced in Budget 2012 (still a RM 500-600 pay cut). Even though I support the shift system which will make the houseman more alert and attentive in their duties but if it is not done properly, the standard of continuity of care to the patients will be affected. The training of the housemen will also be affected as the bad ones will try all kind of stunts to push the work to the guy next shift! Soon, when all the posts are filled, there is a high possibility that the critical allowance of RM 750 will be taken away. In fact, getting a job as a doctor will become a privilege and you just have to take what is given and go where you are asked to go. Preference will obviously be given to government scholars and local public university graduates. I was informed that the medical officer post for the state of Selangor, Negeri Sembilan and Malacca is deemed full. I was told that housemanship is now being given on contract basis after which you need to apply for a job.
UK with almost 500 year’s history of medical education has about 32 medical schools for a population of 63 million! Bangladesh producing 10 000 medical graduates for a population of 156 million. Here, we are going to produce 8-10 000 medical graduates for a population of 25-27 million! For the first time in the history of UK medical education, 10% of their medical graduates could not get a post for internship (foundation year) this year! They need to wait in a “Q” for the next intake! This is mainly due to stiff competition from other EU countries. In Australia, the state of Victoria is unable to take any more interns and they are also slowly closing their gate to international medical graduates. So, you think it will not happen in Malaysia? It is common to see medical graduates working as pharmaceutical company reps, nurses and even taxi drivers in India, Thailand, Philippines and even Vietnam. We may not be too far from this scenario. Ministry of Health has openly declared that we will achieve doctor: population ratio of 1: 600 by 2016 and 1: 400 by 2020. It is simply too fast and too soon. I will not talk about the quality issues anymore as I had written about it before.
Post Graduate Education?
Let’s talk about postgraduate education in Malaysia. We all know that having MBBS alone does not mean anything anymore. It is regarded as a diploma equivalent. That’s the reason the medical undergraduate education has been gradually downgraded compared to what we use to learn during our medical student days. In many developed countries, they expect all medical graduates to pursue postgraduate education. They also maintain a high standard of entry qualifications to medical school. With 8-10 000 medical graduates entering the market soon, can we cope? For all surgical fields, the only way to become a specialist is by completing the local Master’s programme. We still have MRCP for Internal Medicine, MRCPCH for Paediatrics, MRCOG for Obstetrics and Gynaecology, FRACGP for family medicine, FRCR for radiology and FANZCA for anaesthesia as an alternative. This year, the intake for Master’s programme has been increased to 800, all disciplines included. It is presumed that the intake will increase to 1000 by 2015. The number of years of service to enter Master’s programme has been increased to 4-5 years (2 years HO and 2-3 years MO). Even then, this will probably cater for only 10% of the graduates. So, what happens to the rest? Either you wait for years or you say “sayonara” and remain as chronic medical officer! By the way, chronic medical officers are still an important component of our health care system. Since your undergraduate degree is not recognised elsewhere, you can’t go anywhere else for your postgraduate studies.
Madness is like gravity, what you need is just a little push!
Unfortunately the villain who is giving the push is our very own administrators. The push has been done and the madness has started. It will continue till it hits the bottom of the barrel. I don’t think anything can stop the drop and I hope parents will seriously consider other options for their children. Most of my friends who are millionaires now and flying all over the world are not doctors! If money is your aim than there are many more things you can do other than medicine unless you have real passion for medicine and willing to put up with all the frustration which comes along the way. If not, don’t join this madness.
Every epic has its conclusion and every legend will come to an end. For medicine in Malaysia, the end is coming soon…………. will the Dark Knights ever rise…………again………..?
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[…] wrote this artilce https://pagalavan.com/my-mma-articles/unpublished-since-september-2011-madness-is-like-gravitywhat-yo… in September 2011 for MMA Magazine. Unfortunately, up to date, it is yet to be published in […]
There was a news article recently, pointing out that MMA is but a “social club”
It sounds insulting, but looking at the deregistration issues and all the dramas, it is perhaps a fitting description. Maintaining an eerie silence and praying that nature would take its sweet course does not bode well for the association. As a bystander I would like to point out that one of the most commonly cited reasons as to why younger members of the medical profession do not join the MMA is because that they felt the MMA is not vocal and bold enough in many of its endeavours.Unity among association members also is at doubt. No offence intended, but I think somebody has to point out the painful truth, whether it is known or not.
The shift system is doing more harm than good. Most of the juniors are not motivated to utilise the extra time to improve on their knowledge and skills. ( except a few hardworking souls) Most MOs and Specialist are still overworked due to the maldistribution of staff and the constant exodus of senior doctors. The burden of taking care of an ever increasing load of patients in the government hospitals as well as the constant bureaucracy and hostile environment that government doctors are working in, has improved, but there is still much to be desired.
Then we have our Local masters programmes, offered by various universities, who are more interested to churn out money from KKM/MOHE rather than training the trainees to better suit the needs of our population. There are often instances whereby a trainee has not met the so called supervisor for 2 years, but yet this supervisor continues to claim honorarium from KKM. Where is the guidance? well, they will tell you, since you are an adult, you are supposed to be “self directed in learning”. The universities will also try their level best to organise all sorts of courses, which they claim will help the trainee pass exams, and at the same time charge money from the trainees( The trainees are supposed to claim back from KKM/JPA after a few months). In these courses there will be non-medical personnel teaching ” applied sciences” to the trainees. Does it sound fishy? and in the end there will be a very poor passing rate, but who cares, blame it on the lazy trainees who are not on par! ( when in fact these poor KKM souls are doing back to back calls, taking leaves for studies, travel often to outstations and etc. Some of them are even doing double degrees. Most are unable to stay awake at work! They will also run all sorts of CME and education programmes for the HOs) The reality is that all these so called masters courses are hardly recognised outside our own country despite them setting so many unrealistic targets and standards all aimed at bull-dozing the trainees!
Dr Paga is very right in mentioning doctors running out of jobs and etc. Its all about the money, not education, and please forget about world class hubs.
you are right. Well said.
Thank you for your comprehensive article about the poor status Malaysia healthcare system.
I am a self-sponsored medical student in the UK, preparing for final exam this year.Question remains about where I could start my housemanship training. I have been weighing on my options which includes UK, Singapore or Malaysia.
The easiest option here is to integrate myself into the NHS career pathway once I graduate. However, I do not plan to settle down in the UK in the long-run, due to various reasons/ commitment (i.e. family, friends or social).
Looking at the current healthcare in Malaysia which is not favorable to me as a junior doctor, the viable option would be either UK or Singapore. I am familiar with the UK and Malaysia healthcare system, but the system in Singapore remains unclear to me. It would be helpful if Dr. Paga could elaborate on that matter?
In your opinion, what would be the best career pathway for me (which includes houseman and postgraduate training)?
If I intend to go back to Malaysia, at what point of career would you recommend for me to return?
Thank you in advance.
do consider Sg if you are intending to be close to home.
They are currently _actively_ recruiting. Last year, they actually sent reps worldwide to established universities to rope in medical grads, and have two hospitals that just opened that need posts to be filled.
System wise, Singapore’s internship lasts 1 year. You will be allocated to a hospital by the MOHH
Since you are self sponsored, I would suggest for you to do everything including speciality training in UK. You can return after completing everything. It will also give you more opportunity in applying consultant post anywhere else.
i suggest going to singapore. i am a malaysian working in singapore healthcare, and i must say the pay is definitely better in sg vs msia, you’ll get better training here and you’ll still be close to home. it’s a good place to be, don’t limit yourself by going back to msia, the country is going to the dumps because of idiotic bureaucrats who think that they are doing a good job but are too short-sighted to plan long term, it’s frustrating and i have given up hope on my home country, it’s time to move on and i am 100% sure many others would agree with me
Thanks for the reply, can anyone elaborate on the pros and cons of the singapore healthcare? As in the career pathway?
You cannot blame these medical schools for opening up. Afterall, a medical degree is an academic/vocational qualification just like many others. If there is a demand for a degree, then, there will surely be supply.
The fault lies entirely with students and their parents who don’t do due diligence before parting with their money. As for jobless doctors, well we have had jobless lawyers, engineers, scientists etc etc.
As for me, if the public would like my children to serve them as doctors/lawyers/dentists etc, then the public will have to pay for their training. I don’t mind paying for a mathematics or a physics degree but not for any sort of licensed profession.
With regards to the “quality” of medical schools-I am not sure if any medical school has got the training of doctors right. A lot of medical curricula seem to be hit-and-miss affairs. The fact that we have so many different programmes (traditional / integrated /PBL based etc) around itself points to inherent instability of medical education- ie there seems to be one right way of doing things.
Government have what I call the ‘ Paradoxical Midas ‘ Syndrome. Instead of gold , whatever they touch seems to turn to shit.
Its very demoralizing to see the policy makers in this country slowly but surely destroying the very fabric of our medical fraternity.
We all went through the hardship of studying and training just to find the profession slowly stripped of its value.
Im a Paeds MO in Selangor and im doing 6- 8 calls a month with no pm off. Almost all of us are sitting for the juggling between work and trying to pass the exams with very minimal help from the existing policy. We fork our own money for training , take our own leave to study and prepare. Who benefits if we become better at our work? Yet , very minimal support from superiors.
Whenever we say we need more MO’s the answer is that there are no more vacant post. If MO position so full in this state , why are we still working like a dog?
Here we are trying to improve ourselves with no one to help except god , the policy makers dump their KPI’s additional work for us to do.
With so many house officers around , the specialists are struggling to train and keep track of all of them. I don’t deny that there are good ones but these are very few in between and hard t come by. Many do not know basic things that should have been thought in medical school and usually they are from this ‘ exotic’ medical schools no one has ever heard of. Yes they are less sleep deprived but it is at the expense of clinical knowledge and practise. We sometimes feel like we are dealing with medical students. Most cannot be assigned to help out with any procedures and present very substandard clerking. Its really taxing for MO’s who I feel have become the neglected personnels by the MOH. Not only are we doing our core duties , we are also carrying the extra burden borught about by gov’s policies and incompletent HOs. I have personally encountered HO’s who have not heard of ‘cafe au lait’ spots or Ortolani and Barlow manouvres! Few months back , someone did not know the number of the chmabers in the heart. My specialist almost passed out!
Dr P , nowadays MO are the ones doing referrals , writing letters and accompanying patients. This used to be the HO’s job!
I think Dr P , you need to get your messages across to the MOH or PM directly.
Conditions are turning very bad very quickly and something needs to be done. Maybe get those top top people come and join us in our day to day rounds and see what sort of nonsense we are dealing with.
This is a chronic problem in MOH. This was one of the reason I left. Most of the superiors in MOH nowadays are apple polishers and world travellers. They are only interested in taking care of their seat and making sure that they look good infront of MOH. You can complain all you want but nothing will move. Putting up for more post in the job of the HOD. I remember when I was a young specialist in JB, I was the one who put up for more post in my department and submitted to HOD.The HOG did nothing other than sending it to MOH.
Trust me, the situation will only get worst with all these substandard doctors running around. In 1994, SCHOMOS invited the JPA guys to follow what a doctor does everyday.They almost collapsed and after that we got our “on-call” allowance.
Mr Pagalavan,
I too am a self sponsored medical student in the UK and it has been bothering me whether or not I should opt to go back to Malaysia. Though I agree with staying in the UK until I have enough recognition to become a senior officer, but what do you recon we should do once we reach that point?
Basically, I’m asking is there something we can do to change (small or big) to change something to avoid the disaster that is heading towards our country?
You can do the change by becoming a voter and asking rest to vote as well. I will still advise for you to do all your speciality in UK before coming.
Dr Paga, but there is no guarantee of a training post. We may end up as chronic doctors in UK or Aussie on contract basis. Would it be better to return home early to join the system ?
It is the same here as well BUT the training that you get in UK is well recognised in many other countries, including Australia. Thus, your options are bigger. The training in Malaysia do not get you anywhere!
Dr P, what are the qualifications of getting a job in Singapore? only UM/UKM graduates are qualified? is there a any chance that USM MD will be also recognized by Singapore?
Not at the moment as far as I know. You need to sit for the entrance exam
A very powerful commentary – very insightful and an excellent analysis of the gravity of the situation here in Malaysia. And you were only focusing on medical schools! Imagine the rot that’s going on out there in mass proportions!
[…] April 2012, I wrote this article in the MMA Magazine https://pagalavan.com/my-mma-articles/unpublished-since-september-2011-madness-is-like-gravitywhat-yo…Unfortunately the madness is continuing and becoming ridiculous at times. Over the last few weeks I […]
Some updates for overseas branch campuses to be open soon in Malaysia.
1) Vinayaka Missions University, India (Dentistry, Pasir Gudang, 2014)
2) Xiamen University, China (Medicine, Salak Tinggi, 2015)
3) Shanghai Jiao Tong University, China (Kuching, 2014/2015)
Yes, I wonder where they are going to get the teaching staff and which hospital they are going to use!
Interesting a chinese university in Kuching, my hometown.
of late, Kuching has seen a huge boost in investment. multiple shopping malls are mushrooming in Kuching and we have our first Apple outlet a few years ago.
A new university in Kuching will no doubt lift up its profile!
But as Dr Pagal says, where will the staffs come from? perhaps mediocre lecturers simply to fill the gap. Sad but true! Unless of course they can offer lucrative salaries to attract top lecturers!
WE have 36 medical schools who are already struggling to get lectures. I can say that almost 60% of the lecturers in all these medical schools are expats from Myanmar, India, Pakistan, Egypt etc.
Dr Paga,
Wasn’t there a rule that most lecturers are to be Malaysians. Or is it that medical schools are exempted?
Malaysia Boleh ! No such rule. In 2010, UCSI had only 1 Malaysian lecturer, with first batch graduating! OH, don’t forget NuMed, just find out how many Malaysian lecturers are there?
btw, guys, check out my review on The Wolverine 2013 on my blog. Just click on my name!
Hi doctor pagavalan. I am a 4th year medical student studying in USM. May I know what are the options for me if I want to work in Singapore right after I graduate or maybe if so, after Ive finished my HO in Malaysia? What kind of entrance exam do I have to sit for? Do I need to take it in Malaysia before applying or do I need to take it in Singapore? Thank you so much for taking your time to read my curious thoughts and I hope you can help to shed some light. Thanks doctor
USM is not recognised in Singapore. You need to sit and pass the SMC exam which is the final year exam in NUS. You need to apply to SMC.
Hi Dr. P, looking for some views here, hope you can help!
I am currently holding a foundation in science under USM and under MARA Loan. I didn’t pass the minimum requirement to join USM MBBS programme as I only achieve a 3.3 CGPA. Received an alternative application under USM for Physical Engineering (Applied Science).
Applied for Melaka Manipal with the foundation that I have and I am accepted by manipal.
After receiving some ideas and views from family members, currently looking at doing A-levels and continue with university in UK or Australia.
My father believes that manipal is the best route, he thinks I should continue with it, study well, perform well and he believe I can continue and specialize easily. he also said that since manipal collaborate with Melaka Hospital, finding a place for housemanship wouldn’t be a problem, with the additional MARA loan that I have.
A-levels is a different route, my mother and I believe there is more future in oversea for me as long as I can perform well in my A-levels and my future doctorate studies. I strongly believe i can achieve this as I know I have the capacity to rectify the mistakes that I’ve done in my foundation. Duration of studies is not a problem, as long as I am a doctor in future and possibility for me to practice and become a specialist in my field of interest is higher.
As for the physical engineering, it seems interesting. Yes, medicine is still my preference. However, I think if the reality for me isn’t medicine but applied science for a more guaranteed future, why not.? I’m not denying this possibility as it may be the best turn in my life and I try to weigh my options well so I won’t regret and turn around, do things all over again just because I realized later in life that I wanted something else.
Currently I’m in dilemma and haven’t decided anything yet. Please give me some views. For anyone who would like to contribute some of your thoughts, feel free to do so. I am all ears.
Your father probably got no clue what medicine is all about. Affiliation of Melaka Maniple to Melaka hospital do not mean anything. Housemanship is done under MOH after you graduate. It has nothing to do with Melaka Manipal etc. Same goes to specialisation. Please read all the information under “For Future Doctors” page.
If your intention is to work/migrate overseas, then do A level and do your medicine overseas bearing in mind that most countries are not giving jobs to foreigners anymore.
Melaka Manipal collaborate with Hospital Muar
[…] a 5 year moratorium. Unfortunately, it is simply too late. By then , as I wrote in MMA Magazine in April 2012 (written in September 2011), there were already 36 approved medical schools conducting close to 45 medical programs. Since I […]
[…] 2016. Almost everything eventually happened, just the timing varied. In my MMA article 2011 & 2012 and my blog posts as well as in my books (2016), I had said that there will come a time when the […]