It’s been 10 years since I first wrote in MMA magazine that surplus of doctors is inevitable if the government continue to approve too many medical schools (here and here). No one listened, including MMA president himself. In 2010, our great minister who is currently the transport minister announced that “there will not be surplus of doctors by 2015“. Just a year later, in May 2011, the cabinet issued 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 started blogging in 2010, I had also written many times about these issues. I predicted that “jobless” scenario will happen by 2015/2016. A blessing in disguise, is the closure of AUCMS (5 programs) and few more twinning programs by certain universities.

Today, TheMalaysianInsider published a report on the “jobless” scenario of medical graduates. It looks like not only the waiting period for posting is about 6-8 months, the waiting period for SPA interviews is also taking 3-4 months. This will create a waiting period of close to a year. Some graduates wanted the SPA interview to be done sooner, probably within a month. I feel many do not understand how civil service works. The appointment to civil service is done by SPA. However, SPA can only offer you a job based on vacancy. So, how would SPA conduct an interview if they do not have any post/vacancy to offer? Thus, SPA can only conduct interviews once they have a considerable amount of post available. Even then, they will call for interview based on first come first serve. With more than 5000 graduates entering the market from this year onwards (4740 new registration in 2014), how many can they call for an interview at any one time? As of this year, all medical schools in Malaysia will be producing graduates!

Once SPA offers you a post in civil service, only then you can apply to MOH for a posting. This is now done via the “ehousemen” portal. Since 2015, you are given the liberty to choose where you want to do your housemanship. However, you decide your own fate on the waiting period. The more popular the hospital, the longer the waiting period. Based on the press statement by DG in December 2015, only once your appointment is confirmed, provisional registration will be issued by MMC. Please be informed that those who went to do medicine after the Minimum Entry Requirement was announced in May 2011 need to fulfill this requirement to be able to get a job. Your SPM results must also be submitted for provisional registration. SPA may reject those who did not fulfil the requirement. SPM BM requirement has also been made compulsory since last year. It has always been a requirement to join civil service but the rule was relaxed in 2006 for doctors.

While no one listened to all that a right thinking medical personal had warned, it is the graduates who eventually ended up in this mess. Poor human resource management and in the name of education hub, our quantity government has done it again. From nurses, teachers, pharmacist and now doctors are all in “jobless” scenario. While housemanship is a rolling post , most will still get a post eventually, probably after 1-2 years. BUT what happens after that? I understand that MO post are also full. Since new posts has been frozen since April 2014, how would the government be able to absorb all post-housemen doctors? I would predict that eventually, housemen post will be given on contract basis and new application has to be made for MOship. Either that or we need an entry/exit exam. The best solution will still be reducing the number of students entering the medical field by strengthening the entry requirement or having a common qualification exam. No one can prevent anyone from doing medicine in this capitalist world but having a stringent criteria will deter many from doing it without proper qualifications.

Medicine has become just like any other job. No job is guaranteed. Never do medicine for wrong reasons!

Grad doctors wait in vain for houseman posting

BY ISTA KYRA SHARMUGAM

Published: 15 February 2016 9:00 AM

There are not enough housemanship posts in public hospitals following a government freeze. – The Malaysian Insider file pic, February 15, 2016.

Despite graduating with a medical degree in October last year, Muhammad Faiz Hassan, 29, is working odd jobs, repairing cars and dabbling in wedding photography to support himself.

He is among hundreds of future doctors who are forced to earn a living in fields unrelated to their medical studies because of a two-year backlog of housemanship placements in public hospitals.

“I’ve heard that we may be expected to wait from six months up to a year for a placeent.

“This is an incredibly long time, which not only affects my financial situation, but also worries me, that I might get rusty with my medical knowledge.

“I am now applying for an assistant teaching position at a medical school in Cyberjaya. This way, I hope to stay in touch with my field and be prepared once I finally get called to work,” said Faiz, from Batu Pahat, Johor.

Faiz, a National Higher Education Fund Corporation (PTPTN) recipient, said he felt pressured to find employment fast after receiving an email informing that he was required to start repaying the loan, six months from the notice date. 

“My course was RM300,000 in total and I took the maximum loan of RM150,000 under PTPTN.

“In addition to the interest expected to be incurred, I am daunted by the large debt I am starting out with immediately after graduating.

“My parents are pensioners and I do not want to burden them, which is why I am hoping the government will be able to sort out my housemanship as soon as possible.”

He said most of his seniors have to wait long despite having gone for the Public Services Commission (PSC) interview, after which they were given an online ID to track their housemanship application.

“Through the e-housemen system, we can know when the next intakes for housemanship will be open.

“But I am still waiting to go for my PSC interview. If this can be sped up, it would be helpful.”

Mastura Mukhtar, 24, from Alor Star, Kedah, said many of her seniors have to wait two to three months after their PSC interview before getting a placement.

“At least, if we are called for the PSC interview faster, we will not have to wait so long.

“I’m rather lucky to have doctors as parents and can shadow them at work, but not many of my batch mates are in a similar position.

“I, too, plan to take up part-time teaching to earn some pocket money and kill time,” she said.

According to Malaysian Medical Association president Dr Ashok Philips, the current backlog was because of a shortage following a government freeze on posts.

“There are only 5,000 housemanship posts each year in the 43 public hospitals nationwide.

“There are about the same number of medical graduates a year… some 20% of housemen take more than two years (the stipulated period) to finish, which creates a backlog in the number of available posts,” he said. – February 15, 2016.

– See more at: http://www.themalaysianinsider.com/malaysia/article/grad-doctors-wait-in-vain-for-houseman-posting1#sthash.93YCDAB2.dpuf

Just a week ago, I wrote on the same topic quoting an article written by a philanthropist, Mr Koon on why he refuse to provide scholarship to those who wants to do medicine. Unfortunately, similar to what I had experienced before, multiple nasty comments were made against him in various blogs and newsportal where his article was posted. Readers can check for themselves. People still do not understand what we are trying to say. It is not about passion we are talking about but the economics. If you are doing medicine purely for economic reasons, than medicine is not the field you should choose at the moment, worst still by taking huge loans. I saw comments like ” there are no such thing as jobless doctors“, ” doctors never get retrenched” , ” doctors will always earn money no matter what the economic situation is ” etc

Today, there were 2 articles that caught my attention. The first was a letter in The Star written by a GP (see below). I have been talking about how opening a GP clinic is not as easy as it used to be. I know quite a number who had closed shop and gone back to work as employee of franchise clinics. Most GPs survive on panels. The letter today clearly illustrates how companies and panels demand what they want from the doctors. Either you take it or leave it. If you don’t want to take, someone else will! That is their motto and since many doctors are also struggling in their business, they do not mind taking the offer. It is interesting that the institution had requested the doctors to pay a fee for the contract renewal and further limit the consultation fee. I know some insurance companies which even controls what medicines that can be given etc. I had written about these issues before. The letter again tells people the actual income of GPs nowadays and not to assume that all GPs are rich with big cars! He quoted 1-2% of GPs of being succesfull which is lower than 10% of doctors that I quoted in my last article.

Another interesting article was published in Malaysian Insider on the issue of patient load in private clinics and hospitals. As I had written before, private healthcare is almost 70-80% supported by insurance and corporate panels. Thus, it is not right for anyone to say that doctors will earn no matter what’s the economic situation is. No doubt you may be able to earn to survive but to say that you will still earn handsomely is not right. The general public still do not understand the economics. The private healthcare cost is simply too high for any middle-income group. Once economic slow down occurs, people will tighten their pockets which in turn reduces the visits to private healthcare. Some will treat themselves with medications bought from pharmacy or cheap medication sold by traditional healers which suppose to cure everything under the sun. Some will default their insurance payment which makes their medical card invalid. Majority will turn to public hospitals and clinics. That is the reality. Income of many doctors especially GPs will decline considerably. Even hospitals can close shop due to high overhead maintenance cost. Insurance companies have already started to control what we do and what we are not supposed to do. They simply refuse to pay if they don’t agree what you had done. And the patient will also not pay! BTW, please read the comments in Malaysian Insider. Just see how many give sarcastic remarks about private doctors!

A GP friend of mine had refuse to sign with most panels due to their unfavourable contracts. He only has one insurance panel. He got this to say “I’m lucky that people around here earns S$… Otherwise I’d be full time Uber driver.. …. ”

So, please listen to Mr Koon! He is a businessman and he knows what he is talking about. 

To make matters worst, it is reported that the government has SUSPENDED JPA and MOE bursary scholarship with immediate effect ( see below)!! 

Panel doctors feeling the squeeze
I AM writing to highlight the underhand methods which some corporations are using to squeeze doctors and general practitioners (GPs) in this country.

Recently, an established and well-known institution of higher learning sent an official communication to all of its existing panel GP clinics, informing them that they were being offered an extension of their panel status with the said institution.

After decades of providing quality primary healthcare services to the institution, these GPs now have to renew their commitments. This is a common exercise, as times are changing and the terms of the contract will need to be reviewed from time to time.

However, what is shocking is the manner it is being done and a new condition which has been introduced. This institution has now decreed that, in order to continue providing services to the institution, the GP clinics would need to pay a processing fee of RM2,500 for the two-year contract period. This means each GP clinic has to pay RM2,500 in order to be eligible to provide services to their employees.

To us, in the medical profession, we feel this is an attack on the integrity of doctors. Through the Hippocratic Oath, we are bound to provide our services to any and all, regardless of race or religion.

Now we have an institution of higher learning, which incidentally also has a medical faculty, that has single-handedly turned this most noble of oaths completely on its head. They are sending a message to the world that doctors now have to pay before they can render medical help to mankind!

They will argue that there is a cost to manage and process the clinics and doctors who provide this care to their employees. They will say that the costs to manage and administer this is rising due to many factors.

But yet, they have the gall to fix consultation rates at RM15 per visit, as opposed to the prescribed rates of between RM35 and RM50 by the Malaysian Medical Association (MMA) through the Fee Schedule.

They have also the nerve to fix medications at unfair rates. For example, upper respiratory tract infection has been fixed at RM21. One pays more for a cup of coffee at certain places these days!

Does this institution, which is also a breeding ground for new doctors, realise that the healthcare industry has also not been spared the increasing costs of doing business?

GPs are subject to increasing costs through higher rentals, utility charges, consumable and disposable charges, equipment costs, etc. This is mainly due to the introduction of the GST, which healthcare has been exempt and therefore cannot transfer the costs to patients. To these people I ask: Who is looking at the welfare of doctors?

The public may have the perception that doctors are wealthy and live the high life. I implore those who have this perception to stand outside any GP clinic and observe what car these GPs drive.

I agree that just like any profession, there would be the top 1% to 2% who have made it. But just because there are high-flying GPs who jet-set across the world, it doesn’t mean all GPs have the same life.

The average income of GPs these days is between RM7,000 and RM10,000 per month, and this is after 15 years of working. Most other professions provide better and greater opportunities to earn much more than that.

In the end, it is the poor GP who suffers. More and more organisations are taking advantage of the market forces to push doctors into a small, pitiful corner.

Additionally, I would like to highlight one important fact. This institution has now also introduced a kickback system into the market. Pay them in order to be allowed to eke some living out of their employees. Pay them before being eligible to provide services and send bills to them. Doctors now need to pay before being allowed to have patients.

What message are they sending to the medical students in their own faculty. This is against the Private Healthcare and Services Act 1998, which outlaws such practices of kickbacks.

Doctors have stood by and just allowed this entire thing to get to this stage. But as a member of this profession, I cannot just stand by and watch anymore.

I am imploring, even begging, for the Health Ministry and the Government to tackle this issue with utmost urgency and importance. Please, help the GPs.

A CORNERED GP

Kuala Lumpur

Private healthcare patients feel pain of weak ringgit, higher cost of living
BY MELATI A. JALIL AND DEBORAH LOH

Published: 20 January 2016 7:00 AM
Private healthcare, the preferred option for those who can afford it, is reportedly seeing a drop in patients with practitioners attributing the trend to the effects of increased cost of living and the ringgit’s depreciation against the US dollar which has made certain treatments more expensive.

Tan Sri Dr Ridzwan Bakar, consultant cardiologist at a private hospital in Kuala Lumpur, said some of his patients have transferred to public hospitals.

He noticed a 10% drop in number of admissions to private hospitals since April last year, when the goods and services tax (GST) was first implemented.
“I think this is the general finding of almost all doctors working at private hospitals in the Klang Valley,” the cardiologist with more than 30 years of experience in private healthcare told The Malaysian Insider.
“The drop has remained persistent towards the end of last year,” added the former president of Association of Private Hospitals.

“People have less disposable income,” said another industry professional, Malaysian Medical Association (MMA) president Dr Ashok Philip.

“We have GST, the economy is not so buoyant, the ringgit has depreciated, and times are uncertain.”

Correspondingly, the number of people seeking treatment at public hospitals appears to have risen. Public healthcare in Malaysia is almost free or certain treatments are heavily subsidised although patients have to endure a longer waiting period for procedures compared with private healthcare.

“My colleagues at public hospitals have noticed a 25% rise in the number of admission in public hospitals, maybe there has been a drifting of patients from the private sector to the public sector,” Dr Ridzwan said.

Dr Ashok concurred.

“Anecdotally, the outpatient load in private clinics and hospitals has declined. This is because the outpatient treatment at government clinics is almost free,” he said.

It’s a sign of the times when even cancer patients are opting to cut back on essential chemotherapy at private facilities in order to trim expenses.

Dr Ridzwan said oncology was a good example of one area in private healthcare affected by the exchange rate because of the nature of the treatment.

“The drugs can easily run into five figures per month and there is no replacement. (Patients) have to be given those drugs.”

Private hospitals which have more patients with insurance might not be as badly affected, but given that about a quarter of patients at most facilities pay out of their own pockets, the impact on the hospitals’ bottom line is of concern.

“Between 30% and 40% of patients at private hospitals are self-funded. We can safely assume that many of them have to tighten their expenses, they have to go to public hospitals,” Dr Ridzwan said.

The weak ringgit has impacted on medical fields requiring expensive chronic therapy, a pharmaceutical industry player said.

“Healthcare involving babies, children and pregnant mothers is less affected,” said the sales representative of a drug firm, who declined to be named.

“The drop in patients also varies greatly between different therapeutic areas.”

Some private clinics are seeing a drop of more than 50% while others seem to have smaller decline of 15% to 20%.

“A large private hospital closed one of its wards due to the lack of patients,” he said, adding that he expected 2016 to be a difficult year for private healthcare, especially those requiring costly and chronic therapies.

“The use of generic medication may increase while health supplements may be affected negatively,” he said.

The Association of Private Hospitals Malaysia did not respond to The Malaysian Insider’s queries on these matters.

Expanding public healthcare

Director-general of the Health Ministry Datuk Dr Noor Hisham Abdullah in a reply to The Malaysian Insider said government facilities have seen a steady increase in demand for services but he did not have data from the private sector to compare with.

“The current economic situation has caused a surge in the demand for our services but with the current strategies we have implemented, we are well prepared to face this surge.”

Figures from the ministry show an increase in total admissions at government hospitals by 13.9%, from 2.16 million patients in 2013 to 2.46 million last year.

The number of hospital outpatients also increased by 2.7 million or 5% from 54.2 million in 2013 to 56.9 million in 2014.

To cope with the numbers, Dr Noor Hisham said the ministry has increased the number of public healthcare facilities, especially Klinik 1Malaysia (K1M), employed more staff by an average of 9% annually and expanded the scope of primary healthcare services.

“For example, in our K1M, from the original treatment of minor ailments, the services have extended to include maternal and child health services, doctor services as well as treatment of chronic diseases.”

Operating hours have also been extended, as well as moves to increase the number of beds throughout the country by building new hospitals, upgrading facilities and using day care services to reduce inpatient demand. – January 20, 2016.

– See more at: http://www.themalaysianinsider.com/malaysia/article/private-healthcare-patients-feel-pain-of-weak-ringgit-higher-cost-of-living#sthash.RqlSI7N3.dpuf

Putrajaya suspends JPA scholarships amid falling revenue

Published Today 9:13 pm     Updated Today 9:25 pm     

Putrajaya has suspended the Public Service Department (JPA) Scholarships for degree courses and the Education Ministry’s bursary for pre-university programmes amid falling national revenue.

According to Sin Chew Daily, this was confirmed by Minister in the Prime Minister’s Department Wee Ka Siong who raised the issue at the cabinet meeting today following several complaints from high-achieving students.

Wee said he had asked the Prime Minister Najib Abdul Razak to rethink and reinstate the scholarship.

“The prime minister understands that the economy is not good at the moment and the people are facing heavy burden so he has instructed the chief secretary to the government and JPA to come up with a new solution.

“I can’t say for certain if there will be a change of decision but we (MCA) have tried our best to appeal the matter because we don’t know how the economic situation will develop,” Wee was quoted as saying by the Chinese language daily.

The suspension applies to both overseas and local scholarships and affects some 700 placements this year.

Urgent resolution

Wee urged for an urgent resolution to the matter as some university commence their intake as early as Feb 1.

He added that Najib had asked the chief secretary and JPA to submit a report to the cabinet next week with their proposal.

The Sin Chew report also pointed out that some students have questioned why the JPA scholarships were suspended, but not Mara scholarships.

However, Wee declined to respond to this claims, citing that he had not heard them personally.

Asked if the suspension of the JPA scholarships was linked to the planned budget revision on Jan 28, Wee said he did not know.

A check with JPA’s website found the “bursary e-filing system” link which is used by students to apply for the scholarships, have also been removed.

Putrajaya is struggling with shrinking revenue as the Brent crude oil price has fallen to a 12-year low, settling at US$27.78 per barrel.

This is in contrast to a high of US$114.81 per barrel in 2014.

Najib has announced that the 2016 budget will be revised to adust for falling revenue and will see government expenditures optimised.

6 months ago I wrote my first part. 2 months before that, I wrote an article titled ” Passion vs Debt” when some students gave some nasty comments in my blog after the AUCMS loan fiasco issue that I brought up. I had always said that no matter what passion you have, in the end, medicine is just another job to earn a living. No one is going to come to your assistance when you got no money. Just because you help safe some lives does not mean people will come to your help when you are left with nothing. It is a capitalist world.

It is also naive to think that doctors are job guaranteed. I had explained enough in this blog. Frankly, there are close to 50K doctors in this country. How many do you see driving big cars and staying in big houses? Probably less than 10%. Isn’t that the same figure for any other profession? Furthermore, most of these doctors are still working 24 hours a day, 7 days a week. The public perception is usually biased towards what they see you having externally. They never see or want to see what happens behind the stage. That’s why many quit medicine after graduating. Never do medicine for wrong reasons!

Few days ago, a philanthropist made an announcement that he is willing to give free additional scholarship to those students whose parents are earning below Rm 4K/month.  Not even 3 days later, he was shocked and amazed to receive close to 50 applications, almost all wants to do medicine (see below)! Thus, today, he wrote an interesting article asking these students and parents to wake up to reality. He had decided not to give scholarship to those who apply for medicine. Well, this is the very reason why I started this blog almost 6 years ago but yet again, no one listens. Every now and then, I too receive phone calls from students and even parents asking for financial assistance. Almost always the students will be doing medicine and already registered for 1st year. However, she/he is unable to pay the tuition fee for the 2nd year. When I ask them what happens for third year if you can somehow manage to get your fee for 2nd year, they almost always can’t answer. I find it ridiculous at times.

No matter how cruel and harsh it may sound, we are living in a capitalist world. Money talks. If you can’t afford to get scholarship, please do not do something that will lead you to huge debts. Never forget the house loan, married life and car loan that will come along the way. We just have to accept the reality and pursue what is affordable. Success in life comes in many ways. The philanthropist above is an engineer who built 2 conglomerate. How many doctors do you see becoming a philanthropist? How many doctors do you see retiring early at age of 40-50 and going for holidays around the world and being financially independent?

Our students lack in financial literacy. They are too dependent on family to the extent that they don’t understand what life is all about. Passion is one thing but living a life is another. At the end of the day it is all about money and living a life. Even in UK, doctors are going for  a strike to challenge the government in reducing their income as mentioned in this blog before. I had warned many times that we are producing future generations with huge debts. Again this was brought up by another newsportal today.

Happy New Year 2016 to everyone. Sure we have a tough year ahead……….. while I publish my first book……….

Be realistic in your pursuit of a medical degree

January 10, 2016

Students should consider other courses such as accountancy, finance, engineering, marketing etc.

By Koon Yew Yin

Since the publication of my scholarship offer to help students whose parents are earning less than RM4,000 per month a few days ago, my wife has received more than 50 applications for financial help and most of the applicants want to pursue a medical degree which costs the most.

The sole purpose of writing this article is to help inform students who wish to study medicine not to apply for my financial assistance.

There are 40 Medical Colleges and about 500 Universities and Colleges in Malaysia. All of them are lowering their entry requirements to compete for more students.

Tuition Fee for a Medical Degree in Malaysia is between RM250,000 to RM1 million:

Among the cheapest are:

• University Tunku Abdul Rahman (UTAR): RM255,000

• AIMST University: RM250,000.

Among the mid range are:

• Asia Metropolitan University (AMU): RM300,000

• MAHSA University College: RM300,000

• Malacca Manipal Medical College (MMMC): RM348,000, Monash University Sunway: RM455,000

• Newcastle University Medicine Malaysia (NuMED): RM450,000

Among the more expensive are:

• Penang Medical College: RM650,000

• Perdana University offers the following: Royal College of Surgeons Ireland: RM800,000, John Hopkins University School of Medicine: RM1,000,000

All the above mentioned fees exclude accommodation, books, traveling costs, food and other expenses which could easily add another RM100,000 to the total cost of studying medicine.

A student will require at least RM350,000 to complete a medical degree. Assuming he can get a RM150,000 PTPTN loan, he will still require RM250,000.

Is it really worth pursuing a medical degree in Malaysia with such high fees?

It is compulsory for all medical graduates to practice in a government hospital for five years to complete their housemanship.

During this period their salary ranges between RM2,600 to RM4,000. As housemen they work for a minimum of 12 to 15 hours a day. After two years, their salary increases gradually to RM4,000 per month.

When they are promoted as medical officers their salaries range between RM4,500 to RM5,000. After the final year they have an option to continue their career in the government service or private concerns.

However, after 12 years and spending a minimum of RM350,000, is it worth it just to earn RM5,000 to RM6,000 per month as a doctor?

They must remember that they have to pay back the RM150,000 PTPTN loan at RM2,000 per month for about 20 years.

An alternative proposal:

I like to suggest to these students to consider other courses such as accountancy, finance, engineering, marketing, etc. The tuition fee for a one year foundation course is RM8,500 and for a 3 years degree course is about RM38,000 in UTAR. The fees for all government universities are less than RM20,000 for a degree course.

All students whose parents are earning less than RM4,000 per month can apply for my scholarships worth RM15,500 to cover the one year foundation course fee and the cost of living. After the completion of the foundation course, all students are entitled to receive PTPTN Government loans to complete their degree courses.

Since I made the offer to consider helping students who find the PTPTN not sufficient, my wife has received more than 50 applications in 2 days and most of the applicants want to study medicine. We found that most of the applicants are not realistic. They are poor and with poor results they want to study medicine.

With the PTPTN loan, the parents need to subsidize a small amount to complete their degree courses with the exception of a medical degree. If the parents are really poor, I am willing to consider helping them. My offer to help students doing degree courses has opened the door for all students in the country. But the students must be realistic. In any case, we reserve the right to reject any application for financial help.

Note: All scholarship recipients do not need to work for me or pay back the money I spent on them. But they must promise me that they will remember I helped them when they were poor and when they are financially solvent they must help other poor students. I believe many graduates will continue to help poor students when I die. Since I started offering scholarships about 10 years ago, I have given out about 300 scholarships and a large number of the recipients have graduated.

Koon Yew Yin is a retired civil engineer and one of the founders of IJM Corp Bhd & Gamuda Bhd.

With a firm belief in freedom of expression and without prejudice, FMT tries its best to share reliable content from third parties. Such articles are strictly the writer’s personal opinion. FMT does not necessarily endorse the views or opinions given by any third party content provider.

READ MORE: Philanthropist Koon offers scholarships to needy

Year-end is always a busy time for me. Accounts to settle, children’s exams, meetings and holidays. Over the last few months, I have been writing about debts, UK crisis and job opportunities. Interestingly, there have been reports in news portals regarding debts that Malaysian students are collecting. In my last article, I attached a report stating that Malaysia’s Gen Y are living on the edge due to debts. Subsequently, few more reports emerged over the past few weeks.

Malaysian Insider quoted report from Asia One that Malaysia is the 5^th most expensive country to do a degree program, in relation to household income. This is not surprising at all. That’s what happens when you commercialised education. It seems Malaysian parents spend 55% of their pay in allowing their child to finish university. The average tuition fee quoted was RM 77K. This is way below any medical course tuition fee, which can reach close to a minimum of 300K. Imagine the amount of debt if you do not get any scholarship. As one of my colleague said, medicine is only for the rich and for those who receive scholarship. Taking huge loans to do medicine is not worth it! Just few days ago there were some interesting advertisement about loan for wedding (nothing new actually)! We are really creating generation in debt! From study loans to car loan to wedding loan and house loan! Do we have anything left to feed ourselves!

It is also interesting to know that unemployment is higher among the highly educated people in Malaysia. This is also nothing unexpected. The higher you are educated, the choosier you become. Imagine, once jobless scenario hits the medical field, how many of these graduates will be willing to work in another field? Everyone will be blaming the government and colleges. There was an interesting write-up in Medical Journal of Australia (MJA) (see below) regarding job opportunities for doctors who can’t get a job or training post. This was a follow-up article to this article (see below) which confirms that Australia is facing the same crisis as any other country. Doctors are finding it difficult to get a permanent job and training post. He has given some suggestions, which I don’t think many would be interested (see the comments as well). At the same time, he also feels that the situation may get better later, when people stop doing medicine. The cycle repeats itself but it definitely does not console those who are already in the situation now. Trust me, there is NO job security anymore for doctors. Parents and students should remove that from their perception and just consider medicine as another job where nothing is guaranteed. The only setback in medicine is the fact that you would have spent huge amount of money (if not sponsored) and would never be able to practise as a doctor without completing housemanship. No training post means, no hope for further advancement.

IN the UK, as I had written on 2/10/2015, doctors took to the streets to protest against the change of working hours and income. Another protest was conducted on 18/10/2015. The UK crisis once again proved to us that at the end of the day, what matters is your income and how you are going to live a life. No matter how much passion you have, living a life is another story all together. Most of the cries of UK doctors were based on their income and survival. How they are going to feed their children, how they are going to lose their family time and how are they going to settle their debts etc? As I had always said, in the end, it is just another job to earn a living. Whatever passion you presumed you had will be thrown out of the window. Only real passion can pull you through. The Health secretary of UK has finally took back some of the statements he made regarding working hours. However, change is definitely coming to NHS. You can read the other articles in The Guardian news.

The world of medicine is not the same anymore. Patient’s demands are high, huge debts to become a doctor, increasing litigations and increasing risk of being unemployed. Not enough with these issues, we now have to compete with traditional healers, anti vaccine movements, home births, religious and non-religious supplements etc. Patients rather trust these guys than us, who had spent years studying evidence based medicine. Below I attach a Facebook post of a “crying” doctor:

It is the same thoughts that run through my mind. Over the last 20 years since I started my medical career, I am seeing increasing number of patients who trust all these “non-western and natural ” based treatment. No matter what you tell a patient, he will always consider you as a person who is making money by selling drugs/chemicals for profit-making pharmaceutical companies. Patients rather spend thousands of ringgit buying a product that supposedly can cure Diabetes and Hypertension. But, do they sue the seller if it does not work? The answer is NO, because you bought the product voluntarily and there is no written agreement between you and the seller on what he had promised. We have various magic drugs being promoted in Internet and even at roadsides, which can cure your Gout, Body aches and Joint pains. Almost all of these pills contain high dose steroids. Instant cure and pain relief is definite. Who are you to say it does not work? Most patients get a shock when I asked them how long have they been taking traditional medicines whenever they walk into my room. The first question they ask “ How do you know?” The answer is right on their face: “Cushingoid” facies!

15-20 years ago, I hardly hear anyone rejecting vaccination. Only a small group of people belonging to a certain religious sect refuses vaccination. Now, we have groups of people who openly rejecting vaccination claiming it is a Jewish plot, causes brain damage etc. We even hear stories that it is a Jewish and Christian plot to poison the Muslim community! Sometimes I do not know whether to laugh or cry but what shocks me further is the fact that there are people who actually believe all these nonsense, even the educated ones. Now, we are beginning to hear cases of Diphteria, Measles and Pertusis increasing day by day. TB will be the next epidemic. Parents are putting their child in danger. Should we create a law to punish these parents? While it is their right to take whatever treatment offered, spreading infectious disease can also be considered as a crime! Some countries have started to remove certain benefits from unvaccinated parents such as reducing tax relief, isolating them in schools etc. Proponents of home birth are another group that is increasing day by day. I had talked about it before.

Frankly, day-by-day I am losing interest in treating patients. The art of medicine is dying. Almost 5 out of 10 patients do not take your advice nor compliant to your medications. We are seeing younger and younger Diabetics and Hypertensives but do they care? WE will be seeing more and more complications from these diseases in years to come. We hoped that as the population gets more educated, we should be seeing fewer complications of chronic diseases but it’s the opposite that we are seeing. Patient feel that it is their right to do what they want as it is their life and body. Who are you to tell them to take medicine? Gone are the days when the community regarded doctors’ advise as golden! This write up from a Malaysian doctor in US is worth reading. That’s exactly what is happening over here as well.

Patients demand that investigations must be done to prove their diagnosis. Do we have test to prove everything in medicine? That’s where clinical skills come into the picture. A good clinician can diagnose a condition from history and examination alone. But patient will never trust you as long as you can’t provide a proof of your diagnosis. Tell them it’s Viral fever and they would want you to show the proof of the type of virus that infected them! These are the type of patients you are seeing nowadays. Tell them the liver derangement is caused by Dengue Fever and they will demand an answer why the liver enzymes are going up despite taking treatment from you! For those who think can do wonders by being a doctor, please understand that doctors don’t cure anything. We are just supporting the body to heal itself. Most of the time we are just buying time. The body will decide which way it’s going to go: recover or succumb! No surgeries are without complications but most patients nowadays do not except that fact either!

The comment below which appeared in my blog few days ago is worth reading:

“Interesting read Dr Paga.
I am amazed by your patience in answering questions here. I think you must be a good and patient doctor!

Anyway, when I was in medical school many years ago, I was already worried about job security and it was not like we have over 30 medical schools in Malaysia back then as it is now.

I think young people will need to look at themselves honestly and not just jump on the bandwagon and try to do medicine just because everybody think it is the right think to do and it is best way to earn money.

If you do something passionately, very likely you will succeed no matter what profession. Need not be medicine.

I used to be a top student in my school and naturally I studied medicine (because I thought that was the best thing to do!). My brother never understood science and he did law. My sister was an average student and did finance. Both of them are far more successful financially than me. Fortunately I have no aspirations to be a very rich man but I do enjoy what I do.

If you want to be rich and successful, you may be disappointed if you think medicine is the answer. Malaysia has very little control system and they allow all sorts of medical schools to sprout out.

UK has twice the number of people as Malaysia and is a far richer country and yet we have more medical schools than them. Something is not quite right.

So my advice is, if your real passion is to be a doctor, to be sensitive and compassionate with people, please go ahead and try your best if you have the means. Going to a good and well-recognized medical school is important. After leaving medical school for over 15 years now, I can still remember the basic medical science taught well to me but many housemen, fresh out of uni, can’t remember a thing!

If you need your dad to sell the house and car for you to realize this dream, you may need to think twice, because you will not necessary return a multi-millionaire to repay him.

If you want to become a doctor because other people tell you it is good, you also need to think twice. Life of a doctor is not for everyone and not everyone will be successful. You may see some successful ones but many are struggling too.

I always like to bring my brother as an example. He is hopeless in studies but can talk and argue really well. Today he is a very successful lawyer, earns easily 5 times more than me !!”

Well, it is time for me to take another break to release my stress. This would be the only article I will likely write for this month. I will be away next week with my parents for Deepavali. A week after that I will be exploring Middle Earth for 2 weeks. Hopefully, when I return early December, my mind will be fresh to start the cycle all over again!

Happy Deepavali to everyone………………..

Simon Hendel: Job opportunities

Simon Hendel

Monday, 2 November, 2015

Tim Lindsay & Harris Eyre: Career crisis

Monday, 26 October, 2015

LAST week the ominous situation facing medical graduates in South Australia was exposed with an estimated 22 domestic graduates projected to miss out on internships in 2017, and up to 39 to miss out in 2018.

Unfortunately, this training gap only represents the tip of the iceberg, with a national workforce report predicting that more than 1000 junior doctors will miss out on an advanced training place by 2030.

The recent approval of a new medical school in Western Australia shows that the tsunami of medical graduates is unlikely to abate, so is it time to rethink medical education?

This year, an estimated 3736 Australian medical students are expected to graduate, an increase of almost 280% from the 1347 who graduated in 2001. Despite this massive increase in graduates, there has been a comparatively small increase in the number of training places available to junior doctors. This leaves many graduates facing a grim training outlook.

The latest Royal Australasian College of Surgeons Activities Report indicates that in 2014 more than 800 applicants to surgical education and training (SET) were unsuccessful. There are reports of similar results for training places in other specialities, including general practice.

Few, if any, training programs across the medical landscape have been under subscribed, with the net result being an unprecedented training backlog with little relief in sight.

When this mass of prevocational junior doctors is added to the still growing tidal wave of graduates year on year, the stark reality is self-evident — not all of us can be clinicians.

Unfortunately, there is no easy solution.

Junior doctors could move offshore, but increasing regulatory barriers mean that the days when young doctors could simply move to the UK or the US and expect to work are gone, let alone come home and have qualifications recognised.

Medical training in Australia could be completely overhauled to more closely resemble US-style training. This would mean service registrar positions, the utility of which has long been questioned, would be abolished and training streamlined.

However, reform would take years and would likely face tenacious opposition.

Another option is to reduce student numbers, but for various reasons this has proven untenable. One reason may be the high cost of establishing and managing medical schools, so reducing numbers is unlikely and potentially short-sighted.

Nonetheless, with an oversaturated market, should these new schools have a moral imperative to ensure that their graduates are employable?

Australian medical education is, by tradition, clinically focused. Variation from this invariably includes teaching, research and, more recently, public health.

The shortening of contemporary medical courses as postgraduate degrees has resulted in an even greater prioritisation of clinical skills, possibly to the detriment of skill diversity. Graduate medics may benefit from exposure to varied subject matter in their undergraduate degrees, but these too are becoming increasingly prescribed and narrow in focus.

The result? Junior doctors often graduate with few transferable skills, making the ramifications on their career prospects even more dire.

The trend towards focused clinical education in Australia actually goes against what is happening in other countries, particularly in the US and UK. In those countries, programs combining degrees such as a Master of Business Administration, Master of Public Health, Juris Doctor or Doctor of Philosophy degree with medicine are booming in popularity and some Australian institutions have been quick to follow this trend.

However, for debt-laden graduates, further studies cannot be the sole answer. Industry placements, non-clinical electives, innovation training and mentorship and coaching programs should all be considered as ways to better equip medical students for modern career challenges.

Producing competent clinicians should always be the main priority of any medical school, but the time has come to ensure that medical schools also prepare graduates for careers outside of practice.

After all, for those trapped in the midst of the graduate tsunami, one thing is crystal clear — we cannot all be clinicians.

Dr Tim Lindsay is an Australian junior doctor and PhD student in the department of surgery, University of Cambridge, UK, supported by the Cambridge Commonwealth Trust. Dr Harris Eyre a psychiatry registrar and is undertaking a PhD through the University of Adelaide.

It is now beyond any reasonable doubt that we are heading towards oversupply of doctors within the next few years. Almost 10 years ago I predicted it will happen in 2016. The waiting period for housemanship posting stands at about 4-6 months now, some extending to about 8 months in popular spots. With ALL medical schools producing graduates from 2016, we may hit 1-year waiting period by 2017. While the government is obliged to provide housemanship as it is part of compulsory training, it is not obliged to provide a job to everyone after that. Health Facts 2015 ( KKM_HEALTH_FACTS_2015) which was just released last month shows that we had achieved a doctor: population ratio of 1: 661 as of December 2014. This was initially targeted only in 2016! A total mess by our government! Doctors may soon join the 200K unemployed graduates.

2 years ago, I did mention that there might come a time where the government may consider using private hospitals for housemanship training. I also mentioned why it should never be implemented. Interestingly, behind closed doors, this issue was discussed by MOH with the Association of Private Hospitals (APHM) 2 months ago. While our DG did not deny that such an issue was discussed, APHM came out to say that it is not the best option (see below). They have also rightfully pointed out that we should address the root of the problem first!

Private hospitals are profit driven. It is consultant-based service but consultants are NOT employed by the hospital. Each consultant is just renting a room in the hospital and providing service for the hospital. That’s the reason we are not exempted from GST as we are not employees but contracted service provider. Since it is a one-man show, how much time would a consultant have to teach or guide the housemen. Secondly, private patients come to private hospitals for privacy and better service. They definitely do not want any “trainee” doctors to be seeing and managing them. The hospitals definitely do not want to be answering complains which is already piling up in all hospitals as patients are becoming more demanding. As what Dr Jacob mentioned in the article attached, who will indemnify these housemen and who will pay their salary? Why would a private hospital pay a houseman who is not going to bring them any return/profit! Oh, please don’t bring “social responsibility” crap into the picture. We are living in a capitalist world where what matters is profit and return of investment. Most hospitals are trying to cut their expenses to increase their profit, not the other way round. Same goes to medical schools. The government do not subsidise patients in private hospitals.

While private hospitals may have all the specialties needed for housemanship training, do they have a good case-mix to train doctors to be competent? Other than some big private hospitals (> 200 beds), most private hospitals are rather small-sized (less than 120 beds) and do not manage complicated cases. Frankly, the type of cases that I see in my hospital is totally irrelevant to training of housemen. Most of my cases in the wards are Dengue, AGE, Pneumonias, Bronchitis and some uncontrolled Diabetes and Hypertension. IN actual fact, most of these cases do not really need any admission. Admissions are needed, as they would not be able to use their medical card if they do not get admitted. If we really follow a tight protocol/criteria on admission (as in GH), most private hospitals will be half empty.

With increasing private healthcare cost (also due to GST), most cash paying patients are finding it difficult to seek or continue treatment at private hospitals. In fact close to 90% of patients that I see in my clinic/ward are paid by insurance or employers. This takes me to a recent article in Malaysian Digest. However, I find the statement on the number of doctors in private and government is rather inaccurate in this article. The more accurate numbers can be seen in Health facts 2015 attached above (Government 33K, Private 13K). The article has rightfully claimed that more and more patients are heading to government clinics for treatment. Due to increasing litigation rate in the field of O&G, the Ministry of Health had recently, in a letter dated 10/09/2015 increased the fee for O&G procedures and also added some new fees. This will increase the total cost for normal delivery and caesarean section by 100%. How many would be able to afford the increase? Most obstetrics cases are cash paying as insurance do not cover maternity cases. Of course, it will be the doctor’s choice to give any discounts.

On the other hand, our current generation Y seem to be collecting more and more debts. I had always said that taking huge loans to do medicine do not make any economic sense. A recent survey showed that close to 75% of Gen Y between the age of 20 and 33 have at least 1 long-term debt with 37% having more than one. It was an interesting survey (see below) which concluded that Malaysia’s Gen Y are living on the edge with huge debt!

I feel it is time for some medical schools to close shop or merge to reduce the numbers. A common entry examination or a more stringent entry criteria should be introduced. Till then, the madness will continue………

Many reasons private hospitals cannot train housemen, says industry group

BY JENNIFER GOMEZ

Published: 19 August 2015 9:00 AM

Private hospitals cannot be the solution for medical graduates who have no placements for housemen training due to a string of issues, the Association of Private Hospitals Malaysia (APHM) told The Malaysian Insider.

Speaking on the supply of newly-graduated doctors exceeding the placements available for housemen in government hospitals, APHM president Datuk Dr Jacob Thomas said the association has had talks with the Ministry of Health (MOH) and the Malaysian Medical Council on the matter of housemen in private hospitals but there is an impasse on a number of issues.

These include the question of who would indemnify trainee doctors against medico-legal issues and concerns whether there would be adequate supervision of housemen in private hospitals.

“Who will indemnify these trainee doctors against any mishaps or medico legal issues?

“Private hospitals might also want to interview and select the housemen they want to allow to be trained,” he said.

Dr Thomas added there were also issues over payment, such as who would remunerate the specialists who had to teach and take these housemen on ward rounds.

“Will these specialist be paid?

“Private hospitals manage with just sufficient staff, so additional medical officers and housemen on the payroll will incur higher expenses and result in increased private healthcare costs and higher patient charges,” he added.

Deal with root cause

The Malaysian Insider had reported on the rising number of medical graduates waiting three to six months for their housemen placements, a situation caused by the high number of medical graduates.

According to Ministry of Health records, there were 3,564 medical graduates reporting for duty as housemen in 2011, 3,743 in 2012, 4,991 in 2013, and another 3,860 last year.

Many graduates held qualifications from recognised medical colleges overseas and their number has increased from 877 in 2008 to 1,600 in 2011.

In 2012, there were 1,563 graduates from foreign medical colleges and this grew to 2,403 in 2013.

To Dr Thomas, one of the root causes of the problem of insufficient housemen placements was the high number of medical graduates each year.

This led to the issue of quality control, with the capabilities of graduates requiring further scrutiny, he added, because medical schools have mushroomed.

“Maybe some colleges should merge. We had a shortage of doctors in the past and had targets to meet.

“So, many medical schools mushroomed, but now it has to be re-looked once more. This problem will never be resolved otherwise,” he said.

Criteria for housemen training centres

The Health Ministry is open to having private hospitals provide housemen training to graduates, as long as they fulfilled certain criteria, the ministry’s director-general Datuk Dr Noor Hisham Abdullah said.

He said the ministry had already raised the possibility of implementing housemen training in private hospitals but said it needed to be explored further.

“This  needs  further  study  in  terms  of  acceptance  by  patients  and  its  long-term  viability,” he told The Malaysian Insider in an email reply.

The criteria to be a houseman training centre includes the hospital having at least six basic specialist services, including internal medicine, paediatrics, general surgery and orthopaedic.

It must also have an adequate clinical workload and mix of cases in order to provide substantial exposure of different medical scenarios to housemen.

The hospital is also required to pay the salary of house officers as well as bear medical indemnity insurance to cover any medico-legal issues.

“There is also the acceptance of private patients to be examined by house officers, as  they (patients) are usually those who prefer privacy and pay higher fees to be seen and treated by specialists,” Noor Hisham said.

The Malaysian Insider had earlier reported the DG as saying that training spots were tight because 30% of housemen do not finish their training in the stipulated period of two years.

Noor Hisham had explained that some of these house officers did not complete their training in the required time frame for various reasons, such as being on leave, their inability to complete their logbook, as well as absenteeism from work without approved  leave and incompetency.

“Currently, the percentage of housemen who do not complete their housemanship training  within the stipulated period is quite acceptable as it is not merely due to competency  issues. 

“However, MOH is working on various mechanisms to reduce this percentage,” he said. – August 18, 2015.

– See more at: http://www.themalaysianinsider.com/malaysia/article/many-reasons-private-hospitals-cannot-train-housemen-says-industry-group#sthash.RO97ePaw.dpuf

Malaysia’s Gen Y in debt, living on the edge, survey reveals

Published: 15 October 2015 11:08 AM

Malaysian young adults are accruing debt at an early age, a survey by the Asian Institute of Finance (AIF)  has revealed, while some 40% are spending more than they can afford.

The survey among Malaysian “Gen Y” respondents between the age of 20 and 33 were living on the “financial edge” and were facing money stress, with the majority living on high cost borrowing of loans and credit cards.

“Our study reveals that 75% of Gen Ys have at least one source of long-term debt and 37% have more than one long-term debt obligation. Long-term debt obligations include car loans, education loans or mortgages,” AIF said in its report “Understanding Gen Y – Bridging the Knowledge Gap of Malaysia’s Millennials”, released today.

“To offset this debt, they are relying on high cost borrowing methods – 38% of Gen Ys reported to taking personal loans, while 47% are engaged in expensive credit card borrowing.”

Their debt woes, AIF said, were the result of “impulse-buying” behaviour, besides easy access to personal loans and credit card financing.

“The impulse buying behaviour of this young consumer is tied to the basic want for instant gratification, which is exacerbated by easy access to the world of online shopping. As a tech-savvy generation, these young adults draw on technology for everyday tasks.

“This includes seamless online purchasing, which encourages the ‘buy-now-pay-later’ behaviour amongst this generation of consumers. Reliance on credit cards for online purchasing has further encouraged this behavioural trait,” the report, targeted at banking, financial and learning institutions, said.

The report said around 16-17% was spent on maintaining lifestyles, 24% on loan repayments and 30% to 31% on living expenses, with little difference between male and female respondents.

There were also indications that there is a steady rise in loan repayment levels as Gen Ys go up the income bracket.

Of the 1,011 young professionals interviewed, 60% were single while the majority (43%) earned between RM1,500 and RM3,000. Some 32% earned between RM3,100 and RM4,500, and 8% earned below RM1,500.

The survey also showed that 40% of respondents were spending more than what they could afford, while only 30% said they were living comfortably within their current income.

“This approach therefore feeds on their impulse-buying behaviour. As a result, many of them stay in debt using credit card lending much longer than they ever intended.”

“Only 30% of Gen Ys surveyed said they live comfortably within their current income, suggesting a generation that is experiencing financial stress. It suggests that they have little knowledge about how to make wise purchasing decisions,” the report said.

Despite this, AIF said Gen Ys were much better at saving then it was believed, as 64% said they saved a portion of their income every month, with the majority keeping aside at least 20% of what they earned.

“The survey findings also reveal that Gen Ys’ appetite for savings grows with age. The highest proportion of savers was the 27 to 33 years age bracket (57%). Studies on Gen Y savings habits also show that, although they do develop good saving habits, these savings tend to be focused on short-terms goals.”

However, AIF expressed worry that youths seemed to be skeptical of professional advice by financial advisors and planners, with only 37% seeking consulting such services on money matters.

Instead, more youths (51%) tended to discuss these things with family and friends.

“This lack of engagement with financial advisors probably stems from their skeptical view of the value of financial advice itself as many of them believe they can find this information more easily by themselves. Again, this is a reflection of the DIY world they grew up with.

“The majority (63%) of Gen Ys who did not opt to seek advice from financial advisors or planners cited ‘prefer to do it on my own’, ‘not interested’ and ‘too expensive’ as the top 3 reasons for not using the latter’s services,” the report said.

Those that do seek advice from experts ask about savings and investments (56%), advice on mortgages or loans (41%) and retirement planning (32%).

As a recommendation, AIF said Gen Ys should look into consulting qualified financial advisors to get the information and confidence they need to make educated investment decisions.

“Grab opportunities to gain financial management knowledge from mainstream channels such as from higher learning institutions,” it said. – October 15, 2015.

– See more at: http://www.themalaysianinsider.com/malaysia/article/malaysias-gen-y-in-debt-living-on-the-edge-survey-reveals#sthash.fN5iYH70.dpuf