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I recently received few emails from medical students involved in the above organisation. It is an organisation of Malaysian medical students both locally and overseas. It is interesting that they have come to realise the issues that need to be addressed for their future. Thus, they are actively organising various events in Malaysia which will be participated by Malaysian students from around the world. Some of them had contacted me to advertise their program in this blog. Their next upcoming event will be in Sg Buloh Hospital next month as attached below. The Event is called MMI MAID – Making an informed choice.

“A little introduction on MMI – it is an organisation that has been very actively organizing major events that involve many medical schools in Malaysia.We are a Malaysian-registered medical student organization representing Malaysian medical students both locally and overseas. Our committee comprises of both local (UM,UPM,PMC,MMMC,IMU,MONASH,AIMST etc) and overseas Malaysian medical students”

Please feel free to visit page in fb : https://www.facebook.com/mmimaid and website for this event : https://malaysianmedicsinternational.wordpress.com/about-2/what-we-do/ They also have another big event coming up in August 2015 known as Malaysian Medical Student Summit as seen over HERE.

MY last article regarding the AUCMS loan fiasco attracted some nasty comments from some students. They accused me of insulting them and not understanding their situation. I tried my best to digest what they are trying to say but I simply do not understand what these students really have in their mind. Many don’t seem to understand what I am trying to say. Thus, I thought of putting my thoughts in this article.

3 years ago, I warned many students not to fall into a trap. It was a gentle advise to all those who contacted me and read my blog. Unfortunately, many refuse to listen and decided to go against my advice. When issues happened last year, what can I do? Thus, I said that students being students, they would choose whichever way to achieve their “dreams” without realising the implications in the future. What surprised me the most is the fact that many of them do not know much about the world out there. They don’t read much. One of them said that competition to enter medicine now is beyond Godly? I am still amazed and shocked with the statement. Do they even know what they are talking about? Let me give them the scenario that I went through in my early years of life!

In 1980s, there were only 3 medical schools in this country, namely UM (started 1964), UKM (started 1972) and USM (started 1979). When I achieved 8A1 and 1 A2 in SPM 1989, the only scholarship available was JPA. Unfortunately, we were told point blank straight to our face that JPA scholarship for medicine is only reserved for bumiputera students but we can choose something else. There is NO such thing as PTPTN loan or even bank loan those days. My father was a teacher and my mother housewife, and I am second in my family of three. Just as a reminder, each state will only have 2-3 students scoring 8A1s those days, unlike now where we have hundreds to thousands.

So, what you do then? Most of us had no choice but to proceed with Form 6 as it is the only way to enter public university aka medical schools. Please remember that there was NO such thing as Foundation studies, a short cut to do any degree programs nowadays. It’s either STPM or Matriculation. Matriculation was ONLY reserved for Bumiputera students. It was only after 2003, 10% of the slots were given to Non-Bumiputera students. So, we studied another 2 years and sat for STPM exams, which was considered one of the toughest exams in the world. Public universities practiced quota system based on population ratio. Sixty percent for Bumiputeras, 30% for Chinese and 10% for Indians. So, to get into a public university medical school, you either need to score 5 or 4As in your STPM. Some Indian students could manage to enter with 3As as they need to fill up the quota. The total medical student intake was 180 for UM, 150 for UKM and 110 for USM(Total 440 students). Since I was the only Indian student to score 5As(out of 71 students) on that particular year, I did not have any problem to enter UM medical faculty. That was how tough it was to enter a medical school those days, which obviously the students nowadays do not know anything about. The fact is, it is very much easier to enter medical school now than during my time (late 1980s to late 1990s). Once you are in the public university medical school, you will be given JPA scholarship and bonded for 10 years with the government.

Would I have done something else if I did not get the results needed to do medicine? Yes, I would have. My parents would not be able to send me anywhere else. There were hardly any private colleges except for some offering law degree and no such thing as PTPTN loan either. I would not have burdened my parents with loans. Some did go to India to do medicine, as it was the only place affordable at that time. You must also remember that the economic situation of this country was much better than. Inflation was lower and our currency was much stronger with RM2.50 for 1 US dollar and RM 1.20 for 1 Singapore dollar!! The cost of living was way lower.

As I had said many times before, passion is one thing but living a life is another. Some feel that they should achieve their dream and passion at whatever cost but, from economic point of view, it is being insane. I had said that if you think you have true passion in medicine and feel that you can put up with all the work life challenges that had been listed in this blog, you could go ahead. BUT I also said that you should NEVER take huge loans to do medicine, as it does not make any economic sense! Life starts after you graduate. When you are student, you are still supported by your parents and thus you do not understand the need to work to earn a living and the burden of debt. Medicine is a noble profession but the world is not the same anymore.

When I graduated, I had NO debt! I worked “like a dog” during housemanship with a salary of RM 1695/month (yes, I can still remember this pathetic figure). “On Call” Allowance was RM20/call. You can’t even afford to buy a car. I bought my first car (Proton Wira) during my first year MOship by using all my savings acquired during my housemanship, subsidized by RM 34K government car loan. Woolah, now you realise that RM 500/month goes to pay your car loan for the next 6 years! I drove this car for 9 years. Thankfully, we did not have mobile phones those days and Internet were dial-up service, which does not cost much. Computers were not a necessity yet. Your annual increment was RM72. Then you get married and began to have kids while you are planning for your postgraduate education. You live in a rented house, which would take another RM 600/month with no proper furniture! By the time I finished my MRCP Part 3 (all paid in British pounds : Rm 5.50 to 1 pound), I had a credit card debt of RM 12K which took me almost 4 years to settle. My salary was RM 2200/month after 5 years of service. I told myself that I would not continue with my MRCP if I fail my attempt as I could not afford it anymore with 2 kids need to be fed.

It is during these times, you will realize that passion is one thing but living a life is another. After some time, it is just a job to earn a living. What matters most is how you are going to feed your children and live a life. Only after I pass my MRCP, I decided to buy a house, which I am staying till today. The house will take another RM 1100 of your salary/month for another 30 years. I am still paying till today.

What I am trying to say is, trying to achieve your passion/dreams by taking huge loans will hunt you in the future. Imagine, the day you graduate, you have a loan of RM 300-500K to settle. This does not include the upcoming car loan, house loan etc. Many parents feel that their children are going to earn tons of money immediately after they graduate. Thus, they feel that the loans are worth taking. As I told one of the students who commented that they are from poor family who could not afford to do medicine without the AUCMS loan:  Are you going to be any better after you graduate? You are going to be poorer than your parents!

Would you do medicine if I tell you that you will not be paid? Would you do medicine if your starting salary is going to be the lowest among all profession? With all the passion that you have, would you still do it? I still see many grouses about housemanship, mostly about their working life and bullying. I also see many who request the salary to be raised! Where is your passion? Basically, once you start working, you are paid for your work, not for your passion. Would you work 24hrs a day if not going to be paid overtime allowance? (BTW, for those who don’t know, On-Call allowance only started in 1994. Prior to that, you do work for free). As for salary of doctors, in government service and private sector, please read my earlier articles.

I also get comments like “ I want to help people” as the reason for doing medicine. How are you going to help people when you can’t even help yourself? I just replied to a girl who wanted to be a doctor, as she wants to give free treatment to people. She feels that many people are dying because they can’t afford medical treatment and the government sector is too long of a queue for patients to get proper timely treatment. No matter what consultant you are, if I throw you to a place where you do not have any medicines or equipments, you are as good as anyone else standing there! There is no way you will be able to treat anyone without medications/equipment. To do this, you need money! That’s why only less than 20% of hospital bill belongs to a consultant. The rests are for the hospitals to cover the cost of medicines, equipment, consumables etc. Unless you are from a rich family, you cannot run a free service. There are many ways you can help people. Most philanthropists are not doctors. Imagine how many people can you help with the RM 300-500K you are spending to do medicine? How many houses can you build for homeless people? I know many who became rich without even having a degree and helping other people via foundations etc. Do you see any doctors running free clinics? Whether you like it or not, everything needs money nowadays. It is a capitalist world!

I hope I am getting the points across. Passion is one thing but living a life is another. That’s why I had always said that education should NEVER be commercialized. The best and qualified students should be given scholarships or absorbed into public funded universities. Unfortunately, commercialization of education in this country is making each and every student poorer. We are creating a future generation of people in debt.

The government is also heading towards bankruptcy, I guess. Imagine not getting a job to even start paying your debt! Ministry of Health had slashed its budget and streamlining allowances this year as reported over HERE. I heard IJN referrals will not be entertained anymore. All cases can only be referred to MOH hospital’s cardiology centres. Today, I received a report from a whistleblower site that NO NEW government post will be created with immediate effect from 22/04/2015. The letter sounds genuine. Again, what I have been saying all these while is becoming a reality. As a country with the highest number of civil servants per-capita population, it is not sustainable. Eventually, it will collapse as what happened to Greece. As a medical graduate, whatever you had spent will become meaningless if you can’t do your housemanship as you will never be able to practice medicine without it.

The world is changing. I would not have done medicine if I could not get into a public university. I would not have become a specialist if I had failed my MRCP Part 3. I worked hard and finally succeeded. BUT I did not have a huge loan to start with. I did not have to spend on so many necessities as nowadays. I had a wife who supported me by living a simple life: no jewelries’, a rented house with no furniture other than a bed, dining table, TV and fridge, no maid and no parents support. The only debt I had been a car loan and credit card debt which did not even exceed RM40K until I passed my MRCP and decided to buy a house.

I can’t imagine how a student who is graduating with a debt of RM 300-500K ever going to live a life. Passion is one thing, living a life is another! I leave the readers to ponder upon!

No more vacancies — Putrajaya confirms hiring freeze
Tuesday May 5, 2015
KUALA LUMPUR, May 5 — The Public Service Commission (PSC) has confirmed that the government is no longer recruiting for any positions effective April.

PSC chairman Tan Sri Mahmood Adam told Sin Chew Daily that the government was not taking in any more people into its service, but declined to explain the rationale for the decision.

Mahmood told the Chinese-language newspaper that 15 agencies, including the police, army and Education ministry, have already received notice of the freeze.

He insisted, however, that agencies that needed emergency replacements could still apply to do so via the Public Service Department.

According to Mahmood, the moratorium does not affect recruitment for vacancies that were advertised prior to the April 22 directive.

His remarks confirm a report by whistleblower website Sarawak Report across the weekend that said Putrajaya was no longer hiring, based on a leaked copy of the memorandum from the PSC.

Malaysia’s civil service force currently costs some RM60 billion in wages annually, accounting for a third of total government spending.

Malaysia also has one of the highest public workers to population ratios in the world.

Putrajaya was forced to reduce its operating budget for 2015 owing to a sharp drop in oil price since last year.

– See more at: http://www.themalaymailonline.com/malaysia/article/no-more-vacancies-putrajaya-confirms-hiring-freeze#sthash.alzCumz1.dpuf

So, after 5 years of me starting this blog and almost 10 years of voicing out my concerns, finally the government has acknowledged the situation. Almost all that I had said in this blog over the last 5 years were clearly mentioned in today’s Star headline. The time has come for the government to admit the mistakes that they had committed. Unfortunately, do they have the political will to change the situation?

As a country with the highest number of medical school per capita population in the world, in a truly Malaysia Boleh spirit, we had allowed countless number of shop-lot medical schools to flourish. Thousands more go to overseas universities either sponsored or self sponsored. We are creating a generation of people who are going to be in debts for years to come. I had always said that you should not take huge loans to do medicine. It does not make any economic sense and do not forget the many more debts that will come along away. Basically, you are starting your life with a RM 500K debt which will only accumulate further.

Today’s Star’s headline discussed several issues. Debts to be paid and huge investments that are going to waste, as the country is unable to provide housemanship post for at least 6 months to a year upon graduating. This waiting period will increase further when all the remaining medical schools (50% of them) start to produce doctors at their maximum capacity from next year onwards. I understand that they have started the e-housemen website.

Another issue was the issue of quality which I had written several times before. The figure that 1 in 5 housemen are quitting their job was rather surprising to me as I had expected a much lower figure. As the Deputy DG said, most of them just go missing in action(MIA) without any resignation letter. In government service, if you leave without a resignation letter, it will take almost a year for disciplinary action to be taken to remove you from the service. During this time, no one can occupy your post! THUS,  for those who intend to leave, please put in your resignation letter. This will benefit the newly graduating doctors in reducing their waiting time. I have said many times before, being  a doctor involves hard work and lost of social life. Working long hours is a norm in many countries including in many developed countries. It’s the healthcare system that wary. Each country will have their own problems. In Malaysia, the public healthcare system is as such that working long hours is sometimes  inevitable. WE need an integrated healthcare to improve this. Being part of civil service, it is very difficult to take disciplinary action against a civil servant. That’s the reason why you may see a lot of deadwood doctors in civil service. That is also the reason why bullying and intimidation will never stop!

There were again suggestion to introduce a common entry exam/MQE. The last time I spoke to a senior MMC member early this year, the obstacles to this idea are the politicians and local public universities. My question is, if you think you are producing competent doctors, why worry about the exam? I am all for a common entry exam. It is the only way forward to maintain the standards. It is impossible for MMC to monitor all the medical schools locally and overseas. That’s the reason why many countries switched to a common entry exams. I hope the politicians and local public universities will lower their ego for the betterment of the future generations and the country.However, I am sure you know the answer!

So, for future doctors and for those who made insulting remarks over the last 5 years in this blog, the time has come to wake up and face the reality. Never do medicine for wrong reasons and I will also add, never do medicine if your intention is to migrate. It takes great passion to overcome the obstacles that you will face as a doctor. Do not forget the numerous laws and regulations that you need to abide to. We have Medical Act, PHFSA, Poison’s Act, Dangerous Drug Act etc. A traditional medicine seller has very much less rules and regulations to follow! The complementary medicine practitioners are laughing to the banks but we doctors are fighting tooth and nail to prevent dispensing separation. Oh, and not to forget the GST which doctors are supposed to absorb in the name of “untuk rakyat”.

On the other hand, we are facing more and more demanding patients. Medico-legal cases are increasing by leaps and bounds. Just recently, a patient sued a government hospital and was awarded RM 3 million in damages. Not to forget a male doctor being charged for molesting a male patient! These are some of the frustration that doctors are facing day by day. The younger generations are still leaving in their past. I attach 3 out of 4 articles that appeared in the Star today.

Housemen do not complete training stint for various reasons
PETALING JAYA: One in every five doctors undergoing training as houseman in Malaysia quit each year, an alarming rate of drop out, considering the high cost of studying medicine.

It may cost up to RM500,000 to study medicine in Malaysia and up to RM1mil if it is completed abroad.

Many newly qualified doctors also quit because of the longer wait to be posted as housemen.

Those who left abruptly have been found working as waiters and even running pasar malam stalls and there has also been a case of a trainee doctor taking up a job as an air stewardess.

Deputy Health director-general Datuk Dr S. Jeyaindran said about 1,000 of the 5,000 housemen employed each year do not complete the two-year training stint.

Among the reasons for housemen to leave the service include unsuitability for the profession as they were pressured to study medicine by their parents.

Having a totally different perception of a doctor’s life, inability to work long hours and suffering from burnouts are the other causes.

He said the rise in numbers of housemen quitting had been growing over the past three years.

Dr Jeyaindran said as housemen were hired by the Public Services Department (PSD), the termination process was tedious and could take up to several months to more than a year.

“Until the person’s service is terminated, the vacancy cannot be filled and those who replace them have to wait for their turn to start,” he said in reply to questions submitted by The Star.

He said many of the housemen who left did not tender official resignation letters.

The large number of medical students graduating each year is another reason for the long wait for postings as a houseman, especially under the new e-houseman system, which allows for newly qualified doctors to choose the place of their posting.

While the average waiting time is about six months, it can be longer for the more popular postings in urban hospitals including the Kuala Lumpur Hospital.

“With 10,000 housemen in all the 45 training hospitals nationwide, these hospitals have varying degrees of waiting periods except for hospitals in Sabah, Sarawak, Kelantan and Terengganu,” Dr Jeyaindran said.

He said the ministry must explore other ways that allow for greater flexibility in employing housemen to replace those who had left.

He said the proposal to have a common entry or fitness to practice examination as proposed by the Malaysian Medical Association (MMA) was among the steps being considered.

Another was a longer induction period for housemen to have better understanding of their work.

“It is not to control numbers as proposed by MMA, but to ensure a minimum standard of competence. The common entry examination is already in place in some Asian countries, the United States and Australia and it might become necessary to ensure safe medical practice especially once there is a liberalisation of trades and services,” he said.

He said a houseman’s workload in Malaysia was lighter than those in other countries, adding that on average, housemen in Malaysia took charge of between four and six patients in a ward compared with eight to 12 in Singapore, Australia and the United States.

“Moreover, house officers in these countries work an average of 80 hours compared with the average of between 65 and 72 hours for Malaysian housemen,” he added.

New docs may have to wait a year for housemanship
PETALING JAYA: Newly qualified doctors must now wait longer – up to a year after their graduation – to take up their stints as housemen at certain training hospitals instead of the previous period of six months.

Malaysian Medical Association (MMA) president Dr Krishna Kumar said that with medical graduates now being given the choice to choose the hospitals to be trained in under the e-houseman system and the long waiting lists in some hospitals, the waiting time could be longer.

Prior to the e-houseman system, which was introduced this year, the average waiting time was about six months.

“The waiting time is getting longer and longer, especially in the more popular urban hospitals, including the Kuala Lumpur Hospital.

“We must have an entrance examination to screen medical graduates for the best candidates,” he said, adding that the bottle neck was reaching a “critical stage”.

Last month, Deputy Health Minister Datuk Seri Dr Hilmi Yahya announced that housemen could choose the hospitals for their internships through the new system.

Dr Krishna said with one in five applicants requesting for specific postings, the ministry decided to let the applicants see the limited spots available for themselves.

He said at the current rate of 5,500 medical students graduating each year, all 45 training hospitals in the country had difficulties in coping with the numbers.

Dr Krishna cited two hospitals as an example. At the obstetric and gynaecology (O&G) department in Seremban Hospital 65 housemen have come under the supervision of two consultants and five specialists while the Kuala Pilah Hospital O&G unit only had one obstetrician overseeing about 30 housemen.

“We are a small nation but we are generating so many doctors and causing a bottle neck in training hospitals,” he said.

He also expressed concern that some might not get postings as medical officers in the future, adding that their career path too would be limited because scholarships for Masters programme were only offered to between 800 and 1,000 medical officers each year.

Five years ago, The Star highlighted the massive number of medical students graduating each year, putting pressures on the limited number of training hospitals. The problem has since worsened.

Dr Krishna attributed this to the lack of political will to resolve the issue and urged the Higher Education Ministry’s moratorium on new medical programmes be maintained and the brain drain among specialists be addressed as it was difficult for a small number of senior doctors to keep tabs on housemen.

Universiti Malaya medical faculty dean Prof Dr Adeeba Kamarulzaman said that there was no waiting list at the Universiti Malaya Medical Centre for housemen but the entry level for medicine course at UM had been raised to 5As for Sijil Pelajaran Malaysia results.

Deputy Education Minister P. Kamalanathan said the five-year moratorium imposed on new medical programmes in 2010 would remain.

Long hours and lack of work-life balance prompt one doc to quit
PETALING JAYA: One doctor decided to opt out of her housemanship training after realising that it was not the life she wanted.

The 32-year-old woman, who only wished to be known as Dr MH, said she decided to stop her housemanship after 14 months of training because the long hours were stressful and there was no work-life balance.

“I was on-call every other day and I realised that even after becoming a medical officer or specialist, the schedule would still be heavy. I didn’t want that kind of lifestyle,” she said.

Dr MH, who is now a medical adviser for a pharmaceutical company, said as a houseman in a training hospital in the Klang Valley then, she worked from 7am to 5pm and would be on-call duty from 6pm to 7am the following morning before continuing with the normal working hours the next day.

“During on-call duty, there are usually patients to attend to. We get little sleep in between and have to wake up at 5am to take blood samples of patients before the senior doctors come in,” she said.

She said her late father was horrified when she resigned and even asked relatives to persuade her to change her mind.

She admitted that her father had wanted her to do medicine although she had wanted to do actuarial science.

“Money was not a factor for leaving the profession even though pharmaceutical companies pay better. I am more satisfied with the stable working hours,” she said.

Asked what advice she would give to students wanting to pursue medicine, she said they must have the passion and good grades because the course was intensive and the work demanding.

“They should not be influenced by their peers or their parents for choosing medicine,” she said.

For 3 weeks I am battling with a virus. Started with an Upper Respiratory Tract Infection just after CNY which subsequently led to severe pharyngo-laryngitis causing me to almost lose my voice a week ago. While I am still recovering from this massive viral assault, with my voice still not back to normal, it has been work as usual. Being a private practitioner with own business to run, you have to work no matter what happens. It is a one man show. Appointments had been given and on-calls has been arranged. As long as you can walk and talk, work goes on. That’s the life as a doctor.

As per the years before, there will always be a surge in the number of visitors to my blog after the SPM/STPM results are announced. As expected thousands of students have scored straight As, close to 11 300 students. Despite being less than last year, it is still a huge number. I can’t imagine the number of students who would have scored at least 5Bs to be eligible to enter medical school. I was made to understand that MMC is in the middle of revising the minimum entry requirement and should be announcing it anytime soon , hopefully.

Again, I will be asked the same questions again and again by these budding doctors. Despite this blog having full of information written over the last 5 years, somehow the current generation of students do not READ. As per our education system, they prefer to be spoon-fed all the way. For those who are interested to do medicine, please spend a couple of days READING ALL the information written under ” For Future Doctors” page.

My advise for budding doctors has always been the same: NEVER DO MEDICINE FOR WRONG REASONS! Life as a doctor is never easy. Even in UK, doctors are struggling with work load. Many of their own doctors are migrating to other countries especially Australia. I had written enough about this in all my previous posts.

I had also proven many times in this blog, even before the Minister confirmed it last year, that we are heading towards surplus of doctors. The 5 years moratorium for new medical schools which was imposed in 2010 is coming to an end this year. I heard the moratorium will be extended. I also heard from reliable sources that MMC has asked some of the universities to slowly terminate some of their twinning programmes to cut down the intake of students. We also know that AUCMS has closed shop last year, reducing the number of medical programmes by 5. I also heard that UniKL’s Vinayaka Mission University twinning program may also be terminated by the college. We heard the withdrawal of John Hopkins collaboration with Perdana University last year. However, they manage to get a new collaboration with University of California, San Diego. Hopefully it won’t end up with the same problem. Our healthcare system is completely different than the US. Even their “suppose” to be ready private teaching hospital has not taken of the ground yet. Almost all other private universities which wanted to build their own teaching hospital have abandoned their plans (Monash, UCSI, MMMC, AUCMS). The career pathway is also not the same as in the US which is clearly shown on their website. PUGSOM is a graduate medical school which is the way forward in many developed countries. The students are more matured and know what they are getting themselves into. However, you will end up doing housemanship at an older age(roughly at the age of 30) and will have to compete for post graduate post at the same level as your juniors, by age. By the time you become a specialist, you will be in your 40s. The only advantage of PUGSOM for time being is the full JPA scholarship!

Public universities were also asked to reduce their intake last year. Remember the magic number 418 which turn out to be a “moronic” statement by a deputy minister? The total intake for public medical schools last year was about 1100 students. However, personally I feel that the government should not limit the intake of public medical schools. Unfortunately, the selection process to public universities are never fair! MMC on the other hand should concentrate in reducing the intake into many of the dubious local and overseas private medical schools. How can we allow “shop-lot” colleges to run medical schools? Only in Malaysia! The truly Malaysia Boleh style.

Once again, I would advise those who intend to migrate that doing medicine is the worst decision you will make! I had written enough regarding this over the last 1-2 years. However, I still get emails and blog comments on intention to migrate with an unrecognised degree obtained locally. Please spend some time reading THIS and THIS blog entry. All the answers are there. I just received the following email from an Indian citizen:

“Sir I am an indian citizen , did my medicine in china graduated in 2011 and ever since I have been on constant run from exams after exams I cleared my USMLE with 247 in part 1 and 258 in part 2 applied to more than 400 surgical programmes and got turned down…“

With Australia and UK almost shutting their doors to foreigners, even after passing their entrance exams (AMC/PLAB), getting into US is also not easy. I know many who spent huge amount of money sitting for exams (USMLE etc) and never got any residency post. Only very few lucky ones manage to get it. Your chances of getting a job overseas is better if you graduate from one of their own medical schools. With the current political climate in this country, almost every non-Bumis that I talk to have intention to migrate, especially for their children. Unfortunately choosing medicine is the worst thing you can do. As my Ophthalmologist friend  said “doing medicine is a trap, you can’t move anywhere!”. I just met a couple who are succesfull GPs and has 3 clinics. They are NOT sending any of their 2 children to do medicine. Of course, their intention is also to let their children migrate.

Thus, I would advise budding doctors to open your eyes and READ…………….. Don’t get glorified with statement like, doctors are needed everywhere and you can work anywhere in this world. There is NO such thing! There are so many information in this blog. Please spend some time READING it. There is NO short cut to life. The more you read , the more successful you will become. Knowledge is key to success and the only way you are going to achieve it is by reading. Enough of spoon feeding in your schooling days! It is time to wake up and face the reality out there!

Please READ…………….

It’s been a while since I updated my blog. It has been a hectic year-end for me with so many stuffs to settle including registration for GST etc. Interestingly, along the way I received a lot of information regarding issues surrounding the field of medicine. After my last post, I received a lot of comments in this blog, some questioning the bullying and long working hours etc. As I have said many times before, doctors cannot run away from working long hours. The recent floods in many of the states in Peninsular tells you how doctors had to work when situation demands. Hospitals in Kelantan were flooded and many critically ill patients had to be transferred to other hospitals including to Klang Valley hospitals. Doctors in these hospitals who worked tirelessly trying to save lives never even considered how many hours they had worked! When the situation demands, as it always does, doctors work. That’s the reality. So, for junior doctors who thought that doctor’s life is just sitting in a cozy room and seeing patients as they walk into your clinic, please change your perception. If you can’t handle it, it is better to change your profession or do something that is not clinically related. As for bullying, I had said enough. Unless the system changes, nothing will change.

Since almost 8 years ago, I have been constantly writing about possible future unemployment of doctors. Despite producing all the facts in this blog over the last 5 years, many refuse to believe and accused me of trying to take care of my rice bowl. Some even said that there is no such thing as unemployed doctors! The reality is now right in front of our eyes. In fact, it is happening 2 years earlier than I predicted (2016). Please remember that 50% of the medical schools in Malaysia just started to produce their graduates since 2014 onwards and these medical schools have not reached their maximum production capacity yet.

MMA had a meeting with the Minister of Health last month and the Minister finally admits (he refuted the allegation last year during a dinner meeting with MMA) that we are facing shortage of post for doctors. I attach the snapshot of the interview below. He said that the waiting period stands at 6 months now and will get longer. He also said that they might raise the min requirement to 5As in SPM. However, he declined any possible pre-employment exams, likely due to political pressure. As I had said many times before, I disagree that SPM being used as sole criteria. A better method would be to limit the type of Pre-U courses that can be accepted for medical schools. Foundation studies, which are NOT standardized, should NOT be used. Established standardized Pre-U courses like STPM, A-Level, IB, AUSMAT etc should be the sole entry qualifications. I also support a common entry exam as practiced in many other countries but of course it is a politically unwise move as many MARA, Majlis Agama and JPA scholars may have a problem if they do not pass the exam.

There are still many out there who do not understand the field of medicine. Just last week I was talking to a Marketing executive regarding the 6 months waiting period for housemen and possible limitation of employment for doctors. His immediate respond was: why not do Masters while waiting for employment!! Their perception is that Masters in medicine is equivalent to any other Masters program as for other fields. In any other field, you can directly go for Masters after graduating without any employment. BUT in medicine, post-graduate training is a FULL TIME WORKING AND PART TIME STUDYING. You can’t get into a Master’s program without completing your housemanship ( aka full MMC registration) and at least a year of MOship. It is the same anywhere in this world.

Recently I received an email from a doctor in Bahrain. He allowed me to share his predicament in my blog, as below:

“I discovered your blog website some time back, and I have to say your words and experiences are a strong confirmation about what I have been feeling about Medicine even before I graduated as a doctor in 2004.                            My parents are old school folks from Karachi, settled in Bahrain since 1979. I was educated in Bahrain, and was sent to Pakistan to study Medicine.                           

During my time as a medical student in Pakistan, I had to suffer a dysfunctional and rotten state education system, and students willing to do anything unethical to cut corners to jump ahead. Following the crowd and herd thinking has always been something I hated.                           

I always had a strong suspicion in medical school that conditions were going to be worse, and the western nations would close their doors and opportunities for everyone taking the USMLE/PLAB path. I really wanted to get myself away from all those problems and study healthcare management in the UK.                           

Business and politics has interested me more than clinical practice. I don’t necessarily hate Medicine, I just hate the lack of opportunities and deep problems that await you even before graduation from Medicine.                           

I told my parents before my graduation that I would change my career after gaining the MBBS degree, but was forced to continue after my housemanship.                           

I passed MRCS part 1, PLAB 1 and PLAB 2 after a lot of investment of time while not working in Bahrain. I really wanted to train as a surgeon in the UK, because I seemed to have been mentally competing against my professor of surgery. But during my time in the UK after gaining full GMC registration, I realised that the market and training job/post for which I had struggled for was non existent.                             

After making no headway in the UK, I returned to Bahrain, cleared the licensing examination and subsequently joined a private medical centre as a General Practitioner. I am grateful to Almighty God for allowing me to earn and save money while living with my father. My saved income has made me feel confident, and allowed me to think about what to do in the following 5 and 10 years ahead.                             

My advice to everyone around me is to avoid medical school at all costs and try achieving more at less financial and mental investment. That is in line with Sun Tzu’s principles in the Art of War. A senior UK registrar from the UK agreed with me when I said studying Medicine does not make any business sense in this day and age.                           

Hope to meet you one day soon to talk about the abysmal state of affairs of doctors worldwide.  

Regards & Best Wishes “  

He also said the following, which I had already mentioned long time ago:

“Most, if not all of the children wishing to become doctors have had no real exposure to hard economic facts of life and the job market. It’s very easy to say one wishes to serve mankind, but once you graduate and your family can no longer support you, and you have utility bills, rent etc to pay every month, then feelings of charity gradually fades away. The world and society have no patience with anyone who can’t pay their way or find a job, why should medical graduates be treated or regarded any different from everyone else?”

As mentioned by him, when you ask anyone who wants to do medicine, the standard answer will always be “ I want to help people”. Of course at that young age, many do not know anything about medicine or just get carried away with what is shown on TV. Furthermore, they are living with their parent’s money with no commitments. I have had many medical students who wanted to help people in war-torn countries and work with WHO etc but ended up going nowhere. I know some students who said that they want to set up charity clinics and even start a foundation to help the poor etc. Do you see any doctors doing as such? Life starts after you graduate, when you start collecting debts (if not already), get married, have children and your parent’s financial help gets cut off (unless your parents are millionaires). This is where you will realize that no matter what your earlier intention was, reality bites. You will realize that being a doctor is just another job to earn a living. All the noble intention will disappear into thin air. Very few will endeavor.

Here I attach another email from a lawyer who reads my blog, which is self-explanatory:

“I think one of the main reasons for the deteriorating quality of HOs is because they don’t understand the profession before leaping into it. This is a  “fast-food generation” where people seek instant gratification and get all disappointed when things do not immediately live up to their expectations. A lot of parents are still under the delusion that doctors immediately earn a lot of money and live a comfortable life with guaranteed jobs, so they keep encouraging their children to do Medicine for all those wrong reasons. It makes me very sad – more people should read your blog in order to quell these misconceptions.”

Doing medicine is not a good idea if you intend to migrate. However, I use to say that if you intend to migrate, please do medicine in the country where you intend to migrate. Unfortunately, even that may change soon. Just last month, there was a suggestion in UK that all foreign students graduating from UK must leave the country before applying for a job. This will have a great impact to medical graduates as they are usually given internship post under student visa. Graduates from outside UK are almost impossible to get an internship post in UK despite passing PLAB due to their immigration laws. The situation in Australia is also the same as I had written over HERE as well as what was written HERE. The reason why I keep saying this is because due to the current political climate of this country, almost 80% of non-bumis that I talk to are planning to migrate, atleast for their children.

Some may argue that we are still short of doctors as you can see hospitals being overcrowded with doctors running around. While I agree that we are short of specialist, I disagree that we are short of general doctors. What we are facing is actually MALDISTRIBUTION of doctors, between urban and rural, between public and private, between hospitals, between departments and between East and West Malaysia. Klang Valley has a doctor: population ratio of 1: 400 but why are we seeing the public hospitals overcrowded with patients? That’s because, public hospitals and clinics are catering for 80% of the population. If you add up all the beds in Klang Valley (private and public), we have enough number of beds to cater for the population. Same goes for the number of doctors but many of these doctors are either running their own clinics (GP clinics), in private hospitals or doing administrative work. The only way this “presumed” shortage of doctors would be solved is when we integrate the private and public health sector into a single entity paid by a National Health Financing Scheme. The supposedly 1CARE scheme is still in limbo for time being. The private healthcare is almost 80-90% supported by insurance. If insurance companies collapses, the private healthcare will collapse! Specialist can also become jobless.

The government on the other hand would not be able to sustain the ballooning healthcare cost by building more hospitals or creating more post. We are one of the very few countries in the world, which is still surviving with a system created by the British almost 50 years ago. It is not sustainable. Thus, as long as housemanship is under civil service, there will come a time where the government will not be able to give employment to everyone as what is happening to the nurses. The filtering has begun with the re-introduction of compulsory SPM BM paper for all, including foreign spouses and non-availability of post for PRs as mentioned in my earlier post.

We also know that government is financially hard pressed now. The fall of the oil and commodity prices, the rise of US dollars etc is putting a lot of burden to our financial coffers. Our ruling regime has wasted enough money. The 47% who voted for them were deceived by the false promises from the ruling government. When the opposition said that we are heading for bankruptcy before the election, many supporters of the ruling government refuse to believe. We have a bloated civil service (one of the highest per capita population in the world), which is also not sustainable in long run. Almost 50% of our budget is allocated as operational budget, meaning paying civil servants (25% of the budget) and to maintain and run the civil service. As much as I don’t like Dr M for his social engineering and the reason for racial polarization in this country, I must agree to some of his long-term policies such as Dasar Pensyarikatan and Dasar Penswastaan. The whole idea is to reduce the number of civil servants to about 500K to reduce the financial burden of the country. Unfortunately, the number has bloated to almost 1.5million in just less than 10 years after he left! No job is going to be guaranteed in the future.

My advice for students is to do what you are interested in after doing some research and not based on which field can make more money and which field has more prospect etc. If money is your intention, than there are many ways you can make money. Most millionaires do not even have a degree! If migrating is your intention, never do medicine. Jobs that are most needed nowadays are not professional jobs but technical jobs like interior designing, any form of designing, architecture, software engineers, accountancy, technicians etc. Professional jobs limits you in many ways. Do it only if you have real passion for it.

Happy New Year  to everyone……………… May 2015 be a better year for Malaysians……….

I attach a request by a medical student to publish the following survey in my blog. Please support her. The closing date will be 15/01/2015.

A dead body can create miracles. Do you believe that it can rise from death and save lives? We want to know how much you know about this mighty act of organ donation. So, please help us to complete this online survey by just a few clicks. 4 minutes of your time means a lot for us, thank you!

English version: http://goo.gl/forms/C0UJSwVPzQ
Malay version: http://goo.gl/forms/84sSK6Y69y

Yours sincerely, UniKL-RCMP Year 4 medical students.