Plight Of The Medical Professionals By Dr S H

I received this from a reader Dr S. H. Thank you.
Dear Tuan Syed,
Hope you can highlight the plight of the medical professionals.

We have too many medical graduates but NOT enough posts. 
FW: From Medical WA groupThere’s a boiling pot with the lid closed amongst Malaysia’s healthcare professionals today.As of Q1 2019, there are approximately 700 “floating” doctors throughout Malaysia who are  without any permanent job placements. They are the first batch of about 1200 doctors that were  made to sign contracts at the start of their training back in late 2016.  (OSTB : Housemen.)
These numbers will continue to rise over the years. Some lucky ones will be absorbed into  government service, while others will be terminated. Presumably, the first batch of contract  doctors will know their fate by 2020.
 Since December 2016, the Ministry of Health (MoH) have made each new house officer sign an  employment contract. 
This contract basically states that they will not be guaranteed permanent positions despite completing the 2 years of compulsory house officer training.
If they manage to succeed, they are then required to sign another 2 year contract as Medical Officers at which there would still be no guarantee of a permanent job position.

After serving the whole 4-year contract, MoH will then finally decide whether your services are still required. Most will eventually be terminated. Bummer.

The reason being, there are just not enough permanent positions available. Unless the  government opens up new healthcare facilities, the rest who aren’t absorbed into service will have to seek  employment elsewhere.

It is estimated that at least 2000 doctors will be without jobs annually.

Some of these people have invested hundreds of thousands of ringgit for 5 years of medical  school and have had to wait up to a year after graduating to even start practicing (I know of  some that have worked in fast food chains in the meantime).

And imagine after all that, you aren’t even guaranteed any permanent positions. Not really a good ROI if you  ask me.

In truth, most of these doctors are still in limbo. Most are kept in the dark and are clueless about what is to come. There’s no contingency plan.

What is being done to help these doctors?  Why are we not discussing measures to tackle this imminent problem?  What do you think?  Let us know below.
 P/S: The contract includes new Dentists and Pharmacists who are also in the same boat as  Doctors. Not to mention all the Medical Assistants and Nurses who are also finding jobs hard to come by.
NOBODY has been taking a lead in this, they blame the poor parents.Legally, MMC is holding on to  things as the law requires these doctors to complete Housemanship & Medical Officer at the Ministry Of Health,  whilst MOH doctors dont feel it is their job to help the new doctors.  
We all groan and watch helplessly!

2.  Next will be too many specialists but no posts. 

The DG mentions 1110 masters students per year... assuming 90% passing rate at the end... We will have 900+ new specialist per year.
Do we have enough posts to employ additional 900+ new specialists per year?
 Thank You.   
Salamun Alaikum.  Regards,
Dr S H
My comments :  Salamun Alaikum Dr S. H. Thank you for sending me these thoughts. 

1.  First of all I do not think the present Minister of Health has the interest to grasp or provide a solution to this problem. 

(It is a problem only if we see it as a problem. I believe it can be turned around for the benefit of the young doctors as well as the nation.)
2.  A few months back the Minister of Health had a town hall meeting with about 800 very angry GPs. After the meeting he held a Press Conference where he came across that his biggest fear was that at certain times during the town hall meeting he was put under great stress - but he managed to survive the session.  That seemed to be his only achievement during the town hall session - that he managed to get through the session itself. That was all.
He did not say anything about doing anything positive for those GPs. And since then everything has gone quiet again. Nothing has changed.  The GPs are back to square one. 
Even the simple fact that over 800 General Practitioners took the time and trouble from their busy schedules to come for the town hall meeting should be worrying enough not just for the Minister but for the Prime Minister as well.  But it appears that this Pakatan government just does not care.
Despite the ridiculousness of many parts of the Private Medical Health Care Act which only adds to unnecessary costs of private medical health care (as commented by many people, even through this blog) there is no action or even discussion about amending or  abolishing parts of the Private Medical Health Care Act.  
Everything has just been swept under the rug.
3.  I am aware of the 'overproduction' of medical doctors. However my view is this is one profession where there is no such thing as too many doctors.  
I do not look at them as numbers or statistics. 
To me the underlying fact is this :  There are still far too many people in our country who are sick, suffering diseases, who need medical assistance and medicines. We need doctors to treat the sick.  This part of the equation will not change.  

In Kuala Lumpur (which DOES NOT represent the whole of Malaysia) you may have FIVE GP clinics within walking distance of each other.  But try Sabah, Sarawak or the small towns in Kedah, Perak, Johor etc. There are not enough medical health facilities within easy range of the people who need them.
I feel we will need even more doctors.   Doctors are those specially chosen people who can heal and cure.   If there are such things as miracles - then it is the skill and the expertise of doctors, dentists and pharmacists who can heal sickness, cure diseases, repair broken bones, perform life saving surgeries and make wonderful medicines that help bodies to become strong again. 

If there is an oversupply of doctors in the government medical service  then how come ordinary people must wait for hours before they can see a doctor in a government hospital? People queue up as early as 7 am to be first in line at the general hospitals. There are not enough doctors to meet the needs of the people in a timely and efficient manner. 
Try to get a dental appointment at the government dental clinic. It takes months before you can get an appointment. Why? There are not enough dentists in the government dental clinics.
And the government still employs foreign doctors on contract.  How come?
These are the underlying facts. 
The other "problem" is not a real problem at all. The "problem" of too many doctors, not enough government jobs for them, not enough government hospitals etc are all simple administrative matters. Whether we are efficient or not. Whether the government (MOH) is on the ball or they are sleeping.  I believe these issues can be overcome.
4.  The fact that there is a Law that requires 
i.    fresh medical graduates to undergo two years of housemanship followed by ii.   two more years of medical officer attachment iii.  (before they are fully licensed to practise medicine in the country) 
simply means that the government is OBLIGED BY LAW to provide ALL graduate medical doctors the two year housemanship programs followed by two years service in government hospitals as medical officers. 
Now if the government cannot abide by its own laws and regulations because of factors like Budgets, a weak economy, its own incompetence, insufficient trained specialists to "train" the housemen and medical officers, etc then the government must quickly amend the rules (even temporarily) to overcome these shortcomings IN THE GOVERNMENT.
The government cannot adopt the lazy, 'tidak apa' attitude and just leave highly trained young doctors to waste their lives. It costs about RM500,000 to train a doctor in Malaysia (in both government and private medical schools).  Doctors still represent the cream of our academic achievers. This is brainpower. Do not let it go to waste because of silly "saya peduli apa" attitudes. 
I have some suggestions. I am thinking aloud. 
My suggestions are maybe outside the box, or not. Here goes.
Since the government does not know how to handle this 'oversupply' situation, may I suggest the government allow a FIVE year moratorium on the existing rules over the compulsory TWO YEARS required for housemen and the compulsory TWO YEARS for medical officers. 

Just to help clear the so called "oversupply" of doctors. There is no oversupply. There is actually a shortage of doctors. We just need to deploy our fresh graduate medical doctors properly. 

5. Allow young medical graduates to get their early work experiences outside the country - in a prescribed list of countries. Countries which have health systems that are on par or better than ours. Australia, New Zealand, Singapore, Europe, Japan, USA, Canada and India. If the government cannot find them jobs in our local government hospitals then let them work overseas. And when they return accept their foreign work experience as sufficient to practise medicine here. And accept them in government medical service with no break in their seniority.

The reason I say this is because there are still expatriate doctors working on contract at our government hospitals. We have Iranian and other Central Asian doctors working here. We used to have Myanmar doctors working at our government hospitals. How come? Where did they complete their compulsory two year housemanship? Where did they complete their two years medical officer training? So why not allow our young doctors to gain working experience in other countries.

6. Allow private hospitals here to "absorb" 'housemen' and junior medical officers. Why the hell would private hospitals want to do "risky" things like that? For money of course.  The government can subsidise the salaries of 'housemen' training at private hospitals. If say housemen are paid RM3000 per month by the government now, the government can subsidise 50% of their salaries to the private hospitals who 'absorb' the housemen for two years.   So the private hospitals need only cough up an extra RM1,500 or so to pay the 'housemen'.  The government saves 50% of the wage bill. Private hospitals also save 50% of the wage bill. But most importantly our young doctors get the early work experiences. Their talents are not wasted. Otherwise some of them may become GrabFood delivery boys.  

And allow these housemen options to rejoin the government medical service within say four years with no break in their seniority.  Meaning they do not lose rank.  Of course the MOH must establish SOPs and minimum work experiences that private hospitals must offer to the housemen (in two years deliver a minimum of 10 babies unassisted, assist in x number of surgeries etc etc). This is where that salary subsidy will help a lot. Money talks loudest. 

7. Not too long ago the housemanship was one year. Then the quality of our medical graduates became not as good as before. So the housemanship was increased to two years. The government should take steps to really improve the clinical training at our medical schools - both at government universities and private medical schools.  Make it easy for private medical schools to tie up with government hospitals for clinicals training (Year three till five of medical school).  There must be a stronger commitment to make sure that medical students get the full quantum of clinical training while they are still at university - to make them less of 'bungling' housemen a couple of years later. Kalau tak tahu macam mana nak buat - please ask the Cubans. Until today Cuba has the best medical system in the world.

8. Many Klinik Kesihatan do not have doctors. Herein lies a great opportunity to provide quality medical services to the whole country (and also absorb the "excess" of doctors).  In Cuba they have 'klinik kesihatan' type outfits in every neighbourhood, manned by doctors who MUST also live in that neighborhood. The "neighborhood" doctor is tasked with monitoring the general health of all the people in his neighborhood. Similar to the local Pondok Polis policemen who know every single house in their area.  Not only does the doctor have regular clinic hours but they are also required to walk around, attend public events and observe the general health of the people. The idea is to go out to the public and monitor their health and detect any sicknesses or diseases as early as possible. Prevention is better than cure. Plus the government medical service reaches all the people - even in the remotest areas.

9. Sarawak, Sabah, the east coast and rural areas still suffer shortage of government doctors in government hospitals. Everyone wants to work in KL, Penang and the large urban areas of the west coast in the peninsula.  More housemen and medical officers can be redeployed to places where there is a shortage of medical personnel. Young doctors, do it for the country.  We are so glad that our son applied to work in Sabah. Among the patients he helped were people who suffered crocodile attacks !! 

The MOH cannot just sit on their hands and do nothing or blame others for the 'glut' of doctors. There is no glut. Just redeploy them more creatively. Relax the rules and regulations - if not forever then at least for FIVE YEARS.

I say Dr Dzul, why does a private hospital operating in a two storey shophouse require a 24 person capacity lift?  Amend lah itu Private Medical Health Care Act. 

Who says there are free market forces acting in private health care? Semua GLC saja control. Using taxpayers' money. Those are not market forces. 

Folks if you have other suggestions lets hear them.  I believe the presence of more doctors is a good thing.  Because we do not have medical care available in all corners of the country. Neither is it very affordable in the private sector.  

Akhir kalam, tuan-tuan you may or may not agree with my suggestions here.  The long and the short of it folks, is that there is more than one way to skin a cat. 

Cannot, cannot, canot, takbley, takbley, takbley, haram, haram, haram is not any suggestion at all.

Saya tak tahu, saya tak peduli, peduli apa saya, penat lah, malas nak berfikir lah are not options either.

Dah dekat masuk waktu asar, saya nak pergi dengar ceramah Indian Goat are also not options. 

If the MOH only knows how to say cannot, takbley, haram, saya tak tahu, saya tak pedului etc then why do we even need a Ministry of Health or a Minister of Health. Lebih baik balik kampong tanam jagung. Please think harder and please work harder.    Posted by Syed Akbar Ali 

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