A doctor too many !

In the eighties, most of the sales representatives from drug companies were not graduates – most of them who serviced my clinic studied till either Form 5 or Form 6.

Then in the early nineties, the profile of sales representatives, especially those from multinationals, changed. Majority of them were graduates, many of them local graduates from Science stream but a few were even from business stream.

Then came the 1997 financial crisis.  I remember that I was very surprised to read a card from a sales representative that stated his qualification as law graduate. On enquiring, he answered that there was simply too many law graduates, and many of them who had no  strings/connections had difficulty to do chambering with established law firms, and unfortunately he was one of them, and so while hunting for a place to do his chambering ( some sort of housemanship), he decided to work as a sales representative.

I remember at that time, I told the young man that the country was still short of doctors, and that doctors would have no problem finding a place to do housemanship in Malaysia. That was not many years ago.

Now, Malaysia is churning out doctors by the thousands. Not  joking, literally by the thousands. I have lost count how many medical schools are there. At least ten or more, someone told me .

With the country mass producing thousands of doctors each year, it will come a time when the Health service simply cannot accommodate all of them to do housemanship.

There will be a glut of doctors in the foreseeable future.. AUstralia, with about the same population, has fewer medical schools than Malaysia. But even so, they have a health care system which is way ahead of us..

To have a glut of doctors does not mean that healthcare standard will automatically goes up. On the contrary, a glut of doctors will mean fierce competition and undercutting..

Even at the moment, private hospitals which have mushroomed all over the places.. We are beginning to have  too many specialists , especially those in secondary care, like general surgeons and physicians.. Those in the tertiary care are not facing much problem now, but if there is a glut of doctors, they too will ultimately be affected.

Private hospitals are finding it difficult to compete. Many of them are now resorting to setting up primary care clinics (like GPs clinics except they are run by salaried doctors from these private hospitals) in many places. The primary function of these primary care clinics is not to treat , but to source patients for these private hospitals.

SInce many of the private hospitals are now listed entities, they are now answerable not just the patients, but to the shareholders as well. As a listed entity, the shareholders are not interested to see how many patients are cured , they are more concerned with yearly growth of profits, meaning that these hospitals will have to show higher profits year on year. ( I’ve repeatedly voiced out that hospitals should be not allowed to list, but who will bother to listen to a small voice?)

This year-on-year profit growth will have to come from either one of the 3 methods:

1. Increased number of inpatient .. But with private hospitals mushrooming faster than the growth of the number of people who can afford private healthcare, this is not happening. Hence, the setting up of primary care clinics to source for patients… With increased competition, the doctors that are employed to run these primary care clinics will be hard-pressed to refer cases to the ‘mother’ hospitals, and many cases that can actually be treated without hospitalisation will be refered for hospitalization. In other words, there are  over- referrals.. The unsuspecting patients are the ones that are being squeezed dried by this cut throat competition, which will be more and more intense.( As an example, a simple cyst removal which cost less than a hundred if done in a clinic will cause the same patient many hundreds if done in a hospital clinic.)

2. Since the number of patients are not increasing much, to get a higher growth and higher revenue means that the hospitals  have to raise their charges year on year. That is why health care is so much more expensive compared to before.

3. Cost cutting resulting in lowering of overhead. SO far this has not been happening, but with a glut of doctors and specialists, do not discount this possibility. With cost cutting, patients will not be getting value for money..

The government should realise that the days when there will be a glut of doctors are not far away. Instead of mass production of doctors, what should be emphasised should be the standard of these healthcare personnel .Those passing out from Universities must be able to diagnose common diseases. But from what we have seen, the standard of local housemen seems to have dropped , so much so that the government has no choice but to increase housemanship from one year to 2 years.

Doctors are tasked with saving lives. We need competent doctors. We do not need to mass produce doctors because we want to change the social fabric of the nation. We have to be colour blind when we choose to educate our doctors. Medical students should be chosen from those with compassion, with an aptitude for doctoring , and not by imposing certain quotas and trying to fill the quotas with second rated materials. Not all stones can be turned into jade..

I think now that we have enough number of doctors , we should emphasize on quality instead.

We should not be in the business of producing doctors just for the sake of producing them, otherwise there will bound to be adverse consequences later on. Mind you, that day is pretty near..