A doctor too many II

Malaysia, a country with about 26 million populations, boosts of 24 medical schools now.

Just a few years ago, the number was less than 10. In fact, when my eldest son entered medical school 10 years back, i could count medical schools with my fingers. Now even with my toes and my fingers, I could not do so. Some of the names are so new that I, as a doctor, do not even know they exist until I did some research for this article.

The list is below:

Public universities:

• University of Malaya, Faculty of Medicine

•Universiti Kebangsaan Malaysia, Faculty of Medicine

• Universiti Sains Malaysia, School of Medical Sciences

• Universiti Putra Malaysia, Faculty of Medicine and Health Sciences

• Universiti Malaysia Sabah, School of Medicine

• Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences

• International Islamic University Malaysia, Kulliyyah of Medicine

• Universiti Teknologi MARA, Faculty of Medicine

• Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences

• Universiti Darul Iman,Faculty of Medicine

Private Universities and Colleges’

• UCSI University, Faculty of Medical Sciences – School of Medicine

• Monash University Malaysia, School of Medicine and Health Sciences

• International Medical University, Faculty of Medicine

• AIMST University, Faculty of Medicine and Health Sciences

• Allianze College Of Medical Sciences, Faculty Of Medicine

• Management and Science University, Faculty of Medicine

• Cyberjaya University College of Medical Sciences, Faculty of Medicine

• Royal College of Medicine Perak, School of Medicine

• Melaka Manipal Medical College, School of Medicine

• Penang Medical College, School of Medicine

• MAHSA University College, Faculty Of Medicine

• Newcastle University Medicine Malaysia ( NuMED)

• Taylor’s University College, School of Medicine

• UTAR

These are the medical schools in Malaysia. These schools when fully functional will produce about 4000 doctors a year. There will be thousands more Malaysian doctors being produced overseas, since many Malaysians are studying medicine in UK, Australia, New Zealand, India, Indonesia, Russia, Taiwan and even Ukraine.

The sudden mushrooming of medical schools are apparently due to shortages of doctors in the public sectors. This is because most doctors in government service resign after their compulsory services and opt for the supposedly greener pasture in the private sector.

In most other countries, the logical thing to do to counter this brain drain of doctors to private sector is to find out why doctors are resigning from government service and then try to address the woes of the doctors , and hopefully keep them in service. I call this common logic.

The Malaysian solution , like in many other instances, does not take common logic into account but rather uses the sledgehammer approach. After all, we do have Malaysian logic which is different from common logic practiced in most other countries. For example, if we cannot have spacecraft of our own, we can still produce Astronauts by sending Malaysians into space hitchhiking on other countries’ spacecraft.

In most other countries, the common logic will be to try to improve the working conditions in public sector so that doctors will stay back. But Malaysian logic is sledgehammer logic, and is very different.

If the doctors do not want to stay in government service, then Malaysia shall flood the market with doctors, so goes the Malaysian logic. Never mind that setting up of medical schools and training doctors are expensive businesses. We have petroleum and huge amount of development funds. By building more buildings and buying expensive medical equipment to equip these medical schools, billions will have to be spent and of course, in the Malaysian context, everyone will be happy, down from the planners, the contractors, the parents and all others involved, since the perception is that projects in Malaysia inevitably will have some leakages and wastages and many people are very happy with these leakages and wastages. Never mind that we may have the hardware but we may not have enough qualified people to man these medical schools.

The Malaysian logic seems to be like this: If enough doctors are produced, the market will be saturated with doctors and thus doctors will have no where to go but to stay put in government service.

Well, the people may be clapping hands and rejoicing that with more doctors than are needed, medical costs will come down.

Unfortunately, things do not function like this in medical education. Experience in some countries tells us that some doctors in private practice , when faced with too few patients will charge higher and do more investigations, some of which may not be needed, so instead of medical cost going down , it will go up.

In any advanced nation, the setting of a medical school requires a lot of planning and not on ad hoc basis. Planning that must include where to source for experienced and qualified teachers, where to build new or source for existing teaching hospitals which are big enough for the placement of these medical students to do training. Planning such as facilities, equipments, classrooms, curriculum. In the west, it takes many years of planning for a medical school to be set up; whereas in Malaysia, we see more than 10 in the last 5 years.

In Malaysia, due to the sudden ‘exponential’ increase in medical schools, we have medical schools pinching staff from each other, even the mediocre ones, and with that number of qualified teachers only, it is unavoidable that many teachers may not have the experience and qualification to be medical lecturers.

The early birds (medical schools) are more fortunate. Their students are placed in bigger hospitals like the General Hospitals of Kuala Lumpur or Penang. Now, some of the medical schools just opened have to send their students to smaller district hospitals to do their training. The smaller hospitals are often manned by more junior doctors who are not qualified to be medical teachers, and these hospitals have only very basic facilities and equipment.

This is just the beginning of the problems. For a doctor, graduating from a medical school is the beginning of a life long journey, and the basic medical degree is more like a license to start to really learn how to manage and treat patients.

The most important year after a doctor graduated is the houseman-ship. If a doctor does not have proper houseman training, then he would face a lot of problems later on. He or she may know all the medical knowledge in the world (just for argument sake only since knowledge of medicine is so vast that no one can know everything), but without the proper houseman training, he or she will not get the hand-on experience so crucial and important to doctors. A doctor without proper houseman training is not unlike a person, who has played only racing in the arcade games, suddenly being asked to race in a real life race. He would not have the hands on experience to do well. A doctor without proper houseman training would be like a person given a license to kill and a disaster waiting to happen.

Now, with 4000 doctors being produced in a year, where do we find so many houseman positions for these young doctors? Even now, with some of the medical schools just starting and not yet producing doctors, and the number of doctors being produced is much less than the 4000 , the wards in some of the bigger hospitals are filled with so many housemen that in some wards, there are not enough patients for these housemen to learn management skills. About a year back, I was told, in HKL some of the units have more than 20 housemen. Recently one doctor told me that in some units, it may have even more than that. I was aghast. Since with that many housemen in a single unit, and so few senior officers to guide them and so few patients for them to learn from, how are they going to learn the skill of doctoring?

When there is not enough training for these housemen, what do you think our policy planners do? In the typical Malaysian style, they increase the length of houseman-ship from a year to 2, hoping that the longer time will help to give better exposure to these doctors. Compared to Australia, New Zealand, and United Kingdom, houseman-ship is still one year only. By increasing the length of the houseman-ship, it is a tacit admission that our one year houseman training is not as good as the above mentioned countries. A poorly trained houseman will become a not so good medical officer, and since now most of the specialists are trained internally, it will be a matter of time that future specialists may not be as well trained as present.

Many parents do not know about the actual situation and still encourage their children to take up medicine. They are not told of the actual situation. The day will come when there are simply so many doctors that none are adequately trained. There will come a day when a doctor graduating from a medical school cannot even be placed in a houseman position.

That day is actually very near.

(This article was also published in Malaysian Insider )

Recommended readings:

For those interested in this topic, read also an article in medical tribune: Falling Healthcare Standard, a matter of grave concern here

my earlier article : a doctor too many I

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40 Comments (+add yours?)

  1. A true Malaysian
    Mar 24, 2010 @ 11:24:51

    They do things on ‘ad-hoc’ basis and do not think far. As and when things go wrong, then blaming others without looking at themselves first. They are playing politics all the time.

    Many of these politicians are medical doctors themselves, Dr. Mahathir & his wife, Dr. CSL, Dr. NYY,….. and many more, but they do not even ‘meow’ on the subject.

    1Malaysia clinics are not run by qualified doctors but by medical assistants and nurses. How can this happened and these doctor politicians couldn’t bother. Malaysiakini has one report on Malpractices alleged at 1 Malaysia clinics, the so-called ‘brainchild’ of Najib. Medical assistants and nurses can do prescriptions, just imagine these are happening in Malaysia.

    It seems human lives are not precious anymore in Malaysia, sigh!!!!

    Like

  2. clearwater
    Mar 24, 2010 @ 11:56:29

    Malaysian logic? Where got logic, one. It all goes back to entrenched shallow thinking and taking the easy way out to solve a problem. This is what happens when competition and meritocracy gets thrown out the window. Not using one’s brain is now ingrained culture in a large part of the government bureaucracy. Just listen to some of the politicians and you know who leads the way in being near brain dead.

    Not enough doctors? Set up more medical schools. Not enough candidates? Lower the admission standards. Not enough hospitals? Set up 1Malaysia clinics as substitutes. You know the drill. It is the norm in nearly every facet of public life. So long as compliant citizens are not incensed enough to protest on the streets. If we suffer fools to lead this country, we deserve the quality of doctors we ultimately get.

    Like

  3. CL
    Mar 24, 2010 @ 12:51:27

    Dear doc,

    This misplaced problem solving & implementation method is a trademark of Bolehland. Sadly it is under MCA’s portfolio (when those politician (1st) cum doctor (2nd) charting our health care direction, it is scary).

    I have to maintain my health carefully as to reduce the chances of falling sick. The pain is not only from the sickness but also to my pocket. Worse still i may be attend by a run of the mill doctor that care more about the next Merc SLK he is going to buy rather than the cause of my sickness.

    As for the elite BN/UMNOputras they can always hop on a private jet and be attend by top doctors from S’pore, Australia, UK & US.

    The sad facts is that we are still unable to change this. By changing this i mean getting responsible & smart people in charge of our policy. Maybe it can happen when you are the minister of Kementerian Kesihatan via DAP or PKR’s ticket? It is only a maybe….

    Thank you.

    CL

    Like

  4. petestop
    Mar 24, 2010 @ 14:18:25

    See example of how theStar is spinning it,
    Excerpts from theStar Online:

    Published: Wednesday March 24, 2010 MYT 12:00:00 PM
    Updated: Wednesday March 24, 2010 MYT 1:14:50 PM

    EC: Penang and Selangor cannot hold local govt elections (Update1)
    By MAZWIN NIK ANIS

    PUTRAJAYA: The Election Commission cannot hold elections for local governments – including in Penang and Selangor – as the legal provision which allows it to do so was repealed when the Local Government Act 1976 came into effect.

    There is a HUGE difference between the title and the content. Between “Penang and Selangor cannot hold local election….” and “Election Commission cannot hold elections…..”

    It is this kind of spinning and false insinuations that really makes the credibility of the MSM questionable.

    The once proud and independent Penang home-grown, theStar is no more.

    Datuk Wong, you make us sick !!

    Like

  5. disgusted
    Mar 25, 2010 @ 00:12:31

    Medical negligence on the rise and legal suits too. All views expressed here are very valid. But the cheek of all is that this TakBolehLand is promoting health-medical tourism.

    On local elections, you can see a e-copy, titled:

    “Report of the Royal Commission of Enquiry to Investigate into the Workings of Local Authorities in West Malaysia” (under the chairmanship of Senator Dato Athi Nahappan December 1968

    Access Malaysiakini e-Library (Digital Library)

    The other Commissioners at that time, were:

    Dr Awang bu Hassan, D.S.Ramanathan, Chan Keong Hon, Tan Peng Khoon, Haji Ismail Panjang Aris and Choong Ewe Leong.

    Incidentally, Dr Tan Peng Khoon is with Washington University DC now

    Like

  6. Phua Kai Lit
    Mar 25, 2010 @ 11:28:33

    Dear Dr Hsu

    Here is something I prepared for the Ministry of Health:

    SAFEGUARDING ACCESS TO MEDIC AL SERVICES (SECONDARY AND TERTIARY CARE) FOR MALAYSIAN CITIZENS WHILST PROMOTING HEALTH TOURISM

    The Government of Malaysia has decided to promote health tourism in order to move the economy up the value chain and spur economic growth.

    Although this policy will contribute to an increase in the Gross National Product, there are certain negative effects that can be anticipated and which should be pointed out clearly. This will enable the Government and the Ministry of Health to take action in order to safeguard access to medical services for our own citizens.

    When evaluating health tourism, the focus should NOT be on the citizenship of patients. Promotion of health tourism is simply the equivalent of encouraging more consumption of medical services by more affluent patients (i.e. patients who are able to pay for higher end or more expensive medical services).

    We can anticipate the following negative effects:

    Increased demand resulting in higher prices in the short run for Malaysian patients seeking care in private hospitals
    Increased demand for higher end services, thus influencing the distribution of health personnel supplying the different kinds of medical care (“secondary/tertiary care” versus “primary care”) and the distribution of doctors between the different medical specialties (such as more doctors specializing in cosmetic surgery)
    Increased outflow of personnel (especially specialist doctors) from the public hospitals to the more lucrative private hospitals that cater to medical tourists – this will further exacerbate the shortage of specialist doctors in the public hospitals

    In the light of the above, the Government and the Ministry of Health need to take action to safeguard access to medical services by our own citizens, e.g. regulating prices or setting price guidelines for private hospitals; making it easier for doctors to specialize in certain areas (such as cardiology to treat the growing number of heart disease patients) while making it more difficult to specialize in other less essential areas (such as cosmetic surgery); making it more rewarding for specialist doctors to stay in the public sector and so on.

    We can also learn from other countries about the positive and negative effects of promotion of health tourism, e.g. Costa Rica, South Africa, Thailand, India, Singapore, the Czech Republic and so on.

    Like

  7. Tpg2Sg
    Mar 25, 2010 @ 13:27:40

  8. bow
    Mar 26, 2010 @ 04:31:24

    “we can still produce Astronauts by sending Malaysians into space hitchhiking on other countries’ spacecraft.” Actually our astronauts are not hitch hiking on other spacecraft, they were send by umnoputra by spending several hundred millions /billions with our tax dollars to the Russian space agency to buy seats inside their spacecraft , so they can make claims to their supporters how great and superior their race is …… it is a common knowledge to everyone in Malaysia….

    Like

  9. disgusted
    Mar 26, 2010 @ 13:49:09

    Making teh tarik in space, the most expensive drink…?

    Like

  10. ong
    Mar 26, 2010 @ 16:00:25

    Very soon the government will be able to staff the 1Malaysia Clinics with doctors instead of medical assistants.

    Like

  11. WAN
    Mar 27, 2010 @ 00:52:58

    bow..

    Sending astronaut to ISS was not a waste. My university and 2 other universities are running research on various aspects. and that thing still going on..don’t be such a racist here. Just a reminder, MOH is from your race k..

    Like

  12. Dr Hsu
    Mar 27, 2010 @ 09:29:32

    I agree. We should not race profile and should talk on issues only.

    Like

  13. anan
    Mar 27, 2010 @ 09:40:43

    another cabinet member went to Singapore for heart bypass surgery. i guess Malaysia’s doctors just aren’t good enough to treat the vips. maybe they should close down all the medical schools. a small corner of a building can also become a school of medicine, what a joke.

    Like

  14. Dr Hsu
    Mar 27, 2010 @ 12:18:21

    anan
    yes, if they have faith in the system, all government ministers and civil servants should be treated in Malaysia, and by our public hospitals. Because if as leaders, they do not even show examples that they have faith in the system, how do they expect the rakyat to have faith?

    There are still many good and conscientitous doctors in public sectors. But they way as I see it, the rot has started with so many medical schools being set up in such a hurry. Every Tom Dick and Harry with connections will be given a license to run a medical schools.

    Read the comments in Malaysian Insiders , most of them i believe are doctors … http://www.themalaysianinsider.com/index.php/opinion/hsudarren/57572-a-doctor-too-many

    Like

  15. Trackback: Surplus of houseman? « Efenem's Weblog
  16. bow
    Mar 28, 2010 @ 00:06:50

    How can i be a racist by telling the truth here. i am not the one spend billions of tax dollars sending Malaysian to space base on race….you are the racist here instead of me.

    Like

  17. bow
    Mar 28, 2010 @ 00:09:21

    what kind of ‘race’ you think i am?? MOH, or HOM is just another human race in case you don’t know, not my race or your race….lol!!!

    Like

  18. Nathan
    Apr 02, 2010 @ 21:28:39

    Its time either the MOHE(which licences the medical schools) or the MOH the receipient of the influx honestly tells the Malaysian public of the standards the current houseman possesses.
    Its not the number 4000 or more which are placed in so few hospitals,the adminstrators as well as the clinicians and HOD’s are calling it foul.Time for MMC to delete those both local and abroad which do not conform to requirements.Otherwise subject all foreign graduates to an assessment exams,to enable them to practise in this country.
    It appears its politics gain,most of the local schools too have shortage of teaching staff ,but are accreddited.Only God knows how this happens
    Time to get,public opinion on this issue,to stop the growth of further medical schools.Look for Quality not quantity

    Like

  19. medicairo
    Apr 03, 2010 @ 09:41:09

    There are facts and there are views in your writing.

    1) The fact that there are many medical schools means there is a possibility that we do not need to send anymore students overseas – to save on expenses and to retain spending in country.

    2) More medical schools means more job opportunities for the doctors who may want to opt for teaching or training instead of practising.

    3) The more doctors that graduate means more can be sent deeper into the smaller districts or villages to deliver equitable care.

    4) More posts can be created right from the UD41 to JUSAs with more opportuntites for specialization.

    5) If it is troubling that there are more patients than HOs and less opportunity for hands on skills training, then the medical schools will have to start having simulator manikins with video recordings of sessions so that they can be replayed and deficiencies noted and improved with lessons learnt.

    6) It is up to the creativity of the specialist educators and trainers to come up with ways to enhance learning for the HOs. There is always risks in handling cases at that early stage but that is how things are learnt. Frequently the seniors do not want to take responsibility for whatever mishaps that the young HOs do. Many want to play it safe. We are the ones who put limitations yet we blame HOs for not being able to become competent.

    7) Juniors will become seniors while the HO training period is just that – a training period. Thay can never learn everything during that time. It is just early exposure, while they will learn and gain further experience during their minimum 10 years with the Government service (those with scholarships). Learning is continuous and it is one of the aspects of medicine that must always be put in the minds of HOs.

    8) Working experience is variable and can be created to cater to the varied interest of many doctors.

    The National Defence University (NDU)/Universiti Pertahanan Nasional (UPNM) will have its first intake of 50 medical students this year. That adds to another medical school with additional graduates in 6 years time. The market will be saturated but we will be giving citizens of the country equitable medical care.

    Turning any situation into an opportunity is the attribute of an optimist..

    Like

  20. Dr Hsu
    Apr 03, 2010 @ 13:20:40

    medicairo,
    It is not really the number of doctors graduating that is troubling me. It is the number of substandard doctors that we are producing that is troubling .

    I shudder to think that these will be the very people that will be treating all of us someday.

    Medicine is a form of apprenticeship, and we learn from ward rounds and so on. I was just told by a Paediatricians that in some units there are now 40 to 60 house officers. Imagine what you can learn from the senior consultant doing the ward round when there are so many students around him? Most probably , the ward itself has no standing space if all of them are present in the same room at the same time.

    Your idea of using manikins work to some extent only; but nothing can replace real experience in managing patients.

    It is like asking a pilot who has only simulator experience but no real flying experience to fly a plane. He may be able to do so, but I would not want to be the passenger. Would you?

    This is the email that I received from a senior paediatrician Dr Lim (sorry I cannot release his full name) who wrote this:

    “”I was told that in January 2010,there were sixty(60) housemen in the Ortho unit of Penang GH alone,40 housemen in Medical unit and 35 in Surgical unit in Hosp Sultanah Bahiyah,Alor Setar on the same period.The problem will not be not enough doctors but where to place them in the near future.””

    …………………………………………

    My purpose to highlight this problem is to alert the planners that they should put more hospitals in place first before setting more medical schools. The article has been translated by a reader to Mandarin and posted in the various forums discussing medical and health issues, and was even quoted by medscape.com, the international doctors’ professional website for CME.

    AT least, now we have alerted some parents to think twice if they want to send their children for medicine to make money. Medicine is a calling, and is no more a money making professions. If they think they should still send their children to study medicine to help mankind, then by all means do so.

    Like

  21. Medical Student
    Apr 03, 2010 @ 20:09:11

    Dear Dr Hsu,

    I am a first year medical student currently studying abroad. Reading this article of yours Dr. Hsu doesn’t at all give a positive or supportive encouragement to us medical students who are striving in our studies to become a good and professional medical doctors in the future. Instead, you are feeding fear to us, medical students. Let’s make this simple. We make good students because we were taught by good and efficient teachers that have gave us support in our studies. Their support come in many ways, such as by appreciating our work, forming friendship with the students and so many many other ways. This goes the same to doctors. Good medical students will make good doctors when they are inspired by efficient and when the senior doctors set proper encouragement by being a good example to us, medical students. However, I do agree that Malaysia might produce more doctors but not of quality due to lack of hospitals and etc as what you have stated in your article. Why is that? I assume this is because we lack of encouragement, support by our seniors. Malaysia itself doesn’t appreciate doctors and this is witnessed easily by the policy set up by the government and some MO or senior doctors who have abruptly bully the HO’s (which will in time lessen their interest and enthusiasm to treat patients ethically). We have so many limitations. Even the MO doesn’t get a good pay after studying a lot harder than other non-medical students during their 5 years studies for a medical degree. What I’m trying to say here is, people keep on condemning, criticizing this and that but not wanting to find a solution to it. Stop bureaucracy.

    Let’s together find a solution and propose the solution to the Minister in charge or better still to our Prime Minister himself. What’s the point of writing such a long article, belittle people, and not encouraging or give a positive support to us medical students when no one is taking action? I can assure you. This ‘many doctor’ case is a serious issue. Therefore, it is crucial to solve it immediately because in 5 years time, insyaAllah I am going to be a graduated doctor and will be entering houseman-ship. I do not want my respect to the senior doctors to lessen and most importantly, I do not want to lose interest in caring for patients and treat them ethically if happens my fellow medical friends and I are bullied by senior doctors instead of giving support to us and teach us during our long hours of work later. We are here to help people, to treat people who are inflicted by diseases and those underprivileged.

    Dear Dr. Hsu, I am assuming you are a doctor with high reputation. You have power and hence, I am calling all senior doctors to work together and find a solution to help us, medical students in the future to be a professional doctor with all the required qualities to help people in need of health care.
    In my opinion, the first thing to start with is to reform our ‘doctors system’. I agree with the Australian system as we need more specialists. I hope to be a professional specialist one day and along the way, I need your support and the support of other specialists, or senior doctors. I must thank you for your concern Dr Hsu regarding our health care system, but maybe the way you presented it is not the proper way to guide your junior medical students who are reading your article. In every complain or unsatisfied issue, a solution is the most important thing to add in so that, we may view it positively and give a positive input to the community. Thank you.

    Kind Regards,
    Medical student

    Like

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  26. MFAR
    Oct 06, 2011 @ 01:07:13

    correction doc,
    we do housemanship two years in the UK.
    Anyway thanks for the writing. Really like it.

    Like

  27. Dr Hsu
    Oct 06, 2011 @ 10:26:22

    MFAR
    Thanks for letting me know.

    The article was written quite long ago..
    In the older days, housemanship in UK was only one year. So this shows how important is to update oneself and keep in touch with people all over the world in order to know about changes . 🙂

    Like

  28. JFDR
    Dec 16, 2011 @ 11:10:46

    doc:

    i just finish SPM and i planning to join the medicine program. but i heard tat there will be a surplus of doc. I am very worried of this issue. So should i become a doctor?

    Like

  29. Dr Hsu
    Dec 17, 2011 @ 09:10:42

    JFDR
    there is definitely going to be a surplus of doctors.

    having said that, i would not discourage someone who is really pasionate about medicine, and who would treat it as a calling, and not something to make money with.

    I am against producing too many doctors in too short a time not because of anything else, but for the fact that it would lead to a lowering of standard, since we dont have enough good teachers to staff so many medical schools, and we do not have enough training positions in our hospitals.

    Even with a surplus of doctors, if you are well trained and good in your skill( for example, enrol in a really good medical school), and good to your patients, you should be able to live a fairly comfortable life; but you would not be able to be rich. Anyway, to go into medicine to make money is something tht must be discouraged.

    Like

  30. JFDR
    Feb 02, 2012 @ 00:16:54

    oh well i dun really care about how rich i can be… but if i take medicine i will graduate at 2019… i am worried that i dun even get the chance to have a job and show my skills…

    Like

  31. Khalid Kadir AB
    Feb 07, 2012 @ 16:14:22

    Yes, the day will come when there are simply so many doctors in Malaysia that none are adequately trained, or worst trained to take over the job of nurses and medical therapists. And its already happening in main hospitals and UMMC!!! There will come a day when instead of advancing the nurses and medical therapists’ for a cost-effective interdisciplinary health delivery, a porportion of these UM trained Malaysia doctors will be sitting behind desks taking over matron’s job, doing wound-management job, counting wheelchairs (!!), prescribing wheelchair, fitting O&P, running wheelchair seating ‘clinic’. Why do MOHE even provide useless Postgraduate program at the expense of highly critical essential medical disciplines that is lacking. Its about time the Master Rehabilitation in UM be restructured to improved the quality of the nurses and medical therapists. Better wake up for the poor quality in medicine has penetrated the nursing and soon every layers will be infested. What is happening to us in Malaysia – we dont seems to be able to be practical and cost effective nor strategic at all. Nowhere else in the world do they plan for ‘step-down’. The issuing of ‘handicapped’ is so rampant that we have these debilitating movements and ‘de’advancement in MOHE and MOH.

    Like

  32. cosmetic surgery center of maryland jobs
    Jun 04, 2013 @ 02:15:23

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  33. wing wong
    Jul 04, 2013 @ 06:33:35

    Do those medical practioners already produced locally and will those to be produced have medical skills comparable with those of the foreign trained doctors?

    Like

  34. Dr Hsu
    Jul 04, 2013 @ 15:12:11

    wing wong
    When suddenly there is a mushrooming of medical schools, and not enough qualified medical eachers, and not enough beds in hospitals for the students to practice their art, what do you think will be the standard?

    Like

  35. confused
    Aug 13, 2013 @ 22:46:10

    Dear sir,
    I am planning to study medicine in malaysia but as i am an international student, i was told that i wont be able to do housemanship in malaysia. My home country also does not allow housemanship for those who graduated from a foreign university. Is it possible for me to get a houseman position elsewhere eg. UK or Australia after completing the 5 years here?

    Thanks in advance.

    Like

  36. Dr Hsu
    Aug 14, 2013 @ 15:30:55

    I dont think you can do housemanship in UK or Australia. Australia is facing shortage of housemanship positions for their own graduates.

    You can try Singapore nut not all medical shcools in Malaysia are recognised by SIngapore. You can write to their ministry of health to enquire.

    Like

  37. jayshree low
    Sep 26, 2014 @ 20:06:52

    Good evening sir. My name is Jayshree Low and I have an undying passion for medicine. I am currently doing my stpm. Regarding the current issue of Malaysia having too many medical graduates, from government, private and overseas universities, would it be a better choice to do my mbbs in a government university or to go abroad. Your attention to my question is deeply appreciated. Thank you sir.

    Like

  38. Dr Hsu
    Sep 27, 2014 @ 13:07:13

    Hi, jayshree,
    This post was written many years ago. We predicted that there would be too many doctors, and this is indeed the case now. The government has now realized this and has reduced the intake of medical students in a bid to stamp the glut. But already there are too many junior doctors. Specialists and consultants, however, are still short, especially with the mushrooming of private hospitals.

    As in your case, I can’t really comment since I don’t not know your financial background. Overseas medical courses are very expensive. There are still many good local medical schools provided if you can get into one of them.

    Like

  39. Ir Dino
    Dec 10, 2016 @ 21:29:25

    1) All other fields also have oversupply of graduates.
    2) Nowadays having degree is no longer enough. You have to be excel in your field. Otherwise you will be left behind.
    3) Limiting place to study is not a good idea. Again, be among the best in your profession.
    4) Patients are smarter nowadays since many information on medical is available online.
    5) Learn marketing techniques especially for private practice.
    6) Medical doctor can actually venture to other areas even finance and engineering but the first few years will be tough.
    7) Sorry to say this, medical professions are no longer very prestige nowadays (but still has “some” prestige).
    8) Luxury of pay. Professionals in other fields, many just making enough.
    9) Think of long term. Which way your long term route is.
    10) Good luck

    Like

  40. George Tan
    Feb 24, 2017 @ 12:39:08

    Dear Sir / Madam

    Please consider circulating this opinion, the aim is to inform people , and hopefully enable them to carefully consider medical studies

    Recently the news has reported that malaysia currently has too many private medical colleges, too many
    young doctors..

    Many new medical graduates now will have to wait many months , sometimes up to a year
    before they will get a contract housemanship job .

    Housemanship jobs will be given on contract for 3 years and then , subject to satisfactory completion of
    housemanship the young doctor , may get a 2 year contract to do the 2 years compulsory service which is required
    for full MMC registration,

    Unlike previously , permanent employment with the govt & the ministry will not be guaranteed, but based on
    performance appraisals , reports, and reccomendations by the DG Ministry of health

    Recently 1000 of 5000, housemen have been reported to, not complete their housemanship , going missing in action
    because, they were not interested in medicine but were forced to study by their parents, disillusioned by the hard work,
    long hours, because they couldn’t handle the stress of a medical job, as well as the the scolding from their seniors

    Also it has been reported that of those who finally complete their housemanship, about 30 % have repeat a posting
    or get an extension because of unsatisfactory performance

    In addition , the keen competition, low prospect of being able to specialise (only about 5-10%), limited prospects of
    private general practice ( recently reported widespread gp clinic difficulties and closures),and the hignly likely
    prospect of unemployment, or underemployment or or employment in a different /lower professional level or
    in a different industry , individuals wishing to study medicine shoulder consider

    1 Are you brilliant- as the health care industry is knowledge based, values problem solving a, requires innovation and improvisation
    the average individual could survive in the past , but may find difficulty nowadays, as only the fittest survive.
    The average person may take longer to learn, be more often scolded, victimised, sidelined , stressed out, burnt out

    2 Can you cope with dissappointment Are you a kind , compassionate character willing to help the troubled,
    willing to work for next to nothing , ready to to give the needy a free meal wnen? where required

    3 Is there a back up plan- eg willing to accept a lower status job , help work in a family buisness

    4 Never, Never , Never take a big loan to pay high fees you cannot afford , This is stressful , painful and cruel to your family,
    good potential ,brilliant people have had to abandon specialist training because of socioeconomic reasons

    5 Do not be misled by education agents , Make sure , make sure that your qualification will be recognised, in the
    country you wish to work in and you will qualify for residence requirements , and that you have a realistically, a
    reasonable chance of being given a chance to get medical officer position

    6 Choose a medical college which/ with
    -reasonable fees, run by established local Malaysian organisations eg UTAR, AMIST, Mannipal, IMU,Monash
    – with experienced ,clinically competent, and practicing staff with full time appointments,who can speak local languages

    7 Do not , Do not make the big , big mistake , Do not choose any medical college with/which
    – expensive fees , twinning programes linked to colleges overseas , or having preclicinal teaching overseas,
    – advertise , advertise excessively as excessive advertising chews up resources better used for teaching facilities eg library ,
    – charge fees of RM 500,000-00 but do not inform that the real cost , inclusive of the living expenses is about RM 1,200,000-00

    8 If in spite of the difficulties and difficult uncertain future of a medical career, you wish to study medicine then consider,
    a medical college with
    reasonable costs 250k – 350k
    recognised by Malaysian Medical Council
    full time academic staff , who have substantial track records in clinical service, teaching , research and publication

    9 Do not pay excessive amounts for medical college fees hoping that their degree is internationally recognised as claimed in adverts
    because the country you wish to get a job in may
    a) change the recognition , ie cease/ stop recognition of the degree in future eg as happened to one medical college
    b) not have a vacancy for a position at your stage of medical career , when you require one
    c) may only consider international medical graduates for temporary remote , rural jobs after which they need to pass difficult exams
    d) may only consider international medical graduates who qualify for permanent residence or citizenship

    10 Do not study medicine
    to emigrate
    become rich

    11 If a real internationally recognised programe desired , do the IMU partner medical school programe. Recently someone, graduated
    from a New Zweland University, through the IMU partner medical school [rograme, He could not get a housemanship job in NZ , but got
    one in S’Pore,

    Please feel free to edit or publish, Thank You

    Like

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