Monday, May 16, 2011

For Future Doctors in Malaysia: General Misconception of being a doctor (Copy and Pasted)

November 11, 2010 by Pagalavan Letchumana

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

Next: Postgraduate training…………………

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 3)

Let’s look at the postgraduate training in Malaysia. I have written about housemanship, district/rural postings and problems of oversupply of doctors in the near future. The issue of oversupply of doctors by 2015 will lead to another very big issue: postgraduate training. Many of the budding doctors and medical students are not aware that the postgraduate training in Malaysia has many limitations and problems. At this point of time, most postgraduate trainings are dependent on Master’s programme conducted by the local universities. Once upon a time, we were totally dependent on UK-based exams and training but unfortunately we lost it along the way. Currently, only MRCP (UK) – Internal Medicine, MRCPCH (UK) – Paediatric and MRCOG (UK) can be done in Malaysia. FRCS (for surgeons) used to be available to Malaysians but not anymore. None of our hospitals are recognised as a training centre for FRCS, which is now known as MRCS. Thus, for any surgical field in Malaysia, you will need to do Master’s programme!

MRCP (UK) – Internal Medicine

Membership of the Royal College of Physicians (UK) is a well-known exam all over the whole. It has a very strong reputation as an entry exam for speciality training in UK as well as in other parts of the world. It is conducted regularly, usually 3 times a year in various countries. Malaysia is one of the centres for the MRCP exams, all 3 parts.

MRCP Part 1 can be taken about a year after your graduation. It is a theory paper. After passing your Part 1, you need to clear your Part 2 (written paper) and Part 3 (clinical) within 7 years. It is usually coordinated by University of Malaya, where the exams are usually held. Just for your info, the passing rate for MRCP (UK) is always around 45-50% worldwide! You need to have a proposer to sit for these exams, who can verify that you have undergone sufficient training to sit for the exam. If you fail miserably, your proposer will be notified.

Since MRCP (UK) is not a specialist exam in the UK, the Ministry of Health, Malaysia only recognises and gazette’s you as a specialist after undergoing further training of 18 months post MRCP (UK). You will need to submit a log book and recommendation by your HOD before being gazetted. This rule applies for all other overseas degrees which include MRCPCH and MRCOG. You need to undergo this gazettement process in order for you to be recognised as a Physician by the National Specialist Register (NSR).

MRCPCH (UK)

MRCPCH is similar to MRCP (UK) but meant for those who wants to become a Paediatrician. It‘s examination structure is similar to MRCP (UK).

MRCOG (UK)

MRCOG has 2 parts but the second part has both written and clinical component. However, you need to undergo training in O&G department for at least 4 years before being allowed to sit for Part 2 exams. One of the major issues in sitting for MRCOG is the fact that there are not many MRCOG holders in MOH to sign as a proposer for you!

Master’s programme

Now, this is where a big problem is going to appear soon. For all other fields, you are totally dependent on Master’s programme. This includes all surgical fields. Master’s programme is a fixed 4 year programme.

In order for you to be eligible to apply for the Master’s programme, you should have completed at least 3 years of service with good SKT marks of at least 85% and above, recommendation from Head of Department and confirmed in service. You also need to attend an exam or an interview before being selected for certain disciplines.

The major problem that I foresee in the future will be the number of places that are being offered. As of this year, the total number of places available is only 600, all disciplines included. Imagine, with 6000 new doctors coming into the market every year from now onwards, only 10% is going to get into the Master’s programme annually. Furthermore, you must understand that the selection process is never transparent, the typical Malaysian scenario as well as the quota system! Most of it is done by the Universities.

The government is planning to increase the number to 800 next year but the situation is rather critical in the Universities as there are not many Senior Professors to supervise the programme. I must say that the standard of Master’s graduates have dropped significantly over the last 5-10 years. We have Master’s graduates who can’t do surgery but have passed the exams! I just hope that the Master’s programme do not become another “specialists mill” like our undergraduate medical schools!

There are 2 types of Master’s programme, the open and closed system. In the closed system, you will do the entire 4 years within the university, like in UKM Hospital, UH and USM Hospital. The open system may have various programmes, like 2 years in MOH hospitals and another 2 years in the Universities etc. You may even do the entire 4 years in MOH hospitals for some of the fields.

After completing your Master’s programme, you need to undergo another 6 months of gazettement process before being recognised as a specialist. Furthermore, you will be bonded for 5-7 years for receiving scholarship during the programme, which is compulsory!

Subspecialty training

With the advancement in medical field, every discipline now has subspecialty training. As such, everyone will try to do certain subspecialty after gazettment as a specialist by MOH. Generally, the subspecialist training is about 3 years except for certain field like Cardiothoracic and Urology which may take 4 years. Again, whether you get a place or not depends on availability of post and demand for that particular field. For example, the waiting time for Gastroenterology training can even go as far as 1-2 years.

Recently, to overcome this major problem, MOH has taken another step backwards. You can only apply for subspecialty training 1 year after you have been gazetted as a specialist. For MRCP holders, this means 2 and half years after passing MRCP (UK)!

Usually, the subspecialty training is divided into 2 parts, the first part (the first 2 years) will be done locally and the 2nd part (remaining 1 year) will be done overseas. The MOH will provide a fully paid scholarship for overseas training of 1 year but you will be bonded for 3 years. If you have received undergraduate scholarship and Master’s scholarship, you will be bonded a total of 20 years in service!!

Singapore

One good advantage that we have is Singapore. Unfortunately, only UKM and UM undergraduate degrees are recognised in Singapore. Our Master’s degrees are NOT recognised elsewhere. Thus, we would not be able to work in Singapore with any other medical degrees or even with our Master’s degree.

However, Singapore does recognise MRCP, MRCPCH, MRCOG and MRCS. Thus, if you have any of these degrees, it supersedes the undergraduate degree and you should be able to get a job in Singapore. Singapore is also a recognised centre for MRCS Part 3 training, which you can’t do in Malaysia. So, if you have MRCS Part 1 & 2, you can go to Singapore to finish your MRCS training and sit for the Part 3.

I must say that Singapore’s postgraduate training is more structured and organised with their BST (Basic Specialist Training) and AST (Advanced Specialist Training) programmes. I have written about this in my MMA article “Back from the Future: From 1st world to 3rd world”.

For all of you out there; budding doctors, medical students, houseofficers and medical officers; the future is very bleak for the medical field in Malaysia. The oversupply of doctors will get to you sooner or later. My advice to those who insist on doing medicine for passion is to choose an undergraduate course that is recognised internationally. Then, pursue a postgraduate degree that is also recognised internationally. If not, you will end up with a lot of frustration in the future. Jobless doctors in the future will be a reality!


Friday, March 25, 2011

A New Start

Its been one and a half year since I last updated my blog. So I will briefly update about my current life to fill up the missing "spaces".

First of all, I'm kinda happy that I've completed my MUFY studies and got into the Monash University that I was aiming for since I started this foundation program. MUFY has been light and easy and time passes so fast that it ended before I could realize it. So far, its been pleasurable studying in Monash despite having a tight and packed life as I learn new stuff everyday and got inspired every now and then. I'm glad I've made a right decision to choose MBBS although I deviate a little before that as this is in fact what I'm longing for all this while.

The orientation week ( about 4 weeks ago >.<) have been an unforgettable experience to me. Located within a totally unfamiliar group, I found myself being weird and awkward. Introducing myself and knowing each other seem to be the "culture" of transition week until I got fed up with my own name. Later, with various of activities going on, our team start to know each other better and foster strong bonding between us (in fact we won 2 prizes during the transition camp xD) . I was impressed on how a bunch of total strangers could come so close together in merely 3 days 2 night period and become a team for the rest of the semester. Experience with the lecturers and our student guides are great too. They are being helpful in exposing us to the real world of medicine, the life long learning process.

The following weeks are filled with lectures, tutorial and discussions. Indulging myself in this tiring yet fun learning experience, there is some interesting events that I would like to highlight to share with all my blog readers ( if there are still some left >.<):

i) "The Super Size Me" movie. We actually watched this movie in our lecture theater during one of our tutorial session. The movie is about a perfectly fit young man self experimenting on himself by eating McDonald 3 meals a day continuously for a month. The effect is fascinating as we see the man's health dropped drastically over the period of time as well as increase in weight. The movie even showed us the surgical process they did on an obese man to remove the fat around his intestine and it is the grossest thing I've ever seen. So stop or reduce eating fast food as it really devastate our health. At least for me I will :p

ii)The Clinical Contact Visit. We were brought to one of the polyclinic in KL to observe how the doctors work and also to understand further the structure and facilities of the clinic. I expected the trip to be formal and reflective but what's surprising is that I actually witness a scene whereas the doctor that I'm observing was quarreling with her patients over the patient's health problems. She even refuse to talk to the patient after the quarrel. Personally, I think that it might due to her heavy workload and high work stress that overtime she loss her patience and temper or even her passion over her medical career. It makes me realize that certain doctors might lose their passion and dedication over time under the bad working conditions and certainly I hope that those "certain doctors" wouldn't be me one day.

iii) An Inspiring Talk by people with disability. Organized by our sociology lecturer, Dr Phua, we are honored to be given the chance to meet with these peoples in person and see things from their perspectives. It impress me a lot when I knew that one of those guest was disabled in the age of 20 when that's the peak of life for most of us and she accepted it with strong will and continue to live. Another guest which is born with William's Syndrome also gave me an insightful view of how talented a person can be despite of their learning disabilities as I see his hand dancing aross the keyboard followed by the sweet melody. It even impress me further when I know from his mother after the session that he learn by remembering the sound of the key on the keyboard and he could replay the song that he listen before without even knowing the notes. Pretty impressive for me ( who couldn't even play a single instrument properly >.<). It also reminds me of how determine and tough a person could be solely to continue to live. Its a shame that of us who is regarded as "normal" grumbles or even gave up life over tiny little matters whereas they never give up even tough they are continuously facing injustice, discomfort and difficulties in life. So, appreciate our life and always think of how fortunate we are. Don't take our body and mind for granted.

Amitofo and Bio-Psycho-Social xD

Wednesday, July 8, 2009

Memories Of The Hell

remember when I first came to labuan by speedboat accompanied by my dad... It feel like going to an isolated island @ @

But after 2 months living in KMheLL(that's what we used to call the college)...


I suddenly kinda miss my friends there,
although life suck there...

a whole week of orientation with packed schedule made us all totally exhausted as we hardly get any sleep that week...

fire drill during orientation week

but it had made me realised the importance of friendship as we supported each other during the hardtimes...

we shared each others' problems and helped each others...
eventough we live without Tv, internet ascess, newspaper and the worst of all sometimes no water supply z -.-


the 1st time we go outing, searching for pork to eat...

Going to kuliah together

and sleep xD

eat together

eventough it is not tasty

and found out that there are flies inside -.-


sharing our food with the cats there

cursed marigold together and ban it as I spit out some disgusting stuff from the marigold drink

yucks -.-


spotted one of our pensyarah's son wandering alone at the library

and kidnap him xD

blurred when looked at those super tiny word in the big oxford dictionary

watched the latest anime created by KMheLL student...


nah-runtuh!

don't know where to go when we wanna piss or shit as...

the toilet there are only for male who wear skirt >.<

and also cursed that cruel cat killer at our college... KNN CCB YOU!

video

walao you so like to throw cat why don't represent malaysia in olympic for lontar peluru??

Finally,To all my friends at KML, thank you for accompanying and supporting me for these two months...

Thank you and wish you all the best in your studies and hope we can meet again in future...

I will never forget the "sweet" memories we had together at KMheLL...

Kuching Gang xD
Librarian Gang

Saturday, May 23, 2009

Funny Things At Labuan

there are some things that I found very funny in Labuan....
one of them is the cartoons watched by their children on TV:

Gadis Berkuasapuff

Krayon Si-chan

And the toys played by their young children:

Babi Doll

And the most funny one:

“oi! where's my food?!!"
“Sabar ya... Nanti nanti...”

KNN no wonder I always end up empty stomach here la....
cause they never serve me my food.... they want me to sabar menanti -.-

Saturday, May 16, 2009

Internet Problem -.-

haiz... sad to say... at labuan here there is only 3 alphabets to say about its internet...
that is S.U.X
even with my celcom broadband....
even my 10-year-old desktop works better than the internet of the cyber cafe here...
can you imagine a cyber cafe with only 4 computers???
and the internet service they provide can't even sign you in your messenger??
haiz so this will be the last time I step in this CC (the place is posting this now)
so I will post about my life here after I'm back at Kuching (probably 18th July 2009 or earlier if my Jpa appeal is approved)
so hope to see all of you that time...
that's all for this time..
STOP LAGGING PLS~~~ POST!!


p.s : I didn't forget you all... just cant online due to the f*cking internet line here z.. anyway I'm fine here... wish all my friends the same also xD