For Future Doctors: Finally, the Hurricane is leading to a Hartal………Frankly , you don’t need to be a rocket scientist to predict what I had predicted since 2006. It’s just simple mathematics and statistics. When I first started writing about the future of doctors in Malaysia in the MMA Magazine, I was brushed aside by MMA itself. No one took it seriously. In July and […]
Frankly , you don’t need to be a rocket scientist to predict what I had predicted since 2006. It’s just simple mathematics and statistics. When I first started writing about the future of doctors in Malaysia in the MMA Magazine, I was brushed aside by MMA itself. No one took it seriously. In July and November 2006, just before I left the civil service, I wrote my last 2 articles about the civil service doctor’s future. I started my blog in 2010 where I spent the most amount of time writing about the mushrooming of medical schools, quality of medical schools and the very likely scenario of future doctors: unemployment! I was again called by all kind of names by parents and students themselves. Well, all those are history now. My blog posts since 2010 are still available in this blog. I had never removed any of it and even the books I published in 2016 are still available.
Let’s come to the topic. There are various social media and news agencies highlighting the upcoming “Hartal” by contract doctors which is being scheduled on 26th July 2021. Meanwhile SCHOMOS is starting the “Code Black” campaign from 1st-12th July 2021 which will end on 12th July 2021 with Black Monday event. Many have asked for my comment. In August 2020, I had a discussion about contract doctors in DOBBS which was posted in this blog. On 17th April 2021, I gave a talk via Zoom to a group of medical students in UKM for the Career Progression workshop where I spoke about the current situation, how we reached this stage and what are the options for graduates, concentrating on foreign countries’ opportunities. It was an interesting discussion. Some of the slides I will reproduce below.
We must face the fact that we are producing just too many doctors. Poor planning and knee jerk reaction is the reason for this. You can read all these information from my blog post dating back to 2010. We have one of the highest number of medical schools per capita population in the world. Have a look at the slides below ……..
With our typical Malaysia Boleh style, we lead the world, on how to start a medical school in the shortest time possible. Quality? Who cares, we just need the numbers! It is just too fast too soon. Our government is always obsessed with numbers. Let’s look at the doctor’s figures below……
These figures are from our government’s statistics (MMC and MOH). As of 2019, we had achieved the ratio that the government always wanted (1: 400). Almost 50% of the 31 medical schools started to produce their graduates between 2011 and 2018. Fifty percent of that 50% only started to produce their graduates between 2014 and 2018. Basically, we have not even reached the peak yet! This is what I call planning human resource with your butt! We are producing close to 5000 graduates annually since the past 3 years and these figures will continue to increase till about 2023 before it stabilises. But look at the number of new health facilities built since 2010? On paper, we have enough doctors, the issue is maldistribution ( I have written about this many times before) and the healthcare system.
Now, did the government ever promised you a job? The answer is NO. No government in the world promises you a job. These goes to all other profession as well. Do the government stop producing engineers just because engineers are jobless? Obviously NO. However, Malaysia is a unique country. Instead of investing in public universities , we started private universities since 1996. Once education is made into a business, 3 scenarios will happen: mushrooming of poor quality education centres, low quality graduates and mass production. These universities do not give a damn whether there are job markets for their graduates. They are just degree mills and profit driven. The government can only control the public universities intake(which is hardly done) but private universities are driven by market force. Few years ago, MOE did reduce the intake of medical students into public universities which I feel is the dumbest thing to do. It should be the opposite but hey, who do you think are the board of directors of these private universities?
Almost in all developed countries, doctors work on contract basis. Malaysians are just not used to it. The main problem is the fact that we are still stuck in a civil service system which was left behind by the British. Most countries have already restructured their civil service into a contract based system, including the British. The old permanent civil service system and pension system is not sustainable. It is a huge burden to the financial coffers of a country. Remember, for every permanent post created, the burden is not just the salary you are guaranteed of receiving till the age of 60 (aka 35 years with increment and promotion) but also the life long pension that you will get after that, which your spouse will continue to receive after your passing. If you have a 2nd wife , she will also continue to receive 70% of your pension till she gets remarried or dies! Imagine if your wife or second wife is 20 years younger than you! Thus, it is a huge financial burden to the country which may even bankrupt a nation, similar to what happened to Greece few years ago.
Basically, what I am saying is that the government will never be able to create 5000 post annually. It is simply not possible. Based on what the Minister had said, out of about 23 000 contract doctors since December 2016(when it was first introduced) only 789 received permanent post after completing their 1st 3 year contract. Even if against all odds, the government agrees to create 22000 post to absorb all these contract doctors into permanent position, it will be, as usual a knee jerk reaction to satisfy the masses due to COVID. The next question will be on where these posts will be located and whether these doctors will be willing to go there.
Unfortunately, medicine is once again a unique profession. Our training and education does not stop after graduation. It goes on and on with various laws and regulation governing us. I am very sure not all of those 23 000 contract doctors planned to stay in civil service after completing their compulsory service. I have already heard many who had resigned after the 3 year contract and MMC even allowed them to be released before they completed their 4 years compulsory service (less than 1 year short).Some did not even take up the extended 2 years contract. Some left to overseas whenever possible (not to say it is greener out there). The problem with our healthcare system is the fact that specialisation can only be done in KKM hospitals and the local Master’s program. Parallel pathways are available but the training can only be done in KKM hospitals till you are gazetted as a specialist. Private hospitals are simply not suitable for this except for some big tertiary private hospitals but, would the patients allow trainees to treat them?This training process will easily take about 5-10 years depending on whether you want to pursue the subspeciality program. As for our local Master’s program, at the moment, this is only open for KKM staffs who are holding a permanent post (as HLP is only for permanent staffs). Of course you can still enroll as a private candidate and pay the full fee which may be in the range of RM50K/year. While the number of slots for private candidates may be small currently, if the contract system continues, it will likely increase.
I believe the contract system is here to stay. We just have to get used to it. At least you are given the opportunity to complete your housemanship, receive your full registration and complete your compulsory service. You would still have a job for at least the first 5 years. I understand that the 1st batch of contract doctors who started in December 2016 and did not receive permanent post, who are scheduled to complete their extended contract in December 2021 are being promised that their contract will be extended another year. The real problem is for those who want to continue to specialise. Other options are university hospitals and military hospitals.
The entire healthcare system has to be revamped. We have to move on to a more sustainable system. Like many other countries, I believe eventually all doctors will be hired on contract basis. This means that the government employs based on need except for the guaranteed first 3 year contract. Nothing is permanent. You need to reapply for a new contract whenever the previous contract comes to an end (this is how it is done in other countries). However, the way a person is recruited and trained to become a specialist has to change. Both Master’s system and the parallel pathway have to be merged into a single training system under a single body (academic colleges?). Those who wants to do any basic specialist training have to apply directly to this body before their 1st 3 year contract ends. If you are accepted into the training program then your chances of extending the contract till you graduate is almost certain. However, you need to pay whatever training and exam fees needed, by yourself.
What is the purpose for this Hartal? If it is to ask the government to absorb everyone into permanent post, than I feel it is NOT going to happen. It is not the long term solution. If it is to threaten the government, then it is also not going to work as the government never promised you a job anyway. If you think the public is going to support you, rest assured it will not happen (except your family members)! The public will only consider you as a selfish group of people. There are many people out there who have lost their jobs during this pandemic (commiting suicide) and here we have a group of doctors who are earning monthly salary and demanding to be absorbed into permanent jobs and endangering public’s life, if it is really going to be a proper strike. The public will never treat you as someone special. Trust me!
My opinion is to have a complete restructuring of the healthcare system to enable doctors who are interested in specialisation to remain on contract till they complete their training and gazetted as a specialist and continue till they decide to leave. I believe the way forward is to abolish permanent system and only go by contract system with full transparency in selection. Individual hospitals should be given full right to recruit the contract doctors and also determine their workforce numbers. Unfortunately, the word “transparency” do not exist in our government dictionary as you would have noticed from our controversial Minister’s reply letter. As I have said many times before since 2010, the days of guaranteed job for medical graduates is all OVER. Doctors, like any other profession have to find their own way. In Australia, there are consultants who do not have a full time job and ALL medical jobs are given on contract basis, between 3-5 years duration. No one complains as they are simply, used to it!
Stay Safe…………………..
Source:
For Future Doctors: Finally, the Hurricane is leading to a Hartal………
