The Parallel Pathway vs Master’s War: Clash of the Titans Part 2In March 2007, I wrote an article in MMA Magazine with almost similar title (Academician vs Service providers: Clash of the titans). Seventeen years later, we have not moved on. The heated argument in open media regarding the Cardiothoracic parallel pathway has yet again opened the Pandora’s box. Universities on one side, KKM on another […]
In March 2007, I wrote an article in MMA Magazine with almost similar title (Academician vs Service providers: Clash of the titans). Seventeen years later, we have not moved on. The heated argument in open media regarding the Cardiothoracic parallel pathway has yet again opened the Pandora’s box. Universities on one side, KKM on another side with MMC in the middle. At the end, the “rakyat” will become the sardines!
I thought of writing this piece to explain how all this evolved through time. Why we are in this mess and why, forever this will never be solved………….
Warta Kerajaan
Till 2017, Malaysia never had a legal body to recognise who is a specialist. Since independence, all specialists were trained in KKM hospitals and, what is now known as parallel pathway was the only way for someone to become a specialist till the master’s program was started in mid 1970s. Many will fly to UK to sit for the exams which include MRCP, MRCOG, FRCS etc. Medical training has always been an apprenticeship form of training system.
The DG of health, under the General Order(GO) was the only person who had the right to declare someone as a specialist. This is done via Warta Kerajaan. Once you complete your gazettement process, you need to apply to DG of KKM to be gazetted as a specialist. An example of warta kerajaan is as below:
Once you are declared a specialist, you are entitled for specialist allowance. However, if you leave KKM before you are gazetted, there is no law to say that you can’t call yourself as a specialist in private. In fact, I know many doctors/friends who left KKM immediately after passing MRCP and called themselves as a specialist in private hospitals till today. In mid 2000s, there was also an issue with specialist trained in University hospitals where JPA ordered all gazettement done by MOE to be revoked and a new application must be done to DG of KKM to be gazetted as a specialist. Remember, this also applied to Master’s graduates who have to undergo 6 months gazettement period.
What happened in 2006
By mid 2000, there were plans to amend the Medical Act 1971. One of the main amendments were to include a specialist registry, an official body to recognise someone as a specialist. While the legal process was taking place, the then DG of Health in collaboration with Academy of Medicine, started the National Specialist Register(NSR) in 2006. Every specialist was encouraged to register themselves with the registry for a fee. NSR formed many subcommittees to investigate each application and speciality to ascertain whether they can be registered as a specialist. However, there was no legal requirement for any specialist to do so.
By 2012, UKAPS had advised all private hospitals to make sure their specialists are registered with NSR for the hospital’s license renewal.
What happened in 2012 and 2017
In 2012, finally the amendment of Medical Act 1971 was passed in Parliament, and it is now known as Amended Medical Act 2012. Some of the changes added to the medical act was as below:
It took another 5 years before this amendment came into force (usual Malaysia Boleh style!). On 1st July 2017, the amended medical act came into force and the NSR officially became a legal body of specialist register. Academy of Medicine then handed over the registry to MMC. MMC is now the legal guardian of the NSR.
What DID NOT happen!
The first and foremost issue that should have been sorted way back in 1970s and 1980s was the training system. Malaysia is a unique country when it comes to medical specialist training system. We have the KKM apprentice training system where most specialists are trained and the local Master’s programme conducted by the universities. It is 2 separate parallel system and that’s why the KKM’s training system was later redesigned as Parallel pathway despite being older than the Master’s programme. It should have been the other way round, but politics plays an important role as well.
Both these systems were never unified. Unlike many developed countries where the specialist training system is conducted by a separate entity like colleges etc, this never happened in Malaysia. Even countries like India, Pakistan and Arab countries have a more unified system than us. I was informed many years ago that the reason for this is pure politics!
There were attempts to unify these 2 systems in late 2010s when Prof Abeeba started the National postgraduate curriculum program to standardise the training system. This curriculum supposed to be used by both the Master’s program and the KKM training system. My understanding is that some element of this has already been implemented by KKM since 2017. However, the question is, who accreditates the KKM program, supervisors etc. Running a program is more than just having a curriculum, logbook and hospitals. In this sense, the Master’s program is more structured and accredited compared to parallel pathway, not to say the quality is better at all times. I have written about this many years ago in this blog.
Let’s come to the 2nd issue. When the medical act was amended in 2012 and the above clauses were included, no one knew what the role of KKM is, in gazetting a specialist anymore. I remember raising this issue many years ago in one of my blog posting. When NSR becomes legal, it is the only body who recognises a doctor as a specialist according to the Medical Act 2012. So, DG of Health gazettement under the GO is invalid? Another confusion has now been created.
When the act came into force in 2017, I remember the Minister of Health asked all KKM specialist to register with NSR as it has become mandatory. He even said that the paid fee can be claimed from KKM. A circular was issued and I have written(with the circular) about it here: https://pagalavan.com/2017/08/13/for-future-doctors-the-new-rules-and-regulations-for-better-or-worst/
I raised these issues many times with senior colleagues in KKM then. So, you are a specialist only when your name is in the NSR, so what is the point of doing gazettement in KKM with warta kerajaan anymore? Shouldn’t the application go directly to NSR for recognition as a specialist? KKM gazettes a Master’s graduate as a specialist in 6 months but NSR says must be 1-2 years post-graduation depending on the speciality. So, which one to follow? According to the Medical Act 2012 as above, you can’t call yourself as a specialist if your name is not in NSR and disciplinary action can be taken. Does that mean you have immunity if you work in KKM?
What a mess have we got ourselves into? Does anybody ever think about all these issues before amending an Act? Or is this similar to Private Healthcare Facilities and Services Act (PHFSA)? One rule for me and another rule for private sector? This is exactly what is happening now. KKM says that it will gazette those who had completed the Cardiothoracic parallel pathway as specialist in KKM but MMC/NSR says no. So, is KKM committing a crime? Would the candidates be taken disciplinary action for calling themselves as a cardiothoracic surgeon? Section 14 of the amended Medical Act 2012 is so vague, and that is why our Minister is proposing to amend the act as soon as possible. But I got no idea what the amendment is all about. What does recognised training institutions means(Section 14B(b))? Is KKM a recognised training institutions? Technically KKM is not an institution.
Similar issues have now cropped up for MRCGP(Ireland) and icFRACGP programmes from what I gather. All these issues would not have happened if ONLY someone had the brains to unify all specialist training programmes, way back in 1970s or 80s and to have a single legal entity to recognise a specialist. And this legal entity should assess each degree on case by case basis rather than just saying, we don’t recognise your degree collectively. This is what most countries do and they have proper system in place to assess and license such candidates. Unfortunately, in Malaysia the civil service rules are different than the rules for others. We never had equality in whatever we do. Rules for thee and not for me……..
Whatever it is, what we are watching is just the tip of the iceberg. There is more than meets the eye in this entire saga. It all boils down to POLITICS! A war between UiTM and KKM! or should I spill the beans…….
Next……… PHEIA 1996/LAN 1996/MQA 2007and MMC partnership mess……….
Source:
The Parallel Pathway vs Master’s War: Clash of the Titans Part 2
