For Future Doctors: The Hurricane that finally came and sweeping through the nation……….Lately I have been slow in updating my blog as I have been extremely busy and travelling overseas quite frequently. As our children start to begin their university lives, our life changes as well! Yesterday I saw an interesting article in The Star which quoted Prof Adeeba, the Dean of UM Medical Faculty as saying […]
Lately I have been slow in updating my blog as I have been extremely busy and travelling overseas quite frequently. As our children start to begin their university lives, our life changes as well! Yesterday I saw an interesting article in The Star which quoted Prof Adeeba, the Dean of UM Medical Faculty as saying that medical graduates are not prepared for their job. The same article quoted that 30% of housemen do not complete their Housemanship in 2 years, according to Health Minister. Don’t these sound very familiar?
I have been talking about this for almost 10 years now, in fact longer than that, if you have read my MMA articles as way back as 2004. The above statement was made during the UM’s MEDxUM conference held in UM last weekend. I was actually invited to give a talk on bullying and harassment but unfortunately, the notice came late and I was not in the country last weekend.
For years I have been saying that medicine is not a “glamorous”, easy life and good money job! The public would like to think as such until they see their own child “suffering” after graduating. Then they blame everyone else except themselves. I am not saying that the system has no issues but every system in the world has issues. BUT being a doctor means you have to work and work to gain experience and further our studies. Our education do NOT stop after the 5 years MBBS degree. It goes on and on, till you go 6 feet underground, not to mention the number of exams we need to sit etc. It is a life long learning and our teachers are our patients.
Last week, our Minister said that Housemen can be called at any time to help out. Currently housemen working hours have been reduced to 60hrs per week compared to 70 hours before. Shift duties have been going on for few years now. But each hospital would have their own problems and as such every hospital would have their own rules and regulation. The priority is that, the service must run. Many people were unhappy with what the minister had said BUT service comes first. This rule does not apply for doctors alone. It applies to every single civil servant. Any civil servant can be called to duty at any time. During disasters etc, not only doctors are called but also police, bomba, welfare department etc. It is the duty of the government to make sure that the rakyat is taken care. That’s why you are called civil “servant”. You are a servant to the government and the people. The government(aka the people) pays you to take care of the “rakyat”. As a doctor, which you chose to be, your duty is to serve mankind. Isn’t that what most budding medical student would say during interview? Furthermore, the word “Houseofficer” actually means that the doctor stays IN THE HOUSE and is available at all times! That’s the reason it was mandatory for us to stay within the hospital compound during those days. Unfortunately, with increasing graduates, hospitals could not provide the necessary accomodation to all housemen and allowed them to stay elsewhere/home.
If you have pure passion for a profession, you will even do it for FREE! Unfortunately, along the way you will realise that life is more than that. You need to earn a living. You will need to serve your loan, children etc. When you are a student, all these are taken care by your parents and thus you are “stress free”. Reality hits you much later. As a doctor, you need to sacrifice a lot. Hours of work, spending little time with family and even “neglect” family members. The public do not understand all these till they have their own child in the system. Then they go on writing complain letters to the newspaper for their “adult” child who by right, should be able to take care of themselves!
More than 10 years ago I predicted that the time will come when doctors will have to wait in a “Q” for Housemanship, it will likely be given under contract and majority will eventually would not even get a civil service job. All these had surely and slowly come true. Many had emailed, messaged and even called me to say that all my prediction has come true. I have also met some junior doctors, Housemen who came to see me and had read my blog when they were students. They all admitted that every single word that I said about the system, life as a doctor, predictions were all on the dot! Some of them regretted doing medicine.
Next year will be another year to watch, as the first batch of contract doctors/housemen would be finishing their contract. Their contract started in December 2016 and would be completing their 3 years contract this year-end. Majority who had completed their housemanship had applied for a permanent post early this year but I was made to understand that they are yet to get any reply. Their contract can be extended for a maximum of 4 years to complete the compulsory service. Thus, by end of next year, we will know how many will still continue as a civil servant and how many would be left in the limbo. The 1st batch of Pharmacists contract ended end of last year and many were left without a job. Suddenly my hospital received tons of application for pharmacist when we only had 1 post to offer. The rough figure I was quoted was that only 30-50% of the doctors will be absorbed into civil service permanent post. These percentage would gradually decline later as more and more doctors are produced. Even those who get a government job, you can be sent anywhere in Malaysia. Either you take it or leave it! So, what will the rest do? Those from well to do family may end up opening a clinic. You may see a clinic in every other shop-lot by 2020, Wawasan 2020 achieved!
For those who are complaining, you should thank your lucky stars that you even have a job (under contract). Just bite the bullet and do it. Life is never easy and the world do not wait for you. The world is moving and changing daily. I even had some who are planning to return back to Malaysia from UK. They were told that ” tiada urusan pengambilan pada masa ini“. The problem is the fact that MOH do not even have enough post for those who are finishing housemanship in Malaysia, how are they going to provide a job for those who are returning from overseas? Obviously you will be at the bottom of their list and not their main problem. The MMC circular 2 years ago had already given a guideline for those who are returning from overseas. I had posted it in my blog in 2017.
I still have parents who believe that their child can work anywhere in the world with their local medical degree! I find it rather annoying at times. They just refuse to read or take advise and blame the system. Medicine is the most regulated profession in the world. Some countries still practice the “recognised degree” list and some have moved on to “common entry exam” format. MMC still uses the former. If your degree is not recognised in the country where you intend to practise, you need to sit and pass the entrance exam. These exams are not cheap and majority do not pass on 1st try. After spending huge amount of money, there is no guarantee that you will even get a job. Most who do get a job end up working in a rural/remote areas under a “non-training” post. Even Australia has closed their doors to foreign doctors who passed AMC exams. They do not provide internship anymore as they do not have enough post for their own graduates. However, if you have some years of working experience from your home country/elsewhere, you can try to apply for a supervised GP job. Even that rule is changing starting 11/03/2019 as below:
“Visas for GPs initiative
The Visas for GPs initiative will manage growth in Australia’s medical workforce by regulating the number of doctors entering Australia to work in the primary healthcare sector through the skilled migration program. The Visas for GPs initiative will commence on 11 March 2019.
All employers nominating a position that will be filled by a doctor who needs a visa to work in the Australian and New Zealand Standard Classification of Occupations (ANZSCO), occupations listed below will be required to obtain certification (a Health Workforce Certificate) from a Rural Workforce Agency (RWA). A Health Workforce Certificate is a letter issued by a RWA confirming the genuine need to fill a primary healthcare position at a given location in Australia by a doctor in the following three occupations:
- General Practitioner (ANZSCO 253111)
- Resident Medical Officer (ANZSCO 253112)
- Medical Practitioners not elsewhere classified (ANZSCO 253999).
Employers will be required to attach a Health Workforce Certificate to their nomination application for any of the following employer sponsored visas:
- Temporary Skill Shortage (subclass 482) visa
- Employer Nomination Scheme (subclass 186) visa
- Regional Sponsored Migration Scheme (subclass 187) visa.”
The idea is to reduce the number of overseas trained doctors for GPs by 200 yearly for the next 4 years. It is estimated that if they do not do as such, Australia will have an oversupply of 7000 doctors by 2030. Gone are the days when you can sit for AMC Part 1 and then go to Australia to work as a GP/MO before sitting for Part 2. And for those who think that you can sit for the FRACGP via the Academy of Family Physician of Malaysia and go to Australia to work, please be informed that the rules have changed from January 2019. Those who enrol into the program from 2019 will only receive icFRACGP(International Collaboration) and would NOT be registrable in Australia till you complete further modules. How these further modules will be conducted is not made known at the moment. Must you be employed in Australia under supervision or is it done online? If you need to be employed in Australia under supervision, then the above VISA rule will apply which also makes it more difficult as there would not be any FRACGP holders in remote areas to become your supervisor. Even for people like me who had worked 22 years as doctor and have been a specialist for 15 years, I cannot work in Australia as a specialist as my degree is not recognised! Even if I am assessed as “substantially comparable” by the Royal College of Physician of Australia, I need to find a job which can provide me with 2 peer reviewers to peer review me for 12 months before even being considered for specialist registration. To find such a job is almost impossible and you need to find it within 2 years of the assessment. Not to mention the amount of money you need to pay to do all the assessment!
So, for those who feel that spending Rm 300-500K locally would give them a job anywhere in the world, please understand that the world is changing rapidly. Even Singapore has reduced the number of intakes of foreign medical graduates since the last 2 years as they have their 3rd medical school producing graduates since 2017. Only UM and UKM degrees are recognised in Singapore and I heard many who applied the last 2 years never received an offer unlike 10 years ago when Singapore first recognised these degrees. BREXIT may also change some rules in UK.
I started with ” The Storm is coming…..” in 2011 and upgraded it to “Hurricane is coming…..” in 2012. The Hurricane is now sweeping through the nation and the world…………
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For Future Doctors: The Hurricane that finally came and sweeping through the nation……….
