Monday, August 20, 2007

Too Many Medical Graduates From Too Many Medical Schools

I wrote earlier about the present scene of too many medical schools, many with poor teaching staff producing questionable medical graduates. What are the implications of medical schools when some of them are degree mills which would be better off producing sausages rather than bad doctors?

It is obvious that the politicians see flooding the market with too many MBBS' as one way of controlling doctor's fees. A deluge of medical graduates also mean that there will be enough doctors to go around. How else can they hope to man all stations at public hospitals?

YB MOH has been quoted as saying that, "you doctors are so choosy as to where you wish to be posted. Very soon, you will be begging to work in any public hospitals". Alas, with so many medical schools, bringing out so many medical graduates, that statement may actually become true. What kind of doctors will these be? Are they safe? As a physician, we should first do no harm, even if we cannot do any good. Will these graduates from some of these "suspect" medical schools, do any harm? Will the VVIPs be happy to be treated by these medical graduates, or is there going to be one kind of doctors for the elites, and another kind for the common man-in-the-street?

Yes, having many GPs in any one location will bring down the fees charged and we call that "market forces", but do not forget that the same market forces, can also force the same GPs to "cheat" in order to survive. For example, in order to make ends meet, they may be forced to sell MCs, make false claims against insurance companies, sell psychotropics, maybe even peddle drugs, or sell nutritional products (ala direct sales pyramid schemes), just to survive. Note that I am not making excuses for the "badhats". However, the plain truth is churning out
large numbers of doctors of questionable quality exacerbates the problem and invariably will lead to an increase in badhats. This in turn will lead to legislation to counter badhats which will make it harder for the rest of us to practice good medicine.

Worse yet, if you couple the oversupply of medical doctors, of various quality, with an oversupply of lawyers in the country, then you can only have an oversupply of medical law suits. For those who don't know, law suits cost money even for good doctors when we have to pay to insure. Insurance shifts liability from the badhat to the masses. We suddenly see a most interesting thing called the "law of unintended consequences". Churning out doctors whatever the quality, to lower medical costs based on the law of supply and demand actually leads to higher costs. Suddenly YB MOH's plan to bring costs down has actually driven costs up.

This apart, we are presently also seeing the beginnings of medical graduates taking up non-medical duties, like becoming medical advisers to pharmaceuticals, and insurance companies. Soon, not too long from now, we may see doctors becoming physiotherapists, nurses, drug sales representatives, laboratory technologist, and other allied medical disciplines, so that as the standard of medical care falls, the standard of paramedical care will rise. If this trend continues, then there will eventually be less enrollees at medical schools. Then there will be some shortage of doctors for awhile, and the cycle continues.

In the end there doesn't a method to this madness we are undertaking. Of course, by that time I would have retired and so would YB MOH. The long term plan here seems to be to retire ahead of the game while the rakyat continues to suffer.

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