Friday, December 18, 2009


This piece was written for the STAR. Lets see if they will publish, and when.

Recently, there have been much concerned expressed in the mass media about the many medical schools and the concern about the quality of healthcare in our country. It is very worrying when politicians use medical schools as an incentive for votes, oblivious to the effects that too many medical school will have on the healthcare standards in the country. A politician goes on an overseas trip and duely announces the setting up of a medical school. Is this wise?

It is important to note that there are already, at the last count, 22 medical schools up and running in Malaysia, a country of 27 million people. Each year, about 4 thousand medical graduate enter the job market. Because medical school is very much a theoretical course, these 4,000 new medical graduates need to undergo “housemanship “. When I graduated, we were on “ houseman “ night duty, every other night, so we get to clerk and take care ( first hand ) many, many patients. Now, with 4 thousand medical graduates entering the job market, there are not enough patients in government hospitals for all these new medical graduates to get houseman post for training. I hear that houseman nowadays go on call like once a week and they have to share patient with their fellow houseman in the wards. Because of this ( too many housemen ), the housemen are found to be inadequately trained. They have not been adequately exposed to enough patients, so the ministry of Health has decided that housemenship should now be two years. That means that the government hospitals now have 8 thousand housemen, trying to train. Obviously, this will mean that double the number will only get half the already inadequate exposure. Resulting in very poorly trained housemen and eventually medical officers. We hear of medical officers who are unable to make diagnosis, or deal with emergencies, or do simple procedures like central line insertions.

So also nursing training and paramedical training. It is so commercialised that you pay your tuition fees and get a certificate at the end. Supervision and training materials and trainers are limited, so the trainees just memorize facts, sit for an exam and hopefully pass. It is so commercialise that graduates cannot perform when they are out in the real world.

So we now have poorly trained medical officers, houseman, nurses, paramedics.

Even the standard of medical specialist in this country have been subjected to “ political standards “. There are many specialist out there who cannot interprete common Xrays and ECGs.

Of course the off quoted reason is that there are not enough doctors in the country. But this is simply not true. There is a severe mal-distribution of doctors. All doctors, upon completing their training, they all gravitate to work in public hospitals in the urban centres, or set up centers in the urban centers, resulting in urban centres having a doctor-patient ratio is about 1:390. Whereas in the areas, less doctors volunteer to go, and also some states in Malaysia have local rules which bar doctors from practicing, unless they are given exemptions. Therefore, it is true that in some rural areas, the doctor patient ratio could be 1: 4,000 ( partly by design ). It would be good if we can have a doctor patient ratio of 1: 1,000 – 2,000 like some developed countries, and evenly distributed. Towards this end, we actually suggested to the ministry of Health, many years ago, to issue doctors with a certificate of need, so that they can save in areas of need, to even out the mal-distribution of doctors.

We are very concern and wish to ask the governments and politicians not to commercialise and politicize medical schools. Doctors must be adequately trained to care for patients. It is a noble profession and we wish that the politicians will allow it to remain so. Please stop the mass production of doctors and improve medical care for the rakyat.


pilocarpine said...

1malaysia clinic is using only MAs n nurses only.

do our healthcare system still need doctors?

with the growing numbers of inadequate doctors, the good ones will be affected as well.

dHarjma said...

I find it amusing we are actually worried that we have "too many" doctors graduating. a simple way to utilize all this manpower is simple: stringent common qualifying exam for doctors to become houseman.

in harvard there are graduates from the university of bombay, university of zimbabwe etc. they would never be given a chance to practice here, or in singapore for example. but americans true to their nature of being able to snatch a good deal when they see one, lap the overqualified and good ones up, and churn them into highly productive academicians. they then make it worth it for them to stay.

with regards to redistribution to needed areas, malaysia isnt unique with regards to this. in countries like norway, serving close to the north pole is very unattractive, but the government makes it worth it so much so people compete to try and serves this areas.

many of our country's medical manpower problems are not unique by any means. we just need to look beyond our shores for solutions.