Why Sabah rurals lack medical care if docs in oversupply?
Published on: Sunday, March 08, 2020
By: Disillusioned Malaysian Doctor
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Till today Malaysia has not reached the ideal doctor to patient ratio, 1:400. Currently, the ratio seems to stand at 1:625 (based on the Health Ministry’s 2017 data of 1.6:1,000).
In practical terms, if we have an oversupply of doctors, why do people still have to travel by foot and boat and on treacherous journeys just to get to a hospital in the interior of states like Sabah and Sarawak? Try telling those people about the oversupply of doctors and they will gladly ask for doctors to be sent to their villages.
There was a research paper published recently in Australia (available online at bit.ly/docs_supply) which states that an oversupply of doctors has advantages related to: (1) improvements in the quality of clinical medical care; (2) a renewed emphasis on preventive medical care; (3) a more equitable, need-related distribution of doctors; (4) the ability of doctors to participate in regular professional up-grading programmes; and, (5) an increased capacity to participate in aid programmes within the South-East Asia region.
Right now, all complaints are due to the limited number of places for housemanship training. Previously, we claimed that doctors were not properly trained and thus had to serve housemanship in government hospitals, and extended the time to two years and even increased the medical officer (MO) years too. All this was done under the guise of training to have doctors serve with the government for a minimum of four to five years so there would be enough doctors to man wards.
Other countries allow doctors to have a choice upon graduating of either (1) working with the government, or (2) in private practice under supervision or (3) starting their residency to work towards a medical specialisation. Why don’t we consider that? Until there is more infrastructure built, the stagnation of houseman and medical officers will continue to take place.
This is what the Medical Act (1971) says in Part III, 13 (2): “The provisionally registered person shall engage in employment in a resident medical capacity to the satisfaction of the Medical Qualifying Board for a period of not less than one year in any hospital or institution in Malaysia which is approved by the said Board for the purpose of such employment; four months of such period shall be spent in a resident surgical post, four months in a resident medical post and four months in a resident obstetrical and gynaecological post.” So let all medical graduates train in the three departments mentioned above in both government and private hospitals. This will immediately reduce the bottleneck in doctors waiting to begin their housemanship.
I’m sure big private hospitals will be glad to have these doctors to ease their workload and train them up. Just like lawyers undergoing chambering in private law firms, why can’t junior doctors be trained in private hospitals? Why are we still insisting on housemanship only in government hospitals? The Malaysian Medical Council can easily approve private hospitals for such a task. After doing the training in private hospitals, let those who would like to join the government service apply for medical officer posts in rural areas with a bigger cost of living allowance to encourage them.
We could even go a step further and allow those who have passed international exams like the Australian Medical Council exams, Britain’s PLAB exams, the US USMLE and Canadian Exams to forego the housemanship part of the Medical Act and either work under the supervision of a General Practitioner (GP) or start their specialist training immediately.
The Health Minister has the power under Article 12.(1)(a)(ii) to do so. These are world renowned exams – the Australian Medical Council exam is known as being one of, if not the toughest medical exam in the world. But right now we don’t even take into consideration these exams and thus we allow a brain drain to take place (and hope this brain drain will reduce the number of doctors in the country)!
For those who have proven themselves with such external exams, let’s fast track their wish to become GPs and specialists and not hold them back. If they desire a government job with a lifetime pension, then let’s allow these doctors to apply immediately to become MOs in government service. Those who would like a career in the private sector, let’s enable the private sector to vet and train them. This would be a win-win situation for all.
This will motivate young people to sit for those expensive and tough exams to receive the benefit of a fasttracked career pathway without housemanship but with supervision in their future roles as GPs, MOs and residents.
Let’s not moan that we don’t have enough places to train housemen and MOs anymore but find new solutions by treating all equally and not insisting that the training must be done exclusively in government hospitals anymore.
Those who want to lecture or work in the research and pharmaceutical industries should be allowed to do so without forcing them to have an Annual Practicing Certificate (APC). It boggles my mind that the pharmaceutical industry still insists on the APC to secure a job when the jobs do not require interaction with patients. The MMC can have a separate registration for doctors who do not need a valid APC to work.
Being a democratic country, we should practice democracy in all institutions. For instance, all members of the Malaysian Bar Council are elected – yet we have two-thirds (21 members) of the MMC appointed from various universities.
Only when all members are elected will they work towards making changes that are beneficial to doctors. If they know that they can be voted out in the next round of elections, they will immediately buck up and start thinking outside the box and making relevant changes that will ensure our medical sector is not only a thriving healthcare industry for the Malaysian public but also an income generator for the post 2020 economy.
While these might seem like radical new ideas, they are all already practiced in other countries without major problems. Will the government have the moral and political fortitude to implement these changes and put an end to the malaise in the present system? I’m sure everyone is fed up having to wait nearly half a day at government hospitals and being told there are not enough doctors while the medical associations moan that there are too many doctors and not enough places to train them in.
It’s time to change our set ways of thinking.
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