Monday, May 07, 2007

Too Many Doctors in Malaysia?

Medical Tribune, issue 15-30 April 2007 featured an article by Simren Gill entitled, Doc surplus may cap future enrolment.

The projected surplus of 4,000 doctors by 2020 may warrant future governmental control over the enrolment of medical undergraduates, says a Malaysian Medical Council member. Dato’ Dr. Abdul Hamid Abdul Kadir said the MOH’s 2010 goal of one doctor per 600 population had already been exceeded in Kuala Lumpur, where the ratio now stood at one per 400.

He noted that when combined, the nine public and nine private local institutions, alongside foreign accredited ones, produced between 1,500 and 2,000 medical graduates every year.

“What is not in the equation is the quality of students at the point of [admission] and the quality of teaching,” he said, noting that dubious entry requirements were detrimental to the
healthcare system.

Abdul Hamid made these observations during the 5th ASEAN conference on Primary Healthcare held last month in Ipoh. Nationwide, the doctor population remains inadequate with 2005 statistics estimating a ratio of one doctor per 1,400 population. read more

It may be a low estimate that currently Malaysia are receiving 1,500-2,000 medical graduates annualy because there are no statistics on how many Malaysian students are studying medicine overseas. The number of medical students counted overseas are government scholars only. There do not seem to be any overall coordination between the Ministry of Health and the Malaysian Medical Council on what is the medical manpower requirement for the future. And if there is a projected surplus in 2020, should not action on enrolment be taken now? Every university, state and private foundations want to set up a medical school, and apparently they have no difficulty in obtaining the necessary permission. Even at this moment there are apparently not enough houseman posts for the local and returning medical graduates. With the recent changes in immigration laws in the United Kingdom, we shall be expecting more Malaysian medical graduates to return.

At the rate we are producing medical graduates, it will not be long before my experience in Jakarta becomes the norm here. In Jakarta, I was in a cab and the cab driver is a medical doctor. When asked why, he said, "Too many doctors, not enough jobs."

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Blogger doc said...

i don't think i'm alone when i suspect that we're overdoing the medical training. the MOH target of 1:600 is believed to be based on the canadian standard, which of course, is of a vastly different geographical /topographical landscape & a more advanced health system.

the quality is suspect, too. where do they recruit the lecturers? by pinching from the other med schools with attractive offers, & because there aren't enough teachers to begin with, the various departments are poorly staffed. can you produce good doctors with inadequate staffing? let's not get started with the student recruitment.

in the hurried pursuit to achieve vision 2020 or 2010, whatever that means, i think they missed the point altogether.

4:58 PM  
Blogger Bob K said...

I am more concerned about the disparity in the distribution of medical personnel and accessibility of medical care. With my level of income, I find myself hard pressed to find affordable health care in the Klang Valley. This is especially so when one considers the fact that there are only 3 public hospitals serving an estimated 2.5 million people.

Where I stay, the only hospitals within a 10 km radius are 2 privately owned entities. I don't know how long I can afford to pay for their services, esp. now that there are some complications with my wife's pregnancy.

6:17 PM  
Blogger Unknown said...

hi doc,

I agree fully with you with regards to the overproduction and the quality control. The MOH target needed to be revised. However, in spite of the many meetings, it is still NATO (No Action Talk Only).

Of particular concern to me and I am sure to you are the quality of the newly trained doctors. Malaysia is one of the few places in the world that I know of, that the brightest and the best leave government institutions for private practice. Most of these bright doctors will like to be in government institutions where cutting edge advances are made.

So who is left in the government hospitals to teach? There are teachers and there are teachers. Good teachers are rare. How do they staff their faculties? That is best not to know.

There are certain departments in general hospitals with 36 housemans! No matter how big a unit, 36 housemans are one too many. Can you imagine they going on call twice a month! What type of training are we talking about?

6:45 PM  
Blogger Unknown said...

Hi bob,

distribution and availability of healthcare resources is an issue worldwide.

This includes the rising cost of healthcare services. The rising cost is also directly related to patients' expectation. This is a vicious cycle that does not seem to have a viable solution.

Malaysia in actual fact has two healthcare systems. One is governmental and is heavily subsidised. You can see a doctor and get medication for RM 2.00 inclusive, and have an open heart surgery for RM 300. The other is the private healthcare system where you pay and you pay.

This is no way such a heavily subsided system can expand. Hence the lack of hospitals. And because it is cheap, it is overloaded with patients. Hence the quality of service goes down. Staff are overworked and they leave.

My advice to to buy insurance or join a company with good healthcare benefits.

6:57 PM  
Blogger LX said...

I don't think that we will ever have enough doctors as yet. I don't know about KL or West Msia, but where I come from (Sarawak), we really lack doctors in the GH. So you can see imported doctors ended up working as contract doctors. If we can produce enough medical graduates, we won't need them all. In polyclinics, we see medical assistants playing the role of doctors. If we had enough docs, why need M.A.'s?

Being a doctor isn't about earning money. It isn't about finishing that 3 years compulsory and then off for private practice to earn more $$. I feel that many medical grads want the fast way to pay off the 'debt' from their super duper expensive medical school fees. I don't blame them. Some to the extend of working overseas because they earn more so that they can earn back how much they spent getting the medical degree.

I do not deny that those 'cheap' medical degrees offered by some colleges or universities in poorer countries are starting to attract attention. No doubt some might say quality is poor. But ultimately, I believe it depends on the student himself. I have a close relative studying in a particular former Soviet Union. I believe that she really learnt alot.. it may be a different approach, but she is learning, no doubt. I believe she makes a good doctor in the future. But of course, there are some students there who aren't making the grades at all. One or two rotten eggs can spoil the enter basket, I suppose?

Btw, I realised you're the author of the book I bought from Glad Sounds.. hehe!! Nice to meet you on your blog :D

2:32 AM  
Blogger Unknown said...

Hi lynnx01,

Thanks for your comments. You have made a very good point. In Sarawak, Sabah, and many parts of rural Malaysia, there is a shortage of doctors. This is not because there is not enough doctors to go round but taht doctors do not want ot go there. That is why in the Klang valley, there is a surplus of 1:400. Therefore, increasing the student intake will not solve this particular problem.

My comments about doctors leaving for private practice is about career opportunities in government health services. Because of our country's majority affirmative action, many young, well trained ,ambitious doctors have no choice but to leave for private practice or remain frustrated. In spite of numerous Ministers of Health who simplified the reasons why there is a government brain drain, it is not because of money. Who will remain in government service if your junior are promoted above you, gets all the benefits, assess your performance, let you do all the work but receive exemplary awards, get to go overseas on scholarships and sponsorship, and get all the research grants?

You are right that the student is important. Bright and hard working students will do well anywhere. However, medicine is both an art and a science. Medicine traditionally is taught through an apprentice system. So mentors and school curriculum are important.

Many people think a doctor is a doctor, so what is the big deal. The big deal is that whether you are willing to bet your life on that statement.

Quality medical training is important and there is no substitute for that.

Interesting you bought one of my book. May I know which one? I will appreciate some feedback from you when you have finished read it.

12:56 PM  
Blogger LX said...

Now that you mention the promotion and the career prospect in the govt hospital, I think I understand now.

I bought Random Musings from a Doctor's Chair quite some time ago. Read it and now it's at home. I'm encouraged to see Malaysians writing and publishing. Always try to support by buying their books.

12:20 AM  
Blogger Unknown said...

Dear lynnx01,

I am glad that you got my point.

Thank you for supporting local or Malaysian writers. It is tough to be a local Malaysian writer. Still it is my prayer that there will be more Malaysian Christian writers.

12:30 AM  
Anonymous Anonymous said...

Excessive amounts of doctors will serve to dilute the power of the medical profession, as is obvious in countries like Italy and India. THe incompetence of the government in planning is well known and not at all surprising. Allowing more medical schools and giving more scholarships will give political mileage, and afterall, most politicians won't be around by 2020, so there will be no political will to curb the sudden surge of doctors.

My opinion is to increase training posts for post graduates in place of undergraduate traing. We should already have enough interns to insert cannulaes by now, but the insufficiency of specialist physicians and surgeons in the public sector is appaling.

But who cares.... It Malaysia.

10:11 AM  

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