Dilemma of training young doctors
Many
young people want to become doctors, whether of their own volition or at the
behest of their parents.
High
academic qualifications are the sole criteria for admission to local medical
schools in Malaysia, though there are an increasing number of medical schools
that require passing an aptitude assessment as well.
Although
the minimum academic qualifications for entry into local medical schools are
prescribed, there are still isolated claims of non-compliance by some private
medical schools.
There
are also claims that some private medical schools take in more students than
permitted.
The
situation in foreign medical schools is varied. Medical schools in developed
economies adhere strictly to high academic qualifications and aptitude
assessments of the applicants.
However,
certain medical schools in some developing countries admit students whose
academic qualifications would not even qualify them to enter a local university
for courses with lesser entry requirements than Medicine.
Many
such students gain entry through the agencies of these medical schools.
I
wrote in 2011 that “There will have to be 5,000 to 7,000 Medical Officer posts
in the public sector available annually within the next five years for the
young doctors after completion of their housemanship training, and after that
it will be anybody’s guess.
“There
will be no employment problems for doctors of good quality, but the prospect of
unemployment is a possibility for the mediocre, and possibly, some of the
average ones. (Quality first, not quantity, Fit4Life, January 9, 2011).
There
is increasing concern about the variation in the quality of doctors entering
the workforce.
The
reasons are related to the curriculum, training and clinical exposure in
medical schools, as well as the doctors’ values and respect for a multi-ethnic,
multi-cultural and multi-religious population.
Both
these factors impact on patient safety and the future of medical practice.
According
to the World Health Organization, the likelihood of harm in air travel is more
than one in 1,000,000, one in 300 during healthcare, and one in 10 in hospital
care in developed countries.
Until
the year 2000, there were 11 local medical schools – six public and five
private entities. Today, there are 32 medical schools – 11 public and 21
private.
This
compares with 17 and 20 medical schools in Canada and Australia respectively,
both countries with similar populations to Malaysia.
A
significant number of the new local medical schools commenced operations in
2008-2009. One private medical school ceased operations in 2015.
There
were about 18,700 students in local medical schools in 2014 – about 7,600 in
public and 11,100 in private medical schools.
The
number of graduates from local medical schools is projected to increase from
about 3,250 in 2016 to just under 4,500 in 2019, with the increase due to
private medical schools.
In
addition, it has been estimated that there is a similar number of Malaysian
students in foreign medical schools.
Most
of these students are studying in foreign medical schools that are recognised
by the Malaysian Medical Council, but some are not. Many are on scholarships
from government or quasi-governmental agencies.
There
are about 350 qualifications from medical schools listed in the 2nd Schedule of
the Medical Act that are recognised. The Schedule was inherited from colonial
times, with qualifications added to it over the years.
If
all graduates from foreign medical schools return to Malaysia, the doctor
population will be double and treble the current number by the year 2020 and
2025 respectively.
The
number of beds in Health Ministry (MOH) hospitals is about 37,000.
Based
on the ratio of one medical student to five hospital beds, MOH hospitals can
only cater for about 7,400 medical students in their clinical years.
Yet
in 2014, there were about 10,000 such students, a mismatch that inevitably
impacts on the quality of training. This mismatch is likely to worsen in the
next five years and beyond.
The
housemanship was increased from one to two years in 2008 consequent to
complaints about the competence of a significant number of housemen.
Despite
that, there is still a significant percentage of doctors who are unable to
complete their housemanship in two years because of competence and/or attitude
issues.
The
number of houseman posts in the MOH is limited by the Public Services
Commission.
With
the marked increase in the number of provisional registrations and the
inability of some doctors to complete their training in two years, a backlog
has resulted, with a waiting time of six or more months for houseman posts.
The
backlog will impact significantly on a young doctor’s skills, knowledge and
attitude, as well as financially, for many.
Healthcare
facilities in neighbouring countries have been offering housemanship training
posts to the top final year students of public universities.
Faced
with uncertainty, the decisions of our young men and women is obvious, thereby
contributing to a brain drain; a loss which is not beneficial to the country.
Dr
Milton Lum is a past president of the Federation of Private Medical
Practitioners Associations and the Malaysian Medical Association. The views
expressed do not represent that of any organisation he is associated with. The
information provided is for educational and communication purposes only and it
should not be construed as personal medical advice. Information published in
this article is not intended to replace, supplant or augment a consultation
with a health professional regarding the reader’s own medical care. The
Star disclaims all responsibility for any losses, damage to property
or personal injury suffered directly or indirectly from reliance on such
information.
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