According to Senator Dr Lingeshwaran R. Arunasalam, this is a great opportunity to set the direction right again so that we can produce more specialists to meet the needs of the population and continue to deliver safe, timely, efficient, equitable, effective and patient-centric healthcare.
THE Parallel Pathway Programme (PPP) debacle and the inconsistency of the Malaysian Medical Council (MMC) with regards to the recognition of the specialists training programmes has been discomforting.
First, the country needs more specialists. The ratio of specialists per population does not lie. It is more critical for certain fields but there is an overall shortage.
According to a study by Dr Hirman Ismail, the Health Ministry’s (MOH) deputy director of medical development division, specialist doctors account for 40% to 60% of all doctors in developed countries such as Singapore, Japan, Canada, the United States, Australia and the UK.
Malaysia’s National Specialist Register shows 17,014 medical specialists registered here. The ministry’s 2023 Health Indicator booklet says there are 74,694 registered medical officers. This means only 22.8% are specialists, much lower than the developed countries and it is a huge gap to fill.
To narrow this gap and boost specialist training capacity, the ministry had launched the PPP to assist in training specialists, among others, in cardiothoracic surgery and urology, where for now, no university in Malaysia is recognised for by the MMC.
Mind you, there are only 14 cardiothoracic surgeons left in government hospitals serving a population of 32 million!
The programme is adapted from renowned colleges and universities like The Royal College of Physician and Surgeons in the UK, and has been around for a long time, training thousands of specialists from around the world, including Malaysia.
I am not aware of the intrinsic details of why the MMC does not recognise the programme. It does not make sense, more so when there is a dire shortage.
Last week, during his reply to my questions in Dewan Negara, Higher Education Minister Datuk Seri Zambry Abdul Kadir mentioned that local training university hospitals have only produced 7,935 specialists so far while the country needs 19,714 more by 2030. He concurred that the local Masters programmes and the PPP should be complementary and not in direct competition.
Zambry should be lauded for his commitment to assist the PPP, including pushing the government to amend the Medical Act 1971 to streamline the recognition process.
There is a huge gap to fill, especially in the area of family medicine specialists, as we shift our focus towards primary care as well as promotive and preventive care.
There is no doubt about the quality of specialists produced under our local Masters programmes. However, we should also welcome the PPP since most of the programmes will be run in partnership with internationally known medical training institutions, bringing a diversity of perspectives.
Healthcare will be affected if we fail to produce enough specialists. This will have a cascading effect of more complex cases, longer waiting times and delayed diagnosis and treatment. Insurance premiums will also be pricier as a result of higher cost for treatment and healthcare.
While the MMC is an important gatekeeper of the quality of our medical professionals, it should be more transparent in explaining how it arrives at certain decisions.
Every decision and consideration by the Medical Education Committee should be made public with the accompanying reasons and relevant dates. For post-graduate qualifications, decisions and considerations of the Specialty Subcommittee for Education should be made public too.
Following the recent PPP fiasco, we should really look into the Medical Act 1971 and review the MMC’s discretionary powers.
As a regulator and custodian of medical practice in Malaysia, the MMC has to play a just and balanced role.
Even the archaic way of electing council members, particularly postal votes, is not transparent.
The Health Minister should have the right to question the MMC’s decisions and appoint an independent committee comprising medical professionals to review any controversial decisions by MMC as a check and balance.
There is much work ahead.
This is a great opportunity to set the direction right again so that we can produce more specialists to meet the needs of the population and continue to deliver safe, timely, efficient, equitable, effective and patient-centric healthcare.
This article first appeared in Star Biz7 weekly edition.
