The Malaysian Medical Council (MMC) is a corporate body established under the Medical Act 1971 (amended 2012) with two functions: to register medical practitioners and to regulate the practice of medicine in Malaysia.
The Medical Register comprises three sections: Provisional, Full and Specialist.
The regulation of the practice of medicine involves the regulation of the professional conduct and ethics of registered medical practitioners.
The MMC exercises its disciplinary jurisdiction under the Medical Act when there is proven contravention of the MMC’s Code of Professional Conduct, guidelines and directives.
The Council has been mired in controversy in the past few months, raising serious questions about its administration.
Membership conditions
All MMC members have to be Malaysian medical practitioners holding a current annual practising certificate (APC).
This is stated clearly in section 3A(2) of the Act: “No person shall be appointed to be a member under paragraph (1)(b), (c) or (d), or elected as a member under paragraph (1)(e), (f) or (g), unless the person is a citizen of Malaysia and holds a current and valid practising certificate.”
An allegation was made in a local news portal on June 20 (2024), that some MMC members did not have an APC, following a search of the MMC’s Medical Register Information and Technical System (Merits).
It was pointed out on June 21 (2024) that the MMC had updated the APCs of its members with one exception.
As of July 5 (2024), there was no response from the MMC as to the substance of the allegation made.
It could be inferred from the MMC’s silence that there were possible grains of truth to the serious allegation that some of its members had no APCs at that time.
It is the individual responsibility of a registered medical practitioner to apply for an APC.
However, the question arises as to whether the MMC administration informed the Council of the APC status of its members, as it is only the administration that has access to Merits.
Who is responsible for this? MMC, its administration or both?
Corporate practice requires every decision-maker to have locus standi.
When even one MMC member has no APC, it raises the question of whether the MMC was properly constituted under the Act.
It also raises the question of the validity of the decisions made by the Council when one of its members had no APC.
Other fundamental questions that have to be addressed include:
- When did the contravention of section 3A(2) occur?
- Has the contravention been rectified, and if so, when?
- What is the legal status of the registered medical practitioners involved vis-a-vis their membership of MMC?
- What decisions were made by the MMC when some of its “members” had no APC?
- What steps have been taken to rectify this messy situation?
No head
A chief executive officer of any organisation is responsible for its efficiency and effectiveness in ensuring the achievement of outcomes related to the organisation’s mission.
The MMC’s CEO is appointed by the President after consulting the Council.
The duties and responsibilities of the CEO are spelt out in section 4C of the Medical Act.
The MMC has to comply with the Public Services Department guidelines for staff appointments in statutory bodies, including that of CEO.
Currently, the Council has been without a CEO for more than a year.
The MMC held at least two interviews for this position last year (2023).
What happened? Were the applicants unsuitable?
What factors were considered by the interview panel?
Did they include qualifications, experience, gender, etc, or were there other factors?
The current acting CEO was only fully registered with the MMC in August 2014.
Why does the MMC still not have a CEO?
Who is responsible for this situation: the Council, its President, or both?
Parallel pathway issue
This is especially pertinent in view of the recent controversy surrounding the specialist parallel pathway.
To recap, until July 2022, there were two pathways for applications to the MMC’s National Specialist Register (NSR):
- Specialists with qualifications in the MMC’s NSR list
- Consideration on an individual basis for those whose qualifications were not in the NSR list.
The MMC updated its NSR Registration Procedures and Guidelines on Nov 21, 2023, in which the pathway for doctors whose qualifications were not in the NSR list was removed.
The Council did not notify the medical profession of these changes to its NSR Registration Procedures and Guidelines, which is contrary to previous MMC practice.
In the past, it was the practice to ensure that any changes were prospective and not retrospective, and that the implementation date of any changes was announced way in advance.
This was to ensure that no doctor was penalised for any changes that were not of their own making.
The MMC has still not addressed the question of whether all applications to the NSR were considered by its Specialist Sub-Committees, Evaluation Committee and the Council itself, in accordance with their publicly-stated processes.
And if they were not, what were the reasons for non-consideration and rejection at each stage of the process?
Also, what were the number of applications that were not considered or rejected?
The statement by the Health Minister, in reply to a parliamentary question, that there were more than 100 applications to the NSR from doctors who have completed their specialist training that have yet to be decided on, speaks for itself.
The MMC’s failure, in this respect, has contributed to junior doctors’ anxiety, disappointment, confusion, exasperation and burnout, which would have a definite impact on patient safety and quality of care.
Independent audit needed
The medical profession has a legitimate expectation that the MMC will adhere to best practices, i.e. integrity, collaboration, fairness, transparency and consistency in decision-making and administration.
After all, the MMC’s motto is: “Safeguarding patients and guiding doctors.”
Its mission: “The principal aim of the MMC is to ensure the highest standards of medical ethics, education and practice, in the interest of patients, public and the profession through the fair and effective administration of the Medical Act.”
MMC, as a regulator, has a duty to follow the rules, be they the Medical Act, its Regulations, its guidelines, guidelines of the Public Services Department and the Finance Ministry for statutory bodies, or good corporate practice.
When a regulator does not follow the rules, both written and unwritten, it loses its credibility, and finally, its authority.
Is the MMC’s current quagmire due to weak administration?
Or is it due to the Council itself?
Irrespective of what it is, an independent audit of the MMC’s administration is necessary to ensure its credibility does not deteriorate further.
Dr Milton Lum was an elected member of the MMC from August 1995 to July 2022, and a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer 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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