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Headache over lack of specialised medical practitioners


A team of surgeons operating on a patient. — File photo

A team of surgeons operating on a patient. — File photo

While not all is well in the country which is lacking in the number of specialist doctors, plans are now underway to treat the problem.

THE numbers are nowhere near enough and if the situation isn’t rectified soon, Malaysia is going to face a chronic shortage of medical specialists to treat its patients.

In June, The Star reported that there are just over 7,000 specialists in the country, including about 4,000 in the public sector, and this is not enough to meet Malaysia’s medical needs.

This is surprising since there are so many medical graduates in the country, to the point that some have to wait almost a year for their housemanship placing.

However, it is still a long journey from the moment one graduates with a medical degree until they can begin pursuing their Masters to specialise.

Universiti Kebangsaan Malaysia Medical Centre (PPUKM) Faculty of Medicine dean Prof Dr Zaleha Abdullah Mahdy believes that this long time period between graduating and being allowed to pursue their Masters is what puts medical graduates off the idea of becoming specialists.

She says one has to be a medical officer in order to register for the Masters Programme in a public university.

Prof Zaleha, who is also senior consultant obstetrician and gynaecologist and director at the teaching hospital, also known as the Hospital Canselor Tuanku Muhriz, adds that in order to become a specialist, one can enrol in a Masters Programme which is conducted at local public universities.

She points out that it is an extra four years of studying combined with on-the-job training.

Many medical officers may not want to go back to books and specialise since the studying process can be quite taxing.

This could take a toll on them if they have plans to get married or start a family, over the four-year programme.

She also says that the two-year housemanship period is too long as the purpose of being a houseman is to expose the new medical graduates to real working conditions, not turn them into a jack-of-all-trades.

“Those who need additional training in certain areas before being sent off to peripheral or rural hospitals can undergo the extra training as medical officers in urban hospitals before being posted out.”

She says in the early 1990s, she only spent a year as a medical officer before pursuing her specialisation in obstetrics and gynaecology. As part of the training, trainee specialists have to carry out daily ward rounds, attend to patients and the clinic, and training sessions almost every day during the week.

Dr Sng shares that only those who are really passionate about their career will push on and persevere to become specialists.
Dr Sng shares that only those who are really passionate about their career will push on and persevere to become specialists.

“For example, in my department on Monday mornings, we have a session where a trainee has to see a patient and present the patient’s case to a room full of lecturers and their fellow trainees,” she says, adding that these sessions often see the lecturers heavily critiquing the trainee’s findings and presentation.

However, she points out, being what can be considered tough on the trainee specialists is necessary to ensure they are truly ready to take on their role as life savers in the future.

On top of all this, trainees also have to do research work for their thesis, she points out.

“At UKM, we have 1,217 trainee specialists right now,” she says, adding that this is not enough to deal with the chronic shortage of specialists in the country.

There are 4,483 active trainee specialists throughout Malaysia.

In an attempt to address the shortage, she says, universities continually strive to increase their intake.

But, Prof Zaleha stresses, the increase will not affect the quality of the specialists that they produce as more hospitals can be included as training ground for the programme.

“We in the Medical Deans Council plan to improve the accessibility of young doctors to the Masters Programmes by collaborating with the Malaysian Examinations Council (MPM) to conduct the entrance examination into the clinical Masters programmes, targeted to begin early next year.”

She says that under this arrangement, registration and payment can be done online through MPM and the entrance examinations will be conducted in regional centres all over Malaysia so that candidates do not need to travel far to sit for the examination.

The Health Ministry acknowledges the entrance examination as part of the criteria to fast track the housemanship programme. More good news, she says is that the universities now provide private candidacy for specialist training.

To overcome the shortage of specialists, universities must increase their intake in the relevant fields, says Prof Zaleha.
To overcome the shortage of specialists, universities must increase their intake in the relevant fields, says Prof Zaleha.

“In view of the ministry’s current policy that provides contract to young doctors, we foresee many candidates will not be part of the government workforce after finishing their term as contractual housemen and medical officers.

“Such candidates can then train to become specialists by enrolling as private candidates in our teaching hospitals, but only if they fulfil the entry criteria including passing the entrance examination and interview.”

She believes the Government is doing its best to encourage more doctors to become specialists.

“But I think a lot more can be done,” she says, adding that she hopes the fast-track programme can take off soon especially for those who perform well during their housemanship, in order to cut short the housemanship programme.

The fast-track system allows outstanding housemen to undergo a shorter housemanship instead of the usual 24-months.

“In the past, MOH, in collaboration with the universities that run the programmes, made it a policy not to accept candidates who are less than two years post-housemanship to start specialist training, as there was a shortage of medical officers in government service at that time.”

“However, now that there is a glut of junior doctors, this policy should be changed to enable these young doctors to enter the clinical masters training programmes sooner. After all, the programmes are structured and span four years with comprehensive formative and summative assessment systems in place, giving them enough exposure to attain the necessary experience to go on to the next stage as specialists.”

“Those who can decide on their specialty of choice early on should be given the chance to pursue it as soon as possible.”

Sub-specialising

Association of Specialists in Private Medical Practice Malaysia president Dr Sng Kim Hock agrees with Prof Zaleha, saying that the time frame is too long, especially if one plans on subspecialising later on.

“It takes 10 or more years from qualifying as a doctor to become a specialist and more if one subspecialises. For example, a cardiologist is a physician specialist in internal medicine who subspecialises in the heart, while a brain surgeon is a specialist surgeon who goes on to specialise in brain surgery,” he says.

“After their initial specialist training, they may sub-specialise either locally or even overseas, if they can get a scholarship or placement abroad,” he adds.

He also says not every doctor wants to specialise as it is a passion rather than “opportunity or persuasion.”

“Only those who are really passionate about their career will push on and persevere to become a specialist,” he points out.

On the lure of money to entice more doctors to specialise, Dr Sng says: “It is only certain specialists who do well.”

“The perception is that all specialists are doing well. Yes, many of them are comfortable but they work very hard.”

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