Too many doctors, too little training


  • Nation
  • Sunday, 18 Aug 2013

The future remains uncertain for aspiring doctors unless more training hospitals are opened.

COME next year, some 5,000 doctors are expected to be jobless.

This is because there are not enough government hospitals to train the large number of medical graduates being churned out, says Malaysian Medical Association (MMA) president Datuk Dr N.K.S. Tharmaseelan.

“There are just too many doctors and too many medical institutions flooding the market,” he claims, adding that there are now about 40,000 active doctors in the country.

“Some 5,000 doctors are graduating yearly but where are they going to do their housemanship and compulsory training?

“Currently in government hospitals, there are some 60 doctors in one unit so how are they going to learn?” he asks, adding that soon there will not be enough posts for medical officers in government hospitals.

According to the 2011 Health Ministry Annual Report, 21,765 out of 28,309 vacancies for medical officers have been filled, he says.

“This means that by now, the 6,544 available posts would have almost been filled. Where will the fresh graduates go next year?”

Dr Tharmaseelan calls on the government to build more hospitals, increase the number of beds in existing ones and equip the district hospitals with training facilities to accommodate the influx of aspiring doctors.

“There were 130 government hospitals in 2007 and 132 in 2011 – that’s an increase of only two hospitals in four years. It’s definitely insufficient. If this continues, doctors will soon join the flock of some 15,000 unemployed nurses,” he claims.

He adds that although the Health Ministry has assured the association that there are some 1,000 vacancies for doctors this year, the future remains uncertain for aspiring doctors unless more training hospitals are opened.

He believes the problem of unemployed doctors would be worse if the compulsory two-year government service is stopped.

“There is talk that after completing their housemanship, the doctors won’t need to serve at government hospitals anymore. MMA is concerned because this will result in doctors who are not adequately trained,” he says. MMA is urging the Education Ministry to monitor closely the many medical colleges that have sprouted recently, adding that entry requirements are too low for most.

“Students from colleges that are not recognised can sit for an examination to make them eligible to practice locally.

“We have an Air Asia ‘everyone can fly’ syndrome – it seems that everyone can become a doctor. Adopting Henry Ford’s industrialisation of car production to training doctors will result in poor quality medical practitioners,” he adds.

He attributes the glut to a lack of co-ordination between Education Ministry and Health Ministry, with the former bent on allowing medical colleges to mushroom without considering the Health Ministry’s needs.

He adds that medical colleges should have their own hospitals instead of sending their graduates to train in government hospitals.

“Another way to prevent unemployment from setting in is for doctors to become specialists and ‘super specialists’ in niche areas of medicine,” he says.

MMC member and senior medical practitioner Dr Milton Lum points out that there are currently almost 9,000 housemen nationwide.

“How many of them can the government hospitals absorb? Unemployment is not a possibility – it’s a probability.

“In one to two years’ time, government hospitals won’t be able to take in housemen anymore so medical graduates will have to leave the country to find work because they can’t get registered here,” he says, adding that less than 50 hospitals in the country are equipped with the necessary training facilities.

Quoting a Health Ministry study done last year, he says housemen now see less than three new patients daily.

“When I was doing my housemanship 40 years ago, I was seeing between 15 and 25 patients daily.

“Medical graduates today are not getting enough exposure and experience which will definitely result in a drop in quality for doctors,” he cautions, adding that in recent years, the MMC had received more than 100 complaints concerning doctors yearly. Before 2005, the council only received about two or three complaints.

Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) president Dr Steven Chow says there are more than 33 local medical schools in “full production” excluding overseas institutions.

“The total number of posts for doctors available in the Health Ministry, universities and other public institutions is about 25,000.

“We are already seeing difficulties in getting enough training posts for housemen and medical officers.

“This will worsen with influx from neighbouring countries in due course,” he adds.

Comenting on the “glut of doctors”, Health director-general Datuk Dr Noor Hisham Abdullah says the phrase is “very relative”.

The Health Ministry, he says, is working closely with the Malaysian Medical Council (MMC) and the Education Ministry in managing the supply of doctors for the country.

The country has been producing more doctors yearly with almost 85% of the ministry’s vacancies for doctors already filled, he adds.

“However, the posts available do not commensurate with the needs of the country.

“Malaysia will definitely need more doctors when we reach the status of a high income country.

“By 2020, the population is expected to reach 34 million so Malaysia will need a total of 85,000 doctors to attain the ratio of 1:400,” he says, adding that the ministry will apply to Public Service Department (JPA) for additional posts for doctors.

More doctors are needed to accommodate the fast expanding private healthcare services, health tourism, new health facilities, higher level of care by the Health Ministry, rise in specialisation and sub-specialisation of medical practice, expansion of more complex speciality services like cardiothoracic and hepatobiliary surgeries, and the emergence of new infectious diseases, lifestyle-associated diseases and chronic disease patients.

“More are joining the post graduate and sub-speciality programmes and coupled with the brain drain of medical practitioners, we need doctors.”

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