PETALING JAYA: The problem the country is facing with contract doctors is not due to the oversupply of medical graduates but the insufficient number of posts available for housemanship, medical experts say.
Universiti Kebangsaan Malaysia Faculty of Medicine, Obstetrician and Gynaecologist senior consultant Prof Dr Zaleha Abdullah Mahdy pointed out that the country’s doctor to population ratio was alarmingly imbalanced.
“The problem now is that there aren’t enough posts for doctors to fill in the public health service sector; it has not expanded in line with the population’s needs.
“There are places in Sabah and Sarawak where there are hardly any doctors and access to health services; some district hospitals don’t even have specialists.
“Because of this, it seems like there is a glut of doctors produced every year but the truth is, there just aren’t enough posts to fill,” she said, adding that more allocation was needed to increase the number of posts available.
The World Health Organisation (WHO) recommends a 1:500 doctor-patient ratio but according to the Health Ministry (MOH) in August last year, Malaysia’s ratio was 1:454, said Malaysian Association of Private Colleges and Universities deputy president Prof Dr Pradeep Nair.
The ministry’s statistics, however, did not take the urban-rural divide into consideration, he said.
“Quoted ratios were 1:856 in Sabah and 1:662 in Sarawak at the same time, with up to 45.6% of rural clinics in Sarawak being without doctors,” he said in a statement yesterday.
He said that in 2009, the housemanship period was extended to 24 months without proportionately increasing the number of posts required for the extended training period, which compounded the shortage of posts available.
“Excluding Universiti Malaya Medical Centre, Hospital Universiti Kebangsaan Malaysia and Hospital Universiti Sains Malaysia, there were 38 MOH hospitals for housemanship training in 2009 compared to 48 in 2019,” he said, adding that there was an increase of 10 hospitals while the number of graduates requiring housemanship places was many more.
Calling for more hospitals to be gazetted for housemanship training, he said the Covid-19 pandemic had brought focus to a problem that many know but did not speak about.
“Apart from not having enough doctors and specialists, there is an uneven distribution of the medical professionals across the country.
“Today, we have 31 medical schools, 11 of which are government institutions.
“Malaysia annually has 5,000 to 6,000 doctors who need housemanship training, and of these about 50% to 60% are locally trained and the rest are graduates from overseas.
“We further recognise about 330 international medical schools and we also have Malaysians graduating from unrecognised medical schools, who may seek provisional registration and housemanship opportunities by appearing for an examination run by the Malaysian Medical Council.
“Over the years, private medical schools have become convenient scapegoats for what is claimed to be an excessive number of medical graduates in this country, when it is self-evident that this is only part of the story,” he added.
On Monday, the “Hartal Doktor Kontrak” (Contract Doctors’ Strike) movement involving medical officers on contract, and pharmaceutical officers and dental officers who are asking for permanent positions in the public service under MOH, staged a walkout from hospitals nationwide to protest against the lack of job security and career progression.
Prof Pradeep suggested ramping up our healthcare expenditure to ease the gridlock in available posts in the medium and long term, as Malaysia currently spends 4.4% of its gross domestic product on healthcare, compared to the recommended 7% by WHO.
“Another solution is to explore the possibility of smart partnerships with private medical centres and medical schools by allowing housemanship training in the private sector.
“This is in place in Australia under the Commonwealth Medical Internships Initiative,” he said.
He said with a moratorium currently placed on the number of medical programmes in the country as well as limits on intakes, the next steps to consider are a phased reduction in the number of overseas schools Malaysia recognises; a scheduled discontinuance of the provisional registration examination for unrecognised graduates; the introduction of a common competencies checklist for all Malaysian medical undergraduates studying locally or abroad; and the introduction of a common exit examination for all Malaysians who are medical graduates intending to work in Malaysia.
Like Prof Zaleha, former Malaysian Medical Association and the Medico-Legal Society of Malaysia president Prof Datuk Dr NKS Tharmaseelan said the glut was a perceived one.
The distribution of doctors is not in sync with the infrastructure and requirements, he said, adding that some hospitals and units have hundreds of doctors while others need to do with a handful.
A common licensing examination, said Universiti Putra Malaysia consultant clinical microbiologist and Faculty of Medicine and Health Sciences dean Prof Dr Zamberi Sekawi, could control the number of medical graduates wanting to work in Malaysia.
“Through this method, only qualified doctors will be absorbed. This also helps us filter which medical schools aren’t producing quality graduates and these schools could then be reviewed by regulatory bodies,” he said, adding that there was a need to look into increasing the number of posts for doctors, especially in rural areas.
While calling for the current contract doctors to be absorbed into permanent positions, Medical Practitioners Coalition Association of Malaysia president Dr Raj Kumar Maharajah said the number of medical colleges in the country must be controlled.
“Cut down student intakes in private medical colleges by at least 70% and by 50% in public institutions until the situation is normalised,” he said.