Housemen should undergo formal exam


THE moratorium on new medical courses in Malaysia will not solve the main problem faced by our healthcare system, namely the large number of housemen with poor skills and questionable competency.

Since these poorly trained doctors come from foreign as well as local institutions, stopping local medical intakes will do nothing to solve the problem.

What is needed urgently now is a training system to improve the ability of these young doctors, and even to weed out those who don’t have the desire or competency to practise medicine.

Some may have hoped that the move to register many housemen would ultimately solve three problems namely, fill vacancies in the Health Ministry, reduce healthcare costs by increasing the doctor supply and achieve developed-country doctor-population ratio of 1:400.

However, in our haste, we have registered poorly trained housemen, exposing them to a system not ready to cope with their numbers and lack of ability.

The call for action comes not from private doctors seeking to protect their rice bowl. Instead, it comes from dedicated senior government doctors worried about the future when these housemen take up increasingly responsible positions in public healthcare institutions.

Poorly trained doctors will be a continuing burden to the Health Ministry, which may have to spend an increasing proportion of its budget on doctor’s salaries since such doctors will not be able to attract fee-paying patients who are very sensitive to doctor competency.

No patient, no matter how poor, deserves an incompetent doctor, and no one, no matter how powerful, can feel totally safe once incompetency creeps into the healthcare system.

We already have in place a system to train and assess our housemen. What is now needed is to formalise the system and have an end-of-housemanship examination.

Housemen must be transparently graded, with one-third coming from the consultant’s assessment, one-third from a theory paper and one-third from a practical examination.

After all, housemanship is only the beginning of a doctor’s educational process. With many examinations still to go through, the houseman should not worry about a formal end-of-housemanship assessment.

Those who do well should be rewarded with choice posting and entry to specialist training programmes.

The majority should pass and proceed into service as responsible medical officers. The really incompetent or disinterested ones should repeat their housemenship postings.

Over the medium term, the MMC must de-recognise poor quality medical schools, whether local or abroad, without fear of political pressure.

The country cannot support 4,000 to 6,000 new doctors annually into the infinite future. It should not be too difficult for the ministry to calculate how many doctors are required annually, then seek to limit new medical registration to the calculated numbers.

Whatever the number, the aim must be to produce only capable, competent and dedicated doctors.

Medical education, and the medical profession, should be for those interested in the art of healing, not those seeking financial rewards.

The public must understand that on this issue of having a competent medical workforce, doctors in both private practice and government service are speaking with one voice and truly have the interests of our community at heart.

DR ONG HEAN TEIK, Penang.

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