THERE’S been quite a hoo-ha recently about the plight of medical officers who are on contract and do not have full-time positions.
Among the many problems they face is that the door to specialisation in certain specialties has been closed to them. Not only is their pay lower compared to that of their colleagues with permanent posts, they also have to come to terms with the fact that they will never be able to further their training in certain fields.
This is demoralising.
How do you expect them to perform well at work with no motivation to do so? There is no point in them learning anything more since at the end of their contract they will just be let go to find work as best they can in the private sector.
Mind you, in certain fields such as surgery, the fact that a medical officer can perform surgery independently does not count for anything in the private sector. No private hospital will employ him or her to perform surgery because it is against the regulations.
I would like to propose a solution to this matter.
The solution is to open up parallel pathways to all medical officers in the manner of the MRCP (Membership of the Royal Colleges of Physicians) pathway for physicians.
For the uninitiated, to become an internal medicine specialist, besides going through the four-year masters programme, there is the option of sitting for external exams before undergoing gazettement to qualify as an internal medicine specialist. The gazettement period is to ensure that the trainee is not just someone who can pass an exam but is able to function in the real world.
Recognising the fact that surgical training is different from non-surgical training, perhaps the way forward is to introduce logbooks for aspiring surgeons. The aspiring surgeon must get the logbook of various procedures signed off by supervising surgeons before they undergo a period of gazettement as a final test of competency, similar to the MRCP pathway for physicians.
Of course, the trainee must also pass his MRCS (Membership of the Royal Colleges of Surgeons) as a prerequisite to enter the programme, and any additional exam to complete the programme, such as the FRCS (Fellowship of the Royal Colleges of Surgeons) or our own exit exam as mandated by the College of Surgeons of Malaysia.
This way, we solve two of the biggest problems in terms of manpower, which is the lack of specialists and not having enough posts for medical officers and housemen.
The solution which I have proposed basically loosens the bottleneck so that medical graduates are not stuck at the level of medical officer. The quality of the parallel pathway will be maintained by having a gazettement period so that the candidate will be expected to perform up to par with those in the masters programme.
In fact, once we have enough specialists from this pathway, we can even open up new specialist centres where house officers can be trained. Therefore, we can even solve the issue of not having enough house officer vacancies due to the lack of teaching hospitals.
Also, the care of patients will improve. And the morale of the healthcare staff, ranging from house officers to specialists, will be boosted, as there is hope for those at the bottom of the hierarchy; and at the top, they will be less stressed out from having more specialists to shoulder the workload.
If it has worked well for internal medicine training and other specialties such as paediatrics, I do not see why it will be any different with surgery.
I welcome any rebuttal of this proposed parallel pathway system for surgical training.
DR JOE CHAN
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