The dilemma of training young doctors

Many young people want to become doctors, whether of their own volition or at the behest of their parents.

High academic qualifications are the sole criteria for admission to local medical schools in Malaysia, though there are an increasing number of medical schools that require passing an aptitude assessment as well.

Although the minimum academic qualifications for entry into local medical schools are prescribed, there are still isolated claims of non-compliance by some private medical schools.

There are also claims that some private medical schools take in more students than permitted.

The situation in foreign medical schools is varied. Medical schools in developed economies adhere strictly to high academic qualifications and aptitude assessments of the applicants.

However, certain medical schools in some developing countries admit students whose academic qualifications would not even qualify them to enter a local university for courses with lesser entry requirements than Medicine.

Many such students gain entry through the agencies of these medical schools.

I wrote in 2011 that “There will have to be 5,000 to 7,000 Medical Officer posts in the public sector available annually within the next five years for the young doctors after completion of their housemanship training, and after that it will be anybody’s guess.

“There will be no employment problems for doctors of good quality, but the prospect of unemployment is a possibility for the mediocre, and possibly, some of the average ones. (Quality first, not quantity, Fit4Life, January 9, 2011).

There is increasing concern about the variation in the quality of doctors entering the workforce.

The reasons are related to the curriculum, training and clinical exposure in medical schools, as well as the doctors’ values and respect for a multi-ethnic, multi-cultural and multi-religious population.

Both these factors impact on patient safety and the future of medical practice.

According to the World Health Organization, the likelihood of harm in air travel is more than one in 1,000,000, one in 300 during healthcare, and one in 10 in hospital care in developed countries.

Until the year 2000, there were 11 local medical schools – six public and five private entities. Today, there are 32 medical schools – 11 public and 21 private.

This compares with 17 and 20 medical schools in Canada and Australia respectively, both countries with similar populations to Malaysia.

A significant number of the new local medical schools commenced operations in 2008-2009. One private medical school ceased operations in 2015.

There were about 18,700 students in local medical schools in 2014 – about 7,600 in public and 11,100 in private medical schools.

The number of graduates from local medical schools is projected to increase from about 3,250 in 2016 to just under 4,500 in 2019, with the increase due to private medical schools.

In addition, it has been estimated that there is a similar number of Malaysian students in foreign medical schools.

Most of these students are studying in foreign medical schools that are recognised by the Malaysian Medical Council, but some are not. Many are on scholarships from government or quasi-governmental agencies.

There are about 350 qualifications from medical schools listed in the 2nd Schedule of the Medical Act that are recognised. The Schedule was inherited from colonial times, with qualifications added to it over the years.

If all graduates from foreign medical schools return to Malaysia, the doctor population will be double and treble the current number by the year 2020 and 2025 respectively.

The number of beds in Health Ministry (MOH) hospitals is about 37,000.

Based on the ratio of one medical student to five hospital beds, MOH hospitals can only cater for about 7,400 medical students in their clinical years.

Yet in 2014, there were about 10,000 such students, a mismatch that inevitably impacts on the quality of training. This mismatch is likely to worsen in the next five years and beyond.

The housemanship was increased from one to two years in 2008 consequent to complaints about the competence of a significant number of housemen.

Despite that, there is still a significant percentage of doctors who are unable to complete their housemanship in two years because of competence and/or attitude issues.

The number of houseman posts in the MOH is limited by the Public Services Commission.

With the marked increase in the number of provisional registrations and the inability of some doctors to complete their training in two years, a backlog has resulted, with a waiting time of six or more months for houseman posts.

The backlog will impact significantly on a young doctor’s skills, knowledge and attitude, as well as financially, for many.

Healthcare facilities in neighbouring countries have been offering housemanship training posts to the top final year students of public universities.

Faced with uncertainty, the decisions of our young men and women is obvious, thereby contributing to a brain drain; a loss which is not beneficial to the country.

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Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of any organisation he is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Source : Star2.com