Tuesday, May 13, 2008

On Malaysian doctors serving in overseas/海外大马医生回流的困境

If all Malaysian doctors serving in Singapore, Australia and the UK were to come back to Malaysia, we would not only at one fell swoop solve the problem of shortage of doctors, but may even have a surplus of specialists. Many options have been deliberated to attract these overseas doctors to come back but it all boils down to:

1) Money

2) Working conditions

3) Prospect of equitable career advancement

4) Social and political environment

The compulsory service in the government is a hindrance to doctors coming back. During my tenure as the minister, on a case by case basis, doctors did not have to serve the compulsory service if:

1) Their age > 40 years old;

2) On a case by case basis especially when there is an acute shortage of specialists in a particular subspecialty, for example oncologists, they may be exempted and;

3) Service in the army and university -->regarded as part of compulsory service. The 3 year compulsory service is not full time for doctors and specialists.

The problem now is that, if we waive the compulsory service for foreign doctors, local doctors will protest. Not only that, they will feel demoralised and discriminated against.

When the above rules were implemented, we managed to attract a mere handful of doctors to return. Nevertheless a major stumbling block was the lumbering bureaucracy known as the MMC secretariat -with regards to basic accreditation. A particular case which comes to mind(bearing in mind that it was only one of a few I had encountered during my tenure)was a Malaysian serving as a professor of surgery in a reknowned South Australian University Pediatric Unit. He applied to be registered with the MMC in order to teach medical students and surgeons in Malaysia. To my horror, he was given the merry go round with conditions that he had to show where he did his housemanship and posting which was done by this particular professor 35 years ago. He was also asked to complete his O&G rotation to qualify for a practising certificate. Fortunately common sense prevailed in the end after intervention. But the very fact that intervention from higher ups was even needed speaks volumes about the hurdles that many doctors coming back face.

In the government service, a lot of well intentioned policies are often frustrated by faceless beaurucrats who apply rules and regulations without using their common sense. Efforts to attract overseas doctors to come back with the current working climate is an uphill task. Until such a time as many fundamental issues can be be adressed, it will remain so.
-------------------------------
我认为,如果所有在新加坡、澳洲和英国工作的马来西亚医生愿意回流,不仅能一劳永逸解决我国医生短缺的问题,我们甚至有额外的专科医生。多年来,政府采取各项措施致力吸引国外的大马医生回国服务,而海外医生的考量可归结为:
1) 薪金
2) 工作环境
3) 合理的晋升机会和工作前景
4) 社会及政治环境

在政府医院实行的强制服务制是让海外医生不愿回流的阻力之一。我担任卫生部长期间,是以个案方式批审海外医生要求豁免强制服务的申请,若申请者符合以下条件,将获免除执行强制服务,或无需全职执行强制服务:

1) 年龄超过40岁
2)特殊原因以个案处理,尤其当申请者所属的次专科在我国正面对严缺医生如肿瘤科
3) 在军队和大学里服务医生

目前,政府面对的考验是,如果废除对海外医生实行强制服务制,本地的医生肯定群起抗议。不仅如此,他们会觉得被剥削而士气大跌。

话说回头,当时我们虽实施上述三项条件,惟只成功吸引少数的医生回流。 我发现,主要的绊脚石是对这些医生进行资格基准鉴定的大马医药理事会,在处理他们的申请时非常官僚。在我任部长期间,基本上不常出现类似的情况,但有一个案让我印象深刻:一位在南澳一间医院任职的大马儿科外科教授,曾向大马医药理事会申请注册,以允许他回国后在政府医院任教和指导在职的专科医生。让我震惊的是,程序其实很简单,但这位教授却被领着不断地兜圈子,包括必须出示他在35年前见习记录、期间被派任的记录和报告等。理事会甚至规定这位教授必须到妇产科轮值,以获取实践证书。最终,幸得部门高层介入而顺利解决该教授的问题。

事实上,我们需要有关当局的高层更全面地检视外国医生回流所面对的障碍。在公共服务领域,因为一些官老爷的愚昧和官僚,许多善意的政策被曲解,无法让人民受惠。如果政府机构内续存这种不良的文化,吸引外国专才包括医生回流的努力,恐怕依旧事倍功半。

10 comments:

The Gap said...

Dear Dr. Chua,

It would do wonders if the Govt would actually put in the effort to 'forcibly' bring back JPA/MARA/Petronas scholarship holders who are happily working in UK/Eire/Australia when they have a contract to fulfil.

Concerned Citizen said...

Dear Datuk Dr.

I'm very pleased to learn that you find some rationals in the overseas doctors case. They're exactly the reasons why Malaysian doctors are suffering for years. Unfortunately this understanding did not manifested when power was in your hand. Overseas dr. mostly found your (and your predecessor) 'go-home' poilcy was lacking in humane and rational approach. They're not been approached properly and mostly one-way communications. You're not talking to the doctors but to the press. You may find some good soldiers amongst gov. servants as scapegoats, but the failure reflects your lack of control and leadership.
I think the real issues of high patient:doctors ratio rest mainly on the rate of doctors who leave the government to the private sectors. If all overseas doctors return, this ratio is still unchanged in long run because they will, after compulsory service period, follow the caravan. The reasons are well presented by your goodself in this article. The most ill-treated public servants are the doctors, with inhumane service condition and beaucracy, plus politics.
I hope you will lead the initiative for reformation if your dream to see the ratio become reality. By the way, the soultion to reduce the rate of 'jumping' to private service is not to introduce 'anti-jumping' laws, but to correct the inhumane conditions of our public service. Please come out from our state of self-denial. We can use the simple motivation-based approached such as carrot-and-stick and Motivation-Hygiene factors to lure Malaysian doctors to stay with the public service. In UK, Australia etc, doctors are proud to work with the public service. It offers more than money- the self-esteem and dignity.

kamamuhammad said...

Dear Dr. Chua Soi Lek,

Let me be the first to comment in your blog, and to congratulate you on your readiness in opening up this matter, which I think has many serious misunderstanding that needs to be addressed.

My name is Dr. Kama Mustaffa Muhammad, and in training programme in General Surgery with Royal College of Surgeons in Ireland. I've completed Collegiate MRCS ( Membership of Royal College of Surgeons)in 2005 and now in pursuit of Intercollegiate Fellowship Royal College of Surgeons in Ireland. One of the reason why I further this pursuit is because it is disheartening to see that the mindless MMC has refused to acknowledge MRCS and AFRCS. This has indeed further stalled the return of many young, semiskilled surgeons.

I've contacted many university's deen but the best they could offer is to get me entrance into Masters Programme which is so called "recognised" by local standards. However, learning from friends back home, this programme has a great number of drop-puts and failures. I don't really know why, and I'm not so sure it is true, but it sure put off my intention to go back home for a while and continue to further train here.

Doing so, I took the opportunity to familiar myself with research. Therefore, I'm now in pursuit in doing Masters in Healthcare Management and Services, on top of my surgical training programme. I hope to bring the knowledge back home both as a surgeon and health service administrator, by Allah's willing.

Dr. Chua Soi Lek,

I hope you could make plans to ease the registration and decrease the hassle of people coming home. We now lived in the era of science and technology where things can be done and verified in a split of a second. Why can't this be applied in our government department ?

These Little Napoleons and Josphine should be given what we Malays called "Kata Dua"...."Either work with us, or get out".

Dr. Chua Soi Lek,

It is my hope to see ALL Malaysians work together without prejudice in race, religion and status.

I do believe that if we all bring out the best in us, we can take on any challenges that we may have to face in future.

Again, congratulation for opening your heart and mind to be reached directly to the people.

Salam hormat,

Mr. Kama Mustaffa Muhammad,
Irish Surgical Residence, RCSI.
LRCPI & SI, MB BCh, BAO, NUI, Colegiate MRCS (Dublin)

peisheah said...

That means there's no medicine to cure this disease?

Oh, just live with it.

I really kesian the doctors :
http://unwantedcitizen.blogspot.com/

We're a nation producing talents to be used by other countries. The good we export out (& we paid for their education), and we import some mediocre & downright lousy into our country to "treat" our children & grandchildren & their offsprings.

Tak-kan Malaysia hilang di dunia.

p/s : You think your successor can do better? Argh, be a vegetarian.

KoSong Cafe said...

With a bit of common sense, I see the following problems to overcome:

1. making it attractive enough to attract them back - usually, money is not the only criterion and especially if they were already thinking of returning because of homesickness, relations, and old friends;

2. ensuring that they are treated with respect and genuinely welcomed - by being pro-active in speeding applications, even to the extent of waiving some irrelevant requirements especially in view of their professional standing;

3. ensuring that the institution they are supposed to be working in, is conducive to them in terms of working conditions, adequate research facilities (where necessary), respect from the existing staff and prospects for promotion without discrimination;

4. ensuring that the existing staff are happy with the incoming 'expatriates' - for example, their salaries and perks should be comparable, instead of being at their expense; and so on.

I have just heard from a friend that his relation came back after completing an engineering course in Germany which was under JPA scholarship. He came on his own initiative and was surprised that he was told to register the fact that he has completed, without any indication, let alone interest, as to what he should do to fulfil his part of the contract!

I am sure this was the main reason for the large number of scholarship holders who completed and failed to return - the lack of initiative on the part of the government run by disinterested staff! It was no surprise that some could get away from paying back compensation in lieu of contract of work.

What we need is a concerted effort by the government to do the necessary, and not just policies by Ministers whose own terms of service are uncertain.

Get rid of 'tidak apa-thy' first.

10th PM said...

Malaysia is facing crisis: 1. the political situation is unstable. 2. the high oil and food price. 3. In-effective leadership from UMNO, MCA, MIC. There must be a way to change the mind set of people in charge.

Lysendar said...

Dear Dr. Chua,

I would said that, if the government can simplify the conditions and process, i think it would attract not only the doctors but also other talents to come back to serve the country. It is a very competitive world, as every country is trying very hard to attract the talents to their country. Since Malaysia produce so many talents, but serve other countries, why not we attract them to come back. There are many ways to attract the talents of malaysia to come back. It is all depends on the policy of the government. May be the government can study the policies that used by some other countries, how can they attract talents to their country. Nobody is perfect, and it is nothing wrong to learn good things from other people. God Bless.....

DeLiRiuM said...

Dear Dr Chua,

I echo the statements of the individuals before me. The main obstacle that the Health Ministry faces is the absence of factors that will help stem the haemorrhage of doctors out of the public sector.

More money is needed, not necessarily in the wages, but in the upkeep of infrastructure and the provision of services that cater to those in need of it the most.

Most doctors merely desire a comfotable lifestyle, the more important factor would be a dynamic work and training environment that is not hampered by bureacracy and political limitations.

Do bear in mind that most Malaysian doctors overseas (including myself) are quite keen on returning home with added qualifications. There is a world of difference between returning home after a degree and returning home with a certain amount of specialist training.

On that note, are the number of junior doctors equivalent to the number of equitable training posts available? Until this discrepancy is sorted out, it will continue to be difficult to attract the best minds.

P.S. Are there any statistics on the number of Malaysian doctors undergoing training in Singapore at present?

KoSong Cafe said...

Dear Dr. Chua,

I am not sure if you were the Minister of Health who mentioned that our country needs some 800 psychologists. Anyway, I am quite surprised with the number and also unlike psychiatrists, they do not have medical background.

I hope you can help me with some information.

My daughter obtained her B.Sc.(Psychology) in 2007 and is now working as a carer in UK while deciding whether to continue to work or do a Masters course in Hospital Management in Aberdeen, Scotland. She has been accepted but she is worried about our financial constraints.

What do you think of the post-grad course in terms of prospects in Malaysia?

In her situation, is there any government scholarship for this particular course?

By the way, I believe there are those who did their first year medical course on their own and need scholarships for post-graduate specialist courses which the government could have taken advantage of.

I should be most grateful if you would direct me to the right place to enquire for further information, or at least, inform me that there are no scholarships for such a course of study.

Thank you.

Popeye Chiew said...

Dear Dr Chua,

Surprisingly to know how you understand why malaysian doctors are not keen to return to Malaysia and rather stays overseas to complete their training and move on with their life. We need people like you to change the mindset of the people, the system always good but is the enforcement that causing the 'troubles'

I am a Malaysian training to become a cardiologist in Canada, over my past research fellowship, internal medicine residency and cardiology fellowship, I received fundings and equal opportunities from the Government of Canada (as a permanent residence holder) like anyone else in the country. This government never asked me to stay in Canada and I am free to move to everywhere I want and always ready to help me. Of course, i worked as hard as anyone else like other malaysian doctors in overseas with average 6 days per week and reach home at least 8pm.

In Canada, I know at least 10 Malaysian doctors in training in general surgery, internal medicine, anesthesia, neurology, pediatrics, most of them are keen to return to Malaysia once completed the training. And not to your surprise too, there are many 1st generation malaysian-canadian here in different fields. Their parents migrated from Malaysia in 70's for the sack of their children's future. You will be amazed how malaysians are so talented globally!!!

Dr Chua, I have never seen such wonderful government (Canada) in my life. I left Malaysia in 2001 and always keen to return because it is the country where I grew up and culturally more associated.

Over the past years, I have started making my mind to stay in Canada for good. The recent changes in the election gave me a sense that there is a hope for this country to be more transparent, justice, equality and more matured citizens. In Canada, we are free to criticise the politicians and none of them can hide their bad history from the citizen. The media assumes complete freedom.

My main struggle issue is the health care systems in Malaysia. Having trained in North American System, it will be very difficult for me to restart new environment in Malaysia, in addition to it, I am seeing myself blurred with no proper guidance in the Malaysian systems. In my mind, Malaysian government always so so perfect to sweet-talk, but then, often lots of frustrations when you step your foot inside, in the other words, I do not trust and have NO faith with Malaysian government At ALL (very sorry to say this)

I may want to come back to share my experience and teachings with the local graduates/students and contribute towards cardiac electrophysiology field in Malaysia

Thankyou

Best wishes,

SK Sean Chiew, MD
Cardiology Fellow
University of Western Ontario
Canada

Welcome to my Blog

As a concerned MCA member, I am trying my best to help in the process of rebuilding and repositioning of the party.

Therefore, I welcome party members and members of public to post your constructive suggestions and opinions on my blog on how to rebuild and reform the party, eventually enabling MCA to regain support from all party members and the community.


Thank you for your suggestions.