Sunday, June 22, 2008

Recognition of Unregistered Medical Degrees

The Malaysia Medical Council (MMC) recognizes more than 340 Medical Universities in the world. For a small nation like Malaysia it is a huge number. Even when I was a Minister I strongly felt that we should not continue to take the easy way out by recognizing more and more Medical Universities. Some of the existing Universities we recognize may have deteriorated in their standards and some may not even exist in their previous forms. It will be a difficult task to do a scheduled audit in view of the huge number of Universities involved. A good example is the University of Iraq which is recognized by MMC but I am sure is living on its past glory.

While some of the ‘unfit’ universities are being recognized, we cannot deny that some better universities have not been recognized. In the long term, it is good to have a common entry exam for all foreign Medical graduates. If they pass the examination they are allowed to practice in Malaysia. In the same way we should also promote a common entry exam for our local Medical Faculties.

While we are aware of the acute shortage of doctors, we should not compromise on the quality and recognize degrees from dubious universities. Our problem is that in our haste to overcome the shortage of doctors, we produce more locally or recognize more foreign medical degrees. In the process, the quality of doctors is compromised.

Unlike what the parents think, we actually allow graduates from unrecognized Medical Universities to sit for the local examination with maximum of 3 tries. If they fail in 3 attempts, I personally think they should think of changing their profession. It’s cruel to say this but it is a fact. There were a few who took my suggestion seriously and changed paths to medical related disciplines instead of medicine and they are happy with the choice.

Credit transfers from unrecognized Universities to a recognized University is another way. But it only partially solves the problem. I have had the opportunity to talk to some of the examiners. What they told me made me worried about the quality of some of the doctors who are practicing in Malaysia. We must not forget, ultimately the majority of these doctors will find their way into private practice.

One step taken then was to increase the housemanship to 2 years without affecting their promotion and their eligibility for post graduate studies. For doing that I was condemned by a lot of junior doctors. Every year on an average 3-5% of doctors are not signed up at the end of the housemanship. Supervision by the senior doctors in government hospitals is poor and often it is very people centric, and very much depends on the senior doctors concerned whether they are committed and dedicated to the job.

I would prefer to have shortage of doctors but the doctors who are practicing in the government or private hospital are of good quality, rather than a full house of doctors but who are no better than sin-seh. After all, if a doctor is not sure, he should do no harm to the patient.


jonathan said...

Dear Chua,

Did you ever have the feeling that the examiners you spoke to could be biased? This is the medical field you are talking about where professional jealousy and rivalry has put to death many promising careers.

Your own lousy stint at the MOH was colored by the incompetent officers you surrounded yourself with. Instead of focusing on a new critical healthcare thrust through a change in policy from government subsidized healthcare to a more equitable scheme, you wasted precious time and money, among other things, nitpicking on clinics which was reflective of your small town upbringing.

You never saw the big picture, courtesy, of the childish pinching denigration that Danaraj and co probably meted out to you at UM. Finding fault was your mantra probably well taught by your teachers. In fact you encouraged traditional healthcare vs evidence based medicine. Meaning you can still practice hocus pocus and chelation therapy without having to provide even evidence by randomized trials let alone comparative blinded ones?

As for the medical school recognition need to crack your head. Just follow the one on the WHO list and make certain an MCQ based qualifying examination is carried out. The key word is MCQ. And make certain that even the time keepers are from overseas. Our local UKM, USM and UM dungu invigilators cannot be trusted not to cheat. And many of our government specialists can’t even read an ECG or X-ray properly. In fact if you give them a CT scan report they would quickly look for the radiologist report because.....they can’t read it!!!

You know all those examiners you spoke to....a word of advice. These buggers had it easy during their time and the bloody clinicals which are subjective are downright fixed to fail students according to their whims and fancies.

And Chua remember, not all doctors want to be private practitioners, some maybe are interested in research which of course the MOH wasn’t bothered about. Malaysia needs doctors, clinical and research based ones, but more importantly it needs a visionary Health Minister that can make this country's healthcare shine.....and that guy was certainly not you.

nckeat88 said...

Jonathan: I think you are unfair to Dr Chua. I am a consultant in a public hospital. Over the years I had seen the deterioration of our HO quality. Dr Chua is right, we would have shortage of doctor than compromise our standard.

The deterioration of doctor quality from local university, in my opinion is due to the ever increasing intake of number of medical student. The teaching faculty and facility just couldn't cope it. The oversea gradutae are no better neither. They may come from UK or even Australia but they too have absolutely no idea of basic knowledge. Often the housemanship period is used to reteach them the basic rather than gaining clinical experience.

I personally saw how the exam conducted for the medical graduate from the unrecognised university. The written exam is of the same standard of the local universities. Often, it was the same paper that used for the local final exams. The clinical exam had been carried out in order to HELP THEM PASS THE EXAMS. The clinical exam are very easy and even easier then those given for the local graduates. The sole aim is to help them pass the exam.

Why they still failed the exams? That's because many of them took the exam many years after their graduation after working few years abroad and they forgot their basic knowledge and don't bother to brush up. Many who pass the exams were students who are freshly graduated from their univerisities. When they fail, they don't bother to study, they continue to do illegal locum and when they come for 2nd time and thrid time, they will continue to fail. I personally wouldn't want them to be my HOs or seeing my relative, they are hopeless rubbish. They should change profession.

Lastly, the student (including their parent) should blame themselve for destroying their own life. They shouldn't insist of doing medicine when they are not qualified to do in the local or even recognised oversea univerisities. They should bear the full responsibility of landing themselves in this dire state by insisting to do medicine in unrecognised univerisity.

The government shouldn't change the exam format. Gov should insist to carry out such exam and bar those who failed 3 times continuously from practicing in this country.

DR SURESH K said...

Dear Dr Chua,

I absolutley agree with you that Drs should have the highest standard and responsibilty in dicharging their duties,esp when it comes to dealing with one's life.

Then why didn't you as a former health minister,failed to vet the standards of our very own locally produced drs.Do you think many of our locally produced drs have the aptitude for medical studies in the first place?Esp the majority who are accepted under a certain quota system simply because they belong to a certain ethnic group?

And how sure are you that these examiners who are entrusted to supervise or examine these drs with unrecognized foreign medical degrees are not biased to the core?
Have you done your home work on this?

Now let me come to the crux of the matter.Why are these people willing to risk everything to get enrolled in unrecognized medical universities or colleges to earn a medical degree?Do you think they like to go through all those night mares and humiliation in their own country?They probably had no other option to realize their life long dream to become a dr.I for one dare to say that these people can make much better drs than many of our very own locally produced ones,if given a proper deal.
You were also just another pawn of the ruling government and nothing much.

Most of these people had studied in some of the oldest medical institutes who had been coached by lecturesr and proffessors of the highest repute.Please check on all these facts before blindly deciding against them.You should have also cleaned up all those biased officials in the MOH,before you decided to speak up.

NEIL said...

DR,Sad to say that my brother-in-law die the the local hospital without knowing what is the real cause.I try to see the doctors but he is always busy.I was keen to know if the doctor can't do it then they have to tell me so I can transfer him to other specialist center but I never got to see the evasive doctor and 1 week later my bro-in-law pass away leaving behind 3 young kids and a young wife.It's a long painful story and we can hear this very often.I bet there are hundreds who die a silent death not knowing if the doctor who was treating them is qualified to do the job.I wonder!!!

Anonymous said...

Dear Datuk Seri,

I feel it's unfair to punish students/doctors who have graduated from the best medical schools by making them sit for YET another unnecessary exam thus making them the same as everyone else.

For instance, after slogging for years in the Royal College of Surgeons in Ireland or Queen Mary's Hospital London or Cambridge, you tell them they are NOT GOOD enough for Malaysia????

Gimme a break.

Please just remove the dubious unis from the list.

After reading Product of The System's latest blog post that a houseman from a Sarawak uni was killing a patient by giving him three types of drugs that produced mortal results. To top it off, the houseman could not give the SCIENTIFIC NAMES of the drugs!!!! OH MY GOD!!!!!

Pls remove that particular local university from the list as a first step cheers.

Onekampung said...

I may not be a doctor myself, but have many friends and close relatives who are doctors, and I follow what happens in the medical development of the country closely.

It is grossly unfair for Jonathan to say Dr Chua has done nothing or little for the general medical health develoments and progress in Malaysia. I think Jonathan simply has selected memories and is totally biased in this aspect, because of his own personal frustrations, for whatever reasons.

Giving an example, is cutting down patients' waiting time in hospital not a positive and significant step? Even in many of Singapore hospitals, it is common for patients to wait for 2-3 hours because the doctors have time to see them, and they have to pay a minimum of SGD30 for an outpatient visit. How much we Malaysians pay.

When the Pandan hospital was closed down hardly a few months after opening due to moth growing on the walls. Dr. Chau blasted the JKR for doing a lousy works. Is it not speaking out the heart of the people? Sorry to say, many doctors are a selfish lots (nothing personal here), if they don't even want to properly register their clinics, then better close it down. The MOH has a responsibility towards the general public too, not only to the doctors.

Dr. Chua has done tremendous contributions in the health aspects of the country, only too sad he left too early. He has got many of those unrecognised degrees recognised during his tenure as minister, especially those medical courses pursued by those in Taiwan, some in China.So this is no good enough.

As nckeat88 said, you have been totally unfair to a person wo has contributed much to the Malaysian health care.

I am no supporter of Dr Chua, sometimes I don't like his approach too; but that is a diffrent matter.

dranony said...

Your rationale for extending the period of housemanship to 24 months, is unsound.
You said that 3%-5% of housemen are not signed up at the end of housemanship.
IF that is the reason, then why subject the other 95%-97% of good housemen to double the period of housemanship?

Would you extend medical school from five years to ten years, simply because 3%-5% of medical students fail their final exams at the end of the fifth year?

You should have just ordered these 3%-5% of bad housemen, to continue their housemanship!
And there should be NO definite endpoint to their housemanship - if these bad housemen continue to perform poorly even after 24 months, they should be compelled to go on performing housemanship UNTIL they prove themselves to the supervising consultants to be capable and safe to be unleashed upon the public.

I put it to you that your reason for extending the period of housemanship, is that it was just an underhanded way to increase the total number of junior doctors in the government service!
Just by that act alone, you would have increased the number of junior doctors in "captive government service" by 25%!
Instead of doing 1 year HO plus 3 year MO (total 4 years), they would now have to do 2 year HO plus 3 year MO (total 5 years)!

Previously, there had already been an extension to the period of housemanship from 12 months to 18 months, with the last 6 months being described "third posting," ostensibly to enable the housemen to complete the rotations of the major disciplines before sending them out to the peripheral hospitals.
This is well and good, since the "third posting" of six months counted officially as the first six months of the compulsory three years of MO service,
therefore effectively the total period of service in government hospitals was still 4 years in total.

BUT with this new 2+3 formula, junior doctors have to spend another one year in government service, another 25% of their service in "indentured labour" to the MoH!

Datuk Seri Dr. Chua Soi Lek said...

Dear Jonathan,

You sound like a very angry and frustrated man. You think just because I came from a small town, I have no vision and brain.

You are so arrogant and probably this is reflective of the poor upbringing and think all the government specialist and examiners are dumb.

If you are a doctor, I think you may have been trained by some of these government specialists. The best doctor has to go through the mill. By one stroke of the brush, you painted all as dumb. Is this a rational and fair judgment?

While you have make money in the private sector, I have no grudge against that, but please do not blast all doctors in the government hospital. They are still providing services to 39 million outpatients and 1.8 million inpatients in 2006. I am sure you wish all this patients are yours but you will probably not be seeing them as they are from the poorer section of the community. I am sure you have no time for this group of patient too.

You are probably not aware that when we enforced the Private Healthcare Service and Facility Act 1998, we flushed out about 20 fraud or bogus doctors by 2007. I am sure they are many out there and I hope you are not of them.

Thank you for your time reading my blog.

DR SURESH K said...

As expected you didnt publish my comments neither you replied to my questions which I posted yesterday.

Nevertheless,I wish to ask you here ,why do you need the Private Health Service and Facility act,when the MOH had all the relevant rules and regulations to check on private practitioners?

Why didnt the enforcement officers from MOH do their job?So who do you want to blame for the existence of bogus doctors?

What did you do to improve the standards of our locally produced doctors?Do you think most of those locally produced doctors have an aptitude for medical studies?

I would like to hear your explanation on these matters.TQ

hornbill said...

Dear Datuk Seri Dr Chua,

Let me share my views on this topic.

Public hospitals are meant to SERVICE hospitals not teaching hospitals. Doctors in service hospitals especially specialists are bogged down with administration duties, non clinical work as well as clinical work. We simply do not have the time nor energy to function as a University teaching housemans what they ought to learn from medical schools.

Housemans should be getting practical experience in public hospitals not medical school knowledge. They should be asking "How do I administer streptokinase?" or "What is the benefit of PCI versus thrombolysis?" Instead, nowadays they are asking "What does this ECG show?" or "Is this sinus rhythm or not?" Most housemans nowadays have no clue how to read an ECG for instance.

Why are we breaking our back trying to accomodate housemans who have graduated from unrecognized medical schools, for instance the 250 40 year old or older housemans highlighted in the press lately? If they have failed 3 times the conjoint local exams, perhaps they are not fit to be doctors. Sounds harsh but let me put it this way. How many of us would want a 45 year old houseman who failed the conjoint exams 3x, then offered a 3 year repeat medical school leeway again, which was then reduced to 18 months to treat our loved ones?

How would one reprimand a 45 year old houseman who could possibly be a grandfather now and treat him/her as though they are 25 year fresh graduates? How would they cope to survive the rigorous on calls of housemanship eg EOD (unfortunate but a fact of life)on calls as a 45 year old and only 10 years away from retirement?

In our culture of "lebih tua lebih berisi" and "Lebih tua makan lebih garam", how can one reprimand them on front of more junior and younger doctors? Perhaps the specialists even are younger than them!

The harsh truth is if one is willing to go to a unrecognized medical school and then "gamble" to pass the local conjoint exams, then they themselves are to be blamed for their own predicament. Not everyone is cut out to be doctors. Harsh but true.

Extending housemanship is just "passing the buck" to the next department. It does not address the underlying problem of poorly taught housemans or poor quality housemans who shouldn't be in medical schools in the first place. Another additional year is not gonna transform an E student to an A+ student. It just doesn't.

The difficulty is monitoring the standards of recognized medical school is understandable. Perhaps we can link our recognized medical schools to the GMC in the UK for example and the rest which is not in the list needs to undergo the conjoint exams in the local unis.

The public hospitals have benefited a large proportion of the population. Don't add more burden to government doctors/specialists by expecting them to train "Unqualified Housemans". We are burdened enough already.

Datuk Seri Dr. Chua Soi Lek said...

Dr Suresh K

I have not received and have not seen your comment in my comment's moderation page.

Thank you.

Dr said...

Dear Jonathan

Does it ever occur to you that you are biased by your
very first sentence? -->(Did you ever have the feeling
that the examiners you spoke to could be biased?)

Anyway, yes, I agree with you that research is of course important. How important? Enough to sacrifce clinical services in the name of research? If you do so want to do research, perhaps you can join the
university hospitals. But do not do it at the expense of the poor patients. I think you're aiming your arrows in the wrong place.

Anyway, having being trained overseas myself and being a non-bumi and also being involved in some of the medical qualifying exams, I have to honestly say that
the standards of some of the foreign trained doctors are atrocious. Since u so vehemently believe in their right to practise, perhaps I suppose they could treat your
sick loved ones?

Anyway, I rest my case. I do not wish to waste anymore time debating to your colored, biased mail full of vitriol which in no way adresses any of the problems.

Dr. JFR (Selangor)

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