Tuesday, March 31, 2015

From Doctors to Salesman

I am not surprised to find one in five houseman quit each year. This is actually a very high attrition rate. It represents a sheer wastage of resources.

In 2006, when I was the Minister of Health, I predicted that by 2014 that there would be a surplus of doctors (houseman). Malaysia with a population of 29 million has currently a whopping 33 Medical Schools (11 public and 22 private). In 2009, number of Medical Graduates per 100,000 populations was 11.2 and in the year 2012, it was 14.6 (4,067 graduates).

The United Kingdom, with a population of 63 million, has 32 Medical Schools. Australia, with a population of 23 million, has 18 Medical Schools and Canada with a population of 34 million has 17 Medical Schools.

We cannot deny that we are producing more doctors than the developed countries. We are compromising quality in order to get the quantity we think we need. With this rate, we expect Malaysia (local and overseas) will be producing a total of about 6,000 graduates per year.

To compound the problem, we recognize more than 350 Medical Universities worldwide. Some of these universities have passed their prime of life.

In 2007, when it became obvious that the quality of doctors (trained locally and overseas) was going downhill, I decided the compulsory houseman-ship to be extended from one year to two years. I was condemned and criticized. Some parents even wrote to me that the two years of houseman-ship will delay them from recouping their investment in their children medical education. Till today, I still think that I have made a right decision to extend the houseman-ship training to 2 years. I am confident that many senior doctors will agree with me.

Two years of compulsory houseman-ship may help to improve their clinical knowledge but it will never be able to rectify their shortcoming in training in the medical schools. Today, Malaysia public hospitals are confronted with too many housemen in one ward. Sometimes, housemen are more than the patients. This is really a Boleh-land.

Due to poor supervision and inadequate training, a lot of housemen clerk only 1 – 3 patients per day when they should clerk more than 10 per day in order to get adequate exposure or training.

In short, we are producing half-baked doctors. Some senior medical consultants told me that they are training the un-trainable due to a host of factors: poor attitude, lacking interest with no passion, poor basic medical training, poor command of English, poor patient relationship skill, frustration because working condition and pay do not meet expectation and etc.

Hence, there is a need to relook into a more holistic solution for medical education, houseman-ship training and expansion of public hospitals especially in semi urban areas.

If we delay we will soon have unemployed doctors and inadequately trained medical officers.

Presently, MOH has 132 hospitals and the total number of hospital beds in the public sector is 38,394. Currently we are short of 15,000 public hospital beds.

Those walking in the corridor of power in Putrajaya should have the political will and commitment to address these problems. One should not be afraid to rock the boat.

With nearly 6,000 housemen every year, soon housemen will need to wait for more than a year to get a posting. 

Ideally, the time has come to set up a Medical Commission to address many issues confronting medical education, training and services.

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对于我国每年每5名实习医生中,就有一人自动放弃从医的现象,我并不感到惊讶。这其实是一种相当惊人的耗损,也是资源浪费。

我在2006年担任卫生部长时,就曾预测我国在2014年会出现医生(包括实习)过剩的现象。目前马来西亚的人口是2900万人,但我们却有多达33所医学院(11所公立和22所私立)。在2009年,每10万名大马人口中,就有11.2名医学毕业生。到了2012年,人数比例增加到14.6名,总共4067名毕业生。

英国的人口有6300万,但只有32所医学院;澳洲人口是2300万,有18间医学院;加拿大人口3400万,而医学院只有17间。

一个不能否认的事实是,我国栽培的医生人数比先进国还多。为了达到我们自己认为所需的医生人数,我们不惜在素质上做出妥协。以目前大马的医学院的阵容 而言,预料我国每年将栽培约6000名医学毕业生(包括国内外毕业)。

更加剧问题的是,我国承认全球超过350所医学院的文凭,而其中有些医学院已过了它们的学术辉煌期。

2007年,当我们发现无论是国内或国外受训的医生素质下跌时,我决定将实习医生的强制实习期从一年延长至两年。当时,我被很多人抨击和谴责。有一些家长甚至写信告诉我,延长医生实习期的措施,也拖延了他们从投资在孩子身上的医学费中取得回酬。不过,时至今日,我还是坚信当初的决定是正确的。我也相信,许多资深的医生也会认同我。

两年的强制实习期,可能有助于提升实习医生的临床经验,但却无法修补他们在医学院深造时所面对的不足之处。今天,大马政府医院面对实习医生过剩的问题,即一个病楼里的实习医生比病人还多。难道这就是我们的“马来西亚能”?

由于缺乏监管和实习不足,许多实习医生每天只看护1到3名病人,而实际上他们每天是理应看护超过10名病人,才能有足够的接触和实习训练。

简而言之,我们培训出许多未达标的医生。一些资深的咨询医生告诉我,他们培训的一些医学生根本无法训练,因为这些医学生学习态度差、没耐心也缺乏兴趣、医学训练根基差、无法掌握英文、缺乏与病人的沟通技巧、有些还因为工作环境欠佳和薪水无法达到本身要求而感到灰心。

因此,我们必须重新探讨医学教育、实习医生培训的解决方案,以及在半城市地区扩建政府医院。

如果我们拖延处理这些事,我们不但很快将面临医生失业问题,也会面对医务人员缺乏培训的难题。

目前卫生部管辖的医院共有132所,政府医院拥有3万8394个病床。不过,在政府医院我们还缺少1万5千个病床。

而那些身在布城的政治权贵,必须要有政治意愿和决心来处理这些问题。他们必须不惧畏及勇于纠正弊端。

随着每年有6千名实习医生投入服务,他们或将需要等待候超过一年的时间,才获调派工作。

随着这些问题日趋恶化,是时候让设立一个医药委员会,来专司处理冲击医学教育、培训和服务的各种问题。


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