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For Future Malaysian Doctors: General Misconception of being a doctor

Colleges in Malaysia - Diploma in Business, Engineering, IT, Aircraft, Nursing, Hotel Management

Dr. Pagalavan
MBBS(Mal.) MRCP(UK) FRCP(Edin) AM(Mal)
Consultant Physician & Rheumatologist
Columbia Asia Hospital Nusajaya
Johor Bahru

General Misconception of being a doctor

Guaranteed Job and Good salary/can make money
Many parents still believe that being a doctor guarantee their childrenís future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

Whatís going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacistís critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctorís salary is only RM 200 more than a pharmacist in civil service!

Medical degree recognition
If I canít work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere. Malaysia Boleh mah! Only Monash University Malaysiaís medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

Housemanship & Compulsory service
I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

Hard work and post graduate training
20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, donít assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Masterís programme is very much limited in local universities. The demand is greater than supply and of course doní forget the quota system as well! Other than MRCP (UK) Ė internal medicine, MRCPCH (UK) Ė paediatric and MRCOG Ė Obstetric, you have to depend on local masterís programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

Being a GP
As I have written before in my MMA articles, the future of GPs are bleak. If you think that you just want to complete your MBBS and open up a clinic, then I think you are misinformed badly. Many GPs are suffering nowadays. Many have even closed their shops due to severe competition. GPs, not only have to compete with their fellow GPs but also with private hospitals, government clinics, pharmacy and traditional medicine sellers. The scenario has changed as I have said in Part 1. You are also strictly regulated by the Private Healthcare and Facilities Act which was implemented from 2006 onwards. Many GPs are only earning a net profit of RM 10 000 a month which is ridiculous compared to the amount of work that you are doing. Imagine that you have to work from 9am to 10pm daily including Saturdays and Sundays, especially during your early days. Thatís the reason why you notice less and fewer doctors resigning from the government sector to set up their clinic. GPs are now moving from urban areas to sub-urban and rural areas to open up their practises. There may be a better market for GPs in these areas compared to town areas.

Being a Consultant in a Private Hospital
Only in medicine I can earn RM 50 000/month when I work in private hospital? I had many friends and budding doctors who feel that medical specialist earns the highest in private sector compared to any other profession. Again, I would say that you are mistaken. Even though you may be right in terms of the earning capacity but what you are not aware is the fact that the private hospitals DO NOT pay us a salary!

Basically you are NOT employed by the private hospital. You are just running a clinic as a self-employed person in the hospital. Whatever you earn is the consultation/surgical fees that you are charging the patients. In fact, the hospital takes 10-15% of your consultation fee as their administrative fee. Furthermore you also need to pay a rental for the clinic space that you are renting! The rental can range from RM 4000 to RM 8000/month. Yes, if you are an interventionist/surgeon or have a lot of patients, you may earn as high as above but at the same time you can also earn very much less than expected depending on the number of patients that you see for that particular month. You may even end up earning less than RM 10 000/month at times! Again, with more and more private hospitals coming up, the competition will be greater and the income of each doctor in each hospital will definitely drop even further. Remember, if a patientís hospital bill for an admission is RM 5000, only less than 25% of the bill is the consultation fee which belongs to you, of which the hospital will take another 10%!

Also, when you are in a private hospital you are all alone. There are no junior doctors to help you. You need to do all the procedures by yourself and must be available at all times to entertain any medical complaints from the patients (even in the middle of the night). It is not just a matter of running a clinic! So basically you can only charge a patient when you see a patient for consultation and that is your salary!

And also donít forget, for you to reach the status of a subspecialists before going full-time private practise, it will take at least 12 years following undergraduate medical education, a total of 15-17 years !! By this time some of your fiends will be earning much more than you and driving bigger cars and going holidays all over the world. Many of my friends who went on to do IT, accountancy etc etc had become company managers and directors by the time I finish my subspeciality. They have started to enjoy their life when I was just beginning to think of earning money.

TV programmes : ER, CSI, House etc
Donít get carried away by watching TV programmes like ER, CSI and House. Things do not work the way it is shown on the TV. I had one budding doctor who said that she wants to become a forensic pathologist. I am sure she was influenced by CSI. In Malaysia, the reality is, any forensic pathologist just sits in the mortuary the whole day. They hardly go down to the scene of the crime. Furthermore, if you do attend a court case, you will be tortured by the lawyer. BTW, donít think we have all the high-end technology in our mortuary like what you see in CSI. In Malaysia, forensic pathologist doesnít work in a police department. You are just another specialist in a government hospital forever, as you wonít be able to go private. Malaysian law do not accept a report by a private specialist.

Patientís demand and increasing medico-legal issues
Many doctors are being sued nowadays. This happens in most developing or developed countries. Gone are the days where patients will forgive and forget. Even the government is asking all doctors in civil service to take their own indemnity insurance as the government may not be able to cope with the legal suits. The cost of insurance has gone up tremendously especially for surgeons and obstetrician. For Obstetrician, the yearly insurance stands at RM 40 000 Ė 50 000! So, donít think that the public has high respect for you and thus they will not take any action against you. A small mistake can land you in court and your entire reputation will be affected, no matter how many lifeís that you have saved.

I am sure I would have made a lot of you very depressed by now. Please do not do medicine for the reasons that I have mentioned above. You will regret it later. If you really have passion for medicine then by all means, go ahead. I give the same advice to all parents who seek my advice regarding medicine. But always remember, no matter how much passion you have for medicine, it is still a job for you to earn money for a living. Once you are married and have children, money will be the most important factor no matter what you think now.

The amount of money you are spending to do undergraduate medicine alone can easily be used to start-up a business! Most private medical colleges in Malaysia charges about RM50 000-90 000/year which comes to about RM 250 000 to 500 000 in total, not including accommodation and food. You can easily safe this money, do accountancy/engineering/designer etc etc and use it later to start your own business venture. Donít you think it is a better option? To get back the investment that you have made for medicine will take another 20 years, not including the money that you need to spend for postgraduate education!

Let me tell you, the money now is not in professional field. If you are smart and only want to earn money, please try technical studies like architect, interior designer, accountancy etc. This is where the money is! If you are good, you can easily become a manager or director of a company by the age of 35.

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