Tuesday, February 09, 2010

Compulsory service for doctors

At first, there was a eye catching headline made by Datuk T Murugiah.

I quote from The Malaysian Insider's article - Move to extend compulsory government service for doctors, T Murugiah said :

" The government proposes to extend the compulsory public service for doctors to five or 10 years from the current three to overcome the annual shortage of doctors in its hospitals. The doctors should not only think about profit. They also have to think about the country’s interests — your contribution to the country. "

That surprised me and I don't know whether it was his idea or it was a result of his advisors' brainstorming session.

Whatever it is, ask all Malaysian medical students if it is a good idea. If there are punters taking bets on this, I place my money on "Bad idea".

Now, the latest news from Liow Tiong Lai (Health Minister) said that the Government will reduce the compulsory service period. Read it here : Shorter service for new doctor

"The suggestion is not practical at all. We must make it attractive for doctors to join the service. We cannot force them to work."

And it was backed by the Health Ministry Director General too :

"We are providing more incentives to retain the doctors who are in service, attracting Malaysian doctors from overseas, allowing locums, providing extra allowances for overtime and making arrangements to hire foreign doctors to work with us on fellowship programmes."

My advice ? Simple. Every year JPA sponsors tonnes of medical students overseas to Middle East, Czech Republic, Russian Federation, United Kingdom, Scotland, United States, Australia, New Zealand.

Did I leave out any ? Yes, there are those sponsored to local medical institutions like IMU and Monash University Malaysia.

Ask them to provide you with feedbacks. They tell me all sorts of stories and frequently I hear about the system in the country they were sent to study in compared to ours in Malaysia.

Some friends can point out what is the "turn off" for not returning to Malaysia as a qualified medical doctor.

Do I need to lay out the methodology to gather feedback from them or how to reach them ? I can easily lead you to a handful of JPA sponsored medical students who will tell you what is in their minds.

And please. Share with them your plans to see if they think it is good or not. Brainstorm with the FUTURE doctors as well.

I have many medical friends who have plenty to say about the current system and I believe addressing such issues will settle the "crisis" in our public medical sector ONCE AND FOR ALL.

It is getting very dull and boring each time you tell us "yes we know the problems" and "yes we are planning to attract them back".


Anonymous said...

If paid by the government, they should carry on their duty as a payback to the government and the tax payers. If you can't make it for any reasons...u should never ask for sponsorship from the JPA... ...

Anonymous said...

gong xi fa chai brooo...united for all..peace!!


keropok lekor said...

Maybe we can introduce new and achievable KPIs to our MOH.

Instead of harping on the lack of doctors and "yes we will get them back", I agree with you that they should find a once-for-all workable and sustainable solution to solve this crisis. That includes changing the way they hire doctors, changing their pay scheme or even corporatise all public hospitals.

Number of doctors is not a good indicator of the efficiency of services. As someone wrote, we always complain about the lack of doctors in hospitals, but why don't we ask why are there so many patients at the first place?

After all, many people who go to hospitals don't actually need to be there if they could have obtained adequate primary care in clinics and GPs. Is it because primary care (GP) in Malaysia is unaffordable, inaccessible or inadequate? If that's the case, why aren't these issues being addressed?

Instead of blaming the lack of doctors for the ineffiency, the minister should have thought of creative ways to channel services to the population despite of the resource limitations.

We can employ all the doctors in this world, and still complain of the lack of doctors if we choose to insist on a myopic view of the healthcare industry.

Thus, like the problem with public transportation, the problem is not the lack of buses or drivers, but how the bus links are organised to streamline services to serve more commuters in the most efficient way. Instead of adding more buses, we should be asking why aren't people taking them?

Likewise in healthcare, the KPI should not be the number of doctors-in-service, but how the health sector can be better streamlined and organised to widen their coverage to all Malaysians.

Some measures include the deinstitutionalisation of services (hospitals are expensive to run) into the community, improving access, quality and subsidising private primary care, making public hospitals financially sustainable (think IJN), and reasonable remuneration for doctors so that services can be maximised to meet the needs of the rakyat.

Real KPIs like the prevalence of smoking, rate of infectious disease, infant mortality rate or the rate of hospitalizations should be used as a performance indicator, to be reduced. Not the number of doctors alone.

The responsibility of caring for the society doesn't lie on the number of doctors alone, but the wisdom of the policy makers.

katdog said...

Everyone knows the problems with our country. The local health and services problem is no exception. (other problems being education, economy, crime & safety etc)

The REAL problem: The BN leaders is incapable (or unwilling) to admit to the real problems.

Hence the trouble in Malaysia is two-fold. We have problems with lack of qualified doctors. Then we have the problem that the leaders are still unable to figure out why we have problems with lack of qualified doctors.

Are BN leaders just plain dumb? Or are they just too arrogant to listen to what the little people have to say? Or are they both (dangerous combination: dumb AND arrogant)?

Reduce the compulsory service period? It might help a bit. But you know what? Anybody with half a brain will tell you - that ain't solving the problem.

All i can say is: "BN, i wish you luck in solving the various problems of the country. God knows, you look like you are going to need lots of it"

Anonymous said...

It would be naive to actually compare the health system in Msia with that of the UK, US, Aus, or even some other countries in Asia for instance. In my opinion, the health service in msia has still plenty of room for improvement.

The gov should start fresh, provide more reasonable wages to doctors to begin with, more promising career advancement in the public sector, and more EQUAL OPPORTUINITIES for specialty training posts for ALL MALAYSIANS.

I believe that with the number of sprouting medical schools in msia, be it public or private ones, there ARE and WILL BE sufficent doctors in Msia every year. I was informed that in a ward of 20 patients in a general hospital, there are 4-5 junior doctors over-looking patients in the ward. I have friends who are also junior doctors here in the UK; and at any time in the day, they would be responsible for on average 20 patients in the ward by themselves.

Nobody likes to stay away from home for a very long time, although it would seem apparent to overseas medical students how good and developed health systems are overseas, I believe a HUGE number of msian medical students (like myself) are willing to return home to serve the msian community EVEN with the current wages junior doctors get, PROVIDED that they receive the same career advancement opportunities in msia as msian citizens as they would get being an immigrant overseas.
(ALL MALAYSIAN = malays, chinese, indian, lain-lain):P

From representing yr own school for national competitions, to getting a place in a local uni, to applying for scholarships for higher education, to getting a specialist training post or even a job in msia, we get tired of trying and trying but not gettin anywhere with anything, the only choice we are left with is to leave the country...