Monday, May 01, 2006

Calling all Malaysian doctors in the UK

Just as I was highlighting medical students as an 'at risk' occupational category, the dean of the UKM medicine faculty, Prof Dr Lokman Sain, hits back at the lack of opportunities for Malaysian doctors in Britain.

I have to give the dean credit for responding so quickly to the UKEC preliminary report. It was a proactive approach given that he would have been asked to comment on the specific situation of medical students studying overseas. Since perception or image is often as important (if not more so) than reality, it was good of him to come out and point out that Malaysian doctors who come back home can get better training opportunities compared to overseas doctors. It was also honest of him to come out and state that pay differentials was clearly one of the main reasons why Malaysian doctors who are overseas don't want to come back home. Even though most of us know this to be true, not many politicians have the guts to come out and say it straight out.

But we have to take his comments with a pinch of salt since journalists don't often report comments in full and sometimes take comments out of context. For example, the report stated that Prof Dr Lokman Sain was visiting students in Ireland and not Britain. This might have made a difference since Malaysian doctors praticising in the UK might have more opportunities open to them in London, Manchester and other major teaching hospitals given that there are more major cities and teaching hospitals in the UK compared to Ireland, which has a much smaller population.

We also have to weigh his following comments carefully:

“The information is misleading as some people will think that it is easier to become specialists in Britain but it is indisputable that we produce more specialists – about 400 specialists a year from UKM, Universiti Malaya and Universiti Sains Malaysia, compared to the 50 or so who come back from Britain every year,” he said.

Is he saying that of the Malaysian doctors who stay in the UK, only 50 or so manage to become specialists every year? Or is he saying that of only 50 or so who have managed to become specialists come back home to Malaysia every year? Both have different implications. The first is largely supportive of his argument. The second might not be. For example, there might be 50 or so specialists which come back to Malaysia every year but another 300 to 400 who become specialists and stay put in the UK. His statement seems a little unclear. (But if there are 50 specialists or so who come back from the UK to Malaysia, I think that's a good thing and worth investigating further e.g. by asking them why they came back instead of staying put in the UK)

I don't know the number of Malaysian doctors who are training to be specialists in the UK and Ireland at the moment but my sense is that the number of them becoming specialists in a year is probably closer to the 50 number rather than the 400 number for the 3 local varsities referred to by Prof Lokman Sain.

But is it the number of specialists or the proportion of specialists which is of greater importance here? For example, if only 400 out of 1000 (40%) of those intending to be specialists actually make it in the local varsities compared to 50 out of, let's say 100 (50%), in the UK, wouldn't it be more attractive to pursue a specialist career path in the UK? Or shouldn't we consider the total number of specialists that the UK produces each year versus the total number of specialists that the local varsities produce each year instead of comparing the total number of Malaysian specialists that the UK produces each year versus the total number of Malaysian specialists which Malaysia produces each year? If there are a larger number of specialists being produced in the UK, does it mean that a Malaysian doctor has a better chance of becoming a specialist in the UK?

I'm not a doctor but I would appreciate it greatly if someone who knows can enlighten me and the rest of our readers as to the thought process that an aspiring specialist goes through as he or she considers his or her options.

Another point not brought up directly by Prof Lokman Sain (or perhaps not reported) is that there might be certain facilities or resources or networks or faculty that a certain aspiring specialist has access to in the UK context which he or she would not have in the Malaysian context. For example, there might be a specific area of cancer that an oncologist might be interested in for which there are only a handful of people with the pre-requisite cutting edge knowledge, none of whom are in Malaysia. Of course, the opposite situation might also occur in that there might be expertise in the Malaysian context that are not available in the UK context, perhaps for certain diseases that are more prevalent in Malaysia compared to the UK. Again, I'm not a doctor so I wouldn't know. I'd just like to point out these possibilities.

I also want to question the following statement made by Prof Lokman Sain:

“Many of our doctors have been sent to the smaller peripheral hospitals as they couldn’t get into the major hospitals in Dublin and Cork,” he said.

Is there any way to guarantee that a doctor coming back to Malaysia won't be sent to a 'smaller peripheral' hospital in Kota Bahru or Kuala Terengganu or Raub? Is there some sort of guarantee that a Malaysian doctor who is trained overseas will be sent to a hospital in Penang or KL and that only locally trained doctors will be sent out to the more rural areas? I doubt it but perhaps someone more in the know would be able to enlighten us.

I gave the earlier example of a friend who graduated from the University of Melbourne, got sent to Kota Bahru and promptly quit after 2 weeks primarily because of poor working conditions. He's now a GP in Singapore. It sounded eerily simliar to the situation described at the end of the Star report by a houseman working in a local hospital.

“For example, yesterday I was forced to work for close to 36 consecutive hours, with only 15-minute breaks for meals,” he said.

Finally I want to address a possibility not touched by Prof Lokman Sain. He stated that many Malaysian doctors he met in Ireland were stuck there as junior housemen and denied promotions as priority was given to European Union doctors. Is it possible that some Malaysian doctors fear that they might face discimination of a similar kind if they come back to Malaysia? Again, I'm not sure of the promotion process in the local hospitals but if the promotion process in the local universities are anything to go by, then I think it's a relevant point to raise.

It's good marketing and a proactive approach on the part of Prof Lokman Sain. But we need to look deeper into the numbers and the issues if we are to understand the situation of non-returning doctors better and to try to find possible remedial solutions.

26 comments:

Anonymous said...

a lot of prof. lokman's arguments doesn't really hold well. in fact, i would say that what he's trying to do is to retaliate the star report with a double salvo.

he's pointing of facts such as only 50 become specialists in UK cannot be regarded as accurate simply because there are not many doctors able to fund their postgrad specialisation abroad. moreover, the quality of our teaching universities and their adjacent hospitals are poor. so i am sceptical of UKM, USM, and UM's ability to produce real qualified specialists.

among all his arguments, the one's that i feel is accurate is that doctors abroad are definitely in it for the money and better working conditions. labour laws in UK are one of the best in the world. 36 hrs for local doctors is totally unrealistic. it's borderline ridiculous. this is human lives we're talking here, not machines. there can be no mistake during their shifts.

my opinion is there is nothing wrong with studying and working overseas. but these professionals should come back and serve later on in their careers. besides, there is nothing wrong with these graduates getting good work experience from world-class environments. a good example of what i mean is that doctor who has returned from Japan to start a brain research centre recently. at the end of it all, everyone will gain. professionals get good pay and experience the first few years abroad, then contributes back to malaysia when they return.

good boy said...

This Tony is very funny guy.

I come to this blog but I never write any feedback for the past 6 months.

Why? Because this blog is useless to me.

The most “funny” thing is, the government ban the person talk about racism, but the government is “working” racism matters everyday.

This Tony is like the government running dog - make me vomit and sick.

More better, put your head into the sand, see no evil, hear no evil.

After all, I bet you will ban me if you are serious enough.

Anonymous said...

Errr good boy, what are you talking about? Have you had too much X or too much alcohol lately?

Pur.Boy

Anonymous said...

you know, i've come to a point where i realise such nuts like "good boy" is a curse upon themselves. no point arguing back. their shallowness and naivety will bring them down.

Anonymous said...

I think the UK is undergoing a radical reform in the way it's hiring new doctors...I'm from Imperial (but not a medic) and there were 39 recent medicine graduates jobless.

Apparently even if your CV is pretty good, you can still end up jobless!

Read more here:

http://www.newmediamedicine.com/forum/showthread.php?t=19692

Anonymous said...

REMEMBER!

They say London's streets are paved with gold.....

In the end they found out, it is not so..

You may complain a lot of things lacking in Malaysia, but in the end you will find Malaysia is still the best despites its shortcomings

The Malays have a saying..."hujan emas di negeri orang, hujan batu di negeri sendiri...."

Anonymous said...

Which is the better specialist qualifications?
1 Post grad medical qualifications generated by our local universities
or
2 Specialist qualifications such as MRCP, FRCS? MRCOG?

As for me, my qualifications are MSSEE, LCE.MCE,SC,HSC.....hehe
Thought of adding it further with DBKL,IWK,MPPJ

Anonymous said...

I think you avoid one critical general point which is its a shame to allow oneself to be treated as second class(or third class etc) in one own country but to be treated such in a foreign land is still excusable.

Frankly, if conditions in UK or elewhere were discriminatory and the pay were the same,
people would still move. Why because at least its not legal, whatever else you want to argue about the facts, this one is above everything else. Human being makes decision on their perception of dreams and hopes not political arguments. Period.

Anonymous said...

Kian Ming

Can you create a blog on the justifications and sensibilities of applying ISO exercises in the local universities? Does it really monitor or guarantee the quality of the universities, or is it just another " wayang kulit' to give respect and dignity to our universities?

Anonymous said...

I really don't see any needs for ISO XXX at university..ISO auditing is more on documentation not implementation..I really don't understand why universities really want this...I don't see any improvement to quality of academicians nor students..:-)

Anonymous said...

Youre very right! ISO is more in the manufacturing purposes. It is no point implementing ISO just to record the whereabouts of a particular furniture.

Any way wats the point of the ISO auditing if it is not followed?
I think UM is a money pit...all the money drained away for nothing

Anonymous said...

I think money is a big factor, while things like discrimination, working environment come into the picture as well.

For I know, discrimination do occur in Europe and Australia. This is not the case if it is USA or Singapore.

For places like UK and Ireland, even European countries, yes, money is a big factor.

But for Singapore and USA, I think people like to work there because the working culture is better. If you are really good, the promotion opportunities are great.

In conclusion, I would say Prof Lokman's report is not thorough as he generalised from just a visit to Ireland. How about malaysian doctors who works in the Australia? USA? Singapore? Why didn't he comment on that? Damned biased!

Tony, why don't you guys create a poll website asking all malaysian doctors out there to vote why they did not want to return home?

I think that will knock-out Prof Lokman's comment on the Star.

The Malaysian. said...

Dear Kian Ming, I got to this page by chance and I'm glad I did. You've discussed the issue comprehensively and that's a pointer for me, being new to blogging. I too touched on the subject but very briefly if compared to you. Please pop over when you're free and any advice that you give will be very gratefully received.
http://the-malaysian.blogspot.com/
Thanks and Cheers.

Anonymous said...

Malaysian professionals such as the medical doctors can choose wherever they like to further their respective careers (provided they have fulfilled the contractual obligations). There are a number of reasons, which explain their decisions. But I hope that the Malaysian government is committed to creating a reasonable and fair working environment in public organizations such as the hospitals and universities so that those who deserve to be promoted or given financial assistance for further training may get what they want. I do not know of a better way to encourage Malaysians to return. Whether it involves a doctor's job, PhD holder's lectureship or otherwise, Malaysians can get a much higher salary in some countries (USA, UK, Hongkong and Singapore, just to name a few), but money aside, there are factors which are important, at least to some of them.

1. As a country in the Asean, Malaysia is a comparatively advanced country with an economy marked by low cost of living.

2. Malaysia is where the relatives are, especially if one's parents desire that he or she be around due to ill-health, old age or emotional reasons.

However there is one distinct disadvantage of local training. The UK or Australasian qualifications such as FRCS, MRCP and the likes are internationally recognized. Malaysians who have such qualifications and who choose to live in an overseas country may be admitted to professional bodies of the country either with no further examinations or with the maximum exemptions. Malaysian ladies who are married to foreigners, know the relevance of the point very well.

vincent said...

I would only like to refer to the case of the doctor who got posted in Kota Bahru and then got annoyed with the situation and ran to Singapore.

We DON'T WANT doctors like that. These are doctors who choose the profession because of the glamour. Didn't he already know that there are small towns in Malaysia? Do we not need doctors for places like that?

A vicious circle, really. A doctor doing his housemanship works 36 hours because there aren't enough of them around!

Anonymous said...

For those who are working in oversea, do enjoy ur work out there and don't come back. Coz' the malaysian government will not appreciate anyone of you. Just look at the pass, how many professional candidates are being rejected here in m'sian. These pro are all been well treated in s'pore, australia, uk etc.

med student said...

there are many factors why students studying overseas wouldnt want to come back. Money undeniably is one of them, how about our parents who had to pay for our education so that we would be given the chance to achieve our dreams. isnt it only fair if could give something back to them. secondly, like what one of the bloggers said, isnt it better to be treated as 3rd class when it comes to job oppurtunities etc in a foregn land rather than in your own country. Also, if one were to come back to train to be a specialist, im sure once again there would be a quota system ie depending on race etc only will you be given a chance to rise to the top, so obviously your talent and hardwork does not matter. So if a student chooses not to come back, cn you blame them? we only want to be the best doctor we can be and and achieve the best possible education and in the end it's for the people we treat. So if we make it here as a specialist, sometime down the line we will be able to bring back our specialities. Plus, training overseas, opens you mind to a variety of latest reasearch and technology not currently available locally. Its true, that Malaysia despite its shortcomings, is an ideal place to live if u exclude its politics.So whats the solution?

Anonymous said...

Surveys should be compiled by Malaysia's second class citizens...because their plight on the lack of meritocracy is the truth. But then again, these things are politically sensitive. So in the end, the real reason would have to remain obscure. Sorry, but someone had to say this!

Alan said...

I am writing here as someone who IS working in Dublin, Ireland. I have been here for around 10 years. And yes, the money here is reasonable, but only when we convert it back to malaysian ringgit. So the people who think that doctors here are making big bucks is totally wrong. I can's speak for the others but I'm sure the majority of malaysian who stay behind feels the same like me, where we would like to progress til the top (ie become a so call "specialist") before we return to malaysia. So that we don't have to be trained further in malaysia. Everyone knows that the career promotion in the malaysian system is grossly unfair. So why go back when you are doing well here? Yes there are people who are working here with poor career progression too. But we live in a democratic world where people should be allowed to do whatever they want. This of course does not apply to "government scholar" who has used the money from the general public to pursue a medical degree and now is not honouring the contract where they will have to serve in Malaysia. Whereas for those of us who was funded solely by out father mother scholarship, LEAVE US ALONE!!! Coz my parents HAVE.

KS said...

I am currently a Radiology registrar in Birmingham. First point I want to make is that the situation in UK has become extremely difficult. It is almost impossible to get into proper specialist training if you are not UK resident. This is also true for Malaysians who graduated in the UK. I am one of the lucky one who got into specialist training before the change in immigration rules and training structure. This is actually good news in a sense that more Malaysian doctors in UK will go back home. I certainly have a few friends who are jobless and are planning to go home.

Personally, I still want to go back to Malaysia after I complete my training. I have been here for 4 years and I have not changed my mind.

The main reasons I want to do my training here are:

1. Qualification which is more widely recognised worldwide. This gives me options of working else where, even though I always want to work at home.

2. Better pay. It is easier to save money and I can earn back the money I spent for my medical degree faster. For other people, they can pay back their study loan faster.

3. Better working life. Better working hours. You can call me lazy, but I rather have more life outside medicine.

4. I love travel. Working in UK gives me the opportunity to travel to Europe and US, because of the close proximity. The high UK currency also makes travelling cheaper.

Once i have travelled enough, save enough money and get my specialist qualification, I will settle down in Malaysia.

I also have friends who want to stay in UK for good. Their reasons being:

1. Better education for next generation.

2. More stable political situation.

3. Used to life in UK or found a UK wife/girlfriend.

Hope these information useful.

Anonymous said...

I am a Malaysian doctor working as a Consultant in Ireland and would like to provide some insight into the real situation here in Ireland. Firstly, we have to separate Ireland from the UK, different countries, different laws, different salaries, different healthcare systems, different training systems; only similarity being the exams and post graduate qualifications.

Ireland has a shortage of doctors, many being recruited from overseas. There is a preference here for Irish graduates, including Malaysians. It is true that EU law states that an EU national has to be given preference over an equally qualified non EU national, however the keyword here is 'equally'. As someone that has sat on interview panels, I can tell you that it is not always the EU candidate that is the most suitably qualified.

It is true that many foreign doctors are working in the peripheral hospitals. However, many peripheral hospitals here are accredited for training. In addition, there are Malaysian doctors in high positions in Dublin hospitals too. Academic qualifications only form part of what employers look for over here. Research and publications, communications skills, interpersonal relationships, non medical activities as well as solid references are key too. I cannot generalise and say that Malaysians are lacking in these other areas, but more often than not, they do.

The general attitude here is one of independent learning and taking a proactive stance in furthering one's education. Seniors here will probe on the odd occasion what study you're doing or what journal you're reading. Sometimes they may make suggestions on articles and book chapters to read. But there is no spoon feeding or hand holding here. This is the difference between Irish and Malaysian culture.

The salary offered here is of course a highly contentious issue. It is also one of the main reasons why I stayed back here even though it has taken me 12 years to complete my specialist training compared to 4-5 years in Malaysia. Currently, a Registrar in a surgical specialty, typically a post attainable 3-4 years after graduation can earn anywhere from 80-150k euros a year depending on the specific on call rota worked! In Malaysian Ringgit, that's around RM350k - RM700k per year! It is one of the highest salaries of any doctor at this level in the world and is considered high even by Irish standards.

There is an attitude prevalent among some Malaysian doctors here that they would rather be paid a high salary and be stuck out in a peripheral hospital in the middle of nowhere in Ireland, than be stuck in a peripheral hospital in Malaysia with a very low salary. I am in total agreement with them.

It is time the Malaysian government started treating doctors as professional, giving them the higher salaries that they deserve and recognition of qualifications and standing. It is after all the nations brightest that become doctors, and a meager salary with a pat on the back just does not do it anymore in today's world. Denial that times HAVE changed will only worsen the problem.

Doc Sims said...

1. I think the plea for oversea doctors to serve its country and people apply to those who would like to serve its country and people. Nevermind those who would rather serve sick ppl in other parts of the world, and not their own.

2. Everyone has its goal. So some of us prefer money for their profession. Lets just hope they do their job well. So some ppl prefer rm100 for consultation fees while another feel adequate with rm10. Why can't they come back and serve the private hospitals if they want money? Maybe because they feel inadequate of the inexperience? U should see the car park in Malaysian private hospitals, they are like car shows! If they feel that they lack the experience, why can't they come back and get the experience here since the government is encouraging them to come back? S-h-y?

3. I knew Prof. Lokman Saim, and I think he is one of the best dean for UKM, in fact, perfect. Because if the medical students who applied to UKM read carefully of its mission in producing UKM medical graduates, one of them states that they are being trained so that they can provide service especially for rural areas, not for money, not for being the best in the world, not for competition, but simply to serve. If any doctors can serve the rural areas, they surely can serve our state hospital. I remember asking his advice for placement for my housemanship. He prefer for us to go to district hospitals where the experience is greater, and only come back when we would like to do specialty.

4. The world is becoming materialistic, and maybe because the world is demanding for materialism. Look at our tv shows, restaurants for the riches, house for the riches, hotels for the riches, car meant for the riches.

5. If what the previous anonymous said is true, then we do need their experience to replace those spoon-feeding method for the new generations like me.

6. So next time you've got a cousing or son or sisters preparing to be a doctor, please ask them to visit our district hospital, visit the emergency department, and the ward. They have to know that's where the doctors are needed, not the private hospitals. If they preferred elsewhere, they they should study at a private school. At least they can help another person for a place to get a medical degree in a government's university, and serve it's people and country as a payback for all the teachings the doctors, lecturers and especially the patients, given to them through the years of their study.

mth said...

Nonsense!
Salary is but a disguise to shadow the disgust at the almost total absence of meritocracy in Malaysia. I rather endure the discrimination in a foreign country than one perpetuated in my own.

My experiences at peripheral hospitals have actually proved that these are better places to work at and train than the university hospitals in most aspects.

Anonymous said...

Dear Kian Ming, i have particularly liked ur blog because it triggers me to discuss on the topic with my mates, though at times i may not agree with you. This is among the topic that interests me most as I am a malaysian doctor currently under going specialis training in the UK. While i totally agree on the debate to improve working conditions for local doctors in malysia, i need to point out the bad stereotype that has plagued the malaysian mentality of doctors. The typical one is about local graduates are regarded as inferior to overseas medical grads, especially if they graduate from US, UK, ireland or Australia This is a bad mentality that has to be eradicated. The Malaysian specialist training is very recognised by the UK itself, with the MRCP (UK) is equivalent to the M.Med Malaysia. In fact, here is a link i provide that will inform you on that, from the Royal College of Physician in UK:

http://www.rcplondon.ac.uk/International/OverseasDoctorsHandbookAustralasia.pdf


As a doctor myself, i can say that all overseas medical grads (if not most of them) do not see themselves as better than their fellow local colleague, especially after they have undergone 7-10 years of training+ studying + exams after havng graduated from our first medical degree. Medicine is a very demanding course and having been qualified a training from a recognized university is already good.

So the real question here shouldnt be the differences about overseas and local qualification, but more towards why doctors do not keep on staying in our hospitals. Most of doctors would reply that the governement do not seem to acknowledge doctors plight on the too demanding workload. Though low salary seems like the most obvious answer to lure doctors back into public hospitals, that is not entirely the only answer. If any of the politicians have studied management studies, there are other ways to improve motivation of employees, like less clerical and less of those hasselful paperwork would surely help so that a doctor focusses only on medicine, or even give perks to research. Many doctors i noe would love doing research and teaching with university especially if giving the chance to... please lessen all the red tape as well!!!.. these may seem like my worthless rant, but what im trying to say is make a study/research first before implementing policies, any governement policy that is.. These doctors are not asking to be paid millions or work 1 hour a day, but rather rather to be treated reasonably.

Anonymous said...

Thank you everyone for your comments. I have been in the UK coming near to 20 years. I have now completed my specialist training and am seriously considering coming home. Why? Simply, because there is no place like home. I am willing to accept a pay cut (currently earning RM 25,000 a month clean after UK 40% income tax). I appreciate that there is no way I am going to earn that much in Malaysia but then again, money is not the be all and end all. Can you guys help me out here? Does one still have to serve the compulsory three years with the government even returning as a specialist? I know there are other options such as affiliating oneself with a teaching hospital or private organisation but what about just working in a respectable district general hospital? More importantly, can someone please let me know what life is like as a consultant / specialist in Malaysia? Many thanks for help.

Anonymous said...

Hello, was reading through the comments by your readers. I'm looking for doctors with training in pathology or haematology. If you're interested and have an APC in Malaysia, please email me at saritaone@hotmail.com, attention Sarita. Doctors looking to come home are also welcome to drop me a line.