Wednesday, August 09, 2006

Doctor, Are You Qualified?

I've written previously on several issues with regards to the medical profession. First the almost irrational desire by many students, and more so their parents, for them to become doctors, irrespective of talents and ability. There was also a bit of a verbal fistcuffs between the Ministry of Health and the Ministry of Higher Education with regards to the "deplorable standards" of medical education at some of the local medical institutions. Plus, in a study by Malaysian Medical Association (MMA), the doctor population in Malaysia will rise at a very rapid rate from 1:1,361 to 1:400 by 2020.

The simple question then, is whether we are sacrificing too much of quality to boost quantity?

It was reported in the New Straits Times last week that there are now television advertisements promoting medical schools in Poland and Romania to Malaysian students and parents. Knowing how desperate that some of these students and parents are, irrespective of the students calibre, they might just rush headlong into signing up for these courses without knowing that they are not accredidated in Malaysia.
Director-General of Health Tan Sri Dr Ismail Merican said medical colleges in Poland and Romania had not been registered. "The agents should not be airing the advertisements. They are misleading the public," he said.
And now we hear that there are going to be even more medical schools, public and private in Malaysia despite that clear evidence that the country does not have the necessary capacity to sustain the required quality in medical education. There's the Cyberjaya University College of Medical Studies (CUCMS) "ready" for its first intake this year. Earlier this year, Kolej Universiti Islam Antarabangsa Selangor (Kuis), one of two institutions of higher learning set up by the Selangor Government, declared that they will offer medical degree courses from 2008 as part of its expansion. And at the end of last year, the Terengganu government has requested for a medical faculty at the new Darul Iman University. Are we just getting from bad to worse?

Yes, the resultant impact of these expansionary programmes both by the Government as well as by parents attracted to misleading advertisements is that we will indeed accelerate the quantity of doctors in this country. However, at what cost?

Let's do a simple comparison between ourselves and our neighbour down south. We all know that Singapore has one of the best medical faculties in National University of Singapore (NUS), which is recognised as among the top 20 in the world. More interestingly, the Government of Singapore recognises some 120 medical degrees in the world, not exactly a small number.

So, how many degrees does the Malaysian Government recognise? A whopping more than 320 degrees from various institutions around the world. While our Singaporean friends recognise only 2 medical colleges in India, All-India Institute of Medical Sciences and Christian Medical College, Vellore, we recognise a whopping excess of 80 colleges.

Less shockingly, but equally significant is that while Singapore recognises some 30 American institutions, Malaysia recognises medical degrees almost 90 universities and colleges from the United States. At the same time, only 11 medical degrees from Asia and Africa, excluding the NUS, is recognised by our neighbours (less than 10% of total) while we recognised some 160 qualifications (50% of total) from the region. For example 6 from Burma, 6 from Bangladesh, 11 from Indonesia, 14 from Pakistan, 4 from Iraq and even 1 from Uganda.

On top of that, there is of course coming to 20 medical schools in Malaysia (serving a population of 25 million) compared to 1 in Singapore (serving 5 million). Of course, absolutely none of the Malaysian medical colleges have received recognition in Singapore. I've asked earlier - is there no cure for our medical schools?

Are we certain that we are not giving recognition to doctors who may not be sufficiently competent? Recognising more than 80 medical colleges from India, for example, sounds just too excessive for me to believe that all of them meet the necessary minimum international standards, acceptable to Malaysians. In short, is our Government short-changing and risking our well-being by giving recognition to qualification from less than reputable institutions?

Correspondingly, I would strongly suggest that students seeking to pursue medical studies select schools which are recognised by our neighbour down south in order to ensure that you receive the best medical education as well as your global prospects. If you can't get into these institutions, you might just want to consider alternative careers.


Anonymous said...

My cousin is one of the adamant doctors-wanna-be, whereas I was put off way back in Forms 4 and 5 by the unbelievably dry (at least to me at that time) biology curriculum. I found out since then that getting an MD (in the US, or MBBS or something like that in Malaysia) is simply more of the same, years of memorizing facts and following established operating procedures, etc. I joke with my fellow engineer friends now that doctors are glorified technicians :)

By the way, the field of biology is another black art by itself, but a lot more interesting as I learnt since secondary school. I guess biologists has the benefit of being able to experiment on other organisms to find out about loads of yet-to-be-discovered cool stuff without injuring or killing a human being :)

Anyway, my point (which isn't that original; it has been raised before) is that perhaps there is some sense to the US system of medical training, which is considered a graduate program which accepts only those who have earned a bachelors degree (or higher). The medical students would have a tad more maturity, and would have been exposed to other fields of study (possibly more interesting than medicine! Say, for instance, biology). Not some hormone-crazed (or parent-crazed) 19- or 20-year-olds with little idea of what else is out there.

Lastly, Tony, some nitpicks. The ranking linked to your entry, in which NUS was no. 15, was for biomedicine universities---possibly focusing on medical research activities way beyond what's covered in a regular MD/MBBS program. (Good post-graduate research programs do not equal good undergraduate teaching.)

And it is "fisticuff", not "fistcuff" :)

clk said...

A few yrs back when I was involved with the education industry, one major criteria for having a medical school in M'sia was a tie-up with a General Hospital(GH). It must be a GH and not a specialist centre, private one etc. as GH patients are reflective of the general population to conduct clinicals and since GH are nearly all allocated in this country to the public universities and some private colleges offering MBBS, you virtually cannot set up another medical school anymore...

Looks like time have change eh?

Anonymous said...

tony, tony, tony... it's the numbers that matters!! not the quality. think like a politician, then everything here makes sense.

Anonymous said...

I dont know what is the fuss about getting into medicine. Doing medicine is relatively easy. For the 5 year period you spend doing your MBBS, you are only trained to ask or answer five questions.

Question 1: " Masuk"
Question2: " Duduk"
Question 3: " Apa sakit"?
Question 4: " Mana sakit"
Question 5: " Makan ini ubat 2 kali satu hari lepas atau belum makan"

he he he

Anonymous said...

I really liked Biology and when I scored 4 As in my STPM, everyone was expecting me to apply to Medic. Which I didn't, as I wasn't really interested in the first place.

Little did I know how unnverving societal pressure could be. Friends gaped in disbelief, and everyone thought it's given that I'd apply for medic. Even my parents ask me to go 'try first'. My parents did accept my choice in the end (I'm now doing Zoology in UKM). But I could tell that even when they're asked what I'm doing right now, they still feel a bit uneasy explaining what I do.

Come on, since when did Bio=medical? How bout those physiologists who helped patients recover their movements after stroke/accidents? Speech therapists? Opticians? Radiologists to carry out scans?

I was shocked when I read once in the papers that a top student said his choice of medic is "I want to find a cure for cancer, since my Grandma had it." Nice sentiment, but wrong way to go about it. Doctors are mostly tied up in administering treatment, rather than researching for it. A course in biotechnology eg Microbiology/Genetics will give you a strong foundation for research into cells and DNA.

We really need to educate the public that the doctors are not the 'be-all' of the healthcare communnity.

Anonymous said...

I think it's very noble to want to be a doctor. Healthcare is so important to all of us. BUT I could not subject myself to see sick people day in day out, touch them all over, touch bodily fluids. ewwwwwwww. GROSS.

Which is why I did the smart thing and did not enrol in medicine eventhough I had the grades and resources.

IF wanting (or wanting your kid) to be a doctor is for bragging rights (prestige etc.) - please reconsider. and reconsider again. I have seen people go through HELL 'cos of this. Life is too short - and there are so many other (more) enjoyable vocations out there.

IF you really really want to contribute to healthcare - there are so many other options out there (as outined in comments above)or why not become a nurse?

BUT we definitely do need more doctors - especially in the rural areas and Africa.

SO imho it's alright if there are less well known/recognized schools out there training med students in general medicine - afterall, it doesn't take great grades to BE a doctor. The tough entry requirements are a result of the competition to get into the course.

Anonymous said...

what i'd like to hear someday ...

"HUH?!! Your son is going to study medicine ah? Aiyo. Why ah? Why he want to be a doctor. You know ah - have to stick finger up the backside one ... eeee ... very dirty job. You know ah, when my daughter said she wanted to study medicine, I REFUSED! I threatened to cut off her inheritance. Aiyo. And then I asked her to become a teacher. Such a distinguished profession! Mrs Lim ay. better advise your son lah. I mean, his grades quite good what ..."

Anonymous said...

While it’s indeed very true that there are herd mentality at play in rushing into doing medicine for the wrong reason, one should not automatically assume those who did are doing it for the wrong reason. I am saying that because I sense some tendency towards that here but if my senses are wrong, then I apology.

I have 2 siblings being medical doctors and I am also in the medical field and yes, it’s not a bed of roses being a doctor. We should know. You really have to put in many years of really hard work and by the time you reach specialist status, you are in your 30’s. Worst still if you are a woman with ‘traditional” Asian duty to take care of as well. My parent who put us siblings into universities used to have great pride that some of us became doctors but if you ask them the same question again, they would recommend NOT to do medicine. I think that’s why when my straight A’s nephew turned down an offer to do medicine from a prestigious Australian university, they said nothing much about his decision.

On the other hand, 2 of our next generation kids amongst our sibling has already set their heart on becoming one since their junior secondary school days despite our gentle suggestion to reconsider. And going by their academic records, they may have a chance. So that leads us to the same concern as this blog: Quality. And this is what we should discuss more and try avoiding to automatically labeling those who did medicine with jaundiced eyes.

If you are qualified to do medicine but didn’t succumb to usual peer and society pressure to take that option, then good for you. It shows either you are matured enough and know what you wanted or have understanding peers.


Anonymous said...

There is another easy alternative to do 'medicine', just apply to the Institute of Biological Sciences of UM. Down there they have an almost 'identical ' course called BIOKESIHATAN. You will be trained to become a 'pseudo doctor"

Anonymous said...

Nowadays, there are only two reasons why youngster wanted to become doctor.

1. Good money

2. You got the chance to see the other sex's shy-shy area (most guy doctors like this) especially when a pretty girl walk in for full medical checkup!

Anonymous said...

Is it true they say Acturial Sc. studies and professional qualifications are more difficult to achieve than doing medicine ?

just curious

Anonymous said...

If you want to see the other's sex "shy shy area" no need to spend so much money, time and effort to become doctor...

just go and visit some areas behind brickfield or chow kit area. and pay rm15, and you can see the other sex shy shy area...

Anonymous said...

To jonoave who said "Radiologists to carry out scans?"

A radiologist actually is a doctor specialising in the medical field of radiology. I think you meant radiographer.

Anonymous said... radiographer but a mammographer...hehe!

Anonymous said...

I dont blame Singapore not recognizing our medical degrees or any other degrees from Malaysia.

Just look at our sordid state of academic standards of our government universities.

I have more confidence going to private clinics with MBBS from Singapore or for the matter from India...but no!, no! no! if I see the MBBS or MD from our local universities, unless they are MBBS graduates from pre 1980s...

Sorry! but that is the truth of the whole matter.

Even if I have to go to see specialists I would ensure first that their post qualifications are from Singapore or those with MRCP, FRCS, FRAACP.

It is sad our universities medical graduates used to be looked up upon with esteem before. Nowadays we are having modern bomohs!

When will our medical graduates be recognized by GMC of Britain?

Anonymous said...

jonoave brought up some good points. The medical field is extremely wide and doctors are not scientists.

However, there are medical doctors who get themselves involved in medical research in research institutes. There, they can make their breakthroughs. These facilities is extremely important in making breakthroughs. I doubt Malaysia have this kind of research facilities to make any medical breakthroughs.

Don't talk about average joe's doctor where they only devote their time in four walls of their clinic. To make a breakthrough is not anybody's job. It requires determination, completely devoted, sacrifices in terms of friends and families, and money. And you need a research facility.

Anonymous said...

If predicted by the MMA that the ratio of doctor to population is about 1:400 by 2020...I really pity and pray for these "Doctor wanna bees"

I pray also for the "pharmacist wanna bee" at 500 new pharmacists coming into the market every year...

Where will they get their jobs? Street vendors or pushing illegal VCDs ...just to repay their PTPN or Along's loans?

Do ACTUARY man! Got a lot of demand there!

Anonymous said...

I wanna be a least tho I am not paid well, but I got job satisfaction! ;)~~

Anonymous said...

Let me correct your error...
A radiologist is person who listens to the radio everyday!

Anonymous said...

first we have unemployed graduates
then we have unemployed doctors / pharmacists.

..sounds like its gonna turn out to be something like monetary inflation..where the value of $ gets lower are the credentials

inspired still :)

Anonymous said...

I think a radiologist is someone who loves to sing along with the radio and also knows the logic how to repair the radio when it breaks down

Anonymous said...

I've nothing against those who wants to pursue medicine because their heart is in it. Some of my best friends are doing medicine, and it's definitely not a bed of roses.

Good grades don't guarantee a good doctor, but your perserverance and willingness does. Many students drop out of medic by 2nd 3rd year due to the immense pressure and workload. Of course having reasonably good grades would be immensely helpful.

I believe that the 'insufficient' problem of medical places in uni can be solved if applicants consider very carefully whether medicine is what they really want to do, and look at other available health sicence courses if their dream is to 'help sick/unfortunate ppl'. This will allow the opportunity for those who's heart is set solely on medic.

daydreamer: Medical doctors who carry out medical research of cells/microbes is the exception, rather than the norm. More often than not, they often collaborate with other scientists eg. virologist/immunologists. My point is if your intent is researching a cure, you'd be better equipped if you pursue a science course rather than a medical course than emphasises more on patient application.

anon: sorry, I got confused with radiology. I meant audiology, which is a 4 year-course offered in UKM. Along with physiology, dietitian, speech therapy that supports the healthcare service.

Anonymous said...

audiologist is a hi-fi expert..
lots of them in pertama complex kl

Anonymous said...

It is good to have many doctors so that we all can have easy access to medical treatment at the lowest costs. Congratulations to the government!

Anonymous said...

Fully agreed with black mojo and more doctors more choices, some of the the current doctors are very arrogant. Met one last month, this particular doctor,a specialist in fact, never even has any eye contact with the patient for the first few minutes, was reading the patient's file while questioning the patient, only look at the patient when it was time to leave. Requested to go for a fellow pocedure next month, of course will switch to another specialist.

Anonymous said...

Better dont be doctors..risky! A number of doctors are known to support junkies and drug addicts by selling cough mixture easily. This was reported in the tv 7 or TV3 quite sometime.

Yet MMA is doing nothing...wat a sham!

Anonymous said...

Have you read in todays The Star from Letter to Editor Column.

A pharmacist claim four of his pharmacist colleagues close shop and work instead as Insurance Agents.
One Doctor friend of him becomes a Manager in Steel factory!

It seems we need not wait for 2020 to find out that our pharmacists and doctors are having no jobs!


Irs no longer a bed of roses out there. Take Actuary!

Anonymous said...

it is very obvious that the negative comments about education, when we should be enhancing this work to educate all people, and not just a few in certain countries, is just jealousy on the part of those negative people who believe that their country is the best... the big ego thing again!!! There is a very high percentage of illiterate people in the USA but it is kept very much under the mat and there education system is out of reach for the average salaried pereson, so only the rich seem to make it or that those others who do have large debts to pay off after they graduate or if they graduate. Besides the quality of english of the USA seems to be far less than the rest of the world, so I wonder how they cope with their thesis work. I now understand why the word "dumb" is so paramount here in USA.

Anonymous said...

A little insider secret:

The health professionals (esp. Drs & Pharmacists) are experts at crying poor even from before when things were "great" by today's measures. There has never been time when they were "satisfied" with their working conditions, which are still magnitudes better than the average working person in a non-professional job.

So, the pitiful-me letters you read in the Editorial, only suggest one of 2 things - lousy money managers or scare-mongerers keen on limiting competition by discouraging new entrants.

Anonymous said...

With more universities does it not mean malaysia will be able to stop sending their students abroad and develop the medical training within the country? surely this is a good thing? but of course standards will have to be maintained and that responsibility will be laid upon the goverment's hands/ministry of health?

The Earth has just been sat on said...
This comment has been removed by the author.
Im-Not_A-Doctor said...


We have Institute of Medical Research (IMR), National Medical Research (NMRR). and few others.

We Malaysia do have this kind of research facilities.

IT been here for a long time already if you would want to know.


Crystal mun said...

I came across this 2006 year post and noticed a lot experienced graduates. Well, I hope everyone could give me suggestion on what course should i take, completely blur myself. I like mathematic and iso love listening to people's problem, help them solve and most importantly, make them happy. That's what i enjoy doing, is something like a psychology but I am afraid that I can't compete with the rising psychologist graduates. Just wan a simple career that I enjoy doing, without fighting agaisnt each other.. help please.