The Star Online, January 27, 2017
IN reference to the letter “Docs face uncertain livelihood” (The Star, Jan 24), I am writing in full support of the author’s proposal and suggestions to improve conditions for doctors.
I graduated from UKM in 2013. I went to medical school at a time when we were taught that Malaysia was short of doctors. We were told to expect long shifts, back-to-back calls, endless waiting lists and more.
We were all passionate about our work and were looking forward to serve for the betterment of our fellow men.
It was a strange situation to be in when we began to hear rumours that there were no more posts for new house officers. Many of us, like me, began to make arrangements for plan B in Singapore.
Some of my batchmates, especially those interested in surgery specialty training, decided to stay as one would get more hands-on training in Malaysia.
Those who left for Singapore were employed immediately. Registration and relocation was prompt and work started just six weeks after the final exam results were released.
Obviously, Singapore had the pick of the first fruits. The rest went back to their hometowns and were left waiting for news. The batch of UKM 2013 only received letters to report for duty six months after their final exams.
I have heard that my juniors who graduated in 2016 have been in limbo for nine months. The final waiting period is still uncertain.
The Government has proposed a three-year contract system in Budget 2017. This will bring more problems than it will solve. It does not address the long-term concerns of the affected doctor. There has been no mention on what would happen once the contract ends.
Senior staff leaving the service would never be able to create enough vacant positions.
With a finite number of posts and thousands of new doctors entering the government workforce yearly, most of the contract doctors will be forced to leave the government service.
The Government has not mentioned what will happen to those forced to leave.
Most doctors currently in service have graduated from public universities or are scholars from non-UK/Australia universities.
With the exception of the best few students from UKM and UM who are eligible for employment in Singapore, the rest are forced to work here as the degrees are not recognised anywhere else.
This does not mean that they are incompetent. Some of the brightest young men and women in my current department have graduated from a lesser known university. They have had no problems passing postgraduate exams and are only being denied reaching their full potential because of their primary degree.
This has trapped doctors in the workforce with no other avenue for employment. If a doctor is out of clinical practice for more than one year, clinical skills would be lost and they would never be able to return to the service.
That amounts to a loss of five years studying, three years working and all the hard work during an individual’s most productive years.
Some of the doctors may choose to take exams and find employment overseas. The process is costly. To practise in the UK, registration for taking the Professional and Linguistic Assessments Board (PLAB) costs £1115, not including courses, books, flights or accommodation.
A few may join the pharmaceutical industry, but vacant jobs will be few and far in between as Malaysia is neither a regional nor international hub for pharmaceuticals. The bulk of individuals without the financial reserves would be forced to join the private sector as GPs.
It is unreasonable to think that they would go into a completely unrelated field as they have invested their youth in the pursuit of medicine.
If one is to assume that market forces would correct the situation I must rebut those arguments now. Free market forces can never be applied in the distribution of healthcare.
Healthcare is about how to distribute a service equitably and to create a system that works in the best interest of doctor and patient. Countries that have let the free market decide, such as the US, have left the most marginalised segments of society without healthcare. This group of people includes the poor, immigrants, and refugees.
Like it or not, the wave of junior doctors whose contracts end will be seen in two to three years’ time. It is best that we meet this challenge fully prepared.
Doctors must form associations now to create a robust nationwide GP system to fill in the role where the Government has failed. A strong network will not only create jobs for doctors but would also integrate pharmacists, nurses, and therapists.
The system first and foremost must be financially self-sustaining. Doctors must be compensated well enough that they can make clinical judgements without fear or favour. If that requires doctors to form unions and charge a minimum consultation fee of RM50 then so be it.
They need to be given enough financial security to fight the influence of unscrupulous pharmaceutical and insurance companies offering shady deals.
More importantly, doctors can issue medical certificates in a fair manner which would increase productivity and benefit our society as a whole.
We can still change the outcome and decide on the future of our profession. I am strongly in favour of Dr Sng’s proposal to strengthen the GP sector in Malaysia.
DR PAU CHEONG PING