Would there be an excess of medical doctors in this country in the future?

[supergoh]

Thank you for sharing the blog ,tehjiao.

The election results are out. Maybe there will be a new (actually former)health official to tackle the issue of an oversupply of doctors.

[orthopod]

Originally Posted by supergoh

Thank you for sharing the blog ,tehjiao.

The election results are out. Maybe there will be a new (actually former)health official to tackle the issue of an oversupply of doctors.

we think there is an oversupply but JPA thinks the shortage is still critical.

[supergoh]

Originally Posted by orthopod

we think there is an oversupply but JPA thinks the shortage is still critical.

Of course ,JPA always thinks that way.

Don't you know that we have one of the highest civil servant- population ratio in the world?

Sometimes,I really think that JPA does not really know how to plan things.

[vseehua]

Originally Posted by littlewheatgrass

From what i read, UN recommend a healthy doctor to population ratio is 600:1. Our country current doctor to population ratio is 1200:1. Considering the fact we were having 2000:1 some 15-20 years ago, today ratio has vastly improved but still long way to go if we want to meet UN standard.

Thing is, the ratio is useless if we don't spread the doctors all over the country. Currently, most doctors are clustered in the cities, leaving the rural areas severely short of capable medical staff. I would bet that most rumah sakit in the kampung areas are staffed by medical assistants with no doctors overseeing them...

[supergoh]

Finally ,compulsory service for doctors has been reduced to 2 years.

But politicians always say that it can attract doctors to stay in the country.

http://thestar.com.my/news/story.asp...931&sec=nation

[tehjiao]

Same author, Dr Hsu, who wrote again regarding "Extraordinary Amount of New Doctors in Malaysia", worth reading.

http://hsudarren.wordpress.com/2010/...-too-many-iii/
http://hsudarren.wordpress.com/2010/...r-too-many-iv/

Part 3
This is the number of house officers as of end of April 2010 in HKL , the biggest hospital in our country:

Unit Number of housemen in the unit
Orthopaedic Department 52
O & G Unit 50
Medical Department 72
Surgical Department 57
Paediatric Department 62
Just as an illustration, the orthopedic unit mentioned in the table above has 182 beds. With 52 house officers, it amounts to 1 houseman to slightly more than 3 patients.. A ratio you would not be able to find anywhere else in the world, believe me! Not even in the most advanced country!

Gone were the days when we had only 2 or 3 house officers in a unit. I remember during my time, when I was doing housemanship in Penang GH, I was for 2 weeks the only houseman in the orthopedic unit. Now I heard they too had 60 housemen in the unit (Jan 2010 figure).

Just imagine, if you have 60 house officers following a consultant doing the ward round, how are those at the back going to learn? I do not think there are even enough standing room for all of them. How are they going to examine a textbook case ( a case with classical signs and symptoms), since to do so would have subjected the patient to examinations 60 times– if the patient does not die from his illness, he might die from too much handling from these housemen!!!

The figures I quoted are real figures. I am sure those of you reading now would agree with me that there are now simply too many doctors being produced, and since there are not enough hospitals to place them in, there is no choice but to place them in the same units…

No wonder i received emails after my last posts saying that many house officrs are seen spending most of their time in the canteens, since they just have nowhere to go…

And in no time, these same people will be treating you and me, including the politicians. Perhaps I should warn them here that Healthcare is different from education. In education, if our schools are no good, they can still send their children overseas to study. But when these politicians get a stroke or heart attack, it would be too late for them to fly out to even Singapore to seek treatment. They would be treated by the same local doctors that they help in mass production.

Our healthcare standard is going to deteriorate with this sort of training of our doctors..Just like almost everything else.

I am now in the process of writing a memorandum to be submitted to the Ministry on this problem and I hope my writings can bring some sense to this madness of indiscriminate issuing of licenses to set up medical schools.

Part 4


At the end of 2008, Malaysia has about 23000 doctors, almost half in private sector.

Our Ministry is trying to achieve a ratio of 1:400 as existed in most OECD countries.

In the haste to achieve this number game, they have forgone quality.

It does not mean the more the better. Look at some of the communist countries like Bulgaria. They have a ratio of 1:200 doctoropulation ratio. That does not mean that they have a better healthcare than Britain which has a ratio of 1:450. Another example is Kazakhstan which has a ration of 1:280 , as compared to Australia which has a ratio of 1:400. Does that means that Kazakhstan has better healthcare than Australia?

Our officials stress too much on achieving numbers. They stress too much on ‘form’ rather than substance.

If we have well trained doctor which are productive, a ratio of 1:1100, will mean that we are on par with those 1;400 countries with doctors which have low productivity.

Alas, we built 5 star hospitals with lobby bigger than Shangri La, but you dont need 5 star bed to treat diseases. You need clinical acumen , experience, and doctors who communicate with their patients.

As for the question asked by MKO in the last post (A doctor too many 3), it is still ok to get treatment from govt hospital NOW. In 5 to 10 years time, I am not sure. Unless they buck up, and set up a body to oversee the standard of doctors produced, I will not want to get treatment there in 10 years time.

I must stress that I am never against producing doctors. I am not in favour of producing too many INADEQUATELY TRAINED doctors. That would be like producing too many gun-carrying policemen without training them as to when to shoot and when not to shoot.

At the rate we are producing doctors, 4000 a year, we will soon be down to 1:100 ratio.

Let us assume that we have a population of 27 million. Let us assume that the population growth is 3%. So every year, we have an additional 800000 people. Divide 800000 by 400, you get 2000. That means once we achieve a ratio of 1:400, we need only to produce 2000 doctors a year to maintain the ratio found in most advanced country. But we will be producing 4000 local plus 1000 from overseas (India, Indonesia etc..many will be staying put in the place they study like my children). So there will be excess 3000 doctors a year… This will quickly bring our ratio down to perhaps 1:100, and you will find some o the hawkers and taxi drivers with MBBS degree hanging in their stalls or taxis.

Not joking…

And looking at the history of medicine at advanced countries, when their doctoropulation ratio decreased, the charges went up, and so was the cost of medical treatment , even when taken into consideration of inflation. This is because those who are competent, will charge higher and do more investigations.

There will come a stage when we have too many doctors, too many lawyers(already happening since some junior lawyers have to pay the senior lawyers to do their chambering), too many nurses, too many hawkers, too many cars, too many motorcycles, too many politicians, too many parties, too many police, too many criminals and too many crooks….. I dread to think of such a day!

As for the suggestion by Stevent in the last post, yes, we can send them overseas to work and gain experience, but which country would take them in if their standard is low? I am sure there is a cutting point where even Singapore would not want to take them in, as is the case now.

So you can still send them, to tag with experience doctors. That would like starting their medical training again and you need to pay overseas doctors money to do that sort of things, and there is really no guarantee these people will come back, once they are competent enough to be able to find a working job overseas.

The whole system is rotten, and all the planners can think of is short term and they are all very short sighted… Ultimately they will suffer too if there is a drop in medical standard. Because health hits everyone equally, it does not mean that if you are wealthy and powerful, you would not get cancer or immune disorders.. Ultimately, like facing the creator, everyone will have to face health problems, and they will then realise that what a monster they have created in their haste to achieve certain figures… Because a healthcare system without good doctors will be like a monster released ..

Well, I strongly agree that the quality of the new doctors are down to the drain recntly, my colleagues and I do encounter a lot of new HO who don’t even know “Aspirin = Antiplatelet” , “Human have “12″Cranial Nerves” which is the BASIC of the medical knowledge in Medical Year 1 syllabus. I’m worried that our health care quality will definitely deteriorate VERY SOON in next 5 years. However, I don’t see any one including our MOH DG forsee this. To make the things worse, recently there is Pekeliling to order HO to RATE their HOD/Consultant/Specialist/ Medical officer whether they treat them “nice or not” but ignore about the HO’s knowledge and attitude problem. I’m not sure that the idea of staying in MOH is a good idea in near future as I can forsee that there will be a lot of BIG PROBLEMS in our health care service soon as these incapable HO will become incapable MO and may even be accepted and trained as specialist by local Master programs. How can we let the Profession end up like this? Sadly, soon in public perception, MBBS/MD= Bomoh= Sinseh. Doctors=MRCP (UK)/ MBBS (SG)/ MD (Taiwan)/ MD (Japan)/ MD (whatever country the public have faith)


Strongly suggest those who are interested to study Medicine oversea esp Ukraine/Russia/Indonesia/India and those new local private college like AI**T and etc, ask around among the doctors in service and the graduates from respective uni/college, before u make your decision. Otherwise, u end up wasting your money and time become a lousy doctor. Good luck.

[youngyew]

Great article series. It might sound a bit alarmist to a skeptical reader and the severity might be a bit exaggerated, but I am convinced that this is an urgent issue. The policy needs to be fixed urgently if we don't want ourselves and our friends and families to be treated by "doctors" who don't even command first-year medical student knowledge.

By the way the population growth is closer to 2% than 3% according to one source. The calculation also didn't consider the number of retiring / dead doctors. Just to point out some inaccuracies in there, but this doesn't change the overall idea.

[tehjiao]

Originally Posted by youngyew

By the way the population growth is closer to 2% than 3% according to one source. The calculation also didn't consider the number of retiring / dead doctors. Just to point out some inaccuracies in there, but this doesn't change the overall idea.

well, i'm sure that the number of retiring/dead doctors won't reach 2000-4000 / year right?
LOL

[supergoh]

Finally,there is a politician aware of an excess of housemen in the country.

The news is in Mandarin.

http://www.kwongwah.com.my/news/2010/05/20/89.html

[Young]

Originally Posted by supergoh

Finally,there is a politician aware of an excess of housemen in the country.

The news is in Mandarin.

http://www.kwongwah.com.my/news/2010/05/20/89.html

That's good news.
Unfortunately, I can't read Mandarin. Any chance that you can post a short summary so a banana like me can be enlightened?